Court Opinion

ID: 2490827
Source: CourtListenerOpinion
Date Created: 2013-10-30 09:54:21.306633+00
Date Added: 2024-06-11T15:44:59.295835
License: Public Domain

78 So. 3d 1045 (2011)
In re IMPLEMENTATION OF COMMITTEE ON PRIVACY AND COURT RECORDS RECOMMENDATIONSAMENDMENTS TO the FLORIDA RULES OF CIVIL PROCEDURE; The FLORIDA RULES OF JUDICIAL ADMINISTRATION; The FLORIDA RULES OF CRIMINAL PROCEDURE; The FLORIDA PROBATE RULES; The FLORIDA SMALL CLAIMS RULES; The FLORIDA RULES OF APPELLATE PROCEDURE; and The FLORIDA FAMILY LAW RULES OF PROCEDURE.
No. SC08-2443.
Supreme Court of Florida.
November 3, 2011.
*1046 Judith L. Kreeger, Chair, the Florida Courts Technology Commission, Senior Judge, Eleventh Judicial Circuit, Miami, FL, Paul Regensdorf, Chair, Subcommittee on Access to Court Records, and Judge Melanie G. May, Fourth District Court of Appeal, West Palm Beach, FL; Ashley McCorvey Myers, Chair, McCorvey and Myers, Jacksonville, FL and Steven Patrick Combs, Past Chair, Family Law Rules Committee, Jacksonville, FL, for Petitioners.
Frank T. Pilotte, Past Chair, Florida Probate Rules Committee, and John F. Harkness, Jr., Executive Director, The Florida Bar, Tallahassee, FL; Russell Robert Winer, St. Petersburg, FL; Robyn L. Vines, Past Chair, Family Law Rules Committee, Fort Lauderdale, FL; Carol Jean LoCicero and Deanna K. Shullman of Thomas, LoCicero and Bralow, PL, Tampa, FL; John S. Mills, Past Chair, Appellate Court Rules Committee, Jacksonville, FL; Judge Robert W. Lee, Past Chair, Small Claims Rules Committee, Seventeenth Judicial Circuit, Fort Lauderdale, FL; Mark Romance, Past Chair, Civil Procedure Rules Committee, Miami, FL; Jack A. Moring, Past Chair, Family Law Rules Committee, Crystal River, FL; John G. Crabtree, Past Chair, Appellate Court Rules Committee, Key Biscayne, FL; Fleur J. Lobree, Past Chair, Criminal Procedure Rules Committee; Dale R. Sanders of Lyons and Sanders, Fort Lauderdale, FL; and Judge Renee Goldenberg, Seventeenth Judicial Circuit, Fort Lauderdale, FL, Responding with comments.
Robert T. Strain, Past Chair, Criminal Procedure Rules Committee, Tampa, FL; Keith H. Park, on behalf of the Rules of Judicial Administration Committee, West Palm Beach, FL, Donald E. Christopher, Chair, Civil Procedure Rules Committee, Orlando, FL, and Jeffrey S. Goethe, Chair, Florida Probate Rules Committee, Bradenton, FL, Also attended oral arguments.

REVISED OPINION
PER CURIAM.
We have for consideration proposed amendments to the Florida rules of court and forms intended to minimize the amount of unnecessary personal information included in documents filed with the courts.[1] Reducing the amount of extraneous personal information in court records is another necessary step in the Court's ongoing effort to provide the public with electronic access to nonconfidential court records.[2] As part of that effort, we recently *1047 adopted procedures that allow clerks of court to readily identify and screen from the public confidential information filed with the courts and refine the procedures for sealing and unsealing court records. See In re Amends. to Fla. Rule of Jud. Admin. 2.420 & Fla. Rules of App. Pro., 31 So. 3d 756, 757 (Fla.2010) (recognizing that refinement of rule governing confidential court records was a necessary step in providing the public electronic access to court records).
The amendments at issue here further implement recommendations of the Committee on Privacy and Court Records (Privacy Committee) and are the result of the combined efforts of the Committee on Access to Court Records (Access Committee), its successor, the Florida Court Technology Commission's Subcommittee on Access to Court Records (Access Subcommittee),[3] and the Florida Bar Rules Committees. After considering the various proposals and comments filed in this case, and hearing oral argument, we amend the rules and forms to minimize the personal information filed with the court. Most notably, we adopt new Rule of Judicial Administration 2.425 (Minimization of the Filing of Sensitive Information) to govern the filing of sensitive personal information, which is the linchpin of the minimization efforts. We take this opportunity to emphasize that in order to avoid the electronic dissemination of sensitive personal information unnecessary to court proceedings, both attorneys and pro se litigants must be vigilant to file only authorized documents that comply with the requirements adopted here.
The newly enacted rules provide for sanctions for violations of these rules. However, continual education and a change in mindset for all those involved in the litigation process are necessary for these rules to work as intended. After all, with the benefits of electronic access to documents comes the responsibility to minimize unnecessary personal information in court records. With those beginning cautions, we explain the evolution of the amendments and the substance of the major amendments.

BACKGROUND
The Privacy Committee was created in November 2003 and charged with providing recommendations to the Court regarding electronic access to court records. See In re Comm. on Privacy and Court Records, Fla. Admin. Order No. AOSC04-04 (Feb. 12, 2004) (substituted for AOSC03-49). As relevant to the amendments at issue here, the Privacy Committee was charged with recommending strategies for reducing the amount of unnecessary personal information in court records. Id. at 5. After the Privacy Committee submitted its report and recommendations[4] and the Court held public hearings on the recommendations, an administrative order was issued partially implementing the Privacy Committee's recommendations.[5] That administrative order noted the Court's *1048 agreement with the Privacy Committee that the Florida judicial branch should have a goal of providing electronic access to nonconfidential court records when appropriate conditions are met, one of which is minimizing the amount of unnecessary personal information in court records.[6] By separate administrative order, the Access Committee was created to assist the Court in implementing a number of the Privacy Committee recommendations,[7] including the "minimization" recommendations addressed here.[8]
As relevant here, the Privacy Committee reported as follows:
Florida court files commonly contain information which is not required by law or rule and which is not needed by the court for purposes of adjudication or case management. Once entered into a court file this information becomes a matter of public record. Much of this information is personal or sensitive in nature. The Committee perceives that there is not a clear understanding on the part of attorneys and the general public of the negative effects on personal privacy of placing unnecessary information in a court record.
Privacy Committee Report at 56. The inclusion of unnecessary personal information in court filings is of special concern because providing electronic access, which would include internet access, to court records will make nonconfidential personal information contained in those records more readily accessible to the public.
To mitigate this concern, the Privacy Committee made four recommendations intended to minimize the filing of extraneous personal information. Privacy Committee Recommendation Seven urges the review and revision of court rules and forms to avoid the filing of personal information that is not necessary for adjudication or case management.[9] Recommendation Eight recommends the study of a court rule to prohibit the filing of unauthorized documents.[10] Recommendation Nine suggests clarifying Family Law Rule of Procedure 12.285 (Mandatory Disclosure) to avoid the unnecessary filing of financial information in family law cases.[11] And Recommendation Ten urges the adoption of a rule that prohibits the filing of discovery information with the court unless the information is filed for good cause and that provides for sanctions if the rule is violated.[12] These "minimization" recommendations were referred to the Florida Bar rules committees to propose rule and form amendments implementing the recommendations.[13] The rules committees' proposals *1049 were then referred to the Access Committee for consideration[14] and preparation of an omnibus petition of proposed rule amendments. The Access Committee's petition of proposed amendments, as well as revised and new proposals offered by the rules committees are before the Court here.
In considering the proposals, the Court had the benefit of comments from interested persons, as well as responses and input from the Access Subcommittee (successor to the Access Committee)[15] and the various rules committees on a number of issues of concern to the Court. See In re Implementation of Comm. on Privacy & Court Records Recommendations, No. SC08-2443 (Fla. order filed April 1, 2010) (seeking input on a number of issues); see also In re Implementation of Comm. on Privacy & Court Records Recommendations, No. SC08-2443 (Fla. order filed May 19, 2010) (seeking input on suggested new rule 2.425). In response to the Court's concern about consistency among the various rules proposed to govern the filing of sensitive personal information, the committees now urge the adoption of new Rule of Judicial Administration 2.425 (Minimization of the Filing of Sensitive Information) and conforming amendments to the other bodies of rules and forms.
After considering the various proposals, we amend the Florida Rules of Civil Procedure, the Florida Rules of Judicial Administration, the Florida Rules of Criminal Procedure, the Florida Probate Rules, the Florida Small Claims Rules, the Florida Rules of Appellate Procedure, and the Florida Family Law Rules of Procedure and forms, as reflected in the appendix to this opinion. We discuss the more significant amendments below.

AMENDMENTS

New Rule of Judicial Administration 2.425 and Other Amendments Limiting the Filing of Extraneous Personal Information
New rule 2.425 (Minimization of the Filing of Sensitive Information) is the centerpiece of the amendments adopted in this case. The new rule governs the filing of sensitive personal information in all types of cases, except traffic and criminal proceedings.[16] It implements Privacy Committee Recommendation Seven, which urges revision of court rules and forms to avoid the filing of personal information that is not necessary for adjudication or case management.[17] The new rule of judicial administration sets forth the categories of personal information that must not be filed or must be truncated or redacted before filing, and provides exceptions that allow for the filing of complete information in appropriate circumstances.
The new rule serves as a companion to recently amended Rule of Judicial Administration 2.420 (Public Access to Judicial Branch Records).[18] New rule 2.425 provides *1050 the procedures for protecting personal information being filed with the court; while rule 2.420 governs the procedures for determining the confidentiality of information after it has been filed and for providing public access to nonconfidential information. Rule 2.425 is loosely modeled after Federal Rule of Civil Procedure 5.2 (Privacy Protection for Filings Made with the Court). The most important provisions of the new rule are discussed below.
First, under subdivision (a) (Limitations for Court Filings) of the new rule, unless exempted by subdivision (b) (Exceptions), or authorized by statute, another rule, or court order,[19] personal information of the type listed either must not be filed or must be truncated or redacted before filing. Under subdivisions (a)(1) and (a)(2) only the initials of a minor and the year of birth of a person's birth date may be included in filings, and under subdivision (a)(3), no portion of a social security number, bank account number, credit card account number, charge account number, or debit account number can be filed,[20] unless the number falls within one of the subdivision (b) exceptions, or is authorized by statute, another rule, or court order.
Only the last four digits of certain other personal identifying numbers (i.e., driver's license number, passport number, taxpayer identification number, and patient or health care number) are allowed under subdivision (a)(4). Similarly, a truncated version of other types of personal information (i.e., email address, password, and other sensitive information as provided by court order) is allowed under subdivisions (a)(5) and (a)(6).
Next, subdivision (b) (Exceptions) allows for the filing of complete information under certain circumstances. For example, under subdivisions (b)(1), (b)(5), and (b)(6) respectively, an account number that identifies the property alleged to be the subject of a proceeding, the birth date of a minor whenever the birth date is necessary for the court to establish or maintain subject matter jurisdiction, and the name of a minor in any document or order affecting the minor's ownership of real property are exempt from the subdivision (a) limitations. Under subdivision (b)(10), information that is relevant and material to an issue before the court also is exempt.
Subdivision (b)(8), which we adopt on an interim basis, exempts from the requirements of the rule filings in traffic and criminal proceedings. This exception is strongly supported by the Criminal Procedure Rules Committee, prosecutors, and defense attorneys, as well as numerous Florida criminal justice organizations.[21]*1051 The Rules Committee and criminal justice organizations maintain that much of the information filed in criminal cases that would have to be truncated or redacted under the new rule must be available to defense attorneys, law enforcement, and others in the criminal justice system. The proponents of the exception also caution that application of the rule would result in substantial workload issues for prosecutors' offices that would be required to truncate or redact massive amounts of information routinely contained in arrest affidavits, search warrants, charging documents, traffic citations, police reports, and discovery documents filed with the court. We acknowledge the reasons advanced for treating filings in criminal and traffic proceedings differently than filings in other cases. However, filings in criminal and traffic cases contain a large portion of the personal information filed with our courts and a "blanket" exception for those filings would not be necessary if a finely tailored rule can be drafted to govern them. Therefore, we direct the Criminal Procedure Rules Committee, the Traffic Court Rules Committee, and the Rules of Judicial Administration Committee to work together to propose a rule or rules similar to Federal Rule of Criminal Procedure 49.1 (Privacy Protection for Filings Made with the Court) to govern the filing of sensitive personal information in criminal and traffic proceedings.[22]
Finally, subdivision (c) (Remedies) provides remedies and sanctions for violations of the rule. And subdivisions (d) (Motions Not Restricted) and (e) (Application) clarify the new rule's interplay with rule 2.420 (Public Access to Judicial Branch Records) and explain that the new rule does not affect the application of constitutional provisions, statutes, or rules of court governing confidential information or access to public records.
Other rules of procedure and forms are amended to conform to or reference new rule 2.425.[23] For example, new Rule of *1052 Appellate Procedure 9.050 (Maintaining Privacy of Personal Data) requires all briefs, petitions, replies, appendices, motions, notices, stipulations, and responses filed with the court comply with rule 2.425. Family Law Rules 12.130(c) (Protection of Account and Personal Identifying Numbers), 12.440(a) (Setting for Trial), 12.540 (Relief from Judgment, Decrees, or Orders), and 12.620 (Receivers) are amended to require compliance with rule 2.425. Amendments to the civil and family law discovery rules also incorporate the requirements of rule 2.425. See Appendix, infra, pp. 1055-57, 1074-78 (amending Fla. R. Civil P. 1.280; 1.310; 1.340; 1.350; Fla. Fam. L.R.P. 12.280; 12.285; 12.340; 12.370; 12.410; 12.560).
To further implement Privacy Committee Recommendation Seven (Revision of Rules and Forms Leading to Extraneous Personal Information), the various civil judgment forms are amended to require that only the last four digits of the judgment debtor's social security number be included in the judgment. Probate Rules 5.200 (Petition for Administration), 5.210 (Probate of Wills without Administration), and 5.530 (Summary Administration) are likewise amended to require that only the last four digits of the decedent's social security number be included in petitions filed under those rules.[24] Similarly, to limit the filing of personal information in criminal cases, Rule of Criminal Procedure 3.140(c)(4) (Personal Statistics) is amended to delete the requirement that the defendant's social security number be included in the charging document.[25]

Rule of Civil Procedure 1.280(f) and Other Amendments Limiting the Filing of Discovery and Financial Information
New Rule of Civil Procedure 1.280(f) (Court Filing of Documents and Discovery) works in conjunction with new rule 2.425, by requiring that all discovery documents filed with the court comply with the requirements for the filing of personal information. However, the new discovery rule's primary purpose is to implement Privacy Committee Recommendation Ten,[26] by prohibiting the filing of information obtained during discovery unless the information is filed for good cause and giving the court authority to impose sanctions for violation of the rule. The Court *1053 revised the language of proposed rule 1.280(f) to clarify that good cause is satisfied only where the filing of the information is allowed or required by another applicable rule of procedure or by court order. This requirement is intended to stop abuses of personal information obtained during discovery by preventing the filing of discovery information unless it is necessary to the proceedings. Other civil discovery rules are amended to require compliance with new rule 1.280(f). See Appendix, infra, pp. 1055-57 (amending Fla. R. Civ. P. 1.310; 1.340; 1.350).
Family law discovery rules also are amended to limit the filing of discovery information. New subdivision (c) is added to Family Law Rule 12.340 (Interrogatories to Parties) to require that responses to interrogatories be served but not filed with the court, unless they are admitted into evidence and are in compliance with rule 2.425. Rule 12.370 (Requests for Admissions) is amended to require that documents attached to a request for admissions be served with the request but not filed with the court. The amendments to rule 12.560 (Discovery in Aid of Execution) prohibits the filing of a fact information sheet, civil form 1.977, unless ordered by the court for good cause shown.
Similarly, subdivisions (b) and (e) of rule 12.363 (Evaluations of Minor Child) are amended to prevent the filing of an evaluation of a minor child unless the report is being admitted into evidence. If the report is filed, the filing must comply with rule 2.425. The Media Organizations[27] that commented on these amendments urge us to reject the requirement, added to subdivision (e), that the court consider whether the report should be sealed under rule 2.420. The Media Organizations maintain that rule 2.420 places the burden of seeking a determination of confidentiality of court records on the proponent of closure, not the court. In response, the Family Law Rules Committee points out that the court has inherent authority to protect the interests of children whose parents are before the court, citing Simms v. State Department of Health & Rehabilitative Services, 641 So. 2d 957, 961 (Fla. 3d DCA 1994). The Access Subcommittee explains that the recent amendments to rule 2.420 were not intended to affect the power of a court to determine, sua sponte, that a particular court record is confidential. Therefore, we defer to the committee and adopt the subdivision (e) requirement.
Next, to implement Privacy Committee Recommendation Nine, which requested that the mandatory disclosure rule be clarified to avoid the unnecessary filing of financial information in family law cases,[28] as well as Recommendations Seven and Ten, we adopt new Family Law Rule of Procedure 12.285(a)(3) (Mandatory Disclosure; Documents Not to be Filed with Court; Sanctions), and amend rule 12.287 (Financial Affidavits in Enforcement and Contempt Proceedings). New rule 12.285(a)(3)(A) highlights language currently in the rule stating that except for financial affidavits and child support guidelines worksheets, documents produced under the rule are not to be filed with the court absent a court order. Subdivision (a)(3)(B) requires that account numbers and personal identifying information are governed by rule 2.425. And subdivision (a)(3)(C) provides that sanctions are governed *1054 by new rule 1.280(f). New rule 12.285(c) (Exemption for Requirement to File and Serve Financial Affidavit) prohibits the filing and service of a financial affidavit if the parties are seeking a simplified dissolution of marriage under 12.105 and certain conditions are met. The current rule 12.105(c) requirement that the parties to a simplified dissolution proceeding file a financial affidavit and marital settlement agreement is deleted, and the family law forms are amended accordingly. Rule 12.287 is amended to delete the requirement that a requested financial affidavit be filed with the court in enforcement and contempt proceedings and to add a requirement that a notice of compliance with the service requirement be filed instead.[29]
The family law rules of procedure forms are amended to conform with the amendments to the family law rules. Additionally, the instructions to several of the rules forms and approved forms are amended to conform to section 119.071(2)(j)(1), Florida Statutes (2010), which was enacted to protect the confidentiality of victims of domestic violence, sexual battery, aggravated child abuse, aggravated stalking, and aggravated battery.

Amendments to Florida Supreme Court Approved Family Law Forms
Finally, with input from the Court's Advisory Workgroup on the Florida Supreme Court Approved Family Law Forms,[30] we amend the Florida Supreme Court Approved Family Law Forms to ensure that the forms do not prompt those who use them to provide unnecessary personal information, such as "place of marriage," "date of separation," "place of birth of minor children," or "gender of minor children." The requirement to include a statement of the "best interest of the child(ren)" is deleted from form 12.905(d) (Supplemental Petition for Temporary Modification of Parenting Issues for Child(ren) of Parent Activated, Deployed, or Temporarily Assigned to Military Service), as unnecessary. Requests for financial information that is required to be provided in the family financial affidavits also is removed from form 12.943 (Motion to Deviate from Child Support Guidelines). Other more minor changes also are made to the approved forms.

CONCLUSION
We thank the Access Committee, the Access Subcommittee, the Florida Bar Rules Committees, the Court's Advisory Workgroup on the Florida Supreme Court Approved Family Law Forms, and those who submitted comments for assisting the Court in moving closer to our goal of providing the public with electronic access to court records. We also take this opportunity to emphasize that in order to avoid the electronic dissemination of sensitive personal information unnecessary to court proceedings, both attorneys and pro se litigants must be vigilant to file only authorized documents that comply with the requirements adopted here.
Accordingly, we amend the Florida Rules of Civil Procedure, the Florida Rules of Judicial Administration, the Florida Rules of Criminal Procedure, the Florida Probate Rules, the Florida Small Claims Rules, the Florida Rules of Appellate *1055 Procedure, and the Florida Family Law Rules as reflected in the appendix to this opinion.[31] New language is indicated by underscoring; deletions are indicated by struck-through type. The committee notes are offered for explanation only and are not adopted as an official part of the rules. We also amend the Family Law Rules of Procedure Forms and the Florida Supreme Court Approved Family Law Forms, as set forth in the appendix to this opinion, fully engrossed for use on the effective date of the amendments. The forms can be accessed and downloaded from this Court's website at www.flcourts. org/gen_public/family/forms_rules/index. shtml. By adopting the amended forms, we express no opinion as to their correctness or applicability.
The amendments to the rules and forms are effective, nunc pro tunc, October 1, 2011, at 12:01 a.m.
It is so ordered.
CANADY, C.J., and PARIENTE, LEWIS, POLSTON, LABARGA, and PERRY, JJ., concur.
QUINCE, J., concurs in result.

APPENDIX

FLORIDA RULES OF CIVIL PROCEDURE

RULE 1.280. GENERAL PROVISIONS GOVERNING DISCOVERY
(a)-(e) [No change]
(f) Court Filing of Documents and Discovery. Information obtained during discovery shall not be filed with the court until such time as it is filed for good cause. The requirement of good cause is satisfied only where the filing of the information is allowed or required by another applicable rule of procedure or by court order. All filings of discovery documents shall comply with Florida Rule of Judicial Administration 2.425. The court shall have authority to impose sanctions for violation of this rule.

Committee Notes
1972 Amendment1996 Amendment. [No change]
2011 Amendment. Subdivision (f) is added to ensure that information obtained during discovery is not filed with the court unless there is good cause for the documents to be filed, and that information obtained during discovery that includes certain private information shall not be filed with the court unless the private information is redacted as required by Florida Rule of Judicial Administration 2.425.

Court Commentary

[No change]

RULE 1.310. DEPOSITIONS UPON ORAL EXAMINATION
(a)-(e) [No change]
(f) Filing; Exhibits.
(1)-(2) [No change]
(3) A copy of a deposition may be filed only under the following circumstances:
(A) It may be filed in compliance with Florida Rule of Judicial Administration 2.425 and rule 1.280(f) by a party or the witness when the contents of the deposition must be considered by the court on any matter pending before the court. Prompt notice of the filing of the deposition shall be *1056 given to all parties unless notice is waived. A party filing the deposition shall furnish a copy of the deposition or the part being filed to other parties unless the party already has a copy.
(B) If the court determines that a deposition previously taken is necessary for the decision of a matter pending before the court, the court may order that a copy be filed by any party at the initial cost of the party, and the filing party shall comply with rules 2.425 and 1.280(f).
(g)-(h) [No change]

Committee Notes
1972 Amendment2010 Amendment. [No change]
2011 Amendment. A reference to Florida Rule of Judicial Administration 2.425 and rule 1.280(f) is added to require persons filing discovery materials with the court to make sure that good cause exists prior to filing discovery materials and that certain specific personal information is redacted.

Court Commentary

[No change]

RULE 1.340. INTERROGATORIES TO PARTIES
(a)-(d) [No change]
(e) Service and Filing. Interrogatories shall be arranged so that a blank space is provided after each separately numbered interrogatory. The space shall be reasonably sufficient to enable the answering party to insert the answer within the space. If sufficient space is not provided, the answering party may attach additional papers with answers and refer to them in the space provided in the interrogatories. The interrogatories shall be served on the party to whom the interrogatories are directed and copies shall be served on all other parties. A certificate of service of the interrogatories shall be filed, giving the date of service and the name of the party to whom they were directed. The answers to the interrogatories shall be served upon the party originally propounding the interrogatories and a copy shall be served on all other parties by the answering party. The original or any copy of the answers to interrogatories may be filed in compliance with Florida Rule of Judicial Administration 2.425 and rule 1.280(f) by any party when the court should consider the answers to interrogatories in determining any matter pending before the court. The court may order a copy of the answers to interrogatories filed at any time when the court determines that examination of the answers to interrogatories is necessary to determine any matter pending before the court.

Committee Notes
1992 Amendment1988 Amendment. [No change]
2011 Amendment. A reference to Florida Rule of Judicial Administration 2.425 and rule 1.280(f) is added to require persons filing discovery materials with the court to make sure that good cause exists prior to filing discovery materials and that certain specific personal information is redacted.

Court Commentary

[No change]

RULE 1.350. PRODUCTION OF DOCUMENTS AND THINGS AND ENTRY UPON LAND FOR INSPECTION AND OTHER PURPOSES
(a)-(c) [No change]
(d) Filing of Documents. Unless required by the court, a party shall not file any of the documents or things produced with the response. Documents or things may be filed in compliance with Florida *1057 Rule of Judicial Administration 2.425 and rule 1.280(f) when they should be considered by the court in determining a matter pending before the court.

Committee Notes
1972 Amendment1980 Amendment. [No change]
2011 Amendment. A reference to Florida Rule of Judicial Administration 2.425 and rule 1.280(f) is added to require persons filing discovery materials with the court to make sure that good cause exists prior to filing discovery materials and that certain specific personal information is redacted.

FORM 1.988. JUDGMENT AFTER DEFAULT
(a) General Form. This form is the general form for a judgment after default, not including recovery for prejudgment interest and attorneys' fees:

FINAL JUDGMENT
This action was heard after entry of default against defendant and
IT IS ADJUDGED that plaintiff, ..... (name and address) ....., recover from defendant, ..... (name and address, and last 4 digits of social security number if known) ....., the sum of $.......... with costs in the sum of $.........., that shall bear interest at the rate of. .... % a year, for which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
______
Judge
(b) Form with Interest and Fees. This form is for judgment after default including prejudgment interest and attorneys' fees recovered:

FINAL JUDGMENT
This action was heard after entry of default against defendant and
IT IS ADJUDGED that plaintiff, ..... (name and address) ....., recover from defendant,.....(name and address, and last 4 digits of social security number if known) ....., the sum of $.......... on principal, $.......... for attorneys' fees with costs in the sum of $.........., and prejudgment interest in the sum of $.........., making a total of $.......... that shall bear interest at the rate of .....% a year, for which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
______
Judge
NOTE: The address of the person who claims a lien as a result of the judgment must be included in the judgment in order for the judgment to become a lien on real estate when a certified copy of the judgment is recorded. Alternatively, an affidavit with this information may be simultaneously recorded. For the specific requirements, see section 55.10(1), Florida Statutes; Hott Interiors, Inc. v. Fostock, 721 So. 2d 1236 (Fla. 4th DCA 1998). The address and social security number (if known) of each person against whom the judgment is rendered must be included in the judgment, pursuant to section 55.01(2), Florida Statutes. However, for privacy reasons, only the last 4 digits of the social security number should be shown.

Committee Notes
1980 Adoption. This form is new.
*1058 2003 Amendment. Subdivision (b) is amended to include prejudgment interest in the total judgment pursuant to Quality Engineered Installation, Inc. v. Higley South, Inc., 670 So. 2d 929 (Fla.1996).

FORM 1.990. FINAL JUDGMENT FOR PLAINTIFF. JURY ACTION FOR DAMAGES

FINAL JUDGMENT
Pursuant to the verdict rendered in this action
IT IS ADJUDGED that plaintiff,.....(name and address) ....., recover from defendant,.....(name and address, and last 4 digits of social security number if known) ....., the sum of $.......... with costs in the sum of $.........., making a total of $.........., that shall bear interest at the rate of .....% a year, for which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
______
Judge
NOTE: The address of the person who claims a lien as a result of the judgment must be included in the judgment in order for the judgment to become a lien on real estate when a certified copy of the judgment is recorded. Alternatively, an affidavit with this information may be simultaneously recorded. For the specific requirements, see section 55.10(1), Florida Statutes; Hott Interiors, Inc. v. Fostock, 721 So. 2d 1236 (Fla. 4th DCA 1998). The address and social security number (if known) of each person against whom the judgment is rendered must be included in the judgment, pursuant to section 55.01(2), Florida Statutes. However, for privacy reasons, only the last 4 digits of the social security number should be shown.

FORM 1.991. FINAL JUDGMENT FOR DEFENDANT. JURY ACTION FOR DAMAGES

FINAL JUDGMENT
Pursuant to the verdict rendered in this action
IT IS ADJUDGED that plaintiff,.....(name and address, and last 4 digits of social security number if known)....., take nothing by this action and that defendant,.....(name and address)....., shall go hence without day and recover costs from plaintiff in the sum of $.......... that shall bear interest at the rate of.....% a year, for which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
........
Judge
NOTE: The address of the person who claims a lien as a result of the judgment must be included in the judgment in order for the judgment to become a lien on real estate when a certified copy of the judgment is recorded. Alternatively, an affidavit with this information may be simultaneously recorded. For the specific requirements, see section 55.10(1), Florida Statutes; Hott Interiors, Inc. v. Fostock, 721 So. 2d 1236 (Fla. 4th DCA 1998). The address and social security number (if known) of each person against whom the judgment is rendered must be included in the judgment, pursuant to section 55.01(2), Florida Statutes. However, for privacy reasons, only the last 4 digits of the social security number should be shown.

*1059 FORM 1.993. FINAL JUDGMENT FOR PLAINTIFF. GENERAL FORM. NON-JURY

FINAL JUDGMENT
This action was tried before the court. On the evidence presented
IT IS ADJUDGED that:
1. (list adjudications in numbered paragraphs)
2. .........................
(See note below on name, address, and social security number requirements.)
ORDERED at ...................., Florida, on .....(date)......
.........
Judge
NOTE: Findings of fact can be inserted after "presented" if desired. The address of the person who claims a lien as a result of the judgment must be included in the judgment in order for the judgment to become a lien on real estate when a certified copy of the judgment is recorded. Alternatively, an affidavit with this information may be simultaneously recorded. For the specific requirements, see section 55.10(1), Florida Statutes; Hott Interiors, Inc. v. Fostock, 721 So. 2d 1236 (Fla. 4th DCA 1998). The address and social security number (if known) of each person against whom the judgment is rendered must be included in the judgment, pursuant to section 55.01(2), Florida sStatutes. However, for privacy reasons, only the last 4 digits of the social security number should be shown.

FORM 1.994. FINAL JUDGMENT FOR DEFENDANT. GENERAL FORM. NON-JURY

FINAL JUDGMENT
This action was tried before the court. On the evidence presented
IT IS ADJUDGED that plaintiff, ..... (name and address, and last 4 digits of social security number if known) ....., take nothing by this action and that defendant,..... (name and address) ....., shall go hence without day and recover costs from plaintiff in the sum of $.......... that shall bear interest at the rate of .....% a year, for which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
______
Judge
NOTE: Findings of fact can be inserted after "presented" if desired. The address of the person who claims a lien as a result of the judgment must be included in the judgment in order for the judgment to become a lien on real estate when a certified copy of the judgment is recorded. Alternatively, an affidavit with this information may be simultaneously recorded. For the specific requirements, see section 55.10(1), Florida Statutes; Hott Interiors, Inc. v. Fostock, 721 So. 2d 1236 (Fla. 4th DCA 1998). The address and social security number (if known) of each person against whom the judgment is rendered must be included in the judgment, pursuant to section 55.01(2), Florida sStatutes. However, for privacy reasons, only the last 4 digits of the social security number should be shown.

FORM 1.995. FINAL JUDGMENT OF REPLEVIN
NOTE APPLICABLE TO FORMS (a)-(d): The address of the person who claims a lien as a result of the judgment must be included in the judgment in order for the judgment to become a lien on real estate when a certified copy of the judgment is recorded. Alternatively, an affidavit with this information may be simultaneously recorded. For the specific *1060 requirements, see section 55.10(1), Florida Statutes; Hott Interiors, Inc. v. Fostock, 721 So. 2d 1236 (Fla. 4th DCA 1998). The address and social security number (if known) of each person against whom the judgment is rendered must be included in the judgment, pursuant to section 55.01(2), Florida Statutes. However, for privacy reasons, only the last 4 digits of the social security number should be shown.
(a) Judgment in Favor of Plaintiff when Plaintiff Has Possession.

FINAL JUDGMENT OF REPLEVIN
This matter was heard on plaintiff's complaint. On the evidence presented
IT IS ADJUDGED that:
1. Plaintiff, .....(name and address)....., has the right against defendant,.....(name and address, and last 4 digits of social security if known)....., to retain possession of the following described property:
(list the property and include a value for each item)
2. Plaintiff shall recover from defendant the sum of $.......... as damages for the detention of the property and the sum of $.......... as costs, making a total of $.........., which shall bear interest at the rate of ..........% per year, for which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
______
Judge
NOTE: This form applies when the plaintiff has recovered possession under a writ of replevin and prevailed on the merits. Pursuant to section 78.18, Florida Statutes (1995), paragraph 2 of the form provides that the plaintiff can also recover damages for the wrongful taking and detention of the property, together with costs. Generally these damages are awarded in the form of interest unless loss of use can be proven. Ocala Foundry & Machine Works v. Lester, 49 Fla. 199, 38 So. 51 (1905).
If the defendant has possession of part of the property, see form 1.995(b).
(b) Judgment in Favor of Plaintiff when Defendant Has Possession.

FINAL JUDGMENT OF REPLEVIN
This matter was heard on plaintiff's complaint. On the evidence presented
IT IS ADJUDGED that:
1. Plaintiff, .....(name and address)....., has the right against defendant,.....(name and address, and last 4 digits of social security number if known)....., to possession of the following described property:
(list the property and include a value for each item) for which the clerk of the court shall issue a writ of possession; or
2. Plaintiff shall recover from defendant [if applicable add "and surety on the forthcoming bond"] the sum of $.......... for the value of the property, which shall bear interest at the rate of..........% per year, for which let execution issue.
3. Plaintiff shall recover from defendant the sum of $.......... as damages for the detention of the property and the sum of $.......... as costs, making a total of $.........., which shall bear interest at the rate of .....% per year, for which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
______
Judge
*1061 NOTE: This form applies when the plaintiff prevails on the merits and the defendant retains possession of the property. Section 78.19, Florida Statutes (1995), allows the plaintiff to recover the property or its value or the value of the plaintiff's lien or special interest. The value for purposes of paragraph 2 is either the value of the property or the value of the plaintiff's lien or special interest.
Paragraph 3 of the form provides for damages for detention only against the defendant because the defendant's surety obligates itself only to ensure forthcoming of the property, not damages for its detention.
Pursuant to section 78.19(2), Florida Statutes, paragraphs 1 and 2 of the form provide the plaintiff the option of obtaining either a writ of possession or execution against the defendant and defendant's surety on a money judgment for property not recovered. Demetree v. Stramondo, 621 So. 2d 740 (Fla. 5th DCA 1993). If the plaintiff elects the writ of possession for the property and the sheriff is unable to find it or part of it, the plaintiff may immediately have execution against the defendant for the whole amount recovered or the amount less the value of the property found by the sheriff. If the plaintiff elects execution for the whole amount, the officer shall release all property taken under the writ.
If the plaintiff has possession of part of the property, see form 1.995(a).
(c) Judgment in Favor of Defendant when Defendant Has Possession under Forthcoming Bond.

FINAL JUDGMENT OF REPLEVIN
This matter was heard on plaintiff's complaint. On the evidence presented
IT IS ADJUDGED that:
1. Defendant, .....(name and address)....., has the right against plaintiff,.....(name and address, and last 4 digits of social security number if known)....., to possession of the following described property:
(list the property and include a value for each item)
2. Defendant retook possession of all or part of the property under a forthcoming bond, and defendant's attorney has reasonably expended ..... hours in representing defendant in this action and $.......... is a reasonable hourly rate for the services.
3. Defendant shall recover from plaintiff the sum of $.......... for the wrongful taking of the property, costs in the sum of $.........., and attorneys' fees in the sum of $.........., making a total of $.........., which shall bear interest at the rate of .....% per year, for which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
______
Judge
NOTE: This form applies when the defendant prevails and the property was retained by or redelivered to the defendant. Section 78.20, Florida Statutes (1995), provides for an award of attorneys' fees. The prevailing defendant may be awarded possession, damages, if any, for the taking of the property, costs, and attorneys' fees.
If the plaintiff has possession of part of the property, see form 1.995(d).
(d) Judgment in Favor of Defendant when Plaintiff Has Possession.

FINAL JUDGMENT OF REPLEVIN
This matter was heard on plaintiff's complaint. On the evidence presented
IT IS ADJUDGED that:
*1062 1. Defendant, .....(name and address)....., has the right against plaintiff,.....(name and address, and last four digits of social security number if known)....., to recover possession of the following described property:
(list the property and include a value for each item) for which the clerk of the court shall issue a writ of possession; or
2. Defendant shall recover from plaintiff [if applicable add "and surety on plaintiff's bond"] the sum of $.......... for the value of the property, which shall bear interest at the rate of.....% per year, for which let execution issue.
3. Defendant shall recover from plaintiff the sum of $.......... as damages for detention of the property and the sum of $.......... as costs, making a total of $.........., which shall bear interest at the rate of .....% per year, for which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
______
Judge
NOTE: This form should be used when the defendant prevails but the plaintiff has possession of the property. Section 78.21, Florida Statutes (1995), does not provide for an award of attorneys' fees when the defendant prevails and possession had been temporarily retaken by the plaintiff. Sections 78.21 and 78.19 allow the defendant to recover the property or its value or the value of the defendant's special interest.
Paragraphs 1 and 2 of the form provide to the defendant the option of obtaining either a writ of possession or execution against the plaintiff and plaintiff's surety on a money judgment for property not recovered and costs. Demetree v. Stramondo, 621 So. 2d 740 (Fla. 5th DCA 1993). If the defendant elects the writ of possession for the property and the sheriff is unable to find it or part of it, the defendant may immediately have execution against the plaintiff and surety for the whole amount recovered or the amount less the value of the property found by the sheriff. If the defendant elects execution for the whole amount, the officer shall release all property taken under the writ.
If the defendant has possession of part of the property, see form 1.995(c).

FLORIDA RULES OF JUDICIAL ADMINISTRATION

RULE 2.425 MINIMIZATION OF THE FILING OF SENSITIVE INFORMATION
(a) Limitations for Court Filings. Unless authorized by subdivision (b), statute, another rule of court, or the court orders otherwise, designated sensitive information filed with the court must be limited to the following format:
(1) The initials of a person known to be a minor;
(2) The year of birth of a person's birth date;
(3) No portion of any
(A) social security number,
(B) bank account number,
(C) credit card account number,
(D) charge account number, or
(E) debit account number;
(4) The last four digits of any
(A) taxpayer identification number (TIN),
(B) employee identification number,
(C) driver's license number,
(D) passport number,
(E) telephone number,

*1063 (F) financial account number, except as set forth in subdivision (a)(3),
(G) brokerage account number,
(H) insurance policy account number,
(I) loan account number,
(J) customer account number, or
(K) patient or health care number;
(5) A truncated version of any
(A) email address,
(B) computer user name,
(C) password, or
(D) personal identification number (PIN); and
(6) A truncated version of any other sensitive information as provided by court order.
(b) Exceptions. Subdivision (a) does not apply to the following:
(1) An account number which identifies the property alleged to be the subject of a proceeding;
(2) The record of an administrative or agency proceeding;
(3) The record in appellate or review proceedings;
(4) The birth date of a minor whenever the birth date is necessary for the court to establish or maintain subject matter jurisdiction;
(5) The name of a minor in any order relating to parental responsibility, time-sharing, or child support;
(6) The name of a minor in any document or order affecting the minor's ownership of real property;
(7) The birth date of a party in a writ of attachment or notice to payor;
(8) Traffic and criminal proceedings;
(9) Information used by the clerk for case maintenance purposes or the courts for case management purposes; and
(10) Information which is relevant and material to an issue before the court.
(c) Remedies. Upon motion by a party or interested person or sua sponte by the court, the court may order remedies, sanctions or both for a violation of subdivision (a). Following notice and an opportunity to respond, the court may impose sanctions if such filing was not made in good faith.
(d) Motions Not Restricted. This rule does not restrict a party's right to move for protective order, to move to file documents under seal, or to request a determination of the confidentiality of records.
(e) Application. This rule does not affect the application of constitutional provisions, statutes, or rules of court regarding confidential information or access to public information.

FLORIDA RULES OF CRIMINAL PROCEDURE

RULE 3.140. INDICTMENTS; INFORMATIONS
(a)-(b) [No change]
(c) Caption, Commencement, Date, and Personal Statistics.
(1)-(3) [No change]
(4) Personal Statistics. Every indictment or information shall include the defendant's race, gender, and date of birth, and social security number when any of these facts are known. Failure to include these facts shall not invalidate an otherwise sufficient indictment or information.
(d)-(o) [No change]

*1064 Committee Notes

[No change]

RULE 3.211. COMPETENCE TO PROCEED: SCOPE OF EXAMINATION AND REPORT
(a)-(b) [No change]
(c) Written Findings of Experts. Any written report submitted by the experts shall:
(1) identify the specific matters referred for evaluation;
(2) describe the evaluative procedures, techniques, and tests used in the examination and the purpose or purposes for each;
(3) state the expert's clinical observations, findings, and opinions on each issue referred for evaluation by the court, and indicate specifically those issues, if any, on which the expert could not give an opinion; and
(4) identify the sources of information used by the expert and present the factual basis for the expert's clinical findings and opinions.
The procedure for determinations of the confidential status of f reports is governed by Rule of Judicial Administration 2.420.
(d) [No change]

Committee Notes

[No change]

RULE 3.212. COMPETENCE TO PROCEED: HEARING AND DISPOSITION
(a)-(c) [No change]
(d) Release on Finding of Incompetence. If the court decides that a defendant is not mentally competent to proceed but does not meet the criteria for commitment, the defendant may be released on appropriate release conditions for a period not to exceed 1 year. The court may order that the defendant receive outpatient treatment at an appropriate local facility and that the defendant report for further evaluation at specified times during the release period as conditions of release. A report shall be filed with the court after each evaluation by the persons appointed by the court to make such evaluations, with copies to all parties. The procedure for determinations of the confidential status of reports is governed by Rule of Judicial Administration 2.420.

Committee Notes

[No change]

RULE 3.218. COMMITMENT OF A DEFENDANT FOUND NOT GUILTY BY REASON OF INSANITY
(a) Commitment; 6-Month Report. The Department of Children and Family Services shall admit to an appropriate facility a defendant found not guilty by reason of insanity under rule 3.217 and found to meet the criteria for commitment for hospitalization and treatment and may retain and treat the defendant. No later than 6 months from the date of admission, the administrator of the facility shall file with the court a report, and provide copies to all parties, which shall address the issues of further commitment of the defendant. If at any time during the 6-month period, or during any period of extended hospitalization that may be ordered under this rule, the administrator of the facility shall determine that the defendant no longer meets the criteria for commitment, the administrator shall notify the court by such a report and provide copies to all parties. The procedure for determinations of the confidential status of reports is governed by Rule of Judicial Administration 2.420.
(b)-(c) [No change]

*1065 Committee Notes

[No change]

RULE 3.219. CONDITIONAL RELEASE
(a) Release Plan. The committing court may order a conditional release of any defendant who has been committed according to a finding of incompetency to proceed or an adjudication of not guilty by reason of insanity based on an approved plan for providing appropriate outpatient care and treatment. When the administrator shall determine outpatient treatment of the defendant to be appropriate, the administrator may file with the court, and provide copies to all parties, a written plan for outpatient treatment, including recommendations from qualified professionals. The plan may be submitted by the defendant. The plan shall include:
(1) special provisions for residential care, adequate supervision of the defendant, or both;
(2) provisions for outpatient mental health services; and
(3) if appropriate, recommendations for auxiliary services such as vocational training, educational services, or special medical care.
In its order of conditional release, the court shall specify the conditions of release based on the release plan and shall direct the appropriate agencies or persons to submit periodic reports to the court regarding the defendant's compliance with the conditions of the release, and progress in treatment, and provide copies to all parties. The procedure for determinations of the confidential status of reports is governed by Rule of Judicial Administration 2.420.
(b)-(c) [No change]

Committee Notes

[No change]

PROBATE RULES

RULE 5.200. PETITION FOR ADMINISTRATION
The petition for administration shall be verified by the petitioner and shall contain:
(a) [No change]
(b) the name, and last known address of the decedent, last 4 digits of the decedent's social security number, date and place of death of the decedent, and state and county of the decedent's domicile;
(c)-(j) [No change]

Committee Notes
Rule History
1977 Revision2010 Revision: [No change]
2011 Revision: Subdivision (b) amended to limit listing of decedent's social security number to last four digits.
Statutory References
[No change]
Rule References
[No change]

RULE 5.210. PROBATE OF WILLS WITHOUT ADMINISTRATION
(a) Petition and Contents. A petition to admit a decedent's will to probate without administration shall be verified by the petitioner and shall contain:
(1) [No change]
(2) the name, and last known address of the decedent, last 4 digits of the decedent's social security number, date and place of death of the decedent, and state and county of the decedent's domicile;
(3)-(8) [No change]
(b)-(d) [No change]

*1066 Committee Notes

[No change]
Rule History
1975 Revision2010 Revision: [No change]
2011 Revision: Subdivision (a)(2) amended to limit listing of decedent's social security number to last four digits.
Statutory References
[No change]
Rule References
[No change]

RULE 5.530. SUMMARY ADMINISTRATION
(a) Petition. The petition shall be verified as required by law and shall contain:
(1) [No change]
(2) the name, and last known address of the decedent, last 4 digits of the decedent's social security number, and date and place of death of the decedent, and the state and county of the decedent's domicile;
(3)-(12) [No change]
(b)-(d) [No change]

Committee Notes

[No change]
Rule History
1977 Revision2007 Revision: [No change]
2011 Revision: Subdivision (a)(2) amended to limit listing of decedent's social security number to last four digits.
Statutory References
[No change]
Rule References
[No change]

FLORIDA SMALL CLAIMS RULES

RULE 7.140. TRIAL
(a)-(d) [No change]
(e) Unrepresented Parties. In an effort to further the proceedings and in the interest of securing substantial justice, the court shall assist any party not represented by an attorney on:
(1) courtroom decorum;and
(2) order of presentation of material evidence; and
(3) handling private information.
The court may not instruct any party not represented by an attorney on accepted rules of law. The court shall not act as an advocate for a party.
(f) [No change]

Committee Notes
1984 Amendment1996 Amendment. [No change]
2011 Amendment. Subdivision (e)(3) was added so that a judge can assist an unrepresented party in the handling of private information that might otherwise inadvertently become public by placement in the court file.

FORM 7.340. FINAL JUDGMENT
(CAPTION)

FINAL JUDGMENT

AGAINST (DEFENDANT(S)'S NAME)
It is adjudged that the plaintiff(s),...................., recover from the defendant(s), ...................., the sum of $.......... on principal, $.......... as prejudgment interest, $.......... for attorneys' fees, with costs of $.........., all of which shall bear interest at the rate of .....% per year as provided for by Florida Statute, for all of which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
______
*1067
County Court Judge
Copies furnished to:
PLAINTIFF(S)
DEFENDANT(S)
Plaintiff(s)'s address:
....................
....................
Defendant(s)'s last known address and last
four digits of defendant(s)'s Social Security
Number (if known):
.....................
.....................
.....................
(OPTIONAL ENFORCEMENT PARAGRAPHTO BE INCLUDED UPON REQUEST PURSUANT TO RULE 7.221)
It is further ordered and adjudged that the defendant(s) shall complete Florida Small Claims Rules Form 7.343 (Fact Information Sheet) and return it to the plaintiff's attorney, or to the plaintiff if the plaintiff is not represented by an attorney, within 45 days from the date of this final judgment, unless the final judgment is satisfied or a motion for new trial or notice of appeal is filed. The defendant should NOT file the completed form 7.343 with the court.
Jurisdiction of this case is retained to enter further orders that are proper to compel the defendant(s) to complete form 7.343 and return it to the plaintiff's attorney, or the plaintiff if the plaintiff is not represented by an attorney.

Committee Notes
1992 Amendment. The optional enforcement paragraph was added to facilitate discovery.
*1068
FORM 7.343. FACT INFORMATION SHEET
      (a) For Individuals
(CAPTION)
                    FACT INFORMATION SHEET  INDIVIDUAL
Full Legal Name: _____________________________________________________________________
Nicknames or Aliases: ________________________________________________________________
Residence Address: ___________________________________________________________________
Mailing Address (if different): ______________________________________________________
Telephone Numbers: (Home) __________ (Business) ______________________________________
Name of Employer: ____________________________________________________________________
Address of Employer: _________________________________________________________________
Position or Job Description: _________________________________________________________
Rate of Pay: $ _____ per _______. Average Paycheck: $ __________ per _________________
Average Commissions or Bonuses: $ ______ per _______. Commissions or bonuses are based
on _________________
Other Personal Income: $ __________ from _____________________________________________
(Explain details on the back of this sheet or an additional sheet if necessary.)
Social Security Number: _________________ Birthdate: _________________________________
Driver's License Number: _____________________________________________________________
Marital Status: __________ Spouse's Name: ____________________________________________
Spouse's Address (if different): _____________________________________________________
Spouse's Social Security Number: ___________________ Birthdate: ______________________
Spouse's Employer: ___________________________________________________________________
Spouse's Average Paycheck or Income: $ _____________ per _____________________________
Other Family Income: $ ______ per _______ (Explain details on back of this sheet or an
additional sheet if necessary.)
Names and Ages of All Your Children (and addresses if not living with you): ___________
_______________________________________________________________________________________
Child Support or Alimony Paid: $ ________ per _________________________________________
Names of Others You Live With: ________________________________________________________
Who is Head of Your Household? _________ You ________ Spouse _______ Other Person
Checking Account at: _________ Account # ______________________________________________
Savings Account at: __________ Account # ______________________________________________
(Describe all other accounts or investments you may have, including stocks, mutual funds,
savings bonds, or annuities, on the back of this sheet or an additional sheet if necessary.)
For Real Estate (land) You Own or Are Buying:
Address: _________________________________________________________________________________
All Names on Title: ______________________________________________________________________
Mortgage Owed to: ________________________________________________________________________
Balance Owed: ____________________________________________________________________________
Monthly Payment: $ _______________________________________________________________________
*1069
(Attach a copy of the deed or mortgage, or list the legal description of the property on the back of
this sheet or an additional sheet if necessary. Also provide the same information on any other
property you own or are buying.)
For All Motor Vehicles You Own or Are Buying:
Year/Make/Model: ________________________________ Color: _________________________________
Vehicle ID #: __________ Tag No: ___________ Mileage: ____________________________________
Names on Title: __________________________ Present Value: $ ______________________________
Loan Owed to: ____________________________________________________________________________
Balance on Loan: $________________________________________________________________________
Monthly Payment: $____________________ (List all other automobiles, as well as other
vehicles, such as boats, motorcycles, bicycles, or aircraft, on the back of this sheet or an
additional sheet if necessary.)
Have you given, sold, loaned, or transferred any real or personal property worth more than $100
to any person in the last year? If your answer is "yes," describe the property and sale price, and
give the name and address of the person who received the property.
Does anyone owe you money? Amount Owed: $_________________________________________________
Name and Address of Person Owing Money: __________________________________________________
Reason money is owed: ____________________________________________________________________
Please attach copies of the following:
   1. Your last pay stub.
   2. Your last 3 statements for each bank, savings, credit union, or other financial
account.
   3. Your motor vehicle registrations and titles.
   4. Any deeds or titles to any real or personal property you own or are buying, or
leases to property you are renting.
UNDER PENALTY OF PERJURY, I SWEAR OR AFFIRM THAT THE FOREGOING
ANSWERS ARE TRUE AND COMPLETE.
                                                            ______________
                                                            Judgment Debtor
STATE OF FLORIDA
COUNTY OF ................
     The foregoing instrument was acknowledged before me on ..... (date)....., by .........,
who is personally known to me or has produced ............. as identification and who
.....did/did not..... take an oath.
    WITNESS my hand and official seal, on .....(date)......
                                                                  _________
                                                                  Notary Public
                                                                  State of Florida
*1070
My Commission expires: ............
MAIL OR DELIVER THE COMPLETED FORM TO THE JUDGMENT CREDITOR OR THE
JUDGMENT CREDITOR'S ATTORNEY. DO NOT FILE THIS FORM WITH THE COURT.
        (b) For Corporate Entities
(CAPTION)
                FACT INFORMATION SHEET  BUSINESS ENTITY
Name/Title of person filling out this form: ________________________________________
Address: ___________________________________________________________________________
Telephone Number: Home: _______________ Business: __________________________________
Address of Business Entity: ________________________________________________________
Type of Entity: (Check One) [] Corporation [] Partnership [] Limited Partnership [] Sole
Proprietorship [] Limited Liability Corporation (LLC) [] Professional Association (PA) []
Other: (Please Explain)
Does Business Entity own/have interest in any other business entity? If so please explain.
Gross/Taxable income reported for Federal Income Tax purposes last three years:
$__________________     $__________________     $____________________________________
Taxpayer Identification Number: _____________________________________________________
List Partners (General or Limited and Designate Percentage of Ownership): ___________
Average No. of Employees/Month: _____________________________________________________
Names of Officers and Directors: ____________________________________________________
Checking Account at: _________________ Account No: __________________________________
Savings Account At: ____________________________ Account No: ________________________
Does the Business Entity own any vehicles: __________________________________________
Years/Makes/Models: _________________________________________________________________
Vehicle I.D. Nos.: __________________________________________________________________
Tag Nos.: ___________________________________________________________________________
Loans Outstanding: __________________________________________________________________
Does the Business Entity own any real property: YES _____________ NO ________________
If Yes: Address: ____________________________________________________________________
Please check if the business entity owns the following:
    _______ Boat                        ______ Camper
    _______ Stocks/Bonds                ______ Other Real Property
    _______ Other Personal Property     ______ Intangible Property
Please attach copies of the following:
1. All tax returns for the past 3 years, including but not limited to state and federal income
tax returns and tangible personal property tax returns.
*1071
2. All bank, savings and loan, and other account books or statements for accounts in
institutions in which the defendant had any legal or equitable interest for the past 3 years.
3. All canceled checks for the 12 months immediately preceding the date of this judgment
for accounts in which the defendant held any legal or equitable interest.
4. All deeds, leases, mortgages, or other written instruments evidencing any interest in or
ownership of real property at any time within the 12 months immediately preceding the date of
this judgment.
5. Bills of sale or other written evidence of the gift, sale, purchase, or other transfer of any
personal or real property to or from the defendant within the 12 months immediately preceding
the date of filing this lawsuit. Any transfer of property within the last year other than ordinary
course of business transactions.
6. Motor vehicle documents, including titles and registrations relating to any motor vehicles
owned by the defendant alone or with others.
7. Financial statements and any other business records, including but not limited to accounts
payable and accounts receivable ledgers, as to the defendant's assets and liabilities prepared
within the 12 months immediately preceding the date of this judgment.
8. Copies of articles, by-laws, partnership agreement, operating agreement, and any other
governing documents, and minutes of all meetings of the defendant's shareholders, board of
directors, or members held within 2 years of the date of this judgment.
9. Resolutions of the shareholders, board of directors, or members passed within 2 years of
the date of this judgment.
10. A list or schedule of all inventory and equipment.
UNDER PENALTY OF PERJURY, I SWEAR OR AFFIRM THAT THE FOREGOING
ANSWERS ARE TRUE AND COMPLETE.
                                         __________________________________
                                         Defendant's Designated Representative
                                         Title:.............
STATE OF FLORIDA
COUNTY OF....................
    The foregoing instrument was acknowledged before me on .....(date)..... by...........,
as the defendant's duly authorized representative, who is personally known to me or has
produced ................... as identification and who ....did/did not..... take an oath.
*1072
     WITNESS my hand and official seal, on .....(date)......
                                                     ________________
                                                     Notary Public
                                                     State of Florida
My Commission expires: ....................
MAIL OR DELIVER THE COMPLETED FORM TO THE JUDGMENT CREDITOR OR THE
JUDGMENT CREDITOR'S ATTORNEY. DO NOT FILE THIS FORM WITH THE COURT.

FLORIDA RULES OF APPELLATE PROCEDURE

RULE 9.050. MAINTAINING PRIVACY OF PERSONAL DATA
(a) Application. Unless otherwise required by another rule of court or permitted by leave of court, all briefs, petitions, replies, appendices, motions, notices, stipulations, and responses and any attachment thereto filed with the court shall comply *1073 with the requirements of Florida Rule of Judicial Administration 2.425.
(b) Limitation. This rule does not require redaction of personal data from the record.
(c) Motions Not Restricted. This rule does not restrict a party's right to move to file documents under seal.

FLORIDA FAMILY LAW RULES OF PROCEDURE

RULE 12.105. SIMPLIFIED DISSOLUTION PROCEDURE
(a) Requirements for Use. The parties to the dissolution may file a petition for simplified dissolution if they certify under oath that
(1) there are no minor or dependent children of the parties and the wife is not now pregnant the parties do not have any minor or dependent children together, the wife does not have any minor or dependent children who were born during the marriage, and the wife is not now pregnant;
(2) the parties have made a satisfactory division of their property and have agreed as to payment of their joint obligations; and
(3) the other facts set forth in Florida Family Law Rules of Procedure Form 12.901(a) (Petition for Simplified Dissolution of Marriage) are true.
(b) [No change]
(c) Financial Affidavit and Settlement Agreement. The parties must each file a financial affidavit (Florida Family Law Rules of Procedure Form 12.902(b) or 12.902(c)), and a marital settlement agreement (Florida Family Law Rules of Procedure Form 12.902(f)(3)).
(dc) Final Judgment. Upon the entry of the judgment, the clerk shall furnish to each party a certified copy of the final judgment of dissolution, which shall be in substantially the form provided in Florida Family Law Rules of Procedure Form 12.990(a).
(ed) Forms. The clerk or family law intake personnel shall provide forms for the parties whose circumstances meet the requirements of this rule and shall assist in the preparation of the petition for dissolution and other papers to be filed in the action.

Commentary

[No change]

RULE 12.130. DOCUMENTS SUPPORTING ACTION OR DEFENSE
Attachment of documents supporting an action or defense shall be governed by Florida Rule of Civil Procedure 1.130.
(a) Documents Attached. If it is essential to state a cause of action, a copy of the bonds, notes, bills of exchange, contracts, accounts, or other documents or the relevant portions of the documents shall be incorporated in or attached to the pleadings.
(b) Part for All Purposes. Any exhibit attached to a pleading shall be considered part of the pleading. Statements in a pleading may be adopted by reference in a different part of the same pleading, in another pleading, or in any motion.
(c) Protection of Account and Personal Identifying Numbers. Any reference in any pleading or exhibit filed with the court to account numbers, social security numbers, employee identification numbers, driver's license numbers, passport numbers, or other personal identifying information shall be presented as provided in Florida Rule of Judicial Administration 2.425.

*1074 RULE 12.280. GENERAL PROVISIONS GOVERNING DISCOVERY
Florida Rule of Civil Procedure 1.280 shall govern general provisions concerning discovery in family law matters with the following exceptions:
(a) Redaction of Personal Information. All filings of discovery information shall comply with Florida Rule of Judicial Administration 2.425. The court shall have authority to impose sanctions for violation of this rule.
(ab) Supplementing of Responses. A party is under a duty to amend a prior response or disclosure if the party:
(1)-(2) [No change]
(bc) Time for Serving Supplemental Responses. Any supplemental response served pursuant to this rule shall be served as soon as possible after discovery of the incorrect information or change, but in no case shall the supplemental response be served later than 24 hours before any applicable hearing absent a showing of good cause.
(cd) Documents Considered Confidential. A determination as to the confidentiality of a court record shall be made in accordance with Florida Rule of Judicial Administration 2.420.
(de) Sealing of Records. Records found to be confidential under Florida Rule of Judicial Administration 2.420 shall be sealed on request of a party.

Commentary

[No change]

RULE 12.285. MANDATORY DISCLOSURE

(a) Application.
(1)-(2) [No change]
(3) Documents Not to be Filed with Court; Sanctions.
(A) Except for the financial affidavit and child support guidelines worksheet, no documents produced under this rule shall be filed in the court file without first obtaining a court order.
(B) References to account numbers and personal identifying information to be filed in the court file shall be governed by Florida Rule of Judicial Administration 2.425.
(C) Sanctions shall be governed by Florida Rule of Civil Procedure 1.280(f).
(b) [No change]
(c) Exemption from Requirement to File and Serve Financial Affidavit. The parties shall not be required to file and serve a financial affidavit under subdivisions (d) and (e) if they are seeking a simplified dissolution of marriage under rule 12.105, they have no minor children, have no support issues, and have filed a written settlement agreement disposing of all financial issues, or if the court lacks jurisdiction to determine any financial issues.
(ed) Disclosure Requirements for Temporary Financial Relief. In any proceeding for temporary financial relief heard within 45 days of the service of the initial pleading or within any extension of the time for complying with mandatory disclosure granted by the court or agreed to by the parties, the following documents shall be served on the other party:
(1)-(4) [No change]
(de) Parties' Disclosure Requirements for Initial or Supplemental Proceedings. A party shall serve the following documents in any proceeding for an initial or supplemental request for permanent financial relief, including, but not limited to, a request for child support, alimony, equitable distribution of assets or debts, or attorneys' fees, suit money, or costs:
*1075 (1)-(16) [No change]
(ef) Duty to Supplement Disclosure; Amended Financial Affidavit.
(1)-(2) [No change]
(fg) Sanctions. Any document to be produced under this rule that is served on the opposing party fewer than 24 hours before a nonfinal hearing or in violation of the court's pretrial order shall not be admissible in evidence at that hearing unless the court finds good cause for the delay. In addition, the court may impose other sanctions authorized by rule 12.380 as may be equitable under the circumstances. The court may also impose sanctions upon the offending lawyer in lieu of imposing sanctions on a party.
(gh) Extensions of Time for Complying with Mandatory Disclosure. By agreement of the parties, the time for complying with mandatory disclosure may be extended. Either party may also file, at least 5 days before the due date, a motion to enlarge the time for complying with mandatory disclosure. The court shall grant the request for good cause shown.
(hi) Objections to Mandatory Automatic Disclosure. Objections to the mandatory automatic disclosure required by this rule shall be served in writing at least 5 days prior to the due date for the disclosure or the objections shall be deemed waived. The filing of a timely objection, with a notice of hearing on the objection, automatically stays mandatory disclosure for those matters within the scope of the objection. For good cause shown, the court may extend the time for the filing of an objection or permit the filing of an otherwise untimely objection. The court shall impose sanctions for the filing of meritless or frivolous objections.
(ij) Certificate of Compliance. All parties subject to automatic mandatory disclosure shall file with the court a certificate of compliance, Florida Family Law Rules of Procedure Form 12.932, identifying with particularity the documents which have been delivered and certifying the date of service of the financial affidavit and documents by that party. The party shall swear or affirm under oath that the disclosure is complete, accurate, and in compliance with this rule, unless the party indicates otherwise, with specificity, in the certificate of compliance. Except for the financial affidavit and child support guidelines worksheet, no documents produced under this rule shall be filed in the court file without a court order.
(jk) Child Support Guidelines Worksheet. If the case involves child support, the parties shall file with the court at or prior to a hearing to establish or modify child support a Child Support Guidelines Worksheet in substantial conformity with Florida Family Law Rules of Procedure Form 12.902(e). This requirement cannot be waived by the parties.
(kl) Place of Production.
(1)-(2) [No change]
(lm) Failure of Defaulted Party to Comply. Nothing in this rule shall be deemed to preclude the entry of a final judgment when a party in default has failed to comply with this rule.

Commentary

[No change]

Committee Notes

[No change]

RULE 12.287. FINANCIAL AFFIDAVITS IN ENFORCEMENT AND CONTEMPT PROCEEDINGS
Any party in an enforcement or contempt proceeding may serve upon any other *1076 party a written request to file and serve a financial affidavit if the other party's financial circumstances are relevant in the proceeding. The party to whom the request is made shall file andserve the requested financial affidavit and file a notice of compliance within 10 days after the service of the written request. The court may allow a shorter or longer time. The financial affidavit shall be in substantial conformity with Florida Family Law Rules of Procedure Form 12.902(b) (Short Form), all sections of which shall be completed.

RULE 12.340. INTERROGATORIES TO PARTIES
Interrogatories to parties shall be governed generally by Florida Rule of Civil Procedure 1.340, with the following exceptions.
(a)-(b) [No change]
(c) Serving of Responses. Parties shall serve responses to interrogatories on the requesting party. Responses shall not be filed with the court unless they are admitted into evidence by the court and are in compliance with Florida Rule of Judicial Administration 2.425. The responding party shall file with the court Florida Family Law Rules of Procedure Form 12.930(d), Notice of Service of Answers to Standard Family Law Interrogatories.

Commentary

[No change]

Committee Note

[No change]

RULE 12.363. EVALUATION OF MINOR CHILD
(a) [No change]
(b) Providing of Reports.
(1) Unless otherwise ordered, the expert shall prepare and provide a written report to the attorney for each party or the party, if unrepresented, and the guardian ad litem, if appointed, a reasonable time before any evidentiary hearing on the matter at issue. The expert also shall send written notice to the court that the report has been completed and that a copy of the written report has been provided to the attorney for each party or the party, if unrepresented, and the guardian ad litem, if appointed. In any event, the written report shall be prepared and provided no later than 30 days before trial or 75 days from the order of appointment, unless the time is extended by order of the court. The expert shall not send a copy of the report to the court unless the parties and their attorneys have agreed in writing that the report will be considered by the court and filed in the court file as provided in subdivision (e).
(2) [No change]
(c)-(d) [No change]
(e) Use of Evidence. An expert appointed by the court shall be subject to the same examination as a privately retained expert and the court shall not entertain any presumption in favor of the appointed expert's findings. Any finding or report by an expert appointed by the court may be entered into evidence on the court's own motion or the motion of any party in a manner consistent with the rules of evidence, subject to cross-examination by the parties. Any report filed in the court file shall be in compliance with Florida Rule of Judicial Administration 2.425. The report shall not be considered by the court before it is properly admitted into evidence. The report shall not be filed in the court file unless or until it is properly admitted into evidence and considered by the court. The court shall consider whether the report *1077 should be sealed as provided by Florida Rule of Judicial Administration 2.420.

Committee Note

[No change]

RULE 12.370. REQUESTS FOR ADMISSION
Requests for admission shall be governed by Florida Rule of Civil Procedure 1.370, except that
(a) the request and any response to it must comply with Florida Rule of Judicial Administration 2.425; and
(b) documents attached to the request for admission shall not be filed with the court and shall only be attached to the copy served on the party to whom the request for admissions is directed.

RULE 12.410. SUBPOENA
Subpoenas shall be governed by Florida Rule of Civil Procedure 1.410, except as follows:
(a) Subpoenas. No subpoena issued under Florida Rule of Civil Procedure 1.410, even if for the purpose of proof of service or nonservice of the subpoena, shall be filed with the court unless in compliance with Florida Rule of Judicial Administration 2.425.
(b) Notice of Issuance of Subpoena. A party issuing a subpoena through an attorney of record or clerk of the court under Florida Rule of Civil Procedure 1.410 shall, on the same day as the subpoena is issued, serve each party to the proceeding with a notice of issuance of subpoena and file this notice with the court. The notice of issuance of subpoena shall identify the person or entity subject to the subpoena, the date the subpoena was issued, and the date and time for appearance or production, and shall recite that all references to account numbers or personal identifying numbers are in compliance with Florida Rule of Judicial Administration 2.425.
(c) Notice to Produce. Any notice to produce issued under Florida Rule of Civil Procedure 1.410 shall comply with Florida Rule of Judicial Administration 2.425.

Committee Note
2008 Amendment. The provisions of Fla. R. Civ. P. Fla. R. Civ. P. 1.410(h) do not alter the requirements of Rulerule 12.407 that a court order must be obtained before a minor child may be subpoenaed to appear at a hearing.

RULE 12.440. SETTING ACTION FOR TRIAL
Florida Rule of Civil Procedure 1.440 shall govern general provisions concerning setting an action for trial in family law matters, with the following exceptions and additions.
(a) Setting for Trial. If the court finds the action ready to be set for trial, it shall enter an order setting the action for trial, fixing a date for trial, and setting a pretrial conference, if necessary. In the event a default has been entered, reasonable notice of not less than 10 days shall be given unless otherwise required by law. Trial shall be set within a reasonable time from the service of the notice for trial. At the pretrial conference, the parties should be prepared, consistent with Florida Family Law Rule of Procedure 12.200, to present any matter that will prepare the parties for trial and that can expedite the resolution of the case. The trial court may also direct the parties to reciprocally exchange and file with the court all documents relative to the outcome of the case; a list of all witnesses, all issues to be tried, and all undisposed motions; an estimate of the time needed to try the case; and any other information the court deems appropriate. Any court filings shall be in conformity *1078 with Florida Rule of Judicial Administration 2.425. This information should be served and filed no later than 72 hours before the pretrial conference or 30 days before the trial.
(b) [No change]

Commentary

[No change]

RULE 12.540. RELIEF FROM JUDGMENT, DECREES, OR ORDERS
Florida Rule of Civil Procedure 1.540 shall govern general provision concerning relief from judgment, decrees, or orders, except:
(a) that there shall be no time limit for motions based on fraudulent financial affidavits in marital or paternity cases; and
(b) the motion and any attachment or exhibit to it shall be in compliance with Florida Rule of Judicial Administration 2.425.

Commentary

[No change]

RULE 12.560. DISCOVERY IN AID OF EXECUTION
(a)-(d) [No change]
(e) Notice of Compliance. The judgment debtor shall file with the clerk of court a notice of compliance with the order to complete form 1.977, and serve a copy of the notice of compliance on the judgment creditor or the judgment creditor's attorney. Form 1.977 shall not be filed with the clerk of the court or in any other public record, except by order of the court after a notice and hearing and for good cause shown. If the court permits the filing of form 1.977, it shall be in compliance with the requirements of Florida Rule of Judicial Administration 2.425.

Committee Notes
2000 Amendment. Subdivisions (b)-(e) were added to the Florida Rules of Civil Procedure and adopted with amendments into the Family Law Rules of Procedure. The amendments to the Civil Rules were patterned after Florida Small Claims Rule 7.221(a) and Form 7.343. Although the judgment creditor is entitled to broad discovery into the judgment debtor's finances (Fla. R. Civ. P. 1.280(b); Jim Appley's Tru-Arc, Inc. v. Liquid Extraction Systems, 526 So. 2d 177, 179 (Fla. 2d DCA 1988)), in family law cases inquiry into the individual assets of the judgment debtor's spouse must be precluded until a proper predicate has been shown. Tru-Arc, Inc., 526 So.2d at 179; Rose Printing Co. v. D'Amato, 338 So. 2d 212 (Fla. 3d DCA 1976).

RULE 12.620. RECEIVERS
Receivers shall be governed by Florida Rule of Civil Procedure 1.620, except that any inventory filed with the court shall be in compliance with Florida Rule of Judicial Administration 2.425.

INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.901(a), PETITION FOR SIMPLIFIED DISSOLUTION OF MARRIAGE (10/11)

When should this form be used?
This form should be used when a husband and wife are filing for a simplified dissolution of marriage. You and/or your spouse must have lived in Florida for at least 6 months before filing for a dissolution in Florida. You may file a simplified dissolution of marriage in Florida if all of the following are true:
 You and your spouse agree that the marriage cannot be saved.
 You and your spouse have no minor or dependent child(ren) together, the wife *1079 does not have any minor or dependent children born during the marriage, and the wife is not now pregnant.
 You and your spouse have worked out how the two of you will divide the things that you both own (your assets) and who will pay what part of the money you both owe (your liabilities), and you are both satisfied with this division.
 You are not seeking support (alimony) from your spouse, and vice versa.
 You and your spouse have filed financial affidavits with the court or you have waived the filing of financial affidavits and you are satisfied with the financial disclosure received from the other spouse.
 You are willing to give up your right to trial and appeal.
 You and your spouse are both willing to go into the clerk's office to sign the petition (not necessarily together).
 You and your spouse are both willing to go to the final hearing (at the same time).
If you do not meet the criteria above, you must file a regular petition for dissolution of marriage.
This petition should be typed or printed in black ink. Each of you must sign the petition in the presence of a deputy clerk (in the clerk's office), although you do not have to go into the clerk's office at the same time. You will need to provide picture identification (valid driver's license or official identification card) for the clerk to witness your signatures.

What should I do next?
1. After completing this form, 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.
If you did not waive the filing of a financial affidavit in the petition, each of you must file a Financial Affidavit. Florida Family Law Rules of Procedure Form 12.902(b) or (c). You may document your agreement by signing a Marital Settlement Agreement, Florida Family Law Rules of Procedure Form 12.902(f)(3) and filing it with the clerk of the circuit court or you may agree that all of your assets (what you own) and liabilities (what you owe) have been disposed of by oral agreement.
2. You must prove to the court that the husband and/or wife has (have) lived in Florida for more than 6 months before filing the petition for dissolution of marriage. Residence can be proved by:
 a valid Florida driver's license, Florida identification card, or voter registration card issued to one of you at least 6 months prior to filing for dissolution of marriage; or
 the testimony of another person who knows that either you or your spouse has resided in Florida for more than 6 months and is available to testify in court; or
 an affidavit. To prove residence by affidavit, use an Affidavit of Corroborating Witness, Florida Supreme Court Approved Family Law Form 12.902(i). This form must be signed by a person who knows that either you or your spouse has lived in Florida for more than 6 months before the date that you filed the petition for dissolution of marriage. This affidavit may be signed in the presence of the clerk of the court or in the presence of a notary public, who must affix his or her seal at the proper place on the affidavit.
3. You must pay the appropriate filing fees to the clerk of the circuit court. If you and your spouse cannot afford to pay *1080 the filing fees, you may fill out an Application for Determination of Civil Indigent Status, and file it with your petition for dissolution of marriage. You may obtain this form from the clerk and he or she will determine whether you are eligible to have filing fees waived.
4. Either you or the clerk of court will need to complete a Family Court Cover Sheet, Florida Family Law Rules of Procedure Form 12.928. The clerk's office can provide this form.
5. You must obtain a date and time for a court appearance from the clerk of court. On that date, you and your spouse must appear together before a judge. You should complete a Final Judgment of Simplified Dissolution of Marriage, Florida Family Law Rules of Procedure Form 12.990(a), and bring it with you to the hearing. At that time, if all of the papers are in order, the judge may grant a final judgment dissolving your marriage under simplified dissolution of marriage procedures by signing the final judgment which you have provided.
6. If you fail to complete this procedure, the court may dismiss the case to clear its records.

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 61, Florida Statutes, and Rule 12.105, Florida Family Law Rules of Procedure.

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 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.
*1081
   IN THE CIRCUIT COURT OF THE _____________ JUDICIAL CIRCUIT,
           IN AND FOR ___________________ COUNTY, FLORIDA
                                          Case No.: _______________
                                          Division: ________________
_______________________,
                Husband,
        and
_______________________,
                   Wife.
          PETITION FOR SIMPLIFIED DISSOLUTION OF MARRIAGE
   We, {full legal name} __________________________, Husband,
and {full legal name} _________________________________________, Wife,
being sworn, certify that the following information is true:
[fill in all blanks]
1. We are both asking the Court for a dissolution of our marriage.
2. Husband lives in {name} ____________ County, {state} __________, and has lived
   there since {date} _________. Wife lives in {name} ______________________
   County, {state} _____________, and has lived there since {date} ___________.
3. We were married to each other on {date} ____________ in the city of {city} _____
   in state of {state} _____, or country of {country} _________________________.
4. Our marriage is irretrievably broken.
5. We do not have any minor or dependent children together, the wife does not have any
   minor or dependent children born during the marriage, and the wife is not pregnant.
6. We have divided our assets (what we own) and our liabilities (what we owe) by agreement.
   We are satisfied with this agreement.
   [Check one only]
   ( ) Our marital settlement agreement, Florida Family Law Rules of Procedure Form
   12.902(f)(3), is attached. This agreement was signed freely and voluntarily by each of us
   and we intend to be bound by it.
   ( ) Our marital settlement agreement is not in writing. We prefer to keep our financial
   agreements private.
Florida Family Law Rules of Procedure Form 12.901(a), Petition for Simplified Dissolution of Marriage (10/11)
*1082
7. [check one only]
   ( )We have each completed and signed financial affidavits, Florida Family Law Rules of
   Procedure Forms 12.902(b) or (c), which are attached to this petition.
   ( ) Each of us is satisfied with the financial disclosure we received from the other spouse
   and we waive the filing of financial affidavits.
8. [ Check one only ] ( ) yes ( ) no Wife wants to be known by her former name, which was
   {full legal name} _________________________________________.
9. We each certify that we have not been threatened or pressured into signing this petition.
   We each understand that the result of signing this petition may be a final judgment ending
   our marriage and allowing no further relief.
10. We each understand that we both must come to the hearing to testify about the things we
    are asking for in this petition.
11. We understand that we each may have legal rights as a result of our marriage and that by
    signing this petition we may be giving up those rights.
12. We ask the Court to end our marriage and approve our marital settlement agreement.
    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 HUSBAND
                                                  Printed Name: ______________________
                                                  Address: ___________________________
                                                  City, State, Zip: __________________
                                                  Telephone Number: __________________
                                                  Fax Number: ________________________
*1083
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 ________________________________
    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 WIFE
                                                   Printed Name: ________________
                                                   Address: ______________________
                                                   City, State, Zip: _____________
                                                   Telephone Number: _____________
                                                   Fax Number: ___________________
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 _________________________________
*1084
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, located at {street} _______________, {city} _________,
{state} ________, {phone} _________, helped {name} __________,
[Choose only one] ( ) Husband ( ) Wife or ( ) both, fill out this form.

*1085 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.901(b)(1), PETITION FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) (10/11)

When should this form be used?
This form should be used when a husband or wife is filing for a dissolution of marriage and you and your spouse have a dependent or minor child(ren) together or the wife is pregnant. You and/or your spouse must have lived in Florida for at least 6 months before filing for a dissolution in Florida. You must file this form if the following is true:
 You and your spouse have a dependent or minor child(ren) together or the wife is pregnant.
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.

What should I do next?
For your case to proceed, you must properly notify your spouse 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, you may use constructive service. You may also be able to use constructive service if your spouse resides in another state or country. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b). If your spouse is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Supreme Court Approved Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues.
If personal service is used, the respondent has 20 days to answer after being served with your petition. Your case will then generally proceed in one of the following three ways:
DEFAULT. If after 20 days, your spouse has not filed an answer, you may file a Motion for Default, Florida Supreme Court Approved Family Law Form 12.922(a), with the clerk of court. 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 your spouse 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.
UNCONTESTED. If your spouse files an answer that agrees with everything in your petition or an answer and waiver, and you have complied with mandatory disclosure and 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 your spouse 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 your spouse files an answer or an answer and counterpetition, which disagrees with or denies anything in your petition, and you are unable to settle *1086 the disputed issues, you should file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. 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). If your spouse files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).

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 61, 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 from the clerk, fill it out, and the clerk will determine whether you are eligible to have filing fees deferred.
If you want to keep your address confidential because you are the victim of sexual battery, aggravated child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence do not enter the address, telephone, and fax information at the bottom of this form. Instead, file Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h).
With this form, you must also file the following:
 Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d).
 Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), if you are asking that child support be ordered in the final judgment. (If you do not know your spouse's income, you may file this worksheet after his or her financial affidavit has been served on you.)
 Affidavit of Corroborating Witness, Florida Supreme Court Approved Family Law Form 12.902(i) OR photocopy of current Florida driver's license, Florida identification card, or voter's registration card (issue date of copied document must be at least six months before date case is actually filed with the clerk of the circuit court).
 Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1), if you and your spouse have reached an agreement on any or all of the issues.
 Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
 Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This must be filed with the petition if the petitioner seeks to establish child support. Otherwise, it must be filed within 45 days of service of the petition on the respondent.)
 Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days of *1087 service of the petition on the respondent, if not filed at the time of the petition, unless you and your spouse have agreed not to exchange these documents.)
 Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a), Safety Focused Parenting Plan, Form 12.995(b), or Relocation/Long-Distance Parenting Plan 12.995(c). If the parents have reached an agreement, a signed and notarized Parenting Plan should be attached. If the parents have not reached an agreement, a proposed Parenting Plan may be filed.
Parenting Plan and Time-Sharing. If you and your spouse are unable to agree on parenting arrangements and a timesharing schedule, a judge will decide for you as part of establishing a Parenting Plan. The judge will decide the parenting arrangements and time-sharing based on the child(ren)'s best interests. Regardless of whether there is an agreement, the court reserves jurisdiction to modify issues relating to the minor child(ren).
The judge may request a parenting plan recommendation or appoint a guardian ad litem in your case. This means that a neutral person will review your situation and report to the judge concerning parenting issues. The purpose of such intervention is to be sure that the best interests of the child(ren) is (are) being served. For more information, you may consult section 61.13, Florida Statutes.
A parenting course must be completed prior to entry of the final judgment. You should contact the clerk, family law intake staff, or judicial assistant about requirements for parenting courses where you live.
Listed below are some terms with which you should become familiar before completing your petition. If you do not fully understand any of the terms below or their implications, you should speak with an attorney before going any further.
 Shared Parental Responsibility
 Sole Parental Responsibility
 Supervised Time-Sharing
 No contact
 Parenting Plan
 Parenting Plan Recommendation
 Time-Sharing Schedule
Child Support. The court may order one parent to pay child support to assist the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents. You must file a Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), and your spouse will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid using the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations.
Alimony. Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse has the ability to pay it. If you want alimony, *1088 you must request it in writing in the original petition or counterpetition. If you do not request alimony in writing before the final hearing, it is waived (you may not request it later). You may request either permanent alimony, lump sum alimony, or rehabilitative alimony.
Marital/Nonmarital Assets and Liabilities. Florida law requires an equitable distribution of marital assets and marital liabilities. "Equitable" does not necessarily mean "equal." Many factors, including child support, time-sharing, and alimony awards, may lead the court to make an unequal (but still equitable) distribution of assets and liabilities. Nonmarital assets and nonmarital liabilities are those assets and liabilities which the parties agree or the court determines belong to, or are the responsibility of, only one of the parties. If the parties agree or the court finds an asset or liability to be nonmarital, the judge will not consider it when distributing marital assets and liabilities.
Temporary Relief. If you need temporary relief regarding temporary use of assets, temporary responsibility for liabilities, parental responsibility and timesharing with child(ren), temporary child support, or temporary alimony, you may file a Motion for Temporary Support and Time-Sharing with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(a). For more information, see the instructions for that form.
Marital Settlement Agreement. If you and your spouse are able to reach an agreement on any or all of the issues, you should file a Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1). Both of you must sign this agreement before a notary public or deputy clerk. Any issues on which you are unable to agree will be considered contested and settled by the judge at the final hearing.
Parenting Plan. In all cases involving minor or dependent child(ren), a Parenting Plan shall be approved or established by the court. If you and your spouse have reached an agreement, you should file a Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a), Safety Focused Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(b), or Relocation/Long-Distance Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(c), which addresses the time-sharing schedule for the child(ren). If you have not reached an agreement, a proposed Parenting Plan may be filed. If the parties are unable to agree, a Parenting Plan will be established by the court.
Final Judgment Form. These family law forms contain a Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.990(c)(1), which the judge may use if your case is contested. If you and your spouse reach an agreement on all of the issues, the judge may use a Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) (Uncontested), Florida Supreme Court Approved Family Law Form 12.990(b)(1). You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Nonlawyer. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a *1089 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.
          IN THE CIRCUIT COURT OF THE ____________ JUDICIAL CIRCUIT,
                   IN AND FOR____________ COUNTY, FLORIDA
                                           Case No: ____________
                                           Division: ___________
   ________________________,
               Petitioner,
          and
   _________________________,
               Respondent.
            PETITION FOR DISSOLUTION OF MARRIAGE
            WITH DEPENDENT OR MINOR CHILD(REN)
      I, {full legal name} __________________________________________, the
[Choose only one] ( ) Husband ( ) Wife, being sworn, certify that the following statements are true:
1. JURISDICTION/RESIDENCE
   ( ) Husband ( ) Wife ( ) Both has (have) lived in Florida for at least 6 months before the filing of
   this Petition for Dissolution of Marriage.
2. The husband [Choose only one] ( )is( ) is not a member of the military service.
   The wife [Choose only one] ( )is( ) is not a member of the military service.
3. MARRIAGE HISTORY
   Date of marriage: {month, day, year} ____________________________________
   Date of separation: {month, day, year}____________ (Please indicate if approximate)
4. DEPENDENT OR MINOR CHILD(REN)
   [Choose all that apply]
   a. ___ The wife is pregnant. Baby is due on: {date} ____________
   b. ___ The minor (under 18) child(ren) common to both parties are:
  Name                          Birth date
  ____________________________________________________________________________________
  ____________________________________________________________________________________
  ____________________________________________________________________________________
  ____________________________________________________________________________________
  _____________________________________________________________________________________
  ______________________________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of
Marriage with Dependent or Minor Child(ren) (10/11)
*1090
c. ___The minor child(ren) born or conceived during the marriage who are not common to both
   parties are:
  Name         Birth date
   _______________________________________________________________________________
   _______________________________________________________________________________
   The birth father(s) of the above minor child(ren) is (are) {name and address} _____
   ______________________________________________________________________________________
  d. ___ The child(ren) common to both parties who are 18 or older but who are dependent upon
  the parties due to a mental or physical disability are:
  Name          Birth date
  _________________________________________________________________________
  _________________________________________________________________________
5. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or
   (c) ( ) is filed or ( ) will be timely filed.
6. A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida
   Supreme Court Approved Family Law Form 12.902(d), is filed with this petition. (You must complete
   and attach this form in a dissolution of marriage with minor child(ren)).
7. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form
   12.902(j), is filed with this petition.
8. This petition for dissolution of marriage should be granted because:
   [Choose only one]
   a. ___ The marriage is irretrievably broken.
   b. ___ One of the parties has been adjudged mentally incapacitated for a period of 3 years prior to
      the filing of this petition. A copy of the Judgment of Incapacity is attached.
SECTION I. MARITAL ASSETS AND LIABILITIES
1. ___ There are no marital assets or liabilities.
2. ___ There are marital assets or liabilities. All marital and nonmarital assets and liabilities are (or
   will be) listed in the financial affidavits, Florida Family Law Rules of Procedure Form
   2.902(b) or (c), to be filed in this case.
   [Choose all that apply]
   a. ___ All marital assets and liabilities have been divided by a written agreement between the
      parties, which is attached, to be incorporated into the final judgment of dissolution of marriage.
      (The parties may use Marital Settlement Agreement for Dissolution of Marriage with Dependent
      or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1).
   b. ___ The Court should determine how the assets and liabilities of this marriage are to be
      distributed, under section 61.075, Florida Statutes.
   c. ___ Petitioner should be awarded an interest in Respondent's property because:
*1091
   ____________________________________________________________________________
   _____________________________________________________________________________
   ______________________________________________________________________________
SECTION II. SPOUSAL SUPPORT (ALIMONY)
     [Choose only one]
1. ___ Petitioner forever gives up his/her right to spousal support (alimony) from Respondent.
2. ___ Petitioner requests that the Court order Respondent to pay the following spousal support
   (alimony) and claims that he or she has a need for the support that he or she is requesting and
   Respondent has the ability to pay that support. Spousal support (alimony) is requested in the
   amount of $ ___ every ( )week( ) other week ( ) month, beginning {date} ____
   and continuing until {date or event}________
   Explain why the Court should order Respondent to pay and any specific request(s) for type of
   alimony (temporary, permanent, rehabilitative, and/or lump sum): __________
   _____________________________________________________________________________________
   _____________________________________________________________________________________
   ________________________________________________________________________________________
   ________________________________________________________________________________________
   ________________________________________________________________________________________
   ________________________________________________________________________________________
   [Choose if applicable] ( ) Petitioner requests life insurance on Respondent's life, provided by
   Respondent, to secure such support.
SECTION III. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING
1. The minor child(ren) currently reside(s) with ( ) Mother ( ) Father ( ) Other: {explain}
   _________________________________________________________________________________________
2. Parental Responsibility. It is in the child(ren)'s best interests that parental responsibility be:
   [Choose only one]
   a. ___ shared by both Father and Mother.
   b. ___ awarded solely to ( ) Father ( ) Mother. Shared parental responsibility would be
          detrimental to the child(ren) because: ________________________________________
   ______________________________________________________________________________________
   ______________________________________________________________________________________
   ______________________________________________________________________________________
3. Parenting Plan and Time-Sharing. It is in the best interests of the child(ren) that the family be
   ordered to comply with a Parenting Plan that ( ) includes ( ) does not include parental time-sharing
   with the child(ren). The Petitioner states that it is in the best interests of the child (ren) that:
   [Choose only one]
   a. ___ The attached proposed Parenting Plan should be adopted by the court. The parties
         ( )have( ) have not agreed to the Parenting Plan.
   b. ___ The court should establish a Parenting Plan with the following provisions:
      ___ No time-sharing for the ___ Father ___ Mother.
*1092
   ___ Limited time-sharing with the ___ Father ___ Mother.
   ___ Supervised Time-Sharing for the ___ Father___ Mother.
   ___ Supervised or third-party exchange of the child(ren).
   ___ Time-Sharing Schedule as follows:
   ___________________________________________________________________________________
   ___________________________________________________________________________________
   ___________________________________________________________________________________
4. Explain why this request is in the best interests of the child(ren): ______________
   ___________________________________________________________________________________
   ___________________________________________________________________________________
   ___________________________________________________________________________________
   ___________________________________________________________________________________
SECTION IV. CHILD SUPPORT
     [Choose all that apply]
1. ___ Petitioner requests that the Court award child support as determined by Florida's child support
   guidelines, section 61.30, Florida Statutes. A completed Child Support Guidelines Worksheet,
   Florida Family Law Rules of Procedure Form 12.902(e), is, or will be filed. Such support should be
   ordered retroactive to:
   a. ___ the date of separation {date} ______________.
   b. ___ the date of the filing of this petition.
   c. ___ other {date} ____________ {explain} ____________________________________
2. ___ Petitioner requests that the Court award child support to be paid beyond the age of 18 years
   because:
   a. ___ the following child(ren) {name(s)} ____________________________________
      is (are) dependent because of a mental or physical incapacity which began before the age of 18.
      {explain}________________________________________________________________________
      __________________________________________________________________________________________
   b. ___ the following child(ren) {name(s)} ______________________ is (are) dependent in fact
      and is (are) in high school while he/she (they) are between the ages of 18 and 19; said child(ren)
      is (are) performing in good faith with reasonable expectation of graduation before the age of 19.
3. ___ Petitioner requests that the Court award a child support amount that is more than or less than
   Florida's child support guidelines. Petitioner understands that Motion to Deviate from Child Support
   Guidelines, Florida Supreme Court Approved Family Law Form 12.943, must be filed before the
   court will consider this request.
4. ___ Petitioner requests that medical/dental insurance for the minor child(ren) be provided by:
   [Choose only one]
   a. ___ Father.
   b. ___ Mother.
5. ___ Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid:
   [Choose only one]
   a. ___ by Father.
   b. ___ by Mother.
*1093
   c. ___by Father and Mother [each pay one-half].
   d. ___according to the percentages in the Child Support Guidelines Worksheet, Florida Family Law
      Rules of Procedure Form 12.902(e).
   e. ___Other {explain}: ___________________________________________
   ____________________________________________________________________________
   ____________________________________________________________________________
6. Petitioner requests that life insurance to secure child support be provided by:
   a. ___Father.
   b. ___Mother.
   c. ___Both.
SECTION V. OTHER
1. [If Petitioner is also the Wife, please indicate by either ( ) yes ( ) or no whether Petitioner/Wife
   wants to be known by her former name, which was {full legal name}
   ________________________________________________________________________________
2. Other relief {specify}:
   _________________________________________________________________________________
   _________________________________________________________________________________
   _________________________________________________________________________________
   __________________________________________________________________________________
   __________________________________________________________________________________
SECTION VI. PETITIONER'S REQUEST (This section summarizes what you are asking the Court to include
     in the final judgment of dissolution of marriage.)
Petitioner requests that the Court enter an order dissolving the marriage and:
[Choose all that apply]
1. ___distributing marital assets and liabilities as requested in Section I of this petition;
2. ___awarding spousal support (alimony) as requested in Section II of this petition;
3. ___adopt or establish a Parenting Plan containing provisions for parental responsibility and timesharing
   for the dependent or minor child(ren) common to both parties, as requested in Section
   III of this petition;
4. ___establishing child support for the dependent or minor child(ren) common to both parties, as
   requested in Section IV of this petition;
5. ___restoring Wife's former name as requested in Section V of this petition;
6. ___awarding other relief as requested in Section V of this petition; and any other terms the Court
deems necessary.
*1094
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: _______________
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]
I, {full legal name and trade name of nonlawyer} ________________,
a nonlawyer, whose address is {street} __________________________,
{city} _____________, {state} ____________, {phone} ________,
helped {name} ________________, who is the petitioner, fill out this form.

*1095 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.901(b)(2), PETITION FOR DISSOLUTION OF MARRIAGE WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN) (10/11)

When should this form be used?
This form may be used when a husband or wife is filing for a dissolution of marriage, and the husband and wife have marital assets and/or marital liabilities but they do not have any dependent children nor is the wife is now pregnant. You and/or your spouse must have lived in Florida for at least 6 months before filing for a dissolution in Florida. If you and your spouse agree on all issues and both can attend the hearing, you may want to file a simplified dissolution of marriage petition, Florida Family Law Rules of Procedure Form 12.901(a). However, you cannot file for a simplified dissolution of marriage if any of the following are true:
 You disagree about property, debts, or other matters and wish to have a judge settle them for you.
 Either you or your spouse is seeking support (alimony).
 You would like to ask questions and get documents concerning your spouse's income, expenses, assets, debts, or other matters before having a trial or settlement.
 You would like to reserve your rights to have any matters reconsidered or appeal the judge's decision.
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.

What should I do next?
For your case to proceed, you must properly notify your spouse 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, you may use constructive service. You may also be able to use constructive service if your spouse resides in another state or country. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b). If your spouse is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Supreme Court Approved Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues.
If personal service is used, the respondent has 20 days to answer after being served with your petition. Your case will then generally proceed in one of the following three ways:
DEFAULT ... If after 20 days, your spouse has not filed an answer, you may file a Motion for Default, Florida Supreme Court Approved Family Law Form 12.922(a), with the clerk of court. 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 your spouse of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved *1096 Family Law Form 12.923, or other appropriate notice of hearing form.
UNCONTESTED ... If the respondent files an answer that agrees with everything in your petition or an answer and waiver, and you have complied with mandatory disclosure and 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 your spouse 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 the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. 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). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).

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 61, 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 from the clerk, fill it out, and the clerk will determine whether you are eligible to have filing fees deferred.
If you want to keep your address confidential because you are the victim of sexual battery, aggravated child abuse, aggravated stalking, harassment, aggravated battery or domestic violence do not enter the address, telephone, and fax information at the bottom of this form. Instead, file a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h).
With this form, you must also file the following:
 Affidavit of Corroborating Witness, Florida Supreme Court Approved Family Law Form 12.902(i) OR photocopy of current Florida driver's license, Florida identification card, or voter's registration card (issue date of copied document must be at least six months before date case is actually filed with the clerk of the circuit court).
 Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(2), if you and your spouse have reached an agreement on any or all of the issues.
 Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
 Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition.)
*1097  Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition, unless you and your spouse have agreed not to exchange these documents.)
Alimony ... Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse has the ability to pay it. If you want alimony, you must request it in writing in the original petition or counterpetition. If you do not request alimony in writing before the final hearing, it is waived (you may not request it later). You may request either permanent alimony, lump sum alimony, or rehabilitative alimony.
Marital/Nonmarital Assets and Liabilities... Florida law requires an equitable distribution of marital assets and marital liabilities. "Equitable" does not necessarily mean "equal." Many factors, including alimony awards, may lead the court to make an unequal (but still equitable) distribution of assets and liabilities. Nonmarital assets and nonmarital liabilities are those assets and liabilities which the parties agree or the court determines belong to, or are the responsibility of, only one of the parties. If the parties agree or the court finds an asset or liability to be nonmarital, the judge will not consider it when distributing marital assets and liabilities.
Temporary Relief ... If you need temporary relief regarding temporary use of assets, temporary responsibility for liabilities, or temporary alimony, you may file a Motion for Temporary Support with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(c). For more information, see the instructions for that form.
Marital Settlement Agreement ... If you and your spouse are able to reach an agreement on any or all of the issues, you should file a Marital Settlement Agreement for Dissolution of Marriage with Property But No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(2). Both husband and wife must sign this agreement before a notary public or deputy clerk. Any issues on which you are unable to agree will be considered contested and settled by the judge at the final hearing.
Final Judgment Form ... These family law forms contain a Final Judgment of Dissolution of Marriage with Property but No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.990(c)(2), which the judge may use if your case is contested. If you and your spouse reach an agreement on all of the issues, the judge may use a Final Judgment of Dissolution of Marriage with Property but No Dependent or Minor Child(ren) (Uncontested), Florida Supreme Court Approved Family Law Form 12.990(b)(2). You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Nonlawyer ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of *1098 the last page of every form he or she helps you complete.
            IN THE CIRCUIT COURT OF THE _____________ JUDICIAL CIRCUIT,
                IN AND FOR __________________ COUNTY, FLORIDA
                                               Case No: _________________
                                               Division: _________________
____________________,
          Petitioner,
     and
_____________________,
           Respondent.
              PETITION FOR DISSOLUTION OF MARRIAGE
         WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN)
       I, {full legal name} ________________________________, the
[Choose one only] ( ) Husband ( ) Wife, being sworn, certify that the following statements are true:
1. JURISDICTION/RESIDENCE
   ( ) Husband ( ) Wife ( ) Both has (have) lived in Florida for at least 6 months before the filing of
   this Petition for Dissolution of Marriage.
2. The husband [Choose one only] ( ) is ( ) is not a member of the military service.
   The wife [Choose one only] ( ) is ( ) is not a member of the military service.
3. MARRIAGE HISTORY
   Date of marriage: {month, day, year}________________________________
   Date of separation: {month, day, year} ________________[Please indicate if approximate]
4. THERE ARE NO MINOR (under 18) OR DEPENDENT CHILD(REN) COMMON TO BOTH PARTIES AND
   THE WIFE IS NOT PREGNANT.
5. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form
   12.902(j), is filed with this petition.
6. THIS PETITION FOR DISSOLUTION OF MARRIAGE SHOULD BE GRANTED BECAUSE:
   [Choose one only]
   a. ____ The marriage is irretrievably broken.
   b. ____ One of the parties has been adjudged mentally incapacitated for a period of 3 years before
      the filing of this petition. A copy of the Judgment of Incapacity is attached.
Florida Supreme Court Approved Family Law Form 12.901(b)(2), Petition for Dissolution of Marriage with Property
but No Dependent or Minor Child(ren)(10/11)
*1099
SECTION I. MARITAL ASSETS AND LIABILITIES
[Choose one only]
1. ____ There are no marital assets or liabilities.
2. ____ There are marital assets or liabilities. All marital and nonmarital assets and liabilities are (or
   will be) listed in the financial affidavits, Florida Family Law Rules of Procedure Form 12.902(b) or (c),
   to be filed in this case.
   [Choose all that apply]
   a. ____ All marital assets and debts have been divided by a written agreement between the
      parties, which is attached to be incorporated into the final judgment of dissolution of marriage.
      (The parties may use Marital Settlement Agreement for Simplified Dissolution of Marriage,
      Florida Family Law Rules of Procedure Form 12.902(f)(3) or Marital Settlement Agreement for
      Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Supreme Court
      Approved Family Law Form 12.902(f)(2).
   b. ____ The Court should determine how the assets and liabilities of this marriage are to be
      distributed, under section 61.075, Florida Statutes.
   c. ____ Petitioner should be awarded an interest in Respondent's property because:
SECTION II. SPOUSAL SUPPORT (ALIMONY)
[Choose one only]
1. ____ Petitioner forever gives up his/her right to spousal support (alimony) from Respondent.
2. ____ Petitioner requests that the Court order Respondent to pay the following spousal support
   (alimony) and claims that he or she has a need for the support that he or she is requesting and
Respondent has the ability to pay that support. Spousal support (alimony) is requested in the
   amount of $ ___ every ( ) week ( ) other week ( ) month, beginning {date} _______   and continuing until
 {date or event} ____________________________________________________.
   Explain why the Court should order Respondent to pay and any specific request(s) for type of
   alimony (temporary, permanent, rehabilitative, and/or lump sum):
   ________________________________________________________________________________
   ________________________________________________________________________________
   ________________________________________________________________________________
   ________________________________________________________________________________
   ________________________________________________________________________________
   ________________________________________________________________________________
   ________________________________________________________________________________
   ________________________________________________________________________________
   [Indicate if applicable] ( ) Petitioner requests life insurance on Respondent's life, provided by
   Respondent, to secure such support.
SECTION III. OTHER
1. [If Petitioner is also the Wife, choose one only] ( ) yes ( ) no Petitioner/Wife wants to be known
   by her former name, which was {full legal name}
   ________________________________________________________________________________.
*1100
2. Other relief {specify}: ______________________________________________.
   ________________________________________________________________________________
   ________________________________________________________________________________
   ________________________________________________________________________________
   ________________________________________________________________________________
   ________________________________________________________________________________
   ________________________________________________________________________________
SECTION IV. PETITIONER'S REQUEST (This section summarizes what you are asking the Court to include
in the final judgment of dissolution of marriage.)
Petitioner requests that the Court enter an order dissolving the marriage and:
[Choose all that apply]
1. ____ distributing marital assets and liabilities as requested in Section I of this petition;
2. ____ awarding spousal support (alimony) as requested in Section II of this petition;
3. ____ restoring Wife's former name as requested in Section III of this petition;
4. ____ awarding other relief as requested in Section III of this petition; and any other terms the Court
   deems necessary.
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: _______________
*1101
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]
I, {full legal name and trade name of nonlawyer} _______________________________________________________,
a nonlawyer, whose address is {street} _________________________________________________________________,
{city} _____________________________________________,{state} ______,{phone} ____________________________,
helped {name} ____________________________________________, who is the petitioner, fill out this form.

*1102 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.901(b)(3), PETITION FOR DISSOLUTION OF MARRIAGE WITH NO DEPENDENT OR MINOR CHILD(REN) OR PROPERTY(10/11)

When should this form be used?
This form may be used when a husband or wife is filing for a dissolution of marriage, and the husband and wife have no marital assets and/or marital liabilities and they do not have any dependent children nor is the wife is now pregnant. You and/or your spouse must have lived in Florida for at least 6 months before filing for a dissolution in Florida. If you and your spouse agree on all issues and both can attend the hearing, you may want to file a petition for simplified dissolution of marriage, Florida Family Law Rules of Procedure Form 12.901(a). However, you may file this form if all of the following are true:
 You have no marital assets or marital debts.
 Neither you nor your spouse is seeking support (alimony).
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.

What should I do next?
For your case to proceed, you must properly notify your spouse 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, you may use constructive service. You may also be able to use constructive service if your spouse resides in another state or country. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b). If your spouse is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Supreme Court Approved Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues.
If personal service is used, the respondent has 20 days to answer after being served with your petition. Your case will then generally proceed in one of the following three ways:
DEFAULT ... If after 20 days, your spouse has not filed an answer, you may file a Motion for Default, Florida Supreme Court Approved Family Law Form 12.922(a), with the clerk of court. 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 your spouse 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.
UNCONTESTED ... If the respondent files an answer that agrees with everything in your petition or an answer and waiver, and you have complied with mandatory disclosure and filed all of the required papers, you may call the clerk, family *1103 law intake staff, or judicial assistant to set a final hearing. You must notify your spouse 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 the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. 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). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).

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 61, 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 from the clerk, fill it out, and the clerk will determine whether you are eligible to have filing fees deferred.
If you want to keep your address confidential because you are the victim of sexual battery, aggravated child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence do not enter the address, telephone, and fax information at the bottom of this form. Instead, file a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h).
With this form, you must also file the following:
 Affidavit of Corroborating Witness, Florida Supreme Court Approved Family Law Form 12.902(i) OR photocopy of current Florida driver's license, Florida identification card, or voter's registration card (issue date of copied document must be at least six months before date case is actually filed with the clerk of the circuit court).
 Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
 Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition.)
 Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition, unless you and your spouse have agreed not to exchange these documents.)
Final Judgment Form ... These family law forms contain a Final Judgment of Dissolution of Marriage with No Property or Minor Child(ren) (Uncontested), Florida Supreme Court Approved Family Law Form 12.990(b)(3). You should check with the clerk, family law intake staff, or *1104 judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Nonlawyer ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1105
                 IN THE CIRCUIT COURT OF THE_______________ JUDICIAL CIRCUIT,
                    IN AND FOR _________________________ COUNTY, FLORIDA
                                                      Case No: _________________
                                                      Division: ________________
_______________________________,
                     Petitioner,
          and
_______________________________,
                     Respondent.
      PETITION FOR DISSOLUTION OF MARRIAGE WITH NO DEPENDENT OR MINOR
                           CHILD(REN) OR PROPERTY
       I, {full legal name} ____________________________________, the
[Choose only one] ( ) Husband ( ) Wife, being sworn, certify that the following statements are true:
1.  JURISDICTION/RESIDENCE
    ( ) Husband ( ) Wife ( ) Both has (have) lived in Florida for at least 6 months before the filing of
    this Petition for Dissolution of Marriage.
2.  The husband [Choose only one] ( ) is ( ) is not a member of the military service.
    The wife [Choose only one] ( ) is ( ) is not a member of the military service.
3.  MARRIAGE HISTORY
    Date of marriage: {month, day, year} ____________________________________________
4.  THERE ARE NO MINOR (under 18) OR DEPENDENT CHILD(REN) COMMON TO BOTH PARTIES AND
    THE WIFE IS NOT PREGNANT.
5.  A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form
    12.902(j), is filed with this petition.
6.  THIS PETITION FOR DISSOLUTION OF MARRIAGE SHOULD BE GRANTED BECAUSE:
    [Choose only one]
    a. ____ The marriage is irretrievably broken.
    b. ____ One of the parties has been adjudged mentally incapacitated for a period of 3 years
       before the filing of this petition. A copy of the Judgment of Incapacity is attached.
7.  THERE ARE NO MARITAL ASSETS OR LIABILITIES.
8.  PETITIONER FOREVER GIVES UP HIS/HER RIGHTS TO SPOUSAL SUPPORT (ALIMONY) FROM
    RESPONDENT.
*1106
9.  [If Petitioner is also the Wife, Choose only one] ( ) yes ( ) no Petitioner/Wife wants to be known
    by her former name, which was {full legal name}___________________________________________________.
10. Other relief {specify}: __________________________________________________________________
    ___________________________________________________________________________________________________
    ___________________________________________________________________________________________________
    ___________________________________________________________________________________________________
    ___________________________________________________________________________________________________
    ___________________________________________________________________________________________________
PETITIONER'S REQUEST (This section summarizes what you are asking the Court to include in the final
judgment of dissolution of marriage.)
Petitioner requests that the Court enter an order dissolving the marriage and:
[Choose all that apply]
1. ____ restoring Wife's former name as specified in paragraph 9 of this petition;
2. ____ awarding other relief as specified in paragraph 10 of this petition; and any other terms the
   Court deems necessary.
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: _____________________
*1107
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]
I, {full legal name and trade name of nonlawyer} __________________________________________,
a nonlawyer, whose address is {street} _____________________, {city} ______________________,
{state} _____________, {phone} ___________, helped {name} ______________________, who is
the petitioner, fill out this form.

*1108 INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.902(b), FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM) (10/11)

When should this form be used?
This form should be used when you are involved in a family law case which requires a financial affidavit and your individual gross income is UNDER $50,000 per year unless.
(1) you are filing a simplified dissolution of marriage under rule 12.105 and both parties have waived the filing of a financial affidavit.
(2) you have no minor children, no support issues, and have filed a written settlement agreement disposing of all financial issues, or
(3) the court lacks jurisdiction to determine any financial issues.
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 was filed and keep a copy for your records.

What should I do next?
A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served on him or her with your initial papers. This must be accomplished within 45 days of service of the 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" in these instructions are defined there. For further information, see rule 12.285, Florida Family Law Rules of Procedure.

Special notes ...
If you want to keep your address confidential because you are the victim of sexual battery, aggravated child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence, do not enter the address, telephone, and fax information at the bottom of this form. Instead, file Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h).
The affidavit must be completed using monthly income and expense amounts. If you are paid or your bills are due on a schedule which is not monthly, you must convert those amounts. Hints are provided below for making these conversions.
HourlyIf you are paid by the hour, you may convert your income to monthly as follows:
Hourly amount × Hours worked per week = Weekly amount
Weekly amount × 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
DailyIf you are paid by the day, you may convert your income to monthly as follows:
Daily amount × Days worked per week = Weekly amount
Weekly amount × 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
WeeklyIf you are paid by the week, you may convert your income to monthly as follows:
*1109 Weekly amount × 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
Bi-weeklyIf you are paid every two weeks, you may convert your income to monthly as follows:
Bi-weekly amount × 26 = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
Semi-monthlyIf you are paid twice per month, you may convert your income to monthly as follows:
Semi-monthly amount × 2 = Monthly Amount
Expenses may be converted in the same manner.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1110
               IN THE CIRCUIT COURT OF THE __________________ JUDICIAL CIRCUIT,
                        IN AND FOR ___________________ COUNTY, FLORIDA
                                               Case No.: _________________________
                                               Division: _________________________
_________________________________,
                       Petitioner,
           and
_________________________________,
                       Respondent.
                 FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM)
                    (Under $50,000 Individual Gross Annual Income)
         I, {full legal name}___________________________________, being sworn, certify that the
following information is true:
My Occupation: _________________________ Employed by: _______________________________________
Business Address:____________________________________________________________________________
Pay rate: $ ________________ ( ) every week ( ) every other week ( ) twice a month ( ) monthly
( ) other: ___________________________________________________________________________________
___ Check here if unemployed and explain on a separate sheet your efforts to find employment.
SECTION I. PRESENT MONTHLY GROSS INCOME:
All amounts must be MONTHLY. See the instructions with this form to figure out money amounts for
anything that is NOT paid monthly. Attach more paper, if needed. Items included under "other" should
be listed separately with separate dollar amounts.
1.  ______ Monthly gross salary or wages
2.  ______ Monthly bonuses, commissions, allowances, overtime, tips, and similar payments
3.  _____ Monthly business income from sources such as self-employment, partnerships, close
    corporations, and/or independent contracts (gross receipts minus ordinary and necessary expenses
    required to produce income) (Attach sheet itemizing such income and expenses.)
4.  _____ Monthly disability benefits/SSI
5.  _____ Monthly Workers' Compensation
6.  _____ Monthly Unemployment Compensation
7.  _____ Monthly pension, retirement, or annuity payments
8.  _____ Monthly Social Security benefits
9.  _____ Monthly alimony actually received (Add 9a and 9b)
       a. From this case: $ _______
       b. From other case(s): $____
10. ____ Monthly interest and dividends
*1111
11. ____ Monthly rental income (gross receipts minus ordinary and necessary expenses required to
         produce income) (Attach sheet itemizing such income and expense items.)
12. ____ Monthly income from royalties, trusts, or estates
13. ____ Monthly reimbursed expenses and in-kind payments to the extent that they reduce
         personal living expenses
14. ____ Monthly gains derived from dealing in property (not including nonrecurring gains)
15. ____ Any other income of a recurring nature (list source) ____________________________
16. ______________________________________________________________________________________
17. $ ____ TOTAL PRESENT MONTHLY GROSS INCOME (Add lines 1-16)
PRESENT MONTHLY DEDUCTIONS:
18. _____ Monthly federal, state, and local income tax (corrected for filing status and allowable
          dependents and income tax liabilities)
       a. Filing Status _____
       b. Number of dependents claimed ______
19. ____ Monthly FICA or self-employment taxes
20. ____ Monthly Medicare payments
21. ____ Monthly mandatory union dues
22. ____ Monthly mandatory retirement payments
23. ____ Monthly health insurance payments (including dental insurance), excluding portion paid for
         any minor children of this relationship
24. ____ Monthly court-ordered child support actually paid for children from another relationship
25. Monthly court-ordered alimony actually paid (Add 25a and 25b)
    a. from this case: $ _____
    b. from other case(s): _____
26. $_____ TOTAL DEDUCTIONS ALLOWABLE UNDER SECTION 61.30, FLORIDA STATUTES
           (Add lines 18 through 25).
27. $_____ PRESENT NET MONTHLY INCOME (Subtract line 26 from line 17)
SECTION II. AVERAGE MONTHLY EXPENSES
A. HOUSEHOLD:                          C. CHILD(REN)'S EXPENSES
   Mortgage or rent      $____            Day care                    $____
   Property taxes        $____            Lunch money                 $____
   Utilities             $____            Clothing                    $____
   Telephone             $____            Grooming                    $____
   Food                  $____            Gifts for holidays          $____
   Meals outside home    $____            Medical/Dental (uninsured)  $____
   Maintenance/Repairs   $____            Other:                      $____
   Other:___________     $____
B. AUTOMOBILE                          D. INSURANCE
                                          Medical/Dental              $____
   Gasoline              $____            Child(ren)'s medical/dental $____
   Repairs               $____            Life                        $____
   Insurance             $____            Other: _________________    $____
*1112
E. OTHER EXPENSES NOT LISTED ABOVE     F. PAYMENTS TO CREDITORS
   Clothing                  $_____              CREDITOR:             MONTHLY
   Medical/Dental (uninsured) $____                                    PAYMENT
   Grooming                   $____
   Entertainment              $____       ___________________          $______
   Gifts                      $____       ___________________          $______
   Religious organizations    $____       ___________________          $______
   Miscellaneous              $____       ___________________          $______
   Other:________________     $____       ___________________          $______
   ______________________     $____       ___________________          $______
   ______________________     $____       ___________________          $______
   ______________________     $____       ___________________          $______
   ______________________     $____       ___________________          $______
   ______________________     $____       ___________________          $______
28. $____ TOTAL MONTHLY EXPENSES (add ALL monthly amounts in A through F above)
SUMMARY
29. $____ TOTAL PRESENT MONTHLY NET INCOME (from line 27 of SECTION I. INCOME)
30. $____ TOTAL MONTHLY EXPENSES (from line 28 above)
31. $____ SURPLUS (If line 29 is more than line 30, subtract line 30 from line 29. This is the amount
    of your surplus. Enter that amount here.)
32. $____ (DEFICIT) (If line 30 is more than line 29, subtract line 29 from line 30. This is the amount
    of your deficit. Enter that amount here.)
SECTION III. ASSETS AND LIABILITIES
Use the nonmarital column only if this is a petition for dissolution of marriage and you believe an item
is "nonmarital," meaning it belongs to only one of you and should not be divided. You should indicate
to whom you believe the item(s) or debt belongs. (Typically, you will only use this column if
property/debt was owned/owed by one spouse before the marriage. See the "General Information for
Self-Represented Litigants" found at the beginning of these forms and section 61.075(1), Florida
Statutes, for definitions of "marital" and "nonmarital" assets and liabilities.)

*1113
 A. ASSETS:
 -----------------------------------------------------------------------------------------------------------
|DESCRIPTION OF ITEM(S). List a description of each separate item owned by    |          |    Nonmarital   |
|you (and/or your spouse, if this is a petition for dissolution of marriage). |  Current |  (Check correct |
|LIST ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. Check the box next to any        |   Fair   |     column)     |
|asset(s) which you are requesting the judge award to you.                    |  Market  |-----------------|
|                                                                             |   Value  |          |      |
|                                                                             |          | husband  | wife |
|-----------------------------------------------------------------------------|----------|----------|------|
|     | Cash (on hand)                                                        | $        |          |      |
|-----|-----------------------------------------------------------------------|----------|----------|------|
|     | Cash (in banks or credit unions)                                      |          |          |      |
|-----|-----------------------------------------------------------------------|----------|----------|------|
|     | Stocks, Bonds, Notes                                                  |          |          |      |
|-----|-----------------------------------------------------------------------|----------|----------|------|
|     | Real estate: (Home)                                                   |          |          |      |
|-----|-----------------------------------------------------------------------|----------|----------|------|
|     | (Other)                                                               |          |          |      |
|-----|-----------------------------------------------------------------------|----------|----------|------|
|     | Automobiles                                                           |          |          |      |
|-----|-----------------------------------------------------------------------|----------|----------|------|
|     | Other personal property                                               |          |          |      |
|-----|-----------------------------------------------------------------------|----------|----------|------|
|     | Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.)        |          |          |      |
|-----|-----------------------------------------------------------------------|----------|----------|------|
|     | Other                                                                 |          |          |      |
|-----|-----------------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------------|----------|----------|------|
|     | Check here if additional pages are attached.                          |          |          |      |
|-----------------------------------------------------------------------------|----------|----------|------|
| Total Assets (add next column)                                              | $        |          |      |
 -----------------------------------------------------------------------------------------------------------
 B. LIABILITIES:
 -----------------------------------------------------------------------------------------------------------
|DESCRIPTION OF ITEM(S). List a description of each separate item owned by    |          |    Nonmarital   |
|you (and/or your spouse, if this is a petition for dissolution of marriage). | Current  |  (Check correct |
|LIST ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. Check the box next to any        | Amount   |     column)     |
|bebt(s) which you believe you should be responsible.                        |   Owed    |-----------------|
|                                                                             |          | husband |  wife |
|-----------------------------------------------------------------------------|----------|---------|-------|
|     | Mortgages on real estate: First mortgage on home                      | $        |         |       |
|-----|-----------------------------------------------------------------------|----------|---------|-------|
|     | Second mortgage on home                                               |          |         |       |
|-----|-----------------------------------------------------------------------|----------|---------|-------|
|     | Other mortgages                                                       |          |         |       |
|-----|-----------------------------------------------------------------------|----------|---------|-------|
|     | Auto loans                                                            |          |         |       |
|-----|-----------------------------------------------------------------------|----------|---------|-------|
|     | Charge/credit card accounts                                           |          |         |       |
|-----|-----------------------------------------------------------------------|----------|---------|-------|
|-----|-----------------------------------------------------------------------|----------|---------|-------|
|-----|-----------------------------------------------------------------------|----------|---------|-------|
|-----|-----------------------------------------------------------------------|----------|---------|-------|
|     |   Other                                                               |          |         |       |
 -----------------------------------------------------------------------------------------------------------

*1114
 -----------------------------------------------------------------------------------------------------------
|DESCRIPTION OF ITEM(S). List a description of each separate item owned by    |          |    Nonmarital    |
|you (and/or your spouse, if this is a petition for dissolution of marriage). | Current  |  (Check correct  |
|LIST ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. Check the box next to any        |  Amount  |     column)      |
|debt(s) for which you believe you should be responsible.                     |  Owed    |------------------|
|                                                                             |          |  husband | wife  |
|-----|-----------------------------------------------------------------------|----------|----------|-------|
|-----|-----------------------------------------------------------------------|----------|----------|-------|
|-----|-----------------------------------------------------------------------|----------|----------|-------|
|-----|-----------------------------------------------------------------------|----------|----------|-------|
|     | Check here if additional pages are attached.                          |          |          |       |
|-----|-----------------------------------------------------------------------|----------|----------|-------|
| Total Debts (add next column)                                               |  $       |          |       |
 -----------------------------------------------------------------------------------------------------------

C. CONTINGENT ASSETS AND LIABILITIES:
   INSTRUCTIONS: If you have any POSSIBLE assets (income potential, accrued vacation or sick leave,
   bonus, inheritance, etc.) or POSSIBLE liabilities (possible lawsuits, future unpaid taxes, contingent
   tax liabilities, debts assumed by another), you must list them here.
 -----------------------------------------------------------------------------------------------------------
|                                 Contingent Assets                          |           |    Nonmarital   |
|                                                                            |  Possible |  (check correct |
|Check the box next to any contingent asset(s) which you are requesting the  |   Value   |     column)     |
|judge award to you.                                                         |           |-----------------|
|                                                                            |           | husband |  wife |
|----------------------------------------------------------------------------|-----------|---------|-------|
|      |                                                                     | $         |         |       |
|------|---------------------------------------------------------------------|-----------|---------|-------|
|------|---------------------------------------------------------------------|-----------|---------|-------|
|----------------------------------------------------------------------------|-----------|---------|-------|
| Total Contingent Assets                                                    | $         |         |       |
 -----------------------------------------------------------------------------------------------------------
 -----------------------------------------------------------------------------------------------------------
|                                 Contingent Liabilities                     |           |    Nonmarital   |
|                                                                            |  Possible |  (check correct |
|Check the box next to any contingent debt(s) for which you believe you      |  Amount   |     column)     |
|should be responsible.                                                      |   Owed    |-----------------|
|                                                                            |           |  husband | wife |
|                                                                            |           |          |      |
|-----|----------------------------------------------------------------------|-----------|----------|------|
|                                                                            | $         |          |      |
|-----|----------------------------------------------------------------------|-----------|----------|------|
|Total Contingent Liabilities                                                | $         |          |      |
|----------------------------------------------------------------------------|------------------------------

SECTION IV. CHILD SUPPORT GUIDELINES WORKSHEET
(Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet, MUST be
filed with the court at or prior to a hearing to establish or modify child support. This requirement cannot
be waived by the parties.)
[Check one only]
___   A Child Support Guidelines Worksheet IS or WILL BE filed in this case. This case involves the
establishment or modification of child support.
___   A Child Support Guidelines Worksheet IS NOT being filed in this case. The establishment or
modification of child support is not an issue in this case.
*1115
     I certify that a copy of this document was [choose only one] ( ) mailed ( ) faxed and mailed
( ) hand delivered to the person(s) listed below on {date} _____________________________________.
Other party or his/her attorney:
Name: ____________________________________
Address: _________________________________
City, State, Zip: ________________________
Fax Number: ______________________________
Date: ____________________________________
     I understand that I am swearing or affirming under oath to the truthfulness of the claims
made in this affidavit 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: ____________________________
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]
I, {full legal name and trade name of nonlawyer} ___________________________________________,
a nonlawyer, located at {street} ___________________________, {city} _______________________,
{state} ___________________________, {phone} _________, helped {name} ______________________,
who is the [choose only one] ___ petitioner or ___ respondent, fill out this form.
*1116
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULE OF PROCEDURE FORM
      12.902(c), FAMILY LAW FINANCIAL AFFIDAVIT (10/11)
                   When should this form be used?
This form should be used when you are involved in a family law case which requires a financial affidavit
and your individual gross income is $50,000 OR MORE per year unless:
    (1) You are filing a simplified dissolution of marriage under rule 12.105 and both parties have
        waived the filing of financial affidavits;
    (2) you have no minor children, no support issues, and have filed a written settlement agreement
        disposing of all financial issues, or
    (3) the court lacks jurisdiction to determine any financial issues.
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 then file the original with the clerk of the circuit
court in the county where the petition was filed and keep a copy for your records.
                                What should I do next?
A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served
on him or her with your initial papers. This must be accomplished within 45 days of service of the
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" in these instructions are defined
there. For further information, see rule 12.285, Florida Family Law Rules of Procedure.
                               Special notes...
If you want to keep your address confidential because you are the victim of sexual battery, aggravated
child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence, do not enter the
address, telephone, and fax information at the bottom of this form. Instead, file Request for
Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h).
The affidavit must be completed using monthly income and expense amounts. If you are paid or your
bills are due on a schedule which is not monthly, you must convert those amounts. Hints are provided
below for making these conversions.
Hourly  If you are paid by the hour, you may convert your income to monthly as follows:
Hourly amount       ×     Hours worked per week     =    Weekly amount
Weekly amount       ×     52 Weeks per year         =    Yearly amount
Yearly amount       ÷     12 Months per year        =    Monthly Amount
Daily  If you are paid by the day, you may convert your income to monthly as follows:
Daily amount        ×     Days worked per week      =    Weekly amount
*1117
Weekly amount       ×     52 Weeks per year         =    Yearly amount
Yearly amount       ÷     12 Months per year        =    Monthly Amount
Weekly  If you are paid by the week, you may convert your income to monthly as follows:
Weekly amount       ×     52 Weeks per year         =    Yearly amount
Yearly amount       ÷     12 Months per year        =    Monthly Amount
Bi-weekly  If you are paid every two weeks, you may convert your income to monthly as follows:
Bi-weekly amount    ×                  26           =    Yearly amount
Yearly amount       ÷     12 Months per year        =    Monthly Amount
Semi-monthly  If you are paid twice per month, you may convert your income to monthly as follows:
Semi-monthly amount ×                  2            =    Monthly Amount
Expenses may be converted in the same manner.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms
also must put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.
*1118
                  IN THE CIRCUIT COURT OF THE _____________ JUDICIAL CIRCUIT,
                          IN AND FOR ______________ COUNTY, FLORIDA
                                             Case No.: __________________________
                                             Division: __________________________
_____________________________,
                   Petitioner,
          and
_____________________________,
                   Respondent.
                   FAMILY LAW FINANCIAL AFFIDAVIT
               ($50,000 or more Individual Gross Annual Income)
     I, {full legal name} ____________________________________________________, being sworn,
certify that the following information is true:
 -----------------------------------------------------------------------------------------
|SECTION I. INCOME                                                                        |
 -----------------------------------------------------------------------------------------
1.  My age is: __________________
2.  My occupation is: ________________________________________________________________________
3. I am currently
   [Check all that apply]
   a.  ____ Unemployed
       Describe your efforts to find employment, how soon you expect to be employed, and the pay
       you expect to receive: ________________________________________________________________
       _______________________________________________________________________________________
   b. ___ Employed by: _______________________________________________________________________
      Address:________________________________________________________________________________
      City, State, Zip code: _______________________________ Telephone Number: _______________
      Pay rate: $ ____ ( ) every week ( ) every other week ( ) twice a month
      ( ) monthly ( ) other: _________________________________________________________________
      If you are expecting to become unemployed or change jobs soon, describe the change you
      expect and why and how it will affect your income:
      ______________________________________________________________________________________
      ______________________________________________________________________________________
      ___ Check here if you currently have more than one job. List the information above for the
      second job(s) on a separate sheet and attach it to this affidavit.
*1119
   c. ___ Retired. Date of retirement: _______________________________________________________
      Employer from whom retired: ____________________________________________________________
      Address: _______________________________________________________________________________
      City, State, Zip code: __________________________ Telephone Number: ______________
LAST YEAR'S GROSS INCOME:               Your Income        Other Party's Income (if known)
       YEAR_____                        $______            $ ______
PRESENT MONTHLY GROSS INCOME:
All amounts must be MONTHLY. See the instructions with this form to figure out money amounts for
anything that is NOT paid monthly. Attach more paper, if needed. Items included under "other" should
be listed separately with separate dollar amounts.
1. _____ Monthly gross salary or wages
2. _____ Monthly bonuses, commissions, allowances, overtime, tips, and similar payments
3. _____ Monthly business income from sources such as self-employment, partnerships, close
         corporations, and/or independent contracts (Gross receipts minus ordinary and necessary
         expenses required to produce income.)(Attach sheet itemizing such income and expenses.)
4. _____ Monthly disability benefits/SSI
5. _____ Monthly Workers' Compensation
6. _____ Monthly Unemployment Compensation
7. _____ Monthly pension, retirement, or annuity payments
8. _____ Monthly Social Security benefits
9. _____ Monthly alimony actually received (Add 9a a
      a. From this case: $_________
      b. From other case(s): $___________
10. ____ Monthly interest and dividends
11. ____ Monthly rental income (gross receipts minus ordinary and necessary expenses required to
         produce income) (Attach sheet itemizing such income and expense items.)
12. ____ Monthly income from royalties, trusts, or estates
13. ____ Monthly reimbursed expenses and in-kind payments to the extent that they reduce
         personal living expenses (Attach sheet itemizing each item and amount.)
14. ____ Monthly gains derived from dealing in property (not including nonrecurring gains)
         Any other income of a recurring nature (identify source)
15. __________________________________________________________________________________________
16. __________________________________________________________________________________________
17. $______ TOTAL PRESENT MONTHLY GROSS INCOME (Add lines 1-16).
PRESENT MONTHLY DEDUCTIONS:
All amounts must be MONTHLY. See the instructions with this form to figure out money amounts for
anything that is NOT paid monthly.
18. $____ Monthly federal, state, and local income tax (corrected for filing status and allowable
          dependents and income tax liabilities
          a. Filing Status___________
          b. Number of dependents claimed_______
19. _____ Monthly FICA or self-employment taxes
*1120
20. _____ Monthly Medicare payments
21. _____ Monthly mandatory union dues
22. _____ Monthly mandatory retirement payments
23. _____ Monthly health insurance payments (including dental insurance), excluding portion paid for
          any minor children of this relationship
24. _____ Monthly court-ordered child support actually paid for children from another relationship
25. _____ Monthly court-ordered alimony actually paid (Add 25a and 2
       a. From this case:$________
       b. From other case(s):_______
26. $____ TOTAL DEDUCTIONS ALLOWABLE UNDER SECTION 61.30, FLORIDA STATUTES
    (Add lines 18 through 25).
27. $____ PRESENT NET MONTHLY INCOME (Subtract line 26 from line 17).
 --------------------------------------------------------------------------
|SECTION II. AVERAGE MONTHLY EXPENSES                                      |
 --------------------------------------------------------------------------
Proposed/Estimated Expenses. If this is a dissolution of marriage case and your expenses as listed
below do not reflect what you actually pay currently, you should write "estimate" next to each amount
that is estimated.
HOUSEHOLD:
1.  $____ Monthly mortgage or rent payments
2.  _____ Monthly property taxes (if not included in mortgage)
3.  _____ Monthly insurance on residence (if not included in mortgage)
4.  _____ Monthly condominium maintenance fees and homeowner's association fees
5.  _____ Monthly electricity
6.  _____ Monthly water, garbage, and sewer
7.  _____ Monthly telephone
8.  _____ Monthly fuel oil or natural gas
9.  _____ Monthly repairs and maintenance
10. _____ Monthly lawn care
11. _____ Monthly pool maintenance
12. _____ Monthly pest control
13. _____ Monthly misc. household
14. _____ Monthly food and home supplies
15. _____ Monthly meals outside home
16. _____ Monthly cable t.v.
17. _____ Monthly alarm service contract
18. _____ Monthly service contracts on appliances
19. _____ Monthly maid service
Other:
20. ____________________________________________________________________________________
21. ____________________________________________________________________________________
22. ____________________________________________________________________________________
23. ____________________________________________________________________________________
24. ____________________________________________________________________________________
25. $_____ SUBTOTAL (add lines 1 through 24).
*1121
AUTOMOBILE:
26. $______ Monthly gasoline and oil
27. _______ Monthly repairs
28. _______ Monthly auto tags and emission testing
29. _______ Monthly insurance
30. _______ Monthly payments (lease or financing)
31. _______ Monthly rental/replacements
32. _______ Monthly alternative transportation (bus, rail, car pool, etc.)
33. _______ Monthly tolls and parking
34. _______ Other:_______________________________________________________________
35. _______ SUBTOTAL (add lines 26 through 34)
MONTHLY EXPENSES FOR CHILDREN COMMON TO BOTH PARTIES:
36. $______ Monthly nursery, babysitting, or day care
37. _______ Monthly school tuition
38. _______ Monthly school supplies, books, and fees
39. _______ Monthly after school activities
40. _______ Monthly lunch money
41. _______ Monthly private lessons or tutoring
42. _______ Monthly allowances
43. _______ Monthly clothing and uniforms
44. _______ Monthly entertainment (movies, parties, etc.)
45. _______ Monthly health insurance
46. _______ Monthly medical, dental, prescriptions (nonreimbursed only)
47. _______ Monthly psychiatric/psychological/counselor
48. _______ Monthly orthodontic
49. _______ Monthly vitamins
50. _______ Monthly beauty parlor/barber shop
51. _______ Monthly nonprescription medication
52. _______ Monthly cosmetics, toiletries, and sundries
53. _______ Monthly gifts from child(ren) to others (other children, relatives, teachers, etc.)
54. _______ Monthly camp or summer activities
55. _______ Monthly clubs (Boy/Girl Scouts, etc.)
56. _______ Monthly time-sharing expenses
57. _______ Monthly miscellaneous
58. $______ SUBTOTAL (add lines 36 through 57)
MONTHLY EXPENSES FOR CHILD(REN) FROM ANOTHER RELATIONSHIP: (other than court-ordered child
support)
59. ______________________________________________________________________________________
60. ______________________________________________________________________________________
61. ______________________________________________________________________________________
62. ______________________________________________________________________________________
63. $_______ SUBTOTAL (add lines 59 through 62)
*1122
MONTHLY INSURANCE:
64. $_____ Health insurance, excluding portion paid for any minor child(ren) of this relationship
65. ______ Life insurance
66. ______ Dental insurance
Other:
67. ___________________________________________________________________________________________
68. ___________________________________________________________________________________________
69. $_______ SUBTOTAL (add lines 64 through 68)
OTHER MONTHLY EXPENSES NOT LISTED ABOVE:
70. $_____ Monthly dry cleaning and laundry
71. ______ Monthly clothing
72. ______ Monthly medical, dental, and prescription (unreimbursed only)
73. ______ Monthly psychiatric, psychological, or counselor (unreimbursed only)
74. ______ Monthly non-prescription medications, cosmetics, toiletries, and sundries
75. ______ Monthly grooming
76. ______ Monthly gifts
77. ______ Monthly pet expenses
78. ______ Monthly club dues and membership
79. ______ Monthly sports and hobbies
80. ______ Monthly entertainment
81. ______ Monthly periodicals/books/tapes/CDs
82. ______ Monthly vacations
83. ______ Monthly religious organizations
84. ______ Monthly bank charges/credit card fees
85. ______ Monthly education expenses
           Other: (include any usual and customary expenses not otherwise mentioned in the items
           listed above)
86. ___________________________________________________________________________________________
87. ___________________________________________________________________________________________
88. ___________________________________________________________________________________________
89. ___________________________________________________________________________________________
90. $______ SUBTOTAL (add lines 70 through 89)
MONTHLY PAYMENTS TO CREDITORS: (only when payments are currently made by you on outstanding
balances) List only last 4 digits of account numbers.
MONTHLY PAYMENT AND NAME OF CREDITOR(s):
91. $_____________________________________________________________________________________
92. ______________________________________________________________________________________
93. ______________________________________________________________________________________
94. ______________________________________________________________________________________
95. ______________________________________________________________________________________
96. ______________________________________________________________________________________
97. ______________________________________________________________________________________
98. ______________________________________________________________________________________
99. ______________________________________________________________________________________
100.  ____________________________________________________________________________________
101.  ____________________________________________________________________________________
*1123
102. _____________________________________________________________________________________
103. _____________________________________________________________________________________
104. $_______ SUBTOTAL (add lines 91 through 103)
105. $_______ TOTAL MONTHLY EXPENSES:(add lines 25, 35, 58, 63, 69, 90, and 104 of Section II,
                  Expenses)
SUMMARY
106. $_______ TOTAL PRESENT MONTHLY NET INCOME (from line 27 of SECTION I. INCOME)
107. $_______ TOTAL MONTHLY EXPENSES (from line 105 above)
108. $_______ SURPLUS (If line 106 is more than line 107, subtract line 107 from line 106. This is the
                amount of your surplus. Enter that amount here.)
109. ($_________) (DEFICIT) (If line 107 is more than line 106, subtract line 106 from line 107. This is
                the amount of your deficit. Enter that amount here.)
 ----------------------------------------------------------------------------------
|SECTION III. ASSETS AND LIABILITIES                                               |
 ----------------------------------------------------------------------------------
A.   ASSETS (This is where you list what you OWN.)
     INSTRUCTIONS:
     STEP 1: In column A, list a description of each separate item owned by you (and/or your spouse, if
     this is a petition for dissolution of marriage). Blank spaces are provided if you need to list more than
     one of an item.
     STEP 2: If this is a petition for dissolution of marriage, check the box in Column A next to any item
     that you are requesting the judge award to you.
     STEP 3: In column B, write what you believe to be the current fair market value of all items listed.
     STEP 4: Use column C only if this is a petition for dissolution of marriage and you believe an item
     is "nonmarital," meaning it belongs to only one of you and should not be divided. You should
     indicate to whom you believe the item belongs. (Typically, you will only use Column C if property
     was owned by one spouse before the marriage. See the "General Information for Self-Represented
     Litigants" found at the beginning of these forms and section 61.075(1), Florida Statutes, for
     definitions of "marital" and "nonmarital" assets and liabilities.)

 --------------------------------------------------------------------------------------------------------
|                             A                                              | B       | C               |
|                 ASSETS: DESCRIPTION OF ITEM(S)                             | Current | Nonmarital      |
|                                                                            | Fair    | Check correct   |
|LIST ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS.                                 | Market  | column)         |
|Check the box next to any asset(s) which you are requesting the judge award | Value   |-----------------|
|to you.                                                                     |         | husband | wife  |
|----------------------------------------------------------------------------|---------|---------|-------|
|      | Cash (on hand)                                                      | $       |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|      | Cash (in banks or credit unions)                                    |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|      |                                                                     |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|      | Stocks/Bonds                                                        |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|      |                                                                     |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|      |                                                                     |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|      | Notes (money owed to you in writing)                                |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|      |                                                                     |         |         |       |
 --------------------------------------------------------------------------------------------------------

*1124
 --------------------------------------------------------------------------------------------------------
|------|---------------------------------------------------------------------|---------|---------|-------|
|      | Money owed to you (not evidenced by a note)                         |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|      | Real estate: (Home)                                                 |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|      | (Other)                                                             |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|      | Business Interests                                                  |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|      | Automobiles                                                         |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|      | Boats                                                               |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|      | Other vehicles                                                      |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|      | Retirement plans (Profit Sharing. Pension, IRA, 401(k)s, etc.)      |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|      | Furniture & furnishings in home                                     |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|      | Furniture & furnishings elsewhere                                   |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|      | Collectibles                                                        |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|      | Jewelry                                                             |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
 --------------------------------------------------------------------------------------------------------

*1125
 --------------------------------------------------------------------------------------------------------
|      | Life Insurance (cash surrender value)                               |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|      | Sporting and entertainment (T.V., stereo, etc.) equipment           |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|      | Other assets                                                        |         |         |       |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|Total Assets (add column B)                                                 |$        |         |       |
 --------------------------------------------------------------------------------------------------------

B. LIABILITIES/DEBTS (This is where you list what you OWE.)
   INSTRUCTIONS:
   STEP 1: In column A, list a description of each separate debt owed by you (and/or your spouse, if
   this is a petition for dissolution of marriage). Blank spaces are provided if you need to list more than
   one of an item.
   STEP 2: If this is a petition for dissolution of marriage, check the box in Column A next to any debt(s)
   for which you believe you should be responsible.
   STEP 3: In column B, write what you believe to be the current amount owed for all items listed.
   STEP 4: Use column C only if this is a petition for dissolution of marriage and you believe an item
   is "nonmarital," meaning the debt belongs to only one of you and should not be divided. You
   should indicate to whom you believe the debt belongs. (Typically, you will only use Column C if the
   debt was owed by one spouse before the marriage. See the "General information for Self-Represented
   Litigants" found at the beginning of these forms and section 61.075(1), Florida
   Statutes, for definitions of "marital" and "nonmarital" assets and liabilities.)

*1126
 ----------------------------------------------------------------------------------------------------
|                                   A                                   | B        | C               |
|                   LIABILITIES DESCRIPTION OF ITEM(S)                  | Current  | Nonmarital      |
|                                                                       | Amount   | (Check correct  |
|LIST ONLY LAST FOUR DIGITS OF ACCOUNT NUMBERS.                         | Owed     | coloumn)        |
|Check the box next to any debt(s) for which you believe you should be  |          |-----------------|
|responsible.                                                           |          | husband  | wife |
|-----------------------------------------------------------------------|----------|----------|------|
|     | Mortgages on real estate: First mortgage on home                | $        |          |      |
|-----|-----------------------------------------------------------------|----------|----------|------|
|     | Second mortgage on home                                         |          |          |      |
|-----|-----------------------------------------------------------------|----------|----------|------|
|     | Other mortgages                                                 |          |          |      |
|-----|-----------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------|----------|----------|------|
|     | Charge/credit card accounts                                     |          |          |      |
|-----|-----------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------|----------|----------|------|
|     | Auto loan                                                       |          |          |      |
|-----|-----------------------------------------------------------------|----------|----------|------|
|     | Auto loan                                                       |          |          |      |
|-----|-----------------------------------------------------------------|----------|----------|------|
|     | Bank/Credit Union loans                                         |          |          |      |
|-----|-----------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------|----------|----------|------|
|     | Money you owe (not evidenced by a note)                         |          |          |      |
|-----|-----------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------|----------|----------|------|
|     | Judgments                                                       |          |          |      |
|-----|-----------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------|----------|----------|------|
|     | Other                                                           |          |          |      |
|-----|-----------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------|----------|----------|------|
|Total Debts (add column B)                                             | $        |          |      |
 ----------------------------------------------------------------------------------------------------

*1127
C. NET WORTH (excluding contingent assets and liabilities)
$_______Total Assets (enter total of Column B in Asset Table; Section A)
$_______Total Liabilities (enter total of Column B in Liabilities Table; Section B)
$_______TOTAL NET WORTH (Total Assets minus Total Liabilities)
        (excluding contingent assets and liabilities)
D. CONTINGENT ASSETS AND LIABILITIES
   INSTRUCTIONS:
   If you have any POSSIBLE assets (income potential, accrued vacation or sick leave, bonus,
   inheritance, etc.) or POSSIBLE liabilities (possible lawsuits, future unpaid taxes, contingent tax
   liabilities, debts assumed by another), you must list them here.

 -----------------------------------------------------------------------------------------------------------
|                                   A                                        |      B     |       C         |
|                            Contingent Assets                               |            |    Nonmarital   |
|                                                                            |  Possible  | (Check correct  |
|Check the box next to any contingent asset(s) which you are requesting the  |    Value   |     column)     |
|judge award to you.                                                         |            |-----------------|
|                                                                            |            | husband  | wife |
|----------------------------------------------------------------------------|------------|----------|------|
|      |                                                                     | $          |          |      |
|------|---------------------------------------------------------------------|------------|----------|------|
|------|---------------------------------------------------------------------|------------|----------|------|
|------|---------------------------------------------------------------------|------------|----------|------|
|------|---------------------------------------------------------------------|------------|----------|------|
|------|---------------------------------------------------------------------|------------|----------|------|
|------|---------------------------------------------------------------------|------------|----------|------|
| Total Contingent Assets                                                    | $          |          |      |
 ----------------------------------------------------------------------------|------------|----------|------
 -----------------------------------------------------------------------------------------------------------
|                                    A                                       |       B    |       C         |
|                             Contingent Liabilities                         |            |     Nonmarital  |
|                                                                            |  Possible  | (Check correct  |
|                                                                            |  Amount    |     column)     |
|Check the box next to any contingent debt(s) for which you believe you      |   Owed     |-----------------|
|should be responsible.                                                      |            | husband  | wife |
|----------------------------------------------------------------------------|------------|----------|------|
|      |                                                                     | $          |          |      |
|------|---------------------------------------------------------------------|------------|----------|------|
|------|---------------------------------------------------------------------|------------|----------|------|
|------|---------------------------------------------------------------------|------------|----------|------|
|------|---------------------------------------------------------------------|------------|----------|------|
|------|---------------------------------------------------------------------|------------|----------|------|
|------|---------------------------------------------------------------------|------------|----------|------|
| Total Contingent Liabilities                                               | $          |          |      |
 -----------------------------------------------------------------------------------------------------------

*1128
E. CHILD SUPPORT GUIDELINES WORKSHEET. Florida Family Law Rules of Procedure Form 12.902(e),
   Child Support Guidelines Worksheet, MUST be filed with the court at or prior to a hearing to
   establish or modify child support. This requirement cannot be waived by the parties.
   [Check one only]
   ______ A Child Support Guidelines Worksheet IS or WILL BE filed in this case.
          This case involves the establishment or modification of child support.
   ______ A Child Support Guidelines Worksheet IS NOT being filed in this case.
          The establishment or modification of child support is not an issue in this case.
I certify that a copy of this financial affidavit was: ( ) mailed, ( ) faxed and mailed, or ( ) hand
delivered to the person(s) listed below on {date} _______________________.
Other party or his/her attorney:
Name: _______________________________
Address: ____________________________
City, State, Zip: ___________________
Fax Number: _________________________
Date: _______________________________
      I understand that I am swearing or affirming under oath to the truthfulness of the claims
made in this affidavit 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: __________________________________
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________________________
*1129
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, located at {street} _____________________________, {city} ____________________,
{state} ________________, {phone} _____________________, helped {name}_____________________,
who is the [check only one] ___ petitioner or ___ respondent, fill out this form.
*1130
   INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM
       12.902(e), CHILD SUPPORT GUIDELINES WORKSHEET (10/11)
                      When should this form be used?
   You should complete this worksheet if child support is being requested in your case. If you know the
   income of the other party, this worksheet should accompany your financial affidavit. If you do not
   know the other party's income, this form must be completed after the other party files his or her
   financial affidavit, and serves a copy on you.
   This form should be typed or printed in black ink. You should file the original with the clerk of the circuit
   court in the county where your case is filed and keep a copy for your records.
                      What should I do next?
   A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served
   on him or her with your initial papers.
                      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 section 61.30, Florida Statutes.
                               Special notes...
   If you want to keep your address confidential because you are the victim of sexual battery, aggravated
   child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence,, do not enter
   the address, telephone, and fax information at the bottom of this form. Instead, file a Request for
   Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h).
   The chart below contains the guideline amounts that you should use when calculating child support.
   This amount is based on the number of children and the combined income of the parents, and it is
   divided between the parents in direct proportion to their income or earning capacity. From time to
   time, some of the amounts in the child support guidelines chart will change. Be sure you have the most
   recent version of the chart before using it.
   Because the guidelines are based on monthly amounts, it may be necessary to convert some income and
   expense figures from other frequencies to monthly. You should do this as follows:
         If payment is twice per month    Payment amount  ×    2   =    Monthly amount
         If payment is every two weeks    Payment amount  ×    26  =    Yearly amount due
                                          Yearly amount   ÷    12  =    Monthly amount
*1131
         If payment is weekly             Weekly amount   ×   52  =   Yearly amount due
                                          Yearly amount   ÷   12  =   Monthly amount
If you or the other parent request that the court award an amount that is different than the guideline
amount, you must also complete and attach a Motion to Deviate from Child Support Guidelines, Florida
Supreme Court Approved Family Law Form 12.943.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms
also must put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.

*1132
                 CHILD SUPPORT GUIDELINES CHART
Combined    One     Two        Three      Four       Five       Six
Monthly     Child   Children   Children   Children   Children   Children
Available
Income
800.00      190     211        213        216        218        220
850.00      202     257        259        262        265        268
900.00      213     302        305        309        312        315
950.00      224     347        351        355        359        363
1000.00     235     365        397        402        406        410
1050.00     246     382        443        448        453        458
1100.00     258     400        489        495        500        505
1150.00     269     417        522        541        547        553
1200.00     280     435        544        588        594        600
1250.00     290     451        565        634        641        648
1300.00     300     467        584        659        688        695
1350.00     310     482        603        681        735        743
1400.00     320     498        623        702        765        790
1450.00     330     513        642        724        789        838
1500.00     340     529        662        746        813        869
1550.00     350     544        681        768        836        895
1600.00     360     560        701        790        860        920
1650.00     370     575        720        812        884        945
1700.00     380     591        740        833        907        971
1750.00     390     606        759        855        931        996
1800.00     400     622        779        877        955        1022
1850.00     410     638        798        900        979        1048
1900.00     421     654        818        923        1004       1074
1950.00     431     670        839        946        1029       1101
2000.00     442     686        859        968        1054       1128
2050.00     452     702        879        991        1079       1154
2100.00     463     718        899        1014       1104       1181
2150.00     473     734        919        1037       1129       1207
2200.00     484     751        940        1060       1154       1234
2250.00     494     767        960        1082       1179       1261
2300.00     505     783        980        1105       1204       1287
2350.00     515     799        1000       1128       1229       1314
2400.00     526     815        1020       1151       1254       1340
2450.00     536     831        1041       1174       1279       1367
2500.00     547     847        1061       1196       1304       1394

*1133
2550.00     557     864        1081       1219       1329       1420
2850.00     616     956        1197       1349       1471       1573
2900.00     626     971        1215       1370       1494       1598
2950.00     635     986        1234       1391       1517       1622
3000.00     644     1001       1252       1412       1540       1647
3050.00     654     1016       1271       1433       1563       1671
3100.00     663     1031       1289       1453       1586       1695
3150.00     673     1045       1308       1474       1608       1720
3200.00     682     1060       1327       1495       1631       1744
3250.00     691     1075       1345       1516       1654       1769
3300.00     701     1090       1364       1537       1677       1793
3350.00     710     1105       1382       1558       1700       1818
3400.00     720     1120       1401       1579       1723       1842
3450.00     729     1135       1419       1599       1745       1867
3500.00     738     1149       1438       1620       1768       1891
3550.00     748     1164       1456       1641       1791       1915
3600.00     757     1179       1475       1662       1814       1940
3650.00     767     1194       1493       1683       1837       1964
3700.00     776     1208       1503       1702       1857       1987
3750.00     784     1221       1520       1721       1878       2009
3800.00     793     1234       1536       1740       1899       2031
3850.00     802     1248       1553       1759       1920       2053
3900.00     811     1261       1570       1778       1940       2075
3950.00     819     1275       1587       1797       1961       2097
4000.00     828     1288       1603       1816       1982       2119
4050.00     837     1302       1620       1835       2002       2141
4100.00     846     1315       1637       1854       2023       2163
4150.00     854     1329       1654       1873       2044       2185
4200.00     863     1342       1670       1892       2064       2207
4250.00     872     1355       1687       1911       2085       2229
4300.00     881     1369       1704       1930       2106       2251
4350.00     889     1382       1721       1949       2127       2273
4400.00     898     1396       1737       1968       2147       2295
4450.00     907     1409       1754       1987       2168       2317
4500.00     916     1423       1771       2006       2189       2339
4550.00     924     1436       1788       2024       2209       2361
4600.00     933     1450       1804       2043       2230       2384

*1134
4650.00     942     1463       1821       2062       2251       2406
4700.00     951     1477       1838       2081       2271       2428
4750.00     959     1490       1855       2100       2292       2450
4800.00     968     1503       1871       2119       2313       2472
4850.00     977     1517       1888       2138       2334       2494
4900.00     986     1530       1905       2157       2354       2516
4950.00     993     1542       1927       2174       2372       2535
5000.00     1000    1551       1939       2188       2387       2551
5050.00     1006    1561       1952       2202       2402       2567
5100.00     1013    1571       1964       2215       2417       2583
5150.00     1019    1580       1976       2229       2432       2599
5200.00     1025    1590       1988       2243       2447       2615
5250.00     1032    1599       2000       2256       2462       2631
5300.00     1038    1609       2012       2270       2477       2647
5350.00     1045    1619       2024       2283       2492       2663
5400.00     1051    1628       2037       2297       2507       2679
5450.00     1057    1638       2049       2311       2522       2695
5500.00     1064    1647       2061       2324       2537       2711
5550.00     1070    1657       2073       2338       2552       2727
5600.00     1077    1667       2085       2352       2567       2743
5650.00     1083    1676       2097       2365       2582       2759
5700.00     1089    1686       2109       2379       2597       2775
5750.00     1096    1695       2122       2393       2612       2791
5800.00     1102    1705       2134       2406       2627       2807
5850.00     1107    1713       2144       2418       2639       2820
5900.00     1111    1721       2155       2429       2651       2833
5950.00     1116    1729       2165       2440       2663       2847
6000.00     1121    1737       2175       2451       2676       2860
6050.00     1126    1746       2185       2462       2688       2874
6100.00     1131    1754       2196       2473       2700       2887
6150.00     1136    1762       2206       2484       2712       2900
6200.00     1141    1770       2216       2495       2724       2914
6250.00     1145    1778       2227       2506       2737       2927
6300.00     1150    1786       2237       2517       2749       2941
6350.00     1155    1795       2247       2529       2761       2954
6400.00     1160    1803       2258       2540       2773       2967
6450.00     1165    1811       2268       2551       2785       2981

*1135
6500.00     1170    1819       2278       2562       2798       2994
6550.00     1175    1827       2288       2573       2810       3008
6600.00     1179    1835       2299       2584       2822       3021
6650.00     1184    1843       2309       2595       2834       3034
6700.00     1189    1850       2317       2604       2845       3045
6750.00     1193    1856       2325       2613       2854       3055
6800.00     1196    1862       2332       2621       2863       3064
6850.00     1200    1868       2340       2630       2872       3074
6900.00     1204    1873       2347       2639       2882       3084
6950.00     1208    1879       2355       2647       2891       3094
7000.00     1212    1885       2362       2656       2900       3103
7050.00     1216    1891       2370       2664       2909       3113
7100.00     1220    1897       2378       2673       2919       3123
7150.00     1224    1903       2385       2681       2928       3133
7200.00     1228    1909       2393       2690       2937       3142
7250.00     1232    1915       2400       2698       2946       3152
7300.00     1235    1921       2408       2707       2956       3162
7350.00     1239    1927       2415       2716       2965       3172
7400.00     1243    1933       2423       2724       2974       3181
7450.00     1247    1939       2430       2733       2983       3191
7500.00     1251    1945       2438       2741       2993       3201
7550.00     1255    1951       2446       2750       3002       3211
7600.00     1259    1957       2453       2758       3011       3220
7650.00     1263    1963       2461       2767       3020       3230
7700.00     1267    1969       2468       2775       3030       3240
7750.00     1271    1975       2476       2784       3039       3250
7800.00     1274    1981       2483       2792       3048       3259
7850.00     1278    1987       2491       2801       3057       3269
7900.00     1282    1992       2498       2810       3067       3279
7950.00     1286    1998       2506       2818       3076       3289
8000.00     1290    2004       2513       2827       3085       3298
8050.00     1294    2010       2521       2835       3094       3308
8100.00     1298    2016       2529       2844       3104       3318
8150.00     1302    2022       2536       2852       3113       3328
8200.00     1306    2028       2544       2861       3122       3337
8250.00     1310    2034       2551       2869       3131       3347
8300.00     1313    2040       2559       2878       3141       3357

*1136
8350.00     1317    2046       2566       2887       3150       3367
8400.00     1321    2052       2574       2895       3159       3376
8450.00     1325    2058       2581       2904       3168       3386
8500.00     1329    2064       2589       2912       3178       3396
8550.00     1333    2070       2597       2921       3187       3406
8600.00     1337    2076       2604       2929       3196       3415
8650.00     1341    2082       2612       2938       3205       3425
8700.00     1345    2088       2619       2946       3215       3435
8750.00     1349    2094       2627       2955       3224       3445
8800.00     1352    2100       2634       2963       3233       3454
8850.00     1356    2106       2642       2972       3242       3464
8900.00     1360    2111       2649       2981       3252       3474
8950.00     1364    2117       2657       2989       3261       3484
9000.00     1368    2123       2664       2998       3270       3493
9050.00     1372    2129       2672       3006       3279       3503
9100.00     1376    2135       2680       3015       3289       3513
9150.00     1380    2141       2687       3023       3298       3523
9200.00     1384    2147       2695       3032       3307       3532
9250.00     1388    2153       2702       3040       3316       3542
9300.00     1391    2159       2710       3049       3326       3552
9350.00     1395    2165       2717       3058       3335       3562
9400.00     1399    2171       2725       3066       3344       3571
9450.00     1403    2177       2732       3075       3353       3581
9500.00     1407    2183       2740       3083       3363       3591
9550.00     1411    2189       2748       3092       3372       3601
9600.00     1415    2195       2755       3100       3381       3610
9650.00     1419    2201       2763       3109       3390       3620
9700.00     1422    2206       2767       3115       3396       3628
9750.00     1425    2210       2772       3121       3402       3634
9800.00     1427    2213       2776       3126       3408       3641
9850.00     1430    2217       2781       3132       3414       3647
9900.00     1432    2221       2786       3137       3420       3653
9950.00     1435    2225       2791       3143       3426       3659
10000.00    1437    2228       2795       3148       3432       3666

*1137
             IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT,
                     IN AND FOR ______________ COUNTY, FLORIDA
                                          Case No.: ____________________________
                                          Division: ____________________________
__________________________________,
                        Petitioner,
          and
__________________________________,
                        Respondent.
          NOTICE OF FILING CHILD SUPPORT GUIDELINES WORKSHEET
    PLEASE TAKE NOTICE, that {name}__________________, is filing his/her Child
Support Guidelines Worksheet attached and labeled Exhibit 1.
                               CERTIFICATE OF SERVICE
    I certify that a copy of this Notice of Filing with the Child Support Guidelines Worksheet was
[check one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on
{date} ________.
Other party or his/her attorney:
Name: _______________________________
Address: ____________________________
City, State, Zip: ___________________
Fax Number: _________________________
Date: _______________________________
                                    ________________________________________
                                    Signature of Party
                                    Printed Name: __________________________
                                    Address: _______________________________
                                    City, State, Zip: ______________________
                                    Telephone Number: ______________________
                                    Fax Number: ____________________________

*1138
 -------------------------------------------------------------------------------------------
|                                 CHILD SUPPORT GUIDELINES WORKSHEET                        |
|-------------------------------------------------------------------------------------------|
|                                           |   A. FATHER    |   B. MOTHER   | TOTAL        |
|-------------------------------------------|----------------|---------------|--------------|
| 1.  Present Net Monthly Income            |                |               |              |
|      Enter the amount from line number    |                |               |              |
|      27, Section I of Florida Family Law  |                |               |              |
|      Rules of Procedure Form 12.902(b)    |                |               |              |
|      or (c), Financial Affidavit.         |                |               |              |
|-------------------------------------------|--------------------------------|--------------|
| 2.  Basic Monthly Obligation              |                                |              |
|     There is (are) {number} ____ minor    |                                |              |
|     child(ren) common to the parties.     |                                |              |
|     Using the total amount from line 1,   |                                |              |
|     enter the appropriate amount from     |                                |              |
|     the child support guidelines chart.   |                                |              |
|-------------------------------------------|-----------------------------------------------|
| 3. Percent of Financial Responsibility    | %              | %                            |
|    Divide the amount on line 1A by the    |                |                              |
|    total amount on line 1 to get          |                |                              |
|    Father's percentage financial          |                |                              |
|    responsibility. Enter answer on line   |                |                              |
|    3A. Divide the amount on line 1B by    |                |                              |
|    the total amount on line 1 to get      |                |                              |
|    Mother's percentage financial          |                |                              |
|    responsibility. Enter answer on line   |                |                              |
|    3B.                                    |                |                              |
|-------------------------------------------|-----------------------------------------------|
| 4. Share of Basic Monthly Obligation      |                                |              |
|    Multiply the number on line 2 by the   |                                |              |
|    percentage on line 3A to get           |                                |              |
|    Father's share of basic obligation.    |                                |              |
|    Enter answer on line 4A.               |                                |              |
|    Multiply the number on line 2 by the   |                                |              |
|    percentage on line 3B to get           |                                |              |
|    Mother's share of basic obligation.    |                                |              |
|    Enter answer on line 4B.               |                                |              |
|-------------------------------------------------------------------------------------------|
|                      Additional Support  Health Insurance, Child Care & Other           |
|-------------------------------------------------------------------------------------------|
| 5.                                        |                                |              |
|    a. 100% of Monthly Child Care          |                                |              |
|       Costs                               |                                |              |
|    [Child care costs should not exceed    |                                |              |
|    the level required to provide quality  |                                |              |
|    care from a licensed source. See       |                                |              |
|    section 61.30(7), Fla. Stat. for more  |                                |              |
|    information.]                          |                                |              |
 -------------------------------------------------------------------------------------------

*1139
 -------------------------------------------------------------------------------------------
|    b. Total Monthly Child(ren)'s          |                                |              |
|       Health Insurance Cost               |                                |              |
|      [This is only amounts actually       |                                |              |
|      paid for health insurance on the     |                                |              |
|      child(ren).]                         |                                |              |
|-------------------------------------------|--------------------------------|--------------|
|    c. Total Monthly Child(ren)'s          |                                |              |
|       Noncovered Medical, Dental and      |                                |              |
|       Prescription Medication Costs       |                                |              |
|-------------------------------------------|--------------------------------|--------------|
|    d. Total Monthly Child Care &          |                                |              |
|       Health Costs [Add lines             |                                |              |
|       5a+5b+5c]                           |                                |              |
|-------------------------------------------------------------------------------------------|
| 6. Additional Support Payments            |                |               |              |
|    Multiply the number on line 5d by      |                |               |              |
|    the percentage on line 3A to           |                |               |              |
|    determine the Father's share.          |                |               |              |
|    Enter answer on line 6A.               |                |               |              |
|    Multiply the number on line 5d by      |                |               |              |
|    the percentage on line 3B to           |                |               |              |
|    determine the Mother's share.          |                |               |              |
|    Enter answer on line 6B.               |                |               |              |
|-------------------------------------------------------------------------------------------|
|                                    Statutory Adjustments/Credits                          |
|-------------------------------------------------------------------------------------------|
| 7.                                        |                |               |              |
|    a. Monthly child care payments         |                |               |              |
|       actually made                       |                |               |              |
|-------------------------------------------|----------------|---------------|--------------|
|    b. Monthly health insurance            |                |               |              |
|       payments actually made              |                |               |              |
|-------------------------------------------|----------------|---------------|--------------|
|    c. Other payments/credits actually     |                |               |              |
|       made for any noncovered             |                |               |              |
|       medical, dental and prescription    |                |               |              |
|       medication expenses of the          |                |               |              |
|       child(ren) not ordered to be        |                |               |              |
|       separately paid on a percentage     |                |               |              |
|       basis. [See § 61.30 (8), Florida    |                |               |              |
|       Statutes]                           |                |               |              |
|-------------------------------------------|----------------|---------------|--------------|
| 8.  Total Support Payments actually made  |                |               |              |
|     [Add 7a through 7c]                   |                |               |              |
|-------------------------------------------|----------------|---------------|--------------|
| 9.  MINIMUM CHILD SUPPORT                 |                |               |              |
|     OBLIGATION FOR EACH PARENT            |                |               |              |
|     [Line 4 plus line 6; minus line 8]    |                |               |              |
 -------------------------------------------------------------------------------------------

*1140
 ------------------------------------------------------------------------------------------------------
|                                 CHILD SUPPORT GUIDELINES WORKSHEET                                   |
|------------------------------------------------------------------------------------------------------|
|                                           |   A. FATHER    |   B. MOTHER   | TOTAL                   |
|------------------------------------------------------------------------------------------------------|
|     Substantial Time-Sharing (GROSS UP METHOD) If each parent exercises time-sharing at least 20     |
|      percent of the overnights in the year (73 overnights in the year), complete Nos. 10 through 21  |
|------------------------------------------------------------------------------------------------------|
| 10. Basic Monthly Obligation × 150%       |                                                          |
|     [Multiply line 2 by 1.5]              |                                                          |
|-------------------------------------------|----------------------------------------------------------|
| 11. Increased Basic Obligation for each   |                |               |                         |
|     parent                                |                |               |                         |
|     Multiply the number on line 10 by     |                |               |                         |
|     the percentage on line 3A to          |                |               |                         |
|     determine the Father's share.         |                |               |                         |
|     Enter answer on line 11A.             |                |               |                         |
|     Multiply the number on line 10 by     |                |               |                         |
|     the percentage on line 3B to          |                |               |                         |
|     determine the Mother's share.         |                |               |                         |
|     Enter answer on line 11B.             |                |               |                         |
|-------------------------------------------|----------------|---------------|-------------------------|
| 12. Percentage of overnight stays with    |              % |             % |                         |
|     each parent                           |                |               |                         |
|     The child(ren) spend(s) ______        |                |               |                         |
|     overnight stays with the Father each  |                |               |                         |
|     year. Using the number on the         |                |               |                         |
|     above line, multiply it by 100 and    |                |               |                         |
|     divide by 365. Enter this number on   |                |               |                         |
|     line 12A.                             |                |               |                         |
|     The child(ren) spend(s) ______        |                |               |                         |
|     overnight stays with the Mother       |                |               |                         |
|     each year. Using the number on the    |                |               |                         |
|     above line, multiply it by 100 and    |                |               |                         |
|     divide by 365. Enter this number on   |                |               |                         |
|     line 12B.                             |                |               |                         |
|-------------------------------------------|----------------|---------------|-------------------------|
| 13. Parent's support multiplied by other  |                |               |                         |
|     Parent's percentage of overnights     |                |               |                         |
|     [Multiply line 11A by line 12B. Enter |                |               |                         |
|     this number in 13A. Multiply line     |                |               |                         |
|     11B by line 12A. Enter this number    |                |               |                         |
|     in 13B.]                              |                |               |                         |
|------------------------------------------------------------------------------------------------------|
|                    Additional Support  Health Insurance, Child Care & Other                        |
 ------------------------------------------------------------------------------------------------------

*1141
---------------------------------------------------------------------------------------
|                                       CHILD SUPPORT GUIDELINES WORKSHEET             |
|--------------------------------------------------------------------------------------|
|                                                |  A. FATHER  |  B. MOTHER  |  TOTAL  |
|------------------------------------------------|---------------------------|---------|
|   14.                                          |                           |         |
|       a. Total Monthly Child Care Costs        |                           |         |
|       [Child care costs should not exceed the  |                           |         |
|       level required to provide quality care   |                           |         |
|       from a licensed source. See section      |                           |         |
|       61.30(7), Fla. Stat. for more            |                           |         |
|       information.]                            |                           |         |
|------------------------------------------------|                           |---------|
|       b.  Total Monthly Child(ren)'s           |                           |         |
|           Health Insurance Cost. [This is      |                           |         |
|           only amounts actually paid for       |                           |         |
|           health insurance on the              |                           |         |
|           child(ren).]                         |                           |         |
|------------------------------------------------|                           |---------|
|       c.  Total Monthly Child(ren)'s           |                           |         |
|           Noncovered Medical, Dental and       |                           |         |
|           Prescription Costs.                  |                           |         |
|------------------------------------------------|                           |---------|
|       d.  Total Monthly Child Care &           |                           |         |
|           Health Costs [Add lines              |                           |         |
|           14a+14b+14c]                         |                           |         |
|------------------------------------------------|---------------------------|---------|
|   15. Additional Support Payments              |             |             |         |
|       Multiply the number on line 14d by       |             |             |         |
|       the percentage on line 3A to             |             |             |         |
|       determine the Father's share.            |             |             |         |
|       Enter answer on line 15A.                |             |             |         |
|       Multiply the number on line 14d by       |             |             |         |
|       the percentage on line 3B to             |             |             |         |
|       determine the Mother's share.            |             |             |         |
|       Enter answer on line 15B.                |             |             |         |
|--------------------------------------------------------------------------------------|
|                                           Statutory Adjustments/Credits              |
|--------------------------------------------------------------------------------------|
|   16.                                          |             |             |         |
|       a.  Monthly child care payments          |             |             |         |
|           actually made                        |             |             |         |
|--------------------------------------------------------------------------------------|
|       b.  Monthly health insurance             |             |             |         |
|           payments actually made               |             |             |         |
----------------------------------------------------------------------------------------
*1142
----------------------------------------------------------------------------------------
|                                                |             |             |         |
|       c.  Other payments/credits actually      |             |             |         |
|           made for any noncovered              |             |             |         |
|           medical, dental and prescription     |             |             |         |
|           medication expenses of the           |             |             |         |
|           child(ren) not ordered to be         |             |             |         |
|           separately paid on a percentage      |             |             |         |
|           basis. [See Section 61.30 (8),       |             |             |         |
|           Florida Statutes]                    |             |             |         |
|------------------------------------------------|-------------|-------------|         |
|   17. Total Support Payments actually          |             |             |         |
|       made [Add 16a through 16c]               |             |             |         |
|------------------------------------------------|-------------|-------------|         |
|   18. Total Additional Support Transfer        |             |             |         |
|       Amount [Line 15 minus line 17; Enter     |             |             |         |
|       any negative number as zero]             |             |             |         |
|------------------------------------------------|-------------|-------------|         |
|   19. Total Child Support Owed from            |             |             |         |
|       Father to Mother [Add line 13A+18A]      |             |             |         |
|                                                |             |             |         |
|------------------------------------------------|-------------|-------------|         |
|   20. Total Child Support Owed from            |             |             |         |
|       Mother to Father [Add line 13B+18B]      |             |             |         |
|------------------------------------------------|-------------|-------------|         |
|   21. Actual Child Support to Be Paid.         |  $          |  $          |         |
|       [Comparing lines 19 and 20, Subtract     |             |             |         |
|       the smaller amount owed from the         |             |             |         |
|       larger amount owed and enter the         |             |             |         |
|       result in the column for the parent      |             |             |         |
|       that owes the larger amount of           |             |             |         |
|       support]                                 |             |             |         |
---------------------------------------------------------------------------------------|
ADJUSTMENTS TO GUIDELINES AMOUNT. If you or the other parent is requesting the Court to award a
child support amount that is more or less than the child support guidelines, you must complete and file
Motion to Deviate from Child Support Guidelines, Florida Supreme Court Approved Family Law Form
12.943.
[check one only]
a. ___ Deviation from the guidelines amount is requested. The Motion to Deviate from Child
Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, is attached.
b. ___ Deviation from the guidelines amount is NOT requested. The Motion to Deviate from Child
Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, is not attached.
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, located at {street} ____________________, {city} ___________________,
{state} ________________, {phone} ___________, helped {name} ___________,
who is the [check one only] ___ petitioner or ___ respondent, fill out this form.

*1143 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.903(c)(1), ANSWER TO PETITION AND COUNTERPETITION FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) (10/11)

When should this form be used?
This form should be used when you are responding to a petition for dissolution of marriage with dependent or minor child(ren) and you are asking the court for something not contained in the petition. The answer portion of this form is used to admit or deny the allegations contained in the petition, and the counterpetition portion of this form is used to ask for whatever you want the court to do for you.
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 was filed and keep a copy for your records.

What should I do next?
You have 20 days to answer after being served with the other party's petition. A copy of this form must be mailed or hand delivered to the other party. After you file an answer and counterpetition your case will then generally proceed as follows:
The other party is required to answer your counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).
UNCONTESTED ... Your dissolution is uncontested if you and your spouse agree on all issues raised in the petition and the counterpetition. If this is the case, and you and the other party have complied with mandatory disclosure and filed all of the required papers, either party may call the clerk, family law intake staff, or judicial assistant to set a final hearing. If you request the hearing, you must notify the other party 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 ... Your dissolution is contested if you and your spouse disagree on any issues raised in the petition or counterpetition. If you are unable to settle the disputed issues, either party may file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. 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).

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 61, Florida Statutes.

Special notes ...
With this form, you must also file the following:
 Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d)
 Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). (If you do not know the *1144 other party's income, you may file this worksheet after his or her financial affidavit has been served on you.)
 Affidavit of Corroborating Witness, Florida Supreme Court Approved Family Law Form 12.902(i) OR photocopy of current Florida driver's license, Florida identification card, or voter's registration card (issue date of copied document must be at least six months before date case is actually filed with the clerk of the circuit court).
 Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1), if you have reached an agreement on any or all of the issues.
 Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a), Safety-Focused Parenting Plan, Form 12.995(b), or Relocation-Long-Distance Parenting Plan, Form 12.995(c). If the parents have reached an agreement, a signed and notarized Parenting Plan should be attached. If the parents have not reached an agreement, a proposed Parenting Plan may be filed.
 Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
 Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This must be filed within 45 days of service of the petition on you, if not filed at the time you file this answer.)
 Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days of service of the petition on you, if not filed at the time you file this answer, unless you and the other party have agreed not to exchange these documents.)
Parenting Plan and Time-Sharing ... If you and your spouse are unable to agree on parenting arrangements and a time-sharing schedule, a judge will decide for you as part of establishing a Parenting Plan. The judge will decide the parenting arrangements and time-sharing schedule based on the child(ren)'s best interests. Regardless of whether there is an agreement, the court reserves jurisdiction to modify issues relating to the minor child(ren).
The judge may request a parenting plan recommendation or appoint a guardian ad litem in your case. This means that a neutral person will review your situation and report to the judge concerning parenting issues. The purpose of such intervention is to be sure that the best interests of the child(ren) is (are) being served. For more information, you may consult section 61.13, Florida Statutes.
A parenting course must be completed prior to entry of the final judgment. You should contact the clerk, family law intake staff, or judicial assistant about requirements for parenting courses or mediation where you live.
Listed below are some terms with which you should become familiar before completing your petition. If you do not fully understand any of the terms below or their implications, you should speak with an attorney before going any further.
 Shared Parental Responsibility
 Sole Parental Responsibility
 Supervised Time-Sharing
 No contact
 Parenting Plan
 Parenting Plan Recommendation
 Time-Sharing Schedule
Child Support ... The court may order one parent to pay child support to assist *1145 the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents. You must file a Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), and your spouse will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid using the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations.
Alimony ... Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse has the ability to pay it. If you want alimony, you must request it in writing in your counterpetition. If you do not request alimony in writing before the final hearing, it is waived (you may not request it later). You may request either permanent alimony, lump sum alimony, or rehabilitative alimony.
Marital/Nonmarital Assets and Liabilities... Florida law requires an equitable distribution of marital assets and marital liabilities. Equitable does not necessarily mean equal. Many factors, including child support, time-sharing and alimony awards, may lead the court to make an unequal (but still equitable) distribution of assets and liabilities. Nonmarital assets and nonmarital liabilities are those assets and liabilities which the parties agree or the court determines belong to, or are the responsibility of, only one of the parties. If the parties agree or the court finds an asset or liability to be nonmarital, the judge will not consider it when distributing marital assets and liabilities.
Parenting Plan ... In all cases involving minor or dependent child(ren), a Parenting Plan shall be approved or established by the court. If you and your spouse have reached an agreement, you should file a Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a), 12.995(b), or 12.995(c) which addresses the time-sharing schedule for the child(ren). If you have not reached an agreement, a proposed Parenting Plan may be filed. A Parenting Plan will be established by the court.
Temporary Relief ... If you need temporary relief regarding temporary use of assets, temporary responsibility for liabilities, parental responsibility and time-sharing with child(ren), temporary child support, or temporary alimony, you may file a Motion for Temporary Support and Time-Sharing with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(a). For more information, see the instructions for that form.
Marital Settlement Agreement ... If you and your spouse are able to reach an agreement on any or all of the issues, you should file a Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1). Both parties must sign this agreement before a notary public or deputy clerk. Any issues on which you *1146 are unable to agree will be considered contested and settled by the judge at the final hearing.
Final Judgment Form ... These family law forms contain a Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.990(c)(1), which the judge may use if your case is contested. If you and your spouse reach an agreement on all of the issues, the judge may use a Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) (Uncontested), Florida Supreme Court Approved Family Law Form 12.990(b)(1). You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Nonlawyer ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1147
     IN THE CIRCUIT COURT OF THE __________________ JUDICIAL CIRCUIT,
         IN AND FOR _________________________ COUNTY, FLORIDA
                                            Case No: __________________
                                            Division: _________________
______________________________,
                    Petitioner,
         and
______________________________,
                    Respondent.
   ANSWER TO PETITION AND COUNTERPETITION FOR DISSOLUTION OF MARRIAGE
                   WITH DEPENDENT OR MINOR CHILD(REN)
        I, {full legal name} ____________________ Respondent, being
sworn, certify that the following information is true:
ANSWER TO PETITION
1. I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the
   Petition and, therefore, admit those allegations: {indicate section and paragraph number}
   ____________________________________________________________________________________________________
   ____________________________________________________________________________________________________
2. I disagree with Petitioner as to the allegations raised in the following numbered paragraphs in the
   Petition and, therefore, deny those allegations: {indicate section and paragraph number}
   ____________________________________________________________________________________________________
   ____________________________________________________________________________________________________
3. I currently am unable to admit or deny the following paragraphs due to lack of information: {indicate
   section and paragraph number} ________________________________________________________________
   ___________________________________________________________________________________________________
COUNTERPETITION FOR DISSOLUTION OF MARRIAGE WITH MINOR CHILD(REN)
1. JURISDICTION/RESIDENCE
   ( ) Husband ( ) Wife ( ) Both has (have) lived in Florida for at least 6 months before the filing of
   this Petition for Dissolution of Marriage.
Florida Supreme Court Approved Family Law Form 12.903(c)(1) Answer to Petition and Counterpetition for
Dissolution of Marriage with Dependent or Minor Child(ren) (10/11)
LAKSHMI
*1148
2. Petitioner [one only] ( ) is ( ) is not a member of the military service.
   Respondent [one only] ( ) is ( ) is not a member of the military service.
3. MARRIAGE HISTORY
   Date of marriage: {month, day, year} _______________________________________________
   Date of separation: {month, day, year} _____________________ (indicate if approximate)
4. DEPENDENT OR MINOR CHILD(REN)
   [Choose all that apply]
   a. ___ The wife is pregnant. Baby is due on: {date} _____________
   b. ___ The minor (under 18) child(ren) common to both parties are:
      Name                                 Birth date
      ____________________________________________________________________________________________
      ____________________________________________________________________________________________
      ____________________________________________________________________________________________
      ____________________________________________________________________________________________
      ____________________________________________________________________________________________
      ____________________________________________________________________________________________
   c. ___ The minor child(ren) born or conceived during the marriage who are not common to both
      parties are:
      Name                             Birth date
      ____________________________________________________________________________________________
      ____________________________________________________________________________________________
      The birth father(s) of the above minor child(ren) is (are) {name and address} ___
      ____________________________________________________________________________________________
   d. ___ The child(ren) common to both parties who are 18 or older but who are dependent upon
      the parties due to a mental or physical disability are:
      Name                                 Birth date
      ________________________________________________________________________________________
      ________________________________________________________________________________________
5. A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida
   Supreme Court Approved Family Law Form 12.902(d), is filed with this counterpetition. You must
   complete and attach this form in a dissolution of marriage with minor child(ren).
6. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form
   12.902(j), is filed with this counterpetition.
7. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or
   (c) ( ) is filed or ( ) will be timely filed.
*1149
8. This counterpetition for dissolution of marriage should be granted because:
   [Choose only one]
   a. ___ The marriage is irretrievably broken.
   b. ___ One of the parties has been adjudged mentally incapacitated for a period of 3 years prior to
      the filing of this counterpetition. A copy of the Judgment of Incapacity is attached.
SECTION I. MARITAL ASSETS AND LIABILITIES
[Choose only one]
1. ___ There are no marital assets or liabilities.
2. ___ There are marital assets or liabilities. All marital and nonmarital assets and liabilities are (or will
   be) listed in the financial affidavits, Florida Family Law Rules of Procedure Form 12.902(b) or (c), to
   be filed in this case.
   [Choose all that apply]
   a. ___ All marital assets and liabilities have been divided by a written agreement between the
      parties, which is attached to be incorporated into the final judgment of dissolution of marriage.
     (The parties may use Marital Settlement Agreement for Dissolution of Marriage with Dependent
     or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1).
   b. ___ The Court should determine how the assets and liabilities of this marriage are to be
      distributed, under section 61.075, Florida Statutes.
   c. ___ Respondent should be awarded an interest in Petitioner's property because: __________
      _________________________________________________________________________________________
      _________________________________________________________________________________________
      _________________________________________________________________________________________
SECTION II. SPOUSAL SUPPORT (ALIMONY)
[Choose only one]
1. ___ Respondent forever gives up his/her right to spousal support (alimony) from Petitioner.
2. ___ Respondent requests that the Court order Petitioner to pay the following spousal support
   (alimony) and claims that he or she has a need for the support that he or she is requesting and that
   Petitioner has the ability to pay that support. Spousal support (alimony) is requested in the
   amount of $______ every ( ) week ( ) other week ( ) month, beginning {date} _____________
   and continuing until {date or event} __________.
   Explain why the Court should order Petitioner to pay and any specific request(s) for type of alimony
   (temporary, permanent, rehabilitative, and/or lump sum): __________________
   __________________________________________________________________________________
   __________________________________________________________________________________
   __________________________________________________________________________________
   __________________________________________________________________________________
   __________________________________________________________________________________
   __________________________________________________________________________________
   __________________________________________________________________________________
*1150
   [Please indicate if applicable] ( ) Respondent requests life insurance on Petitioner's life, provided
   by Petitioner, to secure such support.
SECTION III. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING
1. The minor child(ren) currently reside(s) with ( ) Mother ( ) Father ( ) Other: {explain}
   __________________________________________________________________________________
2. Parental Responsibility. It is in the child(ren)'s best interests that parental responsibility be:
   [Choose only one]
   a. ___ shared by both Father and Mother.
   b. ___ awarded solely to ( ) Father ( ) Mother. Shared parental responsibility would be
      detrimental to the child(ren) because: _______________________________________________
      ________________________________________________________________________________________
      ________________________________________________________________________________________
      ________________________________________________________________________________________
3. Parenting Plan and Time-Sharing. It is in the best interests of the child(ren) that the family be
   ordered to comply with a Parenting Plan that ( ) includes ( ) does not include parental time-sharing
   with the child(ren). The Respondent states that it is in the best interests of the child(ren) that:
   [Choose only one]
   a. ___ The attached proposed Parenting Plan should be adopted by the court. The parties
          ( ) have ( ) have not agreed to the Parenting Plan.
   b. ___ The court should establish a Parenting Plan with the following provisions:
          ( ) No time-sharing for the ___ Father___ Mother
          ( ) Limited time-sharing with the ___ Father___ Mother
          ( ) Supervised time-sharing for the ___ Father___ Mother.
          ( ) Supervised or third-party exchange of the child(ren).
          ( ) Time-sharing as follows: __________________________________________________
          ___________________________________________________________________________________
          ___________________________________________________________________________________
          ___________________________________________________________________________________
          Explain why this request is in the best interests of the child(ren): ______________
          ___________________________________________________________________________________
          ___________________________________________________________________________________
          ___________________________________________________________________________________
          ___________________________________________________________________________________
          ___________________________________________________________________________________
SECTION IV. CHILD SUPPORT [Choose all that apply]
1. Respondent requests that the Court award child support as determined by Florida's child support
*1151
   guidelines, section 61.30, Florida Statutes. A completed Child Support Guidelines Worksheet,
   Florida Family Law Rules of Procedure Form 12.902(e), is, or will be filed. Such support should be
   ordered retroactive to:
   a. ___ the date of separation {date} ______________.
   b. ___ the date of the filing of this petition.
   c. ___ other {date} ______________{explain} ______________________________________
          _______________________________________________________________________________________
2. ___ Respondent requests that the Court award child support to be paid beyond the age of 18 years
       because:
   a. ___ the following child(ren) {name(s)} _______________________________________________
      _______________________________________________________________________________________________
      is (are) dependent because of a mental or physical incapacity which began before the age of 18.
      {explain} _____________________________________________________________________________
   b. the following child(ren) {name(s)} _____________________ is (are) dependent in fact and
      is (are) in high school while he/she (they) are between the ages of 18 and 19; said child(ren) is
      (are) performing in good faith with reasonable expectation of graduation before the age of 19.
3. ___ Respondent requests that the Court award a child support amount that is more than or less than
   Florida's child support guidelines. Respondent understands that Motion to Deviate from Child
   Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, must be filed before
   the court will consider this request.
4. Respondent requests that medical/dental insurance coverage for the minor child(ren) be provided
   by:
   [Choose only one]
   a. ___ Father.
   b. ___ Mother.
5. ___ Respondent requests that uninsured medical/dental expenses for the child(ren) be paid:
   [Choose only one]
   a. ___ by Father.
   b. ___ by Mother.
   c. ___ by Father and Mother each paying one-half.
   d. ___ according to the percentages in the Child Support Guidelines Worksheet, Florida Family Law
      Rules of Procedure Form 12.902(e).
   e. ___ Other {explain}: ___________________________________________________________
      _______________________________________________________________________________
      _______________________________________________________________________________
6. ___ Respondent requests that life insurance to secure child support be provided by:
   a. ___ Father.
   b. ___ Mother.
   c. ___ Both.
*1152
SECTION V. OTHER
1. If Respondent is also the Wife, please indicate by either ( ) yes OR ( ) no whether
   Respondent/Wife wants to be known by her former name, which was {full legal name}:
   _________________________________________________________________________________
2. Other relief {specify}: _________________________________________________________
   _________________________________________________________________________________
   _________________________________________________________________________________
   _________________________________________________________________________________
   _________________________________________________________________________________
   _________________________________________________________________________________
   _________________________________________________________________________________
   _________________________________________________________________________________
SECTION VI. RESPONDENT'S/COUNTERPETITIONER'S REQUEST (This section summarizes what you are
asking the Court to include in the final judgment of dissolution of marriage.)
Respondent requests that the Court enter an order dissolving the marriage and:
[Choose all that apply]
1. ___ distributing marital assets and liabilities as requested in Section I of this petition;
2. ___ awarding spousal support (alimony) as requested in Section II of this petition;
3. ___ adopt or establish a Parenting Plan containing provisions for parental responsibility and time-sharing
       for the dependent or minor child(ren) common to both parties, as requested in Section
       III of this petition;
4. ___ establishing child support for the dependent or minor child(ren) common to both parties, as
       requested in Section IV of this petition;
5. ___ restoring Wife's former name as requested in Section V of this petition;
6. ___ awarding other relief as requested in Section V of this petition; and any other terms the Court
       deems necessary.
       I certify that a copy of this document was [Choose only one] ( ) mailed ( ) faxed and mailed
( ) hand delivered to the person(s) listed below on {date} _______.
Petitioner or his/her attorney:
Printed Name: _________________
Address: ______________________
City, State, Zip: _____________
Fax Number: ___________________
*1153
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
answer and counterpetition and that the punishment for knowingly making a false statement includes
fines and/or imprisonment.
Dated: _______________                     _____________________________________________
                                           Signature of Respondent/Counterpetitioner
                                           Printed Name: _______________________________
                                           Address: ____________________________________
                                           City, State, Zip: ___________________________
                                           Telephone Number: ___________________________
                                           Fax Number: _________________________________
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]
I, {full legal name and trade name of nonlawyer} ____________________________________________,
a nonlawyer, whose address is {street} ______________________________________________________,
{city} __________________, {state} ______________, {phone} ___________________________,
helped {name} _______________________, who is the petitioner, fill out this form.

*1154 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.903(c)(2), ANSWER TO PETITION AND COUNTERPETITION FOR DISSOLUTION OF MARRIAGE WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN) (10/11)

When should this form be used?
This form should be used when you are responding to a petition for dissolution of marriage with property but no dependent or minor child(ren) and you are asking the court for something not contained in the petition. The answer portion of this form is used to admit or deny the allegations contained in the petition, and the counterpetition portion of this form is used to ask for whatever you want the court to do for you.
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 was filed and keep a copy for your records.

What should I do next?
You have 20 days to answer after being served with the other party's petition. A copy of this form must be mailed or hand delivered to the other party. After you file an answer and counterpetition your case will then generally proceed as follows:
The other party is required to answer your counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).
UNCONTESTED ... Your dissolution is uncontested if you and your spouse agree on all issues raised in the petition and the counterpetition. If this is the case, and you and the other party have complied with mandatory disclosure and filed all of the required papers, either party may call the clerk, family law intake staff, or judicial assistant to set a final hearing. If you request the hearing, you must notify the other party 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 ... Your dissolution is contested if you and your spouse disagree on any issues raised in the petition or counterpetition. If you are unable to settle the disputed issues, either party may file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. 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).

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 61, Florida Statutes.

Special notes ...
With this form, you must also file the following:
 Affidavit of Corroborating Witness, Florida Supreme Court Approved Family Law Form 12.902(i) OR photocopy of current Florida driver's license, Florida identification card, or voter's registration card *1155 (issue date of copied document must be at least six months before date case is actually filed with the clerk of the circuit court).
 Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(2), if you have reached an agreement on any or all of the issues.
 Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
 Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This must be filed within 45 days of service of the petition on you, if not filed at the time you file this answer.)
 Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days of service of the petition on you, if not filed at the time you file this answer, unless you and the other party have agreed not to exchange these documents.)
Alimony ... Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse has the ability to pay it. If you want alimony, you must request it in writing in your counterpetition. If you do not request alimony in writing before the final hearing, it is waived (you may not request it later). You may request either permanent alimony, lump sum alimony, or rehabilitative alimony.
Marital/Nonmarital Assets and Liabilities... Florida law requires an equitable distribution of marital assets and marital liabilities. Equitable does not necessarily mean equal. Many factors, including alimony awards, may lead the court to make an unequal (but still equitable) distribution of assets and liabilities. Nonmarital assets and nonmarital liabilities are those assets and liabilities which the parties agree or the court determines belong to, or are the responsibility of, only one of the parties. If the parties agree or the court finds an asset or liability to be nonmarital, the judge will not consider it when distributing marital assets and liabilities.
Temporary Relief ... If you need temporary relief regarding temporary use of assets, temporary responsibility for liabilities, or temporary alimony, you may file a Motion for Temporary Support with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(c). For more information, see the instructions for that form.
Marital Settlement Agreement ... If you and your spouse are able to reach an agreement on any or all of the issues, you should file a Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(2). Both parties must sign this agreement before a notary public. Any issues on which you are unable to agree will be considered contested and settled by the judge at the final hearing.
Final Judgment Forms ... These family law forms contain a Final Judgment of Dissolution of Marriage with Property but No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.990(c)(2), which the judge may use if your case is contested. If you and your spouse reach an agreement on all of the issues, the judge may use a Final Judgment of Dissolution of Marriage with Property but No Dependent or Minor Child(ren) (Uncontested), Florida Supreme Court Approved Family Law Form 12.990(b)(2). You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a *1156 final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Nonlawyer ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1157
    IN THE CIRCUIT COURT OF THE ________________ JUDICIAL CIRCUIT,
       IN AND FOR ______________________ COUNTY, FLORIDA
                                      Case No: ________________________
                                      Division: _______________________
_______________________,
             Petitioner,
      and
_______________________,
             Respondent.
ANSWER TO PETITION AND COUNTERPETITION FOR DISSOLUTION OF MARRIAGE
            WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN)
      I, {full legal name} _________________________________________,
Respondent, being sworn, certify that the following information is true:
                      ANSWER TO PETITION
1. I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the
   Petition and, therefore, admit those allegations: {indicate section and paragraph number} _______
   ________________________________________________________________________________________________
2. I disagree with Petitioner as to the allegations raised in the following numbered paragraphs in the
   Petition and, therefore, deny those allegations: {indicate section and paragraph number} ______
   _________________________________________________________________________________
3. I currently am unable to admit or deny the following paragraphs due to lack of information: {indicate
   section and paragraph number} ________________________________________________________________
   ______________________________________________________________________________________________
    COUNTERPETITION FOR DISSOLUTION OF MARRIAGE WITH PROPERTY BUT NO
                          DEPENDENT OR MINOR CHILD(REN)
1. JURISDICTION/RESIDENCE
   ( ) Husband ( ) Wife ( ) Both has (have) lived in Florida for at least 6 months before the filing of
   this Petition for Dissolution of Marriage.
2. Petitioner [Choose only one] ( ) is ( ) is not a member of the military service.
   Respondent [Choose only one] ( ) is ( ) is not a member of the military service.
3. MARRIAGE HISTORY
Florida Supreme Court Approved Family Law Form 12.903(c)(2) Answer to Petition and Counterpetition for
Dissolution of Marriage with Property but No Dependent or Minor Children (10/11)
LAKSHMI
*1158
   Date of marriage: {month, day, year} _______________________________
4. THERE ARE NO MINOR (UNDER 18) OR DEPENDENT CHILD(REN) COMMON TO BOTH PARTIES AND
   THE WIFE IS NOT PREGNANT.
5. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form
   12.902(j), is filed with this counterpetition.
6. This counterpetition for dissolution of marriage should be granted because:
   [Choose only one]
   a. ___ The marriage is irretrievably broken.
   b. ___ One of the parties has been adjudged mentally incapacitated for a period of 3 years prior
      to the filing of this counterpetition. A copy of the Judgment of Incapacity is attached.
SECTION I. MARITAL ASSETS AND LIABILITIES
[Choose only one]
1. ___ There are no marital assets or liabilities.
2. ___ There are marital assets or liabilities. All marital and nonmarital assets and liabilities are (or
   will be) listed in the financial affidavits, Florida Family Law Rules of Procedure Form 12.902(b) or (c),
   to be filed in this case.
   [Choose all that apply]
   a. ___ All marital assets and liabilities have been divided by a written agreement between the
      parties, which is attached to be incorporated into the final judgment of dissolution of marriage.
      (The parties may use Marital Settlement Agreement for Dissolution of Marriage with No
      Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(2).
   b. ___ The Court should determine how the assets and liabilities of this marriage are to be
      distributed, under section 61.075, Florida Statutes.
   c. ___ Respondent should be awarded an interest in Petitioner's property because:
      ________________________________________________________________________________________
      ________________________________________________________________________________________
      ________________________________________________________________________________________
      ________________________________________________________________________________________
      ________________________________________________________________________________________
SECTION II. SPOUSAL SUPPORT (ALIMONY)
[Choose only one]
1. ___ Respondent forever gives up his/her right to spousal support (alimony) from Petitioner.
2. ___ Respondent requests that the Court order Petitioner to pay the following spousal support
   (alimony) and claims that he or she has a need for the support that he or she is requesting and
   Petitioner has the ability to pay that support. Spousal support (alimony) is requested in the amount
   of $___ every ( ) week ( ) other week ( ) month, beginning {date} __________ and
   continuing until {date or event} __________.
*1159
   Explain why the Court should order Petitioner to pay and any specific request(s) for type of alimony
   (temporary, permanent, rehabilitative, and/or lump sum): ___________________________________________
   ____________________________________________________________________________________________________
   ____________________________________________________________________________________________________
   ____________________________________________________________________________________________________
   ____________________________________________________________________________________________________
   ____________________________________________________________________________________________________
   ____________________________________________________________________________________________________
   ____________________________________________________________________________________________________
   [Choose if applies] ( ) Respondent requests life insurance on Petitioner's life, provided by
   Petitioner, to secure such support.
SECTION III. OTHER
1. [If Respondent is also the Wife, Choose one only] ( ) yes ( ) no Respondent/Wife wants to be
   known by her former name, which was {full legal name} _________________________.
2. Other relief {specify}: ________________________________________________________________________
   ____________________________________________________________________________________________________
   ____________________________________________________________________________________________________
   ____________________________________________________________________________________________________
   ____________________________________________________________________________________________________
   ____________________________________________________________________________________________________
   ____________________________________________________________________________________________________
SECTION IV. RESPONDENT'S/COUNTERPETITIONER'S REQUEST (This section summarizes what you are
asking the Court to include in the final judgment of dissolution of marriage.)
Respondent requests that the Court enter an order dissolving the marriage and:
[Choose all that apply]
1. ___ distributing marital assets and liabilities as requested in Section I of this petition;
2. ___ awarding spousal support (alimony) as requested in Section II of this petition;
3. ___ restoring Wife's former name as requested in Section III of this petition;
4. ___ awarding other relief as requested in Section III of this petition; and any other terms the Court
   deems necessary.
*1160
I certify that a copy of this document was [Choose one only] ( ) mailed ( ) faxed and mailed ( ) hand
delivered to the person(s) listed below on {date} ___________.
Petitioner or his/her attorney:
Printed Name: _________________
Address: ______________________
City, State, Zip: _____________
Fax Number: ___________________
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
answer and counterpetition and that the punishment for knowingly making a false statement includes
fines and/or imprisonment.
Dated: __________________                _____________________________________________
                                         Signature of Respondent/Counterpetitioner
                                         Printed Name: _______________________________
                                         Address: ____________________________________
                                         City, State, Zip: ___________________________
                                         Telephone Number: ___________________________
                                         Fax Number: _________________________________
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 ____________________
*1161
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 the petitioner, fill out this form.

*1162 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.904(a), PETITION FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) (10/11)

When should this form be used?
This form may be used to ask the court to enter a support order if you and your spouse are separated, and your spouse has the ability to contribute to you and your minor child(ren), but has failed to do so. You can only use this form if a dissolution of marriage has not been filed and based upon the time-sharing schedule, you are entitled to support. If a petition for dissolution of marriage has been filed, you should file a Motion for Temporary Support and Time-Sharing with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(a), instead of using this petition. Also, if you are requesting that an order be entered for you to pay support to your spouse, you should not file this form.
This petition cannot address the issues of property, debts, or parental responsibility and time-sharing with child(ren). It only deals with alimony and child support.
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.

What should I do next?
For your case to proceed, you must properly notify the other party in your case 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, you may use constructive service. You may also be able to use constructive service if the other party resides in another state or country. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b). If you need to use constructive service, use the Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved Family Law Form 12.913(a), after striking through "for Dissolution of Marriage" and inserting "for Support Unconnected with Dissolution of Marriage with Dependent or Minor Child(ren)." If the other party is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Supreme Court Approved Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues.
If personal service is used, the other party has 20 days to answer after being served with your petition. Your case will then generally proceed in one of the following three 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. 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 other party of the hearing by *1163 using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
UNCONTESTED. If the respondent files an answer that agrees with everything in your petition or an answer and waiver, and you have complied with mandatory disclosure and 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 other party 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 the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. Then you should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).

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 section 61.09, 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 from the clerk, fill it out, and the clerk will determine whether you are eligible to have filing fees deferred.
With this form you must also file the following:
 Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
 Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), if the case involves minor or dependent child(ren).
 Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c).
 Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition, unless you and the other party have agreed not to exchange these documents.)
 Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), if you are asking that child support be ordered in the final judgment. (If you do not know the other party's income, you may file this worksheet after his or her financial affidavit has been served on you.)
Child Support. The court may order one parent to pay child support to assist the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion *1164 of his or her support for the child(ren) to the other parent. Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents and the number of overnights the child(ren) spend with each parent. You must file a Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), and your spouse will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid using the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations.
Temporary Relief. If you need temporary relief regarding child support or temporary alimony, you may file a Motion for Temporary Support and Time-Sharing with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(a). For more information, see the instructions for that form.
Final Judgment Form. These family law forms contain a Final Judgment of Support Unconnected with Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.994(a), which the judge may use if your case is contested. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Nonlawyer. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1165
     IN THE CIRCUIT COURT OF THE ________________ JUDICIAL CIRCUIT,
        IN AND FOR _______________________ COUNTY, FLORIDA
                                          Case No: _____________
                                          Division: ____________
_____________________,
           Petitioner,
   and
_____________________,
           Respondent.
PETITION FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF MARRIAGE WITH
                        DEPENDENT OR MINOR CHILD(REN)
       I, {full legal name} ___________________________________________, the
( ) Husband ( ) Wife, being sworn, certify that the following statements are true:
1. JURISDICTION
   ( ) Husband ( ) Wife ( ) Both live in Florida at the filing of this Petition for Support Unconnected
   with Dissolution of Marriage, which is filed pursuant to section 61.09, Florida Statutes.
2. Petitioner [Choose only one] ( ) is ( ) is not a member of the military service.
   Respondent [Choose only one] ( ) is ( ) is not a member of the military service.
3. MARRIAGE HISTORY
   a. Date of marriage: {month, day, year} _____________
   b. Date of separation: {month, day, year} _______________ (___ Please indicate if
      approximate)
4. MINOR CHILD(REN)
   [Choose all that apply]
   a. ___ The wife is pregnant. The baby is due on: {date} ___________.
   b. ___ The minor (under 18) child(ren) common to both parties are:
      Name              Birth date
      __________________________________________________________________
      __________________________________________________________________
      __________________________________________________________________
      __________________________________________________________________
      __________________________________________________________________
      __________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected with Dissolution of
Marriage with Dependent or Minor Child(ren) (10/11)
LAKSHMI
*1166
   c. ___ The minor child(ren) born or conceived during the marriage who are not common to both
      parties are:
      Name                   Birth date
      __________________________________________________________________
      __________________________________________________________________
      The birth father(s) of the above minor child(ren) is (are) {name and address} ______
      __________________________________________________________________
   d. ___ The child(ren) common to both parties who are 18 or older but who are dependent upon
      the parties due to a mental or physical incapacity are:
      Name                   Birth date
      __________________________________________________________________
      __________________________________________________________________
5. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form
   12.902(j), if required, is filed with this petition.
6. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or
   (c), is, or will be, filed.
7. A completed Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form
   12.902(e), is, or will be, filed.
8. A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida
   Supreme Court Approved Family Law Form 12.902(d), is filed with this petition.
SECTION I. SPOUSAL SUPPORT (ALIMONY)
[Choose only one]
1. ___ Petitioner does not request spousal support (alimony) from Respondent at this time.
2. ___ Respondent has the ability to contribute to the maintenance of Petitioner and has failed to do
   so. Petitioner requests that the Court order Respondent to pay the following spousal support
   (alimony) and claims that he or she has a need for the support that he or she is requesting. Spousal
   support (alimony) is requested in the amount of $ ______ every ( ) week
   ( ) other week ( ) month, beginning {date} _______________, and continuing until
   {date or event} _______________________________________________________
   Explain why the Court should order Respondent to pay and any specific request(s) for type of
   alimony (temporary, permanent, rehabilitative, and/or lump sum): ______________________________
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
*1167
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   [Choose if applies] ( ) Petitioner requests life insurance on Respondent's life, provided by
   Respondent, to secure such support.
SECTION II. CHILD SUPPORT
Respondent has the ability to contribute to the maintenance of his or her minor child(ren) and has failed
to do so. Based upon the time-sharing schedule, the Petitioner is entitled to child support.
[Choose all that apply]
1. ___ Petitioner requests that the Court award child support as determined by Florida's child support
       guidelines, section 61.30, Florida Statutes.
2. ___ Petitioner requests that the Court award child support to be paid beyond the age of 18 years
       because:
   a. ___ the following child(ren), {name(s)} ________________________________________,
      is (are) dependent because of a mental or physical incapacity which began prior to the age of 18
      {explain}: ________________________________________________________________________
      ____________________________________________________________________________________________
      ____________________________________________________________________________________________
   b. ___ the following child(ren), {name(s)} ____________________________________________,
      is (are) dependent in fact and is (are) in high school while he/she (they) are between the ages of
      18 and 19; said child(ren) is (are) performing in good faith with reasonable expectation of
      graduation before the age of 19.
3. ___ Petitioner requests that medical/dental insurance for the minor child(ren) be provided by:
   [Choose only one]
   a. ___ Father.
   b. ___ Mother.
4. ___ Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid:
   [Choose only one]
   a. ___ by father.
   b. ___ by mother.
   c. ___ by Father and Mother each paying one-half.
   d. ___ according to the percentages in the Child Support Guidelines Worksheet, Florida Family Law
      Rules of Procedure Form 12.902(e).
   e. ___ Other {explain}: ___________________________________
      _________________________________________________________________
      _________________________________________________________________
5. ___ Petitioner requests that life insurance to secure child support be provided by:
   a. ___ Father.
   b. ___ Mother.
   c. ___ Both.
SECTION III. OTHER RELIEF
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
*1168
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
SECTION IV. PETITIONER'S REQUEST (This section summarizes what you are asking the Court to include
in the order for support.)
Petitioner requests that the Court enter an order establishing support and:
[Choose all that apply]
   a. ___ awarding spousal support (alimony) as requested in Section I of this petition;
   b. ___ establishing child support for the minor child(ren) common to both parties, as requested in
      Section II of this petition;
   c. ___ awarding other relief as requested in Section III of this petition; and any other terms the
      Court deems necessary.
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: _____________________
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 ________________________
*1169
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 the petitioner, fill out this form.

*1170 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.904(b), PETITION FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF MARRIAGE WITH NO DEPENDENT OR MINOR CHILD(REN) (10/11)

When should this form be used?
This form may be used if you and your spouse are separated, but a dissolution of marriage has not been filed, and you are requesting alimony. If a petition for dissolution has been filed, you should file a Motion for Temporary Support with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(c), instead of using this petition. Also, if you are requesting that an order be entered for you to pay support to your spouse, you should not file this form.
This petition does not address the issues of property or debts. It only deals with alimony.
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.

What should I do next?
For your case to proceed, you must properly notify the other party in your case 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, you may use constructive service. You may also be able to use constructive service if the other party resides in another state or country. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved Family Law Form 12.913(a)(1), and Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b). If you need to use constructive service, use the Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved Family Law Form 12.913(a), after striking through "for Dissolution of Marriage" and inserting "for Support Unconnected with Dissolution for Marriage with No Dependent or Minor Child(ren)." If the other party is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Supreme Court Approved Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues.
If personal service is used, the other party has 20 days to answer after being served with your petition. Your case will then generally proceed in one of the following three 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. 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 other party 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. UNCONTESTED... If the respondent files an answer that agrees with everything in your petition or an answer and waiver, and you have complied ------- with mandatory disclosure and 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 other party 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. *1171 with mandatory disclosure and 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 other party 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 the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. Then you should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).

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 section 61.09, 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 from the clerk, fill it out, and the clerk will determine whether you are eligible to have filing fees deferred.
With this form you must also file the following:
 Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
 Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition.)
 Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition, unless you and the other party have agreed not to exchange these documents.)
Alimony . . . Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse has the ability to pay it. If you want alimony, you must request it in writing in the original petition. If you do not request alimony in writing before the final hearing, it is waived (you may not request it later). You may request either permanent alimony, lump sum alimony, or rehabilitative alimony.
Temporary Relief . . . If you need temporary relief regarding alimony, you may file a Motion for Temporary Support with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(c). For more information, see the instructions for that form. Final Judgment Form . . . These family law forms contain a Final Judgment of Support Unconnected with Dissolution of Marriage with No Dependent or Minor *1172 Child(ren), Florida Supreme Court Approved Family Law Form 12.994(b), which the judge may use if your case is contested. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Nonlawyer . . . Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1173
          IN THE CIRCUIT COURT OF THE ______________ JUDICIAL CIRCUIT,
              IN AND FOR _________________________ COUNTY, FLORIDA
                                                 Case No: _____________________
                                                 Division: ____________________
______________________________,
                    Petitioner,
      and
_____________________________,
                   Respondent.
          PETITION FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF MARRIAGE
                       WITH NO DEPENDENT OR MINOR CHILD(REN)
I, {full legal name} ______________________________________, the
[Choose only one] ( ) Husband ( ) Wife, being sworn, certify that the following statements are true:
1. JURISDICTION
   ( ) Husband ( ) Wife ( ) Both live in Florida at the filing of this Petition for Support Unconnected
   with Dissolution of Marriage, which is filed pursuant to section 61.09, Florida Statutes.
2. Petitioner [Choose only one] ( ) is ( ) is not a member of the military service.
   Respondent [Choose only one] ( ) is ( ) is not a member of the military service.
3. MARRIAGE HISTORY
   Date of marriage: {month, day, year} ____________________
   Date of separation: {month, day, year} ___________________ (___Indicate if approximate)
4. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or
   (c), is, or will be, filed.
5. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form
   12.902(j), if required, is, or will be filed.
SECTION I. SPOUSAL SUPPORT (ALIMONY)
1. ____ Respondent has the ability to contribute to the maintenance of Petitioner and has failed to do
   so. Petitioner requests that the Court order Respondent to pay the following spousal support
   (alimony) and claims that he or she has a need for the support that he or she is requesting. Spousal
   support (alimony) is requested in the amount of $__________ every ( ) week ( ) other week
   ( ) month, beginning {date} __________, and continuing until {date or event} __________
Florida Supreme Court Approved Family Law Form 12.904(b), Petition for Support Unconnected with Dissolution of
Marriage with No Dependent or Minor Child(ren) (10/11)
*1174
   ________________________________________________________________________________________________
   Explain why the Court should order Respondent to pay and any specific request(s) for type of
   alimony (temporary, permanent, rehabilitative, and/or lump sum): _______________________________
   ________________________________________________________________________________________________
   ________________________________________________________________________________________________
   ________________________________________________________________________________________________
   ________________________________________________________________________________________________
   ________________________________________________________________________________________________
   [indicate if applicable] ( ) Petitioner requests life insurance on Respondent's life, provided by
   Respondent, to secure such support.
SECTION II. OTHER RELIEF
   ________________________________________________________________________________________________
   ________________________________________________________________________________________________
   ________________________________________________________________________________________________
   ________________________________________________________________________________________________
SECTION III. PETITIONER'S REQUEST (This section summarizes what you are asking the Court to include
in the order for support.)
Petitioner requests that the Court enter an order establishing support and:
Choose all that apply]
a. ____ awarding spousal support (alimony) pursuant to Section I of this petition;
b. ____ awarding other relief as specified in Section II of this petition; and any other terms the Court
        deems necessary.
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: ___________________________________________
*1175
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]
I, {full legal name and trade name of nonlawyer} ___________________________________________________,
a nonlawyer, whose address is {street} __________________, {city} __________________________________,
{state} _________________, {phone} ___________, helped {name} ______________________________________,
who is the petitioner, fill out this form.
*1176 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.905(d), SUPPLEMENTAL PETITION FOR TEMPORARY MODIFICATION OF PARENTING ISSUES FOR CHILD(REN) OF PARENT ACTIVATED, DEPLOYED, OR TEMPORARILY ASSIGNED TO MILITARY SERVICE (10/11)

When should this form be used?
This form should be used when a parent seeks a temporary modification of an order establishing custody, visitation, a parenting plan, or time-sharing schedule because the parent is activated, deployed, or temporarily assigned to military service and the parent's ability to comply with the prior order (s) and time-sharing schedule is materially affected.
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. This form and these instructions do not apply to modification of temporary orders.

What should I do next?
For your case to proceed, you must properly notify the other party in your case of the supplemental 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, you may use constructive service. You may also be able to use constructive service if the other party resides in another state or country. However, if constructive service is used, other than granting dissolution of marriage, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b). If the other party is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Supreme Court Approved Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues.
If personal service is used, the other party has 20 days to answer after being served with your supplemental petition. Your case will then generally proceed in one of the following three 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. 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 other party 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.
UNCONTESTED . . . If the respondent files an answer that agrees with everything in your supplemental petition or an answer and waiver, and you have complied with mandatory disclosure and 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 other party of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family *1177 Law Form 12.923, or other appropriate notice of hearing form.
CONTESTED . . . If the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your supplemental petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. Then you should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).

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 section 61.13002, 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 from the clerk, fill it out, and the clerk will determine whether you are eligible to have filing fees deferred.
With this form, you must also file the following:
 Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d).
 Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), if you are seeking modification of the child support obligation. (If you do not know the other party's income, you may file this worksheet after his or her financial affidavit has been served on you.)
 Settlement Agreement, if you have reached an agreement on any or all of the issues. Although there is no form for this in these Florida Family Law Forms, you may construct a settlement agreement using the pertinent sections contained in Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1).
 Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), if not previously filed.
 Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), if you are seeking modification of the child support obligation.
 Parenting Plan, Florida Supreme Court Approved Family Law Form, 12.995(a), (b), or (c). If the parties have reached an agreement, a signed and notarized Parenting Plan should be attached. If you have not reached an agreement, a proposed Parenting Plan may be filed.
 Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932, if you are seeking modification of the child support obligation. (This must be filed within 45 days of service of the supplemental petition on the respondent, if not filed at the time of the supplemental *1178 petition, unless you and the other party have agreed not to exchange these documents.)
Temporary Judgment Form . . . These family law forms contain a Supplemental Temporary Judgment Modifying Parenting Issues for Children of a Parent Activated, Deployed or Temporarily Assigned to Military Service Florida Supreme Court Approved Family Law Form 12.993(d), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Nonlawyer . . . Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1179
      IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
       IN AND FOR ______________________________ COUNTY, FLORIDA
                                               Case No: ________________________
                                               Division: _______________________
   _________________________________,
                          Petitioner,
                and
   _________________________________,
                          Respondent.
  SUPPLEMENTAL PETITION FOR TEMPORARY MODIFICATION OF PARENTING ISSUES
  FOR CHILD(REN) OF PARENT ACTIVATED, DEPLOYED, OR TEMPORARILY ASSIGNED
                            TO MILITARY SERVICE
         I, {full legal name} ________________________________________, being sworn, certify that
the following information is true:
1. The parties to the action, {names} ____________________________________, were granted a final
   judgment of [Choose one only] ( ) dissolution of marriage ( ) paternity on {date} ______________,
   ( ) other {describe} __________________________________________________________________.
   A copy/copies of the final judgment or any modification(s) is/are attached.
2. Paragraph(s) _____ of the [Choose one only] ( ) final judgment or ( ) most recent modification of
   it grants custody, primary care, or time-sharing of the minor child(ren), {name(s)}
   ____________________________, with {name of parent} __________________________________.
3. The parent, {name} ____________________, is [Choose all that apply] ( ) activated ( ) deployed
   ( ) temporarily assigned to military service.
4. The parent, {name} _____________________________, is temporarily unable to continue the
   current parenting plan and time-sharing schedule with the minor child(ren) during the period of
   time that the parent is [Choose all that apply] ( ) activated ( ) deployed ( ) temporarily assigned
   to military service.
5. I ask the court to temporarily modify/amend the parental responsibility and time-sharing schedule
   of the minor child(ren) during the period of time that the parent, {name} ___________________, is
Florida Supreme Court Approved Family Law Form 12.905(d), Supplemental Petition for Temporary Modification of
Parenting issues for Child(ren) of Parent Activated, Deployed, or Temporarily Assigned to Military Service
(10/11)
*1180
  [Choose all that apply] ( ) activated ( ) deployed ( ) temporarily assigned to military service as
  follows: {explain}___________________________________________________________________
  ______________________________________________________________________________________________
  ______________________________________________________________________________________________
6. This temporary modification/amendment is in the best interests of the child(ren).
7. I ask that the court adopt ( ) the attached temporary Parenting Plan ( ) time-sharing schedule set
   forth below during the time that the parent is [Choose all that apply] ( ) activated ( ) deployed
   ( ) temporarily assigned to military service:
  ______________________________________________________________________________________________
  ______________________________________________________________________________________________
  ______________________________________________________________________________________________
8. If the requested modification/amendment is granted, Petitioner requests that child support be
temporarily modified/amended, consistent with the temporary modification/amendment of the
Parenting Plan and time-sharing schedule. A Child Support Guidelines Worksheet, Florida Family Law
Rules of Procedure Form 12.902(e) is, or will be, filed if a modification of child support is requested.
9. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or
(c) is filed with this Petition if a modification of child support is requested.
10. A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida
Supreme Court Approved Family Law Form 12.902(d), is filed with this petition.
11. Other: ________________________________________________________________________________________
    a. ____________________________________________________________________________________________
    b. ____________________________________________________________________________________________
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: ___________________________________________
*1181
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]
I, {full legal name and trade name of nonlawyer} _________________________________________________,
a nonlawyer, whose address is {street} ___________________________________________________________,
{city} __________________________________________, {state} ______________, {phone} __________,
helped {name} _________________________________________, who is the petitioner, fill out this form.
*1182 INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.930(b), STANDARD FAMILY LAW INTERROGATORIES FOR ORIGINAL OR ENFORCEMENT PROCEEDINGS (10/11)

When should this form be used?
This form should be used to ask the other party in your case to answer certain standard questions in writing. These questions are called interrogatories, and they must relate to your case. If the other party fails to answer the questions, you may ask the judge to order the other party to answer the questions. (You cannot ask these questions before the petition has been filed.)
The questions in this form should be used in original proceedings or enforcement proceedings and are meant to supplement the information provided in the Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). You should read all of the questions in this form to determine which questions, if any, the other party needs to answer in order to provide you with information not covered in the financial affidavit forms. If there are questions to which you already know the answer, you may choose not to ask them.
This form should be typed or printed in black ink. You must complete the box at the beginning of this form to indicate which questions you are requesting that the other party answer. You should send an original and one copy of this form and the Notice of Service of Standard Family Law Interrogatories, Florida Family Law Rules of Procedure Form 12.930(a), to the other party. You should also keep a copy for your records. You shall not file this form with the clerk of the circuit court unless the answers are admitted into evidence by the court and are in compliance with Florida Rule of Judicial Administration 2.425. However, you must file the Notice of Service of Standard Family Law Interrogatories, Florida Family Law Rules of Procedure Form 12.930(a), to tell the court that you have sent this form to the other party.

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 the instructions for Notice of Service of Standard Family Law Interrogatories, Florida Family Law Rules of Procedure Form 12.930(a), rules 12.280, 12.285, 12.340, and 12.380, Florida Family Law Rules of Procedure, and rules 1.280, 1.340, and 1.380, Florida Rules of Civil Procedure.

Special notes . . .
In addition to the standard questions in this form, you may ask up to 10 additional questions. You should type or print legibly your additional questions on a separate sheet of paper and attach it to this form. If you want to ask more than 10 additional questions, you will need to get permission from the judge.
You may want to inform the other party of the following information: As a general rule, within 30 days after service of interrogatories, the other party must answer the questions in writing and mail (have postmarked) the answers to you. His or her answers shall be written in the blank space provided after each separately numbered interrogatory. If sufficient space is not provided, the answering party may attach additional papers with the answers and refer to them in the space provided *1183 in the interrogatories. He or she should be sure to make a copy for him/herself. All answers to these questions are made under oath or affirmation as to their truthfulness. Each question must be answered separately and as completely as the available information permits. The original of the answers to the interrogatories is to be provided to the requesting party. DO NOT FILE THE ORIGINAL OR A COPY WITH THE CLERK OF THE COURT EXCEPT AS PROVIDED BY FLORIDA RULE OF CIVIL PROCEDURE 1.340(e) AND IN ACCORDANCE WITH THE REQUIREMENTS OF FLORIDA RULE OF JUDICIAL ADMINISTRATION 2.425. The other party may object to a question by writing the legal reason for the objection in the space provided. He or she may also ask the court for a protective order granting him or her permission not to answer certain questions and protecting him or her from annoyance, embarrassment, apprehension, or undue burden or expense. If the other party fails to either answer or object to the questions within 30 days, he or she may be subject to court sanctions.
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.
*1184
                 IN THE CIRCUIT COURT OF THE ________________ JUDICIAL CIRCUIT,
                            IN AND FOR __________________ COUNTY, FLORIDA
                                                    Case No.: ______________________
                                                    Division: ______________________
__________________________________,
                        Petitioner,
            and
__________________________________,
                        Respondent.
                    STANDARD FAMILY LAW INTERROGATORIES
                  FOR ORIGINAL OR ENFORCEMENT PROCEEDINGS
________________________________________________________________________________
        TO BE COMPLETED BY THE PARTY SERVING THESE INTERROGATORIES
     I am requesting that the following standard questions be answered: [check all that apply]
      ____1       ____2        ____3      ____4     ____5          ____6          ____7
   Background   Education   Employment   Assets   Liabilities   Miscellaneous   Long Form
   Information                                    Affidavit
In addition, I am requesting that the attached {#} _________________ questions be answered.
    The answers to the following questions are intended to supplement the information provided in
the Financial Affidavits, Florida Family Law Rules of Procedure Form 12.902(b) or (c). You should answer
the group of questions indicated in the above shaded box. The questions should be answered in the
blank space provided below each separately numbered question. If sufficient space is not provided, you
may attach additional papers with the answers and refer to them in the space provided in the
interrogatories. You should be sure to make a copy for yourself. Each question must be answered
separately and as completely as the available information permits. All answers are to be made under
oath or affirmation as to their truthfulness.
AFTER YOU ANSWER THE INTERROGATORIES, DO NOT FILE THE ORIGINAL WITH THE CLERK OF THE
COURT. ALL PERSONAL INFORMATION CONTAINED IN THE COURT FILE BECOMES PUBLIC RECORD.
INSTEAD, SERVE THE ORIGINAL OF THE ANSWERS TO THE INTERROGATORIES ON THE OTHER PARTY
AND FILE FORM 12.930(d), NOTICE OF SERVICE OF ANSWERS TO INTERROGATORIES, WITH THE CLERK.
Florida Family Law Rules of Procedure Form 12.930(b), Standard Family Law interrogatories for Original or
Enforcement Proceedings (10/11)
*1185
      I, {name of person answering interrogatories} __________________________
being sworn, certify that the following information is true:
1. BACKGROUND INFORMATION:
   a. State your full legal name and any other name by which you have been known.
   b. State your present residence and telephone numbers.
2. EDUCATION:
   a. List all business, commercial, and professional licenses that you have obtained.
   b. List all of your education including, but not limited to, vocational or specialized training,
      including the following:
      (1) name and address of each educational institution.
      (2) dates of attendance.
      (3) degrees or certificates obtained or anticipated dates of same.
3. EMPLOYMENT:
   a. For each place of your employment or self-employment during the last 3 years, state the
      following:
      (1) name, address, and telephone number of your employer.
      (2) dates of employment.
      (3) job title and brief description of job duties.
      (4) starting and ending salaries.
      (5) name of your direct supervisor.
      (6) all benefits received, including, for example, health, life, and disability insurance; expense
          account; use of automobile or automobile expense reimbursement; reimbursement for
          travel, food, or lodging expenses; payment of dues in any clubs or associations; and pension
          or profit sharing plans.
*1186
   b. Other than as an employee, if you have been engaged in or associated with any business,
      commercial, or professional activity within the last 3 years that was not detailed above, state for
      each such activity the following:
      (1) name, address, and telephone number of each activity.
      (2) dates you were connected with such activity.
      (3) position title and brief description of activities.
      (4) starting and ending compensation.
      (5) name of all persons involved in the business, commercial, or professional activity with you.
      (6) all benefits and compensation received, including, for example, health, life, and disability
          insurance; expense account; use of automobile or automobile expense reimbursement;
          reimbursement for travel, food, or lodging expenses; payment of dues in any clubs or
          associations; and pension or profit sharing plans.
   c. If you have been unemployed at any time during the last 3 years, state the dates of
      unemployment. If you have not been employed at any time in the last 3 years, give the
      information requested above in question 3.a for your last period of employment.
4. ASSETS:
   a. Real Estate. State the street address, if any, and if not, the legal description of all real property
      that you own or owned during the last 3 years. For each property, state the following:
      (1) the names and addresses of any other persons or entities holding any interest and their
          percentage of interest.
      (2) the purchase price, the cost of any improvements made since it was purchased, and the
          amount of any depreciation taken.
      (3) the fair market value on the date of your separation from your spouse.
      (4) the fair market value on the date of the filing of the petition for dissolution of marriage.
*1187
   b. Tangible Personal Property. List all items of tangible personal property that are owned by you
      or in which you have had any interest during the last 3 years including, but not limited to, motor
      vehicles, tools, furniture, boats, jewelry, art objects or other collections, and collectibles whose
      fair market value exceeds $100. For each item, state the following:
      (1) the percentage and type interest you hold.
      (2) the names and addresses of any other persons or entities holding any interest.
      (3) the date you acquired your interest.
      (4) the purchase price.
      (5) the present fair market value.
      (6) the fair market value on the date of your separation from your spouse.
      (7) the fair market value on the date of the filing of the petition for dissolution of marriage.
   c. Intangible Personal Property. Other than the financial accounts (checking, savings, money
      market, credit union accounts, retirement accounts, or other such cash management accounts)
      listed in the answers to interrogatories 4.d and 4.e below, list all items of intangible personal
      property that are owned by you or in which you have had any ownership interest (including closed
      accounts) within the last 3 years, including but not limited to, partnership and business interests
      (including good will), deferred compensation accounts unconnected with retirement, including but
      not limited to stock options, sick leave, and vacation pay, stocks, stock funds, mutual funds, bonds,
      bond funds, real estate investment trust, receivables, certificates of deposit, notes, mortgages,
      and debts owed to you by another entity or person. For each item, state the following:
      (1) the percentage and type interest you hold.
      (2) the names and addresses of any other persons or entities holding any interest and the
          names and addresses of the persons and entities who are indebted to you.
      (3) the date you acquired your interest.
      (4) the purchase price, acquisition cost, or loaned amount.
      (5) the fair market value or the amounts you claim are owned by or owed to you:
          (a) presently, at the time of answering these interrogatories.
          (b) on the date of your separation from your spouse.
          (c) on the date of the filing of the petition for dissolution of marriage.
You may comply with this interrogatory (4.c) by providing copies of all periodic (monthly, quarterly,
semi-annual, or annual) account statements for each such account for the preceding 3 years. DO NOT
FILE THESE DOCUMENTS IN THE COURT FILE. However, if the date of acquisition, the purchase price
and the market valuations are not clearly reflected in the periodic statements which are furnished
then these questions must be answered separately. You do not have to resubmit any periodic
statements previously furnished under rule 12.285 (Mandatory Disclosure).
*1188
   d. Retirement Accounts: List all information regarding each retirement account/plan, including but
      not limited to defined benefit plans, 401k, 403B, IRA accounts, pension plans, Florida
      Retirement System plans (FRS), Federal Government plans, money purchase plans, HR10
      (Keogh) plans, profit sharing plans, annuities, employee savings plans, etc. that you have
      established and/or that have been established for you by you, your employer, or any previous
      employer. For each account, state the following:
      (1) the name and last 4 digits of the account number of each account/plan and where it is
          located.
      (2) the type of account/plan.
      (3) the name and address of the fiduciary plan administrator/service representative.
      (4) the fair market value of your interest in each account/plan.
          (a) present value.
          (b) value on the date of separation.
          (c) value on the date of filing of the petition for dissolution of marriage
      (5) whether you are vested or not vested; and if vested, in what amount, as of a certain date
          and the schedule of future vesting.
      (6) the date at which you became/become eligible to receive some funds in this account/plan.
      (7) monthly benefits of the account/plan if no fair market value is ascertained.
      (8) beneficiary(ies) and/or alternate payee(s).
   e. Financial Accounts. For all financial accounts (checking, savings, money market, credit union
      accounts, or other such cash management accounts) listed in your Financial Affidavit, in which
      you have had any legal or equitable interest, regardless of whether the interest is or was held in
      your own name individually, in your name with another person, or in any other name, give the
      following:
      (1) name and address of each institution.
      (2) name in which the account is or was maintained.
      (3) the last 4 digits of account numbers.
      (4) name of each person authorized to make withdrawals from the accounts.
      (5) highest balance within each of the preceding 3 years.
      (6) lowest balance within each of the preceding 3 years.
You may comply with this interrogatory (4.e) by providing copies of all periodic (monthly, quarterly,
semi-annual, or annual) account statements for each such account for the preceding 3 years. DO NOT
FILE THESE DOCUMENTS IN THE COURT FILE. You do not have to resubmit account statements
previously furnished pursuant to rule 12.285 (Mandatory Disclosure).
   f. Closed Financial Accounts. For all financial accounts (checking, savings, money market, credit
      union accounts, or other such cash management accounts) closed within the last 3 years, in
*1189
      which you have had any legal or equitable interest, regardless of whether the interest is or was
      held in your own name individually, in your name with another person, or in any other name,
      give the following:
      (1) name and address of each institution.
      (2) name in which the account is or was maintained.
      (3) the last 4 digits of account numbers.
      (4) name of each person authorized to make withdrawals from the accounts.
      (5) date account was closed.
   g. Trust. For any interest in an estate, trust, insurance policy, or annuity, state the following:
      (1) If you are the beneficiary of any estate, trust, insurance policy, or annuity, give for each one
          the following:
          (a) identification of the estate, trust, insurance policy, or annuity.
          (b) the nature, amount, and frequency of any distributions of benefits.
          (c) the total value of the beneficiaries' interest in the benefit.
          (d) whether the benefit is vested or contingent.
     (2) If you have established any trust or are the trustee of a trust, state the following:
         (a) the date the trust was established.
         (b) the names and addresses of the trustees.
         (c) the names and addresses of the beneficiaries.
         (d) the names and addresses of the persons or entities who possess the trust documents.
         (e) each asset that is held in each trust, with its fair market value.
   h. Canceled Life Insurance Policies. For all policies of life insurance within the preceding 3 years
      that you no longer hold, own, or have any interest in, state the following:
      (1) name of company that issued the policy and last 4 digits of policy number.
      (2) name, address, and telephone number of agent who issued the policy.
      (3) amount of coverage.
      (4) name of insured.
      (5) name of owner of policy.
      (6) name of beneficiaries.
      (7) premium amount.
      (8) date the policy was surrendered.
      (9) amount, if any, of monies distributed to the owner.
*1190
   i. Name of Accountant, Bookkeeper, or Records Keeper. State the names, addresses, and
      telephone numbers of your accountant, bookkeeper, and any other persons who possess your
      financial records, and state which records each possesses.
   j. Safe Deposit Boxes, Lock Boxes, Vaults, Etc. For all safe deposit boxes, lock boxes, vaults, or
      similar types of depositories, state the following:
      (1) The names and addresses of all banks, depositories, or other places where, at any time
          during the period beginning 3 years before the initiation of the action, until the date of your
          answering this interrogatory, you did any of the following:
          (a) had a safe deposit box, lock box, or vault.
          (b) were a signatory or co-signatory on a safe deposit box, lock box, or vault.
          (c) had access to a safe deposit box, lock box, or vault.
          (d) maintained property.
      (2) The box or identification numbers and the name and address of each person who has had
          access to any such depository during the same time period.
      (3) All persons who have possession of the keys or combination to the safe deposit box, lock
          box, or vault.
      (4) Any items removed from any safe deposit boxes, lock boxes, vaults, or similar types of
          depositories by you or your agent during that time, together with the present location and
          fair market value of each item.
      (5) All items in any safe deposit boxes, lock boxes, vaults, or similar types of depositories and
          fair market value of each item.
5. LIABILITIES:
   a. Loans, Liabilities, Debts, and Other Obligations. For all loans, liabilities, debts, and other
      obligations (other than credit cards and charge accounts) listed in your Financial Affidavit,
      indicate for each the following:
      (1) name and address of the creditor.
      (2) name in which the obligation is or was incurred.
      (3) last 4 digits of loan or account number, if any.
      (4) nature of the security, if any.
      (5) payment schedule.
      (6) present balance and current status of your payments.
      (7) total amount of arrearage, if any.
      (8) balance on the date of your separation from your spouse.
*1191
      (9) balance on the date of the filing of the petition for dissolution of marriage.
You may comply with this interrogatory (5.a) by providing copies of all periodic (monthly, quarterly,
semi-annual, or annual) account statements for each such account for the preceding 3 years. DO NOT
FILE THESE DOCUMENTS IN THE COURT FILE. You do not have to resubmit account statements
previously furnished under rule 12.285 (Mandatory Disclosure).
   b. Credit Cards and Charge Accounts. For all financial accounts (credit cards, charge accounts, or
      other such accounts) listed in your Financial Affidavit, in which you have had any legal or
      equitable interest, regardless of whether the interest is or was held in your own name
      individually, in your name with another person, or in any other name, give the following:
      (1) name and address of the creditor.
      (2) name in which the account is or was maintained.
      (3) names of each person authorized to sign on the accounts.
      (4) last 4 digits of account numbers.
      (5) present balance and current status of your payments.
      (6) total amount of arrearage, if any.
      (7) balance on the date of your separation from your spouse.
      (8) balance on the date of the filing of the petition for dissolution of marriage.
      (9) highest and lowest balance within each of the preceding 3 years.
You may comply with this interrogatory (5.b) by providing copies of all periodic (monthly quarterly,
semi-annual, or annual) account statements for each such account for the preceding 3 years. DO NOT
FILE THESE DOCUMENTS IN THE COURT FILE. You do not have to resubmit account statements
previously furnished under rule 12.285 (Mandatory Disclosure).
   c. Closed Credit Cards and Charge Accounts. For all financial accounts (credit cards, charge
      accounts, or other such accounts) closed with no remaining balance, within the last 3 years, in
      which you have had any legal or equitable interest, regardless of whether the interest is or was
      held in your own name individually, in your name with another person, or in any other name,
      give the following:
      (1) name and address of each creditor.
      (2) name in which the account is or was maintained.
      (3) last 4 digits of account numbers.
      (4) names of each person authorized to sign on the accounts.
      (5) date the balance was paid off.
*1192
      (6) amount of final balance paid off.
You may comply with this interrogatory (5.c) by providing copies of all periodic (monthly, quarterly,
semi-annual, or annual) account statements for each such account for the preceding 3 years. DO NOT
FILE THESE DOCUMENTS IN THE COURT FILE. You do not have to resubmit account statements
previously furnished under rule 12.285 (Mandatory Disclosure).
6. MISCELLANEOUS:
   a. If you are claiming an unequal distribution of marital property or enhancement or appreciation
      of nonmarital property, state the amount claimed and all facts upon which you rely in your
      claim.
   b. If you are claiming an asset or liability is nonmarital, list the asset or liability and all facts upon
      which you rely in your claim.
   c. If the mental or physical condition of a spouse or child is an issue, identify the person and state
      the name and address of all health care providers involved in the treatment of that person for
      said mental or physical condition.
   d. Detail your proposed parenting plan for the minor child(ren), including your proposed time-sharing
      schedule. Alternatively, attach a copy of your proposed parenting plan.
   e. If you are claiming that the other parent's time-sharing with the minor child(ren) should be
      limited, supervised, or otherwise restricted, or that you should have sole parental responsibility
      for the minor child(ren), with or without time-sharing with the other parent, or that you should
      have ultimate responsibility over specific aspects of the child(ren)'s welfare or that these
      responsibilities should be divided between you and the other parent, state your reasons and all
      facts which you rely upon to support your claim.
7. LONG FORM AFFIDAVIT: If you filed the short form affidavit, Florida Family Law Rules of Procedure
   Form 12.902(b), and you were specifically requested in the Notice of Service of Standard Family Law
   Interrogatories to file the Long Form Affidavit, Form 12.902(c), you must do so within the time to
   serve the answers to these interrogatories.
*1193
        I certify that a copy of this document was [check one only] ( ) mailed ( ) faxed and mailed ( )
hand delivered to the person(s) listed below on {date} ______________.
  Other party or his/her attorney:
  Name: ____________________________
  Address: _________________________
  City, State, Zip: ________________
  Fax Number: ______________________
I understand that I am swearing or affirming under oath to the truthfulness of the answers to
these interrogatories 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: __________________________
  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]
I, {full legal name and trade name of nonlawyer} ___________________________________,
a nonlawyer, located at {street} ____________________, {city} _____________,
{state} ______, {phone} _______, helped {name} ___________________,
who is the [choose one only] ___ petitioner or ___ respondent, fill out this form.
*1194 INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.930(c), STANDARD FAMILY LAW INTERROGATORIES FOR MODIFICATION PROCEEDINGS (10/11)

When should this form be used?
This form should be used to ask the other party in your case to answer certain standard questions in writing. These questions are called interrogatories, and they must relate to your case. If the other party fails to answer the questions, you may ask the judge to order the other party to answer the questions. (You cannot ask these questions before the petition has been filed.)
The questions in this form should be used in modification proceedings and are meant to supplement the information provided in the Financial Affidavits, Florida Family Law Rules of Procedure Form 12.902(b) or (c). You should read all of the questions in this form to determine which questions, if any, the other party needs to answer in order to provide you with information not covered in the financial affidavit forms. If there are questions to which you already know the answer, you may choose not to ask them.
This form should be typed or printed in black ink. You must complete the box at the beginning of this form to indicate which questions you are requesting that the other party answer. You should send an original and one copy of this form and the Notice of Service of Standard Family Law Interrogatories, Florida Family Law Rules of Procedure Form 12.930(a), to the other party. You should also keep a copy for your records. You do not need to file this form with the clerk of the circuit court. However, you must file the Notice of Service of Standard Family Law Interrogatories, Florida Family Law Rules of Procedure Form 12.930(a), to tell the court that you have sent this form to the other party.
After you receive the completed answers to the interrogatories, DO NOT FILE THE ORIGINAL OR A COPY WITH THE CLERK OF THE COURT UNLESS THE ANSWERS ARE ADMITTED INTO EVIDENCE BY THE COURT AND ARE IN COMPLIANCE WITH FLORIDA RULE OF JUDICIAL ADMINISTRATION 2.425.

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 the instructions for Notice of Service of Standard Family Law Interrogatories, Florida Family Law Rules of Procedure Form 12.930(a), rules 12.280, 12.285, 12.340, and 12.380, Florida Family Law Rules of Procedure and rules 1.280, 1.340, and 1.380, Florida Rules of Civil Procedure.

Special notes . . .
In addition to the standard questions in this form, you may ask up to 10 additional questions. You should type or print your additional questions on a separate sheet of paper and attach it to this form. If you want to ask more than 10 additional questions, you will need to get permission from the judge.
You may want to inform the other party of the following information: As a general rule, within 30 days after service of interrogatories, the other party must answer the questions in writing and mail (have postmarked) the answers to you. His or her answers shall be written in the *1195 blank space provided after each separately numbered interrogatory. If sufficient space is not provided, the answering party may attach additional papers with the answers and refer to them in the space provided in the interrogatories. He or she should be sure to make a copy for him/herself. All answers to these questions are made under oath or affirmation as to their truthfulness. Each question must be answered separately and as completely as the available information permits. The original of the answers to the interrogatories is to be provided to the requesting party. DO NOT FILE THE ORIGINAL OR A COPY WITH THE CLERK OF THE CIRCUIT COURT UNLESS THE ANSWERS ARE ADMITTED INTO EVIDENCE BY THE COURT AND ARE IN COMPLIANCE WITH FLORIDA RULE OF JUDICIAL ADMINISTRATION 2.425. The other party may object to a question by writing the legal reason for the objection in the space provided. He or she may also ask the court for a protective order granting him or her permission not to answer certain questions and protecting him or her from annoyance, embarrassment, apprehension, or undue burden or expense. If the other party fails to either answer or object to the questions within 30 days, he or she may be subject to court sanctions.
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.
*1196
         IN THE CIRCUIT COURT OF THE _________________ JUDICIAL CIRCUIT,
                    IN AND FOR ________________ COUNTY, FLORIDA
                                                 Case No.: _____________________
                                                 Division: _____________________
   ___________________________,
                    Petitioner
            and
  ____________________________,
                    Respondent.
                      STANDARD FAMILY LAW INTERROGATORIES
                              FOR MODIFICATION PROCEEDINGS
------------------------------------------------------------------------------------------------
              TO BE COMPLETED BY THE PARTY SERVING THESE INTERROGATORIES
    I am requesting that the following standard questions be answered: [check all that apply]
        ____1      ____2       ____3     ____4       ____ 5         ____6         ____7
    Background  Education   Employment   Assets   Liabilities   Miscellaneous   Long Form
    Information                                    Affidavit
  In addition, I am requesting that the attached {#} _________________ questions be answered.
------------------------------------------------------------------------------------------------
       The answers to the following questions are intended to supplement the information
provided in the Financial Affidavits, Florida Family Law Rules of Procedure Form 12.902(b) or (c).
You should answer the group of questions indicated in the above shaded box. The questions
should be answered in the blank space provided below each separately numbered question. If
sufficient space is not provided, you may attach additional papers with the answers and refer to
them in the space provided in the interrogatories. You should be sure to make a copy for
yourself. Each question must be answered separately and as completely as the available
information permits. All answers are to be made under oath or affirmation as to their
truthfulness.
AFTER YOU ANSWER THE INTERROGATORIES, DO NOT FILE THE ORIGINAL WITH THE CLERK OF
THE COURT. ALL PERSONAL INFORMATION CONTAINED IN THE COURT FILE BECOMES PUBLIC
RECORD. INSTEAD, SERVE THE ORIGINAL OF THE ANSWERS TO THE INTERROGATORIES ON THE
OTHER PARTY AND FILE FORM 12.930(d), NOTICE OF SERVICE OF ANSWERS TO
INTERROGATORIES, WITH THE CLERK.
*1197
       I, {name of person answering interrogatories} _______________________________,
being sworn, certify that the following information is true:
1. BACKGROUND INFORMATION:
   a. State your full legal name and any other name by which you have been known.
   b. State your present residence and telephone numbers.
2. EDUCATION:
   a. List all business, commercial, and professional licenses that you have obtained since the
      entry of the Final Judgment sought to be modified.
   b. List all of your education since the entry of the Final Judgment sought to be modified
      including, but not limited to, vocational or specialized training, including the following:
      (1) name and address of each educational institution.
      (2) dates of attendance.
      (3) degrees or certificates obtained or anticipated dates of same.
3. EMPLOYMENT:
   a. For each place of your employment or self-employment since the entry of the Final
      Judgment sought to be modified, state the following:
     (1) name, address, and telephone number of your employer.
     (2) dates of employment.
     (3) job title and brief description of job duties.
     (4) starting and ending salaries.
     (5) name of your direct supervisor.
     (6) all benefits received, including, for example, health, life, and disability insurance;
         expense account; use of automobile or automobile expense reimbursement;
         reimbursement for travel, food, or lodging expenses; payment of dues in any clubs
         or associations; and pension or profit sharing plans.
*1198
   b. Other than as an employee, if you have been engaged in or associated with any
      business, commercial, or professional activity since the entry of the Final Judgment
      sought to be modified that was not detailed above, state for each such activity the
      following:
     (1) name, address, and telephone number of each activity.
     (2) dates you were connected with such activity.
     (3) position title and brief description of activities.
     (4) starting and ending compensation.
     (5) name of all persons involved in the business, commercial, or professional activity
         with you.
     (6) all benefits and compensation received, including, for example, health, life, and
         disability insurance; expense account; use of automobile or automobile expense
         reimbursement; reimbursement for travel, food, or lodging expenses; payment of
         dues in any clubs or associations; and pension or profit sharing plans.
   c. If you have been unemployed at any time since the entry of the Final Judgment sought
      to be modified, state the dates of unemployment. If you have not been employed at any
      time since the entry of the Final Judgment sought to be modified, give the information
      requested above in question 3.a for your last period of employment.
4. ASSETS:
   a. Real Estate. State the street address, if any, and if not, the legal description of all real
      property that you own or owned during the last 3 years, or since the entry of the Final
      Judgment sought to be modified, if shorter. For each property, state the following:
      (1) the names and addresses of any other persons or entities holding any interest and
          their percentage of interest.
      (2) the present fair market value.
*1199
   b. Tangible Personal Property. List all items of tangible personal property that are owned
      by you or in which you have had any interest during the last 3 years, or since the entry
      of the Final Judgment sought to be modified, if shorter, including, but not limited to,
      motor vehicles, tools, furniture, boats, Jewelry, art objects or other collections, and
      collectibles whose fair market value exceeds $100. For each item, state the following:
      (1) the percentage and type interest you hold.
      (2) the names and addresses of any other persons or entities holding any interest.
      (3) the present fair market value.
   c. Intangible Personal Property. Other than the financial accounts (checking, savings,
      money market, credit union accounts, retirement accounts, or other such cash
      management accounts) listed in the answers to interrogatories 4.d and 4.e below, list all
      items of intangible personal property that are owned by you or in which you have had any
      ownership interest (including closed accounts) within the last 3 years, or since the entry of
      the Final Judgment sought to be modified, if shorter, including but not limited to,
      partnership and business interests (including good will), deferred compensation accounts
      unconnected with retirement, including but not limited to stock options, sick leave, and
      vacation pay, stocks, stock funds, mutual funds, bonds, bond funds, real estate investment
      trust, receivables, certificates of deposit, notes, mortgages, and debts owed to you by
      another entity or person. For each item, state the following:
      (1) the percentage and type interest you hold.
      (2) the names and addresses of any other persons or entities holding any interest and
          the names and addresses of the persons and entities who are indebted to you.
      (3) the present fair market value or the amounts you claim are owned by or owed to
          you, at the time of answering these interrogatories.
You may comply with this interrogatory (4.c) by providing copies of all periodic (monthly,
quarterly, semi-annual, or annual) account statements for each such account for the preceding
3 years, or since the entry of the Final Judgment sought to be modified, if shorter. DO NOT
FILE THESE DOCUMENTS IN THE COURT FILE. However, if the date of acquisition, the purchase
price, and the market valuations are not clearly reflected in the periodic statements which are
furnished, then these questions must be answered separately. You do not have to resubmit
any periodic statements previously furnished under rule 12.285 (Mandatory Disclosure).
*1200
   d. Retirement Accounts: List all information regarding each retirement account/plan,
      including but not limited to defined benefit plans, 401k, 403B, IRA accounts, pension
      plans, Florida Retirement System plans (FRS), Federal Government plans, money
      purchase plans, HR10 (Keogh) plans, profit sharing plans, annuities, employee savings
      plans, etc. that you have established and/or that have been established for you by you,
      your employer, or any previous employer. For each account, state the following:
      (1) the name and last 4 digits of the account number of each account/plan and where
          it is located.
      (2) the type of account/plan.
      (3) the name and address of the fiduciary plan administrator/service representative.
      (4) the present fair market value of your interest in each account/plan.
      (5) whether you are vested or not vested; and if vested, in what amount, as of a certain
          date and the schedule of future vesting.
      (6) the date at which you became/become eligible to receive some funds in this
          account/plan.
      (7) monthly benefits of the account/plan if no fair market value is ascertained.
      (8) beneficiary(ies) and/or alternate payee(s).
   e. Financial Accounts. For all financial accounts (checking, savings, money market, credit
      union accounts, or other such cash management accounts) listed in your Financial
      Affidavit, in which you have had any legal or equitable interest, regardless of whether
      the interest is or was held in your own name individually, in your name with another
      person, or in any other name, give the following:
      (1) name and address of each institution.
      (2) name in which the account is or was maintained.
      (3) last 4 digits of account numbers.
      (4) name of each person authorized to make withdrawals from the accounts.
      (5) highest balance within each of the preceding 3 years, or since the entry of the Final
          Judgment sought to be modified, if shorter.
      (6) lowest balance within each of the preceding 3 years, or since the entry of the Final
          Judgment sought to be modified, if shorter.
You may comply with this interrogatory (4.e) by providing copies of all periodic (monthly,
quarterly, semi-annual, or annual) account statements for each such account for the preceding
3 years, or since the entry of the Final Judgment sought to be modified, if shorter. DO NOT
FILE THESE DOCUMENTS IN THE COURT FILE. You do not have to resubmit account statements
previously furnished pursuant to rule 12.285 (Mandatory Disclosure).
*1201
f. Closed Financial Accounts. For all financial accounts (checking, savings, money market,
   credit union accounts, or other such cash management accounts) closed within the last
   3 years, or since the entry of the Final Judgment sought to be modified, if shorter, in
   which you have had any legal or equitable interest, regardless of whether the interest is
   or was held in your own name individually, in your name with another person, or in any
   other name, give the following:
   (1) name and address of each institution.
   (2) name in which the account is or was maintained.
   (3) last 4 digits of account numbers.
   (4) name of each person authorized to make withdrawals from the accounts.
   (5) date account was closed.
g. Trust. For any interest in an estate, trust, insurance policy, or annuity, state the
   following:
   (1) If you are the beneficiary of any estate, trust, insurance policy, or annuity, give for
       each one the following:
       (a) identification of the estate, trust, insurance policy, or annuity.
       (b) the nature, amount, and frequency of any distributions of benefits.
       (c) the total value of the beneficiaries' interest in the benefit.
       (d) whether the benefit is vested or contingent.
   (2) If you have established any trust or are the trustee of a trust, state the following:
       (a) the date the trust was established.
       (b) the names and addresses of the trustees.
       (c) the names and addresses of the beneficiaries.
       (d) the names and addresses of the persons or entities who possess the trust
           documents.
       (e) each asset that is held in each trust, with its fair market value.
h. Name of Accountant, Bookkeeper, or Records Keeper. State the names, addresses, and
   telephone numbers of your accountant, bookkeeper, and any other persons who
   possess your records, and state which records each possesses.
*1202
5. LIABILITIES:
   a. Loans, Liabilities, Debts, and Other Obligations. For all loans, liabilities, debts, and
      other obligations (other than credit cards and charge accounts) listed in your Financial
      Affidavit, indicate for each the following:
      (1) name and address of the creditor.
      (2) name in which the obligation is or was incurred.
      (3) last 4 digits of loan or account number, if any.
      (4) nature of the security, if any.
      (5) payment schedule.
      (6) present balance and current status of your payments.
      (7) total amount of arrearage, if any.
You may comply with this interrogatory (5.a) by providing copies of all periodic (monthly,
quarterly, semi-annual, or annual) account statements for each such account for the preceding
3 years, or since the entry of the Final Judgment sought to be modified, if shorter. DO NOT
FILE THESE DOCUMENTS IN THE COURT FILE. You do not have to resubmit account statements
previously furnished under rule 12.285 (Mandatory Disclosure).
   b. Credit Cards and Charge Accounts. For all financial accounts (credit cards, charge
      accounts, or other such accounts) listed in your Financial Affidavit, in which you have
      had any legal or equitable interest, regardless of whether the interest is or was held in
      your own name individually, in your name with another person, or in any other name,
      give the following:
      (1) name and address of the creditor.
      (2) name in which the account is or was maintained.
      (3) names of each person authorized to sign on the accounts.
      (4) last 4 digits of account numbers.
      (5) present balance and current status of your payments.
      (6) total amount of arrearage, if any.
      (7) highest and lowest balance within each of the preceding 3 years, or since the entry
          of the Final Judgment sought to be modified, if shorter.
   You may comply with this interrogatory (5.b) by providing copies of all periodic (monthly
   quarterly, semi-annual, or annual) account statements for each such account for the
   preceding 3 years, or since the entry of the Final Judgment sought to be modified, if
   shorter. DO NOT FILE THESE DOCUMENTS IN THE COURT FILE. You do not have to
   resubmit account statements previously furnished under rule 12.285 (Mandatory
   Disclosure).
*1203
   c. Closed Credit Cards and Charge Accounts. As to all financial accounts (credit cards,
      charge accounts, or other such accounts) closed with no remaining balance, within the
      last 3 years, or since the entry of the Final Judgment sought to be modified, if shorter, in
      which you have had any legal or equitable interest, regardless of whether the interest is
      or was held in your own name individually, in your name with another person, or in any
      other name, give the following:
      (1) name and address of each creditor.
      (2) name in which the account is or was maintained.
      (3) last 4 digits of account numbers.
      (4) name of each person authorized to sign on the accounts.
      (5) date the balance was paid off.
      (6) amount of final balance paid off.
You may comply with this interrogatory (5.c) by providing copies of all periodic (monthly,
quarterly, semi-annual, or annual) account statements for each such account for the preceding
3 years, or since the entry of the Final Judgment sought to be modified, if shorter. DO NOT
FILE THESE DOCUMENTS IN THE COURT FILE. You do not have to resubmit account statements
previously furnished under rule 12.285 (Mandatory Disclosure).
6. MISCELLANEOUS:
   a. If you are claiming a diminished earning capacity since the entry of the Final Judgment
      sought to be modified as grounds to modify alimony or deviate from the child support
      established in your case, describe in detail how your earning capacity is lowered and
      state all facts upon which you rely in your claim. If unemployed, state how, why, and
      when you lost your job.
   b. If you are claiming a change in a mental of physical condition since the entry of the Final
      Judgment sought to be modified as grounds to modify alimony or change the child
      support established in your case, describe in detail how your mental and/or physical
      capacity has changed and state all facts upon which you rely in your claim. Identify the
      change in your mental and/or physical capacity, and state the name and address of all
      health care providers involved in the treatment of this mental or physical condition.
   c. If you are requesting a change in shared or sole parental responsibility, ultimate
      decision-making, the time-sharing schedule, the parenting plan, or any combination
      thereof, for the minor child(ren), describe in detail the change in circumstances since
      the entry of the Final Judgment sought to be modified that you feel justify the
      requested change. State when the change of circumstances occurred, how the change
      of circumstances affects the child(ren), and why it is in the best interests of the
      child(ren) that the Court make the requested change. Attach your proposed parenting
      plan.
*1204
d. If you do not feel the requested change in shared or sole parental responsibility,
ultimate decision-making, the time-sharing schedule, the parenting plan, or any
combination thereof, for the minor child(ren) is in their best interests, or if you feel
there has not been a change in circumstances since the entry of the Final Judgment
sought to be modified, describe in detail any facts since the entry of the Final Judgment
sought to be modified that you feel justify the Court denying the requested change.
State what requested change, if any in shared or sole parenting responsibility, ultimate
decision-making, the time-sharing schedule, or of the parenting plan is justified or
agreeable to you and why it is in the best interests of the child(ren).
7. LONG FORM AFFIDAVIT: If you filed the short form affidavit, Florida Family Law Rules of
Procedure Form 12.902(b), and you were specifically requested in the Notice of Service of
Standard Family Law Interrogatories to file the Long Form Affidavit, Form 12.902(c), you
must do so within the time to serve the answers to these interrogatories.
*1205
    I certify that a copy of this document was [check one only] ( ) mailed ( ) faxed and
mailed ( ) hand delivered to the person(s) listed below on {date} ________________________.
  Other party or his/her attorney:
  Name: _________________________
  Address: ______________________
  City, State, Zip: _____________
  Fax Number: ____________________
        I understand that I am swearing or affirming under oath to the truthfulness of the
answers to these interrogatories 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: ___________________
  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]
I, {full legal name and trade name of nonlawyer} _____________________________________,
a nonlawyer, located at {street} ________________, {city} ___________________,
{state} _____________, {phone} _____, helped {name} ________________,
who is the [check one only] ___ petitioner or ___ respondent, fill out this form.

*1206 INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.930(d), NOTICE OF SERVICE OF ANSWERS TO STANDARD FAMILY LAW INTERROGATORIES (10/11)

When should this form be used?
You should use this form to tell the court that you have responded to the other party's request to answer certain standard questions (interrogatories) in writing.
This form should be typed or printed in black ink. You must indicate whether you are sending the answers to interrogatories for original and enforcement proceedings, Florida Family Law Rules of Procedure Form 12.930(b), or modification proceedings, Florida Family Law Rules of Procedure Form 12.930(c). You must also indicate whether you have additional questions that you were asked to answer. 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.

What should I do next?
A copy of this form and the original completed answers to the interrogatories must be mailed or hand delivered to the other party in your case. However, file only this form with the clerk. DO NOT FILE THE ORIGINAL ANSWERS TO THE INTERROGATORIES OR ANY ATTACHMENTS WITH THE CLERK UNLESS THEY ARE ADMITTED INTO EVIDENCE BY THE COURT AND ARE IN COMPLIANCE WITH FLORIDA RULE OF JUDICIAL ADMINISTRATION 2.425.

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 Florida Family Law Rules of Procedure Rules 12.280, 12.285, 12.340, and 12.380, and Florida Rules of Civil Procedure Rules 1.280, 1.340, and 1.380.

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 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.
*1207
           IN THE CIRCUIT COURT OF THE_______________________JUDICIAL CIRCUIT,
                   IN AND FOR________________________COUNTY, FLORIDA
                                                         Case No.:_________________
                                                          Division:________________
  __________________________,
                  Petitioner
          and
  __________________________,
                 Respondent.
                             NOTICE OF SERVICE OF ANSWERS TO
                           STANDARD FAMILY LAW INTERROGATORIES
I, {full legal name} ________________________________, have on {date}____________ served
on {name}_________________________ fully completed and sworn answers to the standard
family law interrogatories served on me, and additional interrogatories if requested. The
interrogatories were for [check one only] ( ) original or enforcement proceedings
( ) modification proceedings.
I UNDERSTAND THAT I SHOULD NOT FILE THE ANSWERS TO INTERROGATORIES WITH THE
CLERK OF THE CIRCUIT COURT EXCEPT AS PROVIDED BY FLORIDA RULE OF CIVIL PROCEDURE
1.340(e).
*1208
I certify that a copy of this document was [choose only one ( ) mailed ( ) faxed and mailed
( ) hand delivered to the person(s) listed below on {date} _______________________.
  Other party or his/her attorney:
  Name:_____________________________
  Address:__________________________
  City, State, Zip:_________________
  Fax Number:_______________________
  Dated:____________________________
                                              ____________________________________________
                                              Signature of Party
                                              Printed Name:_______________________________
                                              Address:____________________________________
                                              City, State, Zip:___________________________
                                              Telephone Number:___________________________
                                              Fax Number:_________________________________
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, located at {street}___________________________________________,
{city}__________________________________________, {state}__________, {phone}______,
helped {name}_________________________________________________, who is the [check one only]
( ) petitioner or ( ) respondent, fill out this form.

*1209 INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.932, CERTIFICATE OF COMPLIANCE WITH MANDATORY DISCLOSURE (10/11)

When should this form be used?
Mandatory disclosure requires each party in a dissolution of marriage case to provide the other party with certain financial information and documents. These documents must be provided by mail or hand delivery to the other party within 45 days of service of the petition for dissolution of marriage or supplemental petition for modification on the respondent. The mandatory disclosure rule applies to all original and supplemental dissolution of marriage cases, except simplified dissolution of marriage cases and cases where the respondent is served by constructive service and does not answer. You should use this form to notify the court and the other party that you have complied with the mandatory disclosure rule.
Each party must provide the other party with the documents listed in section 2 of this form if the relief being sought is permanent regardless of whether it is an initial or supplemental proceeding. Of the documents listed on this form, the financial affidavit and child support guidelines worksheet are the only documents that may be required to be filed with the court under Florida Family Law Rules of Procedure 12.285(c) and (k) but must be sent to the other party; all other documents should be sent to the other party but shall not be filed with the court. If your individual gross annual income is under $50,000, you should complete the Family Law Financial Affidavit (Short Form), Florida Family Law Rules of Procedure Form 12.902(b). If your individual gross annual income is $50,000 or more, you should complete the Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(c).
In addition, there are separate mandatory disclosure requirements that apply to temporary financial hearings, which are listed in section 1 of this form. The party seeking temporary financial relief must serve these documents on the other party with the notice of temporary financial hearing. The responding party must either deliver the required documents to the party seeking temporary relief on or before 5:00 p.m., 2 business days before the hearing on temporary relief, or mail (postmark) them to the other party seeking temporary relief 7 days before the hearing on temporary financial relief. Any documents that have already been served under the requirements for temporary or initial proceedings, do not need to be reserved again in the same proceeding. If a supplemental petition is filed, seeking modification, then the mandatory disclosure requirements begin again.
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 is filed and keep a copy for your records. A copy of this form must be mailed or hand delivered to any other party in your case.

What should I do next?
After you have provided the other party all of the financial information and documents and have filed this form certifying that you have complied with this rule, you are under a continuing duty to promptly give the other party any information or documents that change your financial status or that make the information already provided inaccurate. You should not file with the clerk any of the documents listed in the *1210 certificate of compliance other than the financial affidavit and child support guidelines worksheet. Refer to the instructions regarding the petition in your case to determine how you should proceed after filing this form.

Where can I look for more information?
Before proceeding, you should read "General Information for Self-Represented Litigants" found at the beginning of these forms. For further information, see rule 12.285, Florida Family Law Rules of Procedure.

Special notes ...
You may provide copies of required documents; however, the originals must be produced for inspection if the other party requests to see them.
Although the financial affidavits are based on individual gross income, either party may ask the other party to complete the Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(c), by serving the appropriate interrogatory form. (See Standard Family Law Interrogatories, Florida Family Law Rules of Procedure Form 12.930(b) (original proceedings) or (c) (modification proceedings)).
Any portion of the mandatory disclosure rule may be modified by order of the judge or agreement of the parties. Therefore, you and your spouse may agree that you will not require each other to produce the documents required under the mandatory disclosure rule. This exception does not apply to the Financial Affidavit, Family Law Rules of Procedure Form 12.902(b) or (c), which is required in all cases and cannot be waived.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1211
              IN THE CIRCUIT COURT OF THE ________________ JUDICIAL CIRCUIT,
                      IN AND FOR __________________ COUNTY, FLORIDA
                                                 Case No.: ________________
                                                 Division: ________________
  _________________________,
                Petitioner,
         and
  _________________________,
                 Respondent.
              CERTIFICATE OF COMPLIANCE WITH MANDATORY DISCLOSURE
         I, {full legal name}________________________________, certify that I
have complied with the mandatory disclosure required by Florida Family Law Rule 12.285 as
follows:
1. FOR TEMPORARY FINANCIAL RELIEF, ONLY:
   The date the following documents were served: ____________________________.
   [Check all that apply]
   a. ___ Financial Affidavit
         (  ) Florida Family Law Rules of Procedure Form 12.902(b) (short form)
         (  ) Florida Family Law Rules of Procedure Form 12.902(c) (long form)
   b. ___(  ) All personal (1040) federal tax, gift tax, and intangible personal property tax
              returns for the preceding year; or
         (  ) Transcript of tax return as provided by IRS form 4506-T; or
         (  ) IRS forms W-2, 1099, and K-1 for the past year because the income tax return
         for the past year has not been prepared.
   c. ___Pay stubs or other evidence of earned income for the 3 months before the service
         of the financial affidavit.
2. FOR INITIAL, SUPPLEMENTAL, AND PERMANENT FINANCIAL RELIEF:
   The date the following documents were served: _______________________.
   [Check all that apply]
   a. ___ Financial Affidavit
         ( ) Florida Family Law Rules of Procedure Form 12.902(b) (short form)
         ( ) Florida Family Law Rules of Procedure Form 12.902(c) (long form)
   b. ___( ) All personal (1040) federal and state income tax returns, gift tax returns, and
           intangible personal property tax returns for the preceding 3 years;
         ( ) IRS forms W-2, 1099, and K-1 for the past year because the income tax return
             for the past year has not been prepared.
   c. ___Pay stubs or other evidence of earned income for the 3 months before the service
         of the financial affidavit.
*1212
   d. ___ A statement identifying the source and amount of all income for the 3 months
          before the service of the financial affidavit, if not reflected on the pay stubs
          produced.
   e. ___ All loan applications and financial statements prepared for any purpose or used for
          any purpose within the 12 months preceding the service of the financial affidavit.
   f. ___ All deeds to real estate in which I presently own or owned an interest within the
          past 3 years. All promissory notes in which I presently own or owned an interest
          within the last 12 months. All present leases in which I own an interest.
   g. ___ All periodic statements for the last 3 months for all checking accounts and for the
          last year for all savings accounts, money market funds, certificates of deposit, etc.
   h. ___ All brokerage account statements for the last 12 months.
   i. ___ Most recent statement for any pension, profit sharing, deferred compensation, or
          retirement plan (for example, IRA, 401(k), 403(b), SEP, KEOGH, etc.) and summary
          plan description for any such plan in which I am a participant or alternate payee.
   j. ___ The declaration page, the last periodic statement, and the certificate for any group
          insurance for all life insurance policies insuring my life or the life of me or my
          spouse.
   k. ___ All health and dental insurance cards covering either me or my spouse and/or our
          dependent child(ren).
   l. ___ Corporate, partnership, and trust tax returns for the last 3 tax years, in which I have
          an ownership or interest greater than or equal to 30%.
   m. ___ All credit card and charge account statements and other records showing my (our)
          indebtedness as of the date of the filing of this action and for the prior 3 months. All
          promissory notes on which I presently owe or owned within the past year. All lease
          agreements I presently owe.
   n. ___ All premarital and marital agreements between the parties to this case.
   o. ___ If a modification proceeding, all written agreements entered into between the
          parties at any time since the order to be modified was entered.
   p. ___ All documents and tangible evidence relating to claims for an unequal distribution
          of marital property, enhancement or appreciation in nonmarital property, or
          nonmarital status of an asset or debt.
   q. ___ Any court order directing that I pay or receive spousal support (alimony) or child
          support.
I certify that a copy of this document was [Check one only] ( ) mailed ( ) faxed and mailed
( ) hand delivered to the person(s) listed below on {date} ___________________________________.
*1213
I understand that I am swearing or affirming under oath to the accuracy of my compliance with
the mandatory disclosure requirements of Fla. Fam. L. R. P. 12.285 and that, unless otherwise
indicated with specificity, this disclosure is complete. I further understand that the punishment
for knowingly making a false statement or incomplete disclosure includes fines and/or
imprisonment.
Other party or his/her attorney:
Name: _________________________________
Address: ______________________________
City, State, Zip: _____________________
Fax Number: ___________________________
Dated: ___________________________
                                       ___________________________________
                                       Signature of Party
                                       Printed Name: _____________________
                                       Address: __________________________
                                       City, State, Zip: _________________
                                       Telephone Number: _________________
                                       Fax Number: _______________________
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]
I, {full legal name and trade name of nonlawyer} ________________________________________,
a nonlawyer, located at {street} __________________________, {city} ____________,
{state} ______________________, {phone}______________, helped {name}___,
who is the [Check one only] ___ petitioner or ___ respondent, fill out this form.

*1214 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.943, MOTION TO DEVIATE FROM CHILD SUPPORT GUIDELINES (10/11)

When should this form be used?
Child support in Florida is determined by the child support guidelines found in section 61.30, Florida Statutes. The court, at its discretion, may raise or lower the child support guidelines amount by up to 5%. In addition, the court may raise or lower the guidelines support amount by more than 5%, if written reasons are given for the adjustment. The court may make these additional adjustments based on certain considerations, which are reflected in this form. You should review this form to determine if any of the reasons for adjusting the child support guidelines amount apply to your situation and you should complete this form only if you want the court to order more child support or less child support than the amount required by the child support guidelines.
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 is filed and keep a copy for your records.

What should I do next?
A copy of this form must be mailed or hand delivered to the other party in your case.

Where can I look for more information?
Before proceeding, you should read General Information for Self-Represented Litigants found at the beginning of these forms. For further information, see section 61.30, Florida Statutes.

Special notes ...
More information on the child support guidelines as well as a chart for converting income and expenses to monthly amounts if paid or incurred on other than a monthly basis is contained in the instructions to Florida Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), and the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e).
With this form you must also file the following, if not already filed:
 Florida Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c).
 Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). (If you do not know the other party's income, you should file this worksheet as soon as you receive a copy of his or her financial affidavit.)
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.
*1215
                   IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
                      IN AND FOR ______________________________ COUNTY, FLORIDA
                                                           Case No: _________________________________________
                                                           Division: ________________________________________
  ________________________________,
                        Petitioner,
            and
  ________________________________,
                        Respondent.
                   MOTION TO DEVIATE FROM CHILD SUPPORT GUIDELINES
( ) Petitioner ( ) Respondent requests that the Court enter an order granting the following:
SECTION I.
   [Choose only one]
   A. ___MORE child support than the amount required by the child support guidelines. The Court
      should order MORE child support than the amount required by the child support guidelines
      because of:
   [Choose all that apply to your situation]
   1. ___ Extraordinary medical, psychological, educational, or dental expenses;
   2. ___ Seasonal variations in one or both parent's income or expenses;
   3. ___ Age(s) of the child(ren), taking into consideration the greater needs of older child(ren);
   4. ___ Special needs, such as costs that may be associated with the disability of a child or
      child(ren), that have traditionally been met within the family budget even though the fulfilling
      of those needs will cause support to exceed the presumptive amount established by the
      guidelines;
   5. ___ Total available assets of obligee, obligor, and the child(ren);
   6. ___ Impact of IRS dependency exemption and waiver of that exemption;
   7. ___ The Parenting Plan, such as where the child or children spend a significant amount of time,
      but less than 40 percent of the overnights, with one parent, thereby reducing the financial
      expenditures incurred by the other parent, or the refusal of a parent to become involved in the
      activities of the child(ren) has increased the financial expenditure incurred by the obligee;
   8. ___ Any other adjustment that is needed to achieve an equitable result, which may include
      reasonable and necessary expenses or debts jointly incurred during the marriage.
      Explain any items marked above: _______________________________________________________________________
      _______________________________________________________________________________________________________
      _______________________________________________________________________________________________________
*1216
B. ___ LESS child support than the amount required by the child support guidelines. The Court
   should order LESS child support than the amount required by the child support guidelines
   because of:
[Choose all that apply to your situation]
1. ___ Extraordinary medical, psychological, educational, or dental expenses;
2. ___ Independent income of child(ren), excluding the child(ren)'s SSI (supplemental security
   income)
3. ___ Payment of both child support and spousal support to a parent that regularly has been paid
   and for which there is a demonstrated need;
4. ___ Seasonal variations in one or both parent's income or expenses;
5. ___ Age of the child(ren), taking into consideration the greater needs of older child(ren);
6. ___ Total available assets of obligee, obligor, and child(ren);
7. ___ Impact of IRS dependency exemption and waiver of that exemption;
8. ___ Application of the child support guidelines which requires the obligor to pay more than 55%
   of gross income for a single support order;
9. ___ Residency of subsequently born or adopted child(ren) with the obligor, include
   consideration of the subsequent spouse's income;
10. ___ The Parenting Plan, where the child(ren) spend a significant amount of time, but less than
    40 percent of the overnights, with one parent, thereby reducing the financial expenditures
    incurred by the other parent; or the refusal of a parent to become involved in the activities of
    the child(ren);
11. ___ Any other adjustment that is needed to achieve an equitable result, which may include
    reasonable and necessary expenses or debts jointly incurred during the marriage.
    Explain any items marked above __________________________________________________________________________
    _________________________________________________________________________________________________________
    _________________________________________________________________________________________________________
SECTION II. INCOME AND ASSETS OF CHILD(REN) COMMON TO BOTH PARTIES
List the total of any independent income or assets of the child(ren) common to both parties (income
from Social Security, gifts, stocks/bonds, employment, trust fund(s), investment(s), etc.). If any account
numbers are listed, please list only the last four (4) digits of the number. Attach an explanation.
TOTAL VALUE OF ASSETS OF CHILD(REN)                $ ____
TOTAL MONTHLY INCOME OF CHILD(REN)                 $ ____
I have filed, will file, or am filing with this form the following additional documents:
1. Florida Family Law Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form
   12.902(b) or (c).
2. Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e).
*1217
I certify that a copy of this document was [Choose only one] ( ) mailed ( ) faxed and mailed
( ) hand delivered to the person(s) listed below on {date} _________________________________________
Other party or his/her attorney:
Name: ________________________________________
Address: _____________________________________
City, State, Zip: ____________________________
Fax Number: __________________________________
                                            _________________________________________________________________
                                            Signature of Party or his/her attorney
                                            Printed Name: ___________________________________________________
                                            Address: ________________________________________________________
                                            City, State, Zip: _______________________________________________
                                            Telephone Number: _______________________________________________
                                            Fax Number: _____________________________________________________
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
                                            Printed name: ___________________________________________________
                                            Address: ________________________________________________________
                                            City, State, Zip: _______________________________________________
                                            Telephone Number: _______________________________________________
                                            Fax Number: _____________________________________________________
STATE OF FLORIDA
COUNTY OF ____________________________
Sworn to or affirmed and signed before me on ______________ by ______________________________________________.
                                             ________________________________________________________________
                                             NOTARY PUBLIC or CLERK
                                             ________________________________________________________________
                                             {Print, type, or stamp commissioned name of notary or
                                             Clerk}
____ Personally known
____ Produced identification {type of identification produced} _____________________________________
*1218
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 the petitioner, fill out this form.

*1219 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.947(a), MOTION FOR TEMPORARY SUPPORT AND TIMESHARING WITH DEPENDENT OR MINOR CHILD(REN) (10/11)

When should this form be used?
This form may be used by:
(1) The respondent or the petitioner in a pending dissolution of marriage action. For you to use this form, a petition for dissolution of marriage must have already been filed. You should use this form to ask the court to award any of the following: temporary use of assets; temporary exclusive use of the marital home; temporary responsibility for liabilities/debts; temporary spousal support (alimony); temporary time-sharing schedule with minor child(ren); temporary child support; and other relief.

OR
(2) The petitioner in a pending action for support unconnected with dissolution. For you to use this form, a petition for support unconnected with dissolution of marriage must have already been filed. You should use this form to ask the court to award temporary spousal support (alimony) and/or temporary child support.
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 the petition for dissolution of marriage was filed and keep a copy for your records.

What should I do next?
A copy of this form, along with all of the other forms required with this motion, must be mailed or hand delivered to the other party in your case. When you have filed all of the required forms, you are ready to set a hearing on your motion. You should check with the clerk, family law intake staff, or judicial assistant for information on the local procedure for scheduling a hearing. When you know the date and time of your hearing, you should notify the other party using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.

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. Words in bold underline in these instructions are defined there. For further information, see chapter 61, Florida Statutes, rule 12.285, Florida Family Law Rules of Procedure, and rule 1.610, Florida Rules of Civil Procedure.

Special notes ...
If you use paragraph 1.c of this form to ask the court to enter a temporary injunction, the court may require you to post a bond.
With this form you must also file the following, if not already filed:
 Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), if this case involves a minor or dependent child(ren).
 Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
 Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), if you are asking that temporary child support be ordered. (If you do not know the other party's income, *1220 you may file this worksheet as soon as a copy of his or her financial affidavit has been served on you.)
The parties seeking relief shall serve a financial affidavit (Florida Family Law Rules of Procedure Form 12.902 (b) or (c)) and certificate of compliance (Florida Family Law Rules of Procedure Form 12.932) with the notice of hearing on the motion for temporary support and time-sharing.
Parenting Plan. If you have reached an agreement on either a temporary Parenting Plan or time-sharing schedule, the proposed temporary Parenting Plan or time-sharing schedule, signed by both parties, should be filed. Florida Supreme Court Family Law Form 12.995(a), 12.995(b), or 12.995(c). If you have not reached an agreement, a proposed Parenting Plan or temporary time-sharing schedule may be filed for consideration by the Court.
Temporary Order ... These family law forms contain a Temporary Order for Support and Time-Sharing with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(b), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing.
Nonlawyer. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1221
                   THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
                    IN AND FOR ______________________________ COUNTY, FLORIDA
                                                      Case No: ______________________________________________
                                                      Division: _____________________________________________
_________________________________,
                       Petitioner,
                and
_________________________________,
                       Respondent.
         MOTION FOR TEMPORARY SUPPORT AND TIME-SHARING WITH DEPENDENT OR
                                MINOR CHILD(REN)
The ( ) Petitioner ( ) Respondent requests that the Court enter an order granting the following
temporary support:
    [Complete all that apply]
1. Assets and Liabilities.
   a. ___ Award temporary exclusive use and possession of the marital home. {address} _______________________
      _______________________________________________________________________________________________________
      The Court should do this because: _____________________________________________________________________
      _______________________________________________________________________________________________________
      _______________________________________________________________________________________________________
   b. ___ Award temporary use and possession of marital assets. {Specify, without giving account
      numbers}
      _______________________________________________________________________________________________________
      _______________________________________________________________________________________________________
      _______________________________________________________________________________________________________
      _______________________________________________________________________________________________________
      The Court should do this because: _____________________________________________________________________
      _______________________________________________________________________________________________________
      _______________________________________________________________________________________________________
   c. ___ Enter a temporary injunction prohibiting the parties from disposing of any marital assets,
      other than ordinary and usual expenses. {Explain} _____________________________________________________
      _______________________________________________________________________________________________________
      _______________________________________________________________________________________________________
*1222
     _______________________________________________________________________________________________________
      The Court should do this because: _____________________________________________________________________
      _______________________________________________________________________________________________________
      _______________________________________________________________________________________________________
      d. ___ Require temporary payment of specific marital debts. {Explain without using account
         numbers} ___________________________________________________________________________________________
         ____________________________________________________________________________________________________
         ____________________________________________________________________________________________________
         ____________________________________________________________________________________________________
         The Court should do this because: _____________________________________________________________________
         _______________________________________________________________________________________________________
         _______________________________________________________________________________________________________
         _______________________________________________________________________________________________________
2. Child(ren).
      a. ___ Enter a temporary Parenting Plan with a time-sharing schedule for the parties' minor
         child(ren). ________________________________________________________________________________________
      b. ___ Enter a temporary injunction prohibiting the parties from permanently removing the
         child(ren) from the jurisdiction of the Court. The Court should do this because: ___________________
         ____________________________________________________________________________________________________
         ____________________________________________________________________________________________________
3. Support.
      a. ___ Award temporary child support of $ _________ per month.
      b. ___ Award temporary spousal support/alimony of $ __________ per month.
         The Court should do this because: __________________________________________________________________
         ____________________________________________________________________________________________________
         ____________________________________________________________________________________________________
4. Attorney's fees and costs.
      a. ___ Award temporary attorney's fees of $ ___________
      b. ___ Award temporary costs of $_______________
         The Court should do this because: __________________________________________________________________
         ____________________________________________________________________________________________________
         ____________________________________________________________________________________________________
5. Other Relief. {specify} __________________________________________________________________________________
   __________________________________________________________________________________________________________
   __________________________________________________________________________________________________________
*1223
   __________________________________________________________________________________________________________
   __________________________________________________________________________________________________________
   __________________________________________________________________________________________________________
6. A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida
   Supreme Court Approved Family Law Form 12.902(d), is filed with this motion or has already been
   filed with the Court.
7. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form
   12.902(j), if required, is filed with this motion or has already been filed with the Court.
    I request that the Court hold a hearing on this matter and grant the relief specifically requested
and any other relief this Court may deem just and proper.
    I certify that a copy of this document was [Choose only one] ( ) mailed ( ) faxed and mailed
( ) hand delivered to the person(s) listed below on {date} __________________________________________________
Other party or his/her attorney:
Name: ________________________________________
Address: _____________________________________
City, State, Zip: ____________________________
Fax Number: __________________________________
                                       ______________________________________________________________________
                                       Signature of Party or his/her attorney
                                       Printed Name: ________________________________________________________
                                       Address: _____________________________________________________________
                                       City, State, Zip: ____________________________________________________
                                       Telephone Number: ____________________________________________________
                                       Fax Number: __________________________________________________________
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 the petitioner, fill out this form.
*1224
                   IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
                       IN AND FOR ______________________________ COUNTY, FLORIDA
                                                           Case No: _________________________________________
                                                           Division: ________________________________________
_________________________________,
                       Petitioner,
            and
_________________________________,
                       Respondent.
                   TEMPORARY ORDER OF SUPPORT AND TIME-SHARING
                        WITH DEPENDENT OR MINOR CHILD(REN)
This cause came before this Court for a hearing on a Motion for Temporary Support and Time-Sharing
with Dependent or Minor Child(ren). The Court, having reviewed the file and heard the testimony,
makes these findings of fact and ORDERS as follows:
The Court has jurisdiction over the subject matter and the parties.
SECTION I. MARITAL ASSETS AND LIABILITIES
A. Injunction.
   1. ( ) Petitioner ( ) Respondent is (are) prohibited and enjoined from disposing of any marital
      assets without the written permission of the other party or a court order. If checked here ( ),
      the person(s) prohibited and enjoined from disposing of any marital assets may continue to pay
      all ordinary and usual expenses.
   2. The Court may enforce compliance with the terms of this injunction through civil and/or indirect
      criminal contempt proceedings, which may include arrest, incarceration, and/or the imposition
      of a fine.
   3. Violation of this injunction may constitute criminal contempt of court.
   4. Bond. This order is conditioned upon ( ) Petitioner ( ) Respondent posting bond in the sum of
      $__________ with the clerk of this Court.
B. Temporary Use of Assets.
   1. The assets listed below are temporarily determined to be marital assets. Each party shall
      temporarily have the use of, as his/her own, the assets awarded in this section, and the other
      party shall temporarily have no further use of said assets. Any personal property not listed
*1225
below shall be for the use of party currently in possession of that item(s), and he or she may
not dispose of that item(s) without the written permission of the other party or a court order.

-----------------------------------------------------------------------------------------
|                                                   | Wife Shall     |    Husband       |
|                                                   |   Have         |   Shall Have     |
|                                                   | Temporary      |   Temporary      |
|   ASSETS: DESCRIPTION OF ITEM(S)             |    Use         |       Use        |
|---------------------------------------------------|----------------|------------------|
| Automobiles                                       |                |                  |
|---------------------------------------------------|----------------|------------------|
|---------------------------------------------------|----------------|------------------|
|---------------------------------------------------|----------------|------------------|
|---------------------------------------------------|----------------|------------------|
| Furniture & furnishings in home                   |                |                  |
|---------------------------------------------------|----------------|------------------|
|---------------------------------------------------|----------------|------------------|
|---------------------------------------------------|----------------|------------------|
|---------------------------------------------------|----------------|------------------|
|---------------------------------------------------|----------------|------------------|
|---------------------------------------------------|----------------|------------------|
|---------------------------------------------------|----------------|------------------|
| Furniture & furnishings elsewhere                 |                |                  |
|---------------------------------------------------|----------------|------------------|
|---------------------------------------------------|----------------|------------------|
|---------------------------------------------------|----------------|------------------|
|---------------------------------------------------|----------------|------------------|
| Jewelry                                           |                |                  |
|---------------------------------------------------|----------------|------------------|
| Business interests                                |                |                  |
|---------------------------------------------------|----------------|------------------|
|---------------------------------------------------|----------------|------------------|
| Other Assets                                      |                |                  |
-----------------------------------------------------------------------------------------

C. Temporary Responsibility for Liabilities/Debts.
   1. The liabilities listed below are temporarily determined to be marital. Each party shall pay as his
      or her own the marital liabilities indicated below and shall keep said payments current. The
      other party shall temporarily have no further responsibility for the payment of these debts.

*1226
------------------------------------------------------------------------------------
|                                              | Current  |           |            |
| LIABILITIES: DESCRIPTION OF DEBT(S)     | Amount   |Wife       |Husband     |
|                                              | Owed     |Shall Pay  | Shall Pay  |
|----------------------------------------------|----------|-----------|------------|
| Mortgages on real estate: (home)             | $        |$          |$           |
|----------------------------------------------|----------|-----------|------------|
|----------------------------------------------|----------|-----------|------------|
|                                              | -        |           |            |
|----------------------------------------------|----------|-----------|------------|
| Charge/credit card accounts                  |          |           |            |
|----------------------------------------------|----------|-----------|------------|
|                                              | =======  |           |            |
|----------------------------------------------|----------|-----------|------------|
| Auto loan                                    |          |           |            |
|----------------------------------------------|----------|-----------|------------|
| Auto loan                                    |          |           |            |
|----------------------------------------------|----------|-----------|------------|
|  Bank/Credit Union loans                     |          |           |            |
|----------------------------------------------|----------|-----------|------------|
|----------------------------------------------|----------|-----------|------------|
|----------------------------------------------|----------|-----------|------------|
|----------------------------------------------|----------|-----------|------------|
| Money owed (not evidenced by a note)         |          |           |            |
|----------------------------------------------|----------|-----------|------------|
|----------------------------------------------|----------|-----------|------------|
| Other                                        |          |           |            |
|----------------------------------------------|----------|-----------|------------|
|----------------------------------------------|----------|-----------|------------|
-----------------------------------------------------------------------------------

SECTION II. TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME
   [Choose all that apply]
   1. ___ ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the
      dwelling located at: {address} ____________________________________________________
      ___________________________________________________________________________________
      until: {date or event} ____________________________________________________________
      ____________________________________________________________________________________.
   2. ___ ( ) Petitioner ( ) Respondent may make a visit to the premises described in the
      paragraph above for the purpose of obtaining his or her clothing and items of personal health
      and hygiene and to obtain any items awarded in this order. This visit shall occur after notice to
      the person granted temporary exclusive use and possession of the dwelling and at the earliest
      convenience of both parties.
   3. ___ Other: ________________________________________________________________
*1227
      ___________________________________________________________________________________
      ___________________________________________________________________________________
SECTION III. TEMPORARY PARENTAL RESPONSIBILITY AND TIME-SHARING WITH DEPENDENT OR
MINOR CHILD(REN)
  1. Jurisdiction. The Court has jurisdiction to determine temporary parental responsibility and
     time-sharing for the parties' minor child(ren) listed in paragraph 2 below.
  2. The parties' dependent or minor child(ren) is (are):
                    Name                                        Birth date
     __________________________________________________________________________
     __________________________________________________________________________
     __________________________________________________________________________
     __________________________________________________________________________
     __________________________________________________________________________
     __________________________________________________________________________
  3. Temporary Parental Responsibility for the Minor Child(ren).
     [Choose only one]
     a. ___ The parties shall have temporary shared parental responsibility for the parties' minor
        child(ren).
     b. ___ ( ) Mother ( ) Father shall have temporary sole parental responsibility for the
        parties' minor child(ren). Temporary shared parental responsibility would be detrimental to
        the child(ren) at this time because _______________________________________________________
        ___________________________________________________________________________________________
        ___________________________________________________________________________________________.
     c. ( ) Mother ( ) Father shall have ultimate decision-making authority regarding the
        following:
        ____________________________________________________________________________________________
        ____________________________________________________________________________________________
        ___________________________________________________________________________________________.
     d. Other provisions: _________________________________________________________________________
        ___________________________________________________________________________________________
        ___________________________________________________________________________________________
  4. Temporary Time-sharing Schedule with Minor Child(ren). The parent(s) shall have:
*1228
     [Choose only one]
     a. ___ reasonable time-sharing schedule with the parties' minor child(ren) as agreed to by the
        parties, subject to any limitations in paragraph 5 below. The Court reserves jurisdiction to
        set a specific schedule.
     b. ___the following specified time-sharing schedule with the parties' minor child(ren), subject
        to any limitations set out in paragraph 5 below: {specify days and times} _________________
        _____________________________________________________________________
        Mother's Temporary Time-Sharing Schedule.
        ___________________________________________________________________________________________
        ___________________________________________________________________________________________
        ___________________________________________________________________________________________
        Father's Temporary Time-sharing Schedule.
        ___________________________________________________________________________________________
        ___________________________________________________________________________________________
        ___________________________________________________________________________________________
     c. ___ Time-sharing in accordance with the temporary Parenting Plan attached as Exhibit ______.
     d. ___ ( ) Mother ( ) Father shall have no contact with the parties' minor child(ren) until
        further order of the Court, due to the existing conditions that are detrimental to the welfare
        of the minor child(ren): {explain}:
        ___________________________________________________________________________________________
        ___________________________________________________________________________________________
     5. Limitations on Time-sharing. Neither parent shall take the child(ren) from the other parent, any
        child care provider or other person entrusted by the other parent with the care of the child(ren)
        without the agreement of the other party during the other party's time-sharing. The above
        time-sharing shall be:
        [Choose if applies]
        a. ___ supervised by a responsible adult who is mutually agreeable to the parties. If the
           parties cannot agree, the supervising adult shall be: {name} ___________________________.
        b. ___ at a supervised visitation center located at: {address} ____________________________
           ________________________________________________________________________________________,
           subject to the available times and rules of the supervised visitation center. The cost of such
           visits shall be paid by ( ) Mother ( ) Father ( ) Both.
     6. Communication Arrangements, Parental Responsibility and Time-sharing with Minor
        Child(ren).
*1229
        [Choose if applies]
        ______ The parties' communications to arrange time-sharing and discuss issues relating to the
        child(ren) (if temporary shared parenting, or time-sharing is provided in paragraph 3 above) are
        restricted as follows: ( ) telephone, ( ) fax, e-mail, or letter, ( ) a responsible person shall
        coordinate the time-sharing arrangements of the minor child(ren). If the parties cannot agree,
        the responsible person shall be: {name} ___________________________________________________
        ( ) other conditions for arrangements or discussions: {explain} __________________________
        ______________________________________________________________________________
        ______________________________________________________________________________
        ______________________________________________________________________________
     7. Exchange of Minor Child(ren). The exchange of the minor child(ren) shall be on time as
        scheduled and as agreed to by the parties. The following conditions, if checked below, shall also
        apply.
        [Choose all that apply]
        a. ___ The parties shall temporarily exchange the child(ren) at the following location(s): _____
           ________________________________________________________________________________________
        b. ___ ( ) Mother ( ) Father shall not get out of the vehicle, and the other parent shall not
           approach the vehicle, during the time the child(ren) are exchanged.
        c. ___ A responsible person shall conduct all exchanges of the child(ren). ( ) Mother
           ( ) Father shall not be present during the exchange. If the parties cannot agree, the
           responsible person shall be: {name} ______________________________________________________________
        d. ___ Other conditions for exchange of the child(ren) are as follows: ______________________________
           __________________________________________________________________________________________________
           __________________________________________________________________________________________________
           __________________________________________________________________________________________________
           __________________________________________________________________________________________________
           __________________________________________________________________________________________________
     8. ___ Injunction Prohibiting Removing the Child(ren). The Court hereby temporarily prohibits
        and enjoins the ( ) Mother ( ) Father ( ) Both from permanently removing the minor
        child(ren) from the State of Florida without a court order or the written consent of the other
        party.
     9. ___ Other Temporary Provisions Relating to the Minor Child(ren).
        _____________________________________________________________________________________________________
        _____________________________________________________________________________________________________
        _____________________________________________________________________________________________________
        _____________________________________________________________________________________________________
        _____________________________________________________________________________________________________
        _____________________________________________________________________________________________________
*1230
        _____________________________________________________________________________________________________
        _____________________________________________________________________________________________________
        _____________________________________________________________________________________________________
SECTION IV. TEMPORARY ALIMONY
     1. ( ) The Court denies the request(s) for temporary alimony. OR
        ( ) The Court finds that there is a need for, and that ( ) Petitioner ( ) Respondent,
        hereinafter Obligor, has/had the present ability to pay temporary alimony as follows:
        [Choose all that apply]
        a. ___ Temporary Periodic. Obligor shall pay temporary periodic alimony to Obligee in the
           amount of $ per month, payable ( ) in accordance with Obligor's employer's
           payroll cycle, and in any event, at least once a month ( ) other {explain}
           __________________________________________________________________________________________________,
           beginning {date} _________ This temporary periodic alimony shall continue until modified
           by court order, the death of either party, or until, {date/event} ________________________________,
           whichever occurs first.
        b. ___ Lump Sum. Obligor shall pay temporary lump sum alimony to Obligee in the amount of
           $ ______. This amount shall be paid as follows: __________________________________________________
           __________________________________________________________________________________________________
           ____________________________________________________________________________________________________.
        c. ___ Rehabilitative. Obligor shall pay temporary rehabilitative alimony to Obligee in the
           amount of $ ______ per month, payable ( ) in accordance with Obligor's employer's
           payroll cycle, and in any event, at least once a month ( ) other {explain} _______________________
           __________________________________________________________________________________________________
           beginning {date} ___________. This temporary rehabilitative alimony shall continue until
           modified by court order, the death of either party or until {date/event}
           _________________ whichever occurs first. The temporary rehabilitative plan
           presented demonstrated the following: ____________________________________________________________
           __________________________________________________________________________________________________
           __________________________________________________________________________________________________.
        d. ___ Retroactive. Obligor shall pay retroactive alimony in the amount of $ ______ for
           the period of {date} _________ through {date} _______, which shall be paid pursuant
           to paragraph 3 below.
     2. Reasons for Awarding/Denying Temporary Alimony Award. The reasons for
        awarding/denying temporary alimony are as follows:
        a. ___ length of the marriage of the party receiving temporary alimony: ________ years;
        b. ___ age of party receiving temporary alimony: ________ years;
        c. ___ health of party receiving temporary alimony: ( ) excellent ( ) good ( ) poor
*1231
      ( ) other ______________________________________________________________;
    d.___other factors ________________________________________________________
     ___________________________________________________________________________
     ___________________________________________________________________________
     ___________________________________________________________________________
     ________ Please indicate here if additional pages are attached.
  3. Retroactive Alimony. ( ) Petitioner ( ) Respondent shall pay to the other party the temporary
      retroactive alimony of $ ______, as of {date} ______. This amount shall be paid in
      the amount of $_________, per month, payable in accordance with Obligor's employer's payroll
      cycle, and in any event at least once a month ( ) other {explain} _____________
      _________________________________________________________________________________________
      beginning: {date} _______________, until paid in full including statutory interest.
   4. Insurance.
      [Choose all that apply]
      a. ___ Health Insurance. ( ) Petitioner ( ) Respondent shall temporarily be required to pay
         health insurance premiums for the other party not to exceed $ _______ per month,
         Further, ( ) Petitioner ( ) Respondent shall pay any uninsured medical costs for the other
         party not exceed $ _______ per year. As to these uninsured medical expenses, the party
         who is entitled to reimbursement of the uninsured medical expense shall submit request for
         reimbursement to the other party within 30 days, and the other party shall, within 30 days
         after receipt, submit the applicable reimbursement for that expense.
     b. ___ Life Insurance (to secure payment of support). To secure the temporary alimony
        obligations set forth in this order, the Obligor shall temporarily maintain life insurance
        coverage on his/her life naming the Obligee as the sole irrevocable beneficiary, so long as
        reasonably available. This temporary insurance shall be in the amount of at least
        $ _________ and shall remain in effect until this temporary obligation for alimony
        terminates.
  5. Other provisions relating to temporary alimony:
      ___________________________________________________________________________
      ___________________________________________________________________________
SECTION V. TEMPORARY CHILD SUPPORT
  1. The Court finds that there is a need for temporary child support and that the ( ) Mother
     ( ) Father (hereinafter Obligor) has the present ability to pay child support. 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 the Court makes the following findings: The
*1232
     Mother's net monthly income is $ _________. The Father's net monthly income is $ _______.
     Monthly child care costs are $ _________. Monthly health/dental insurance costs are
     $ ________.
  2. Amount. Obligor shall be obligated to pay temporary child support in the amount of $ ______
     per month payable ( ) in accordance with Obligor's payroll cycle, and in any event at least once
     a month ( ) {explain} _________________________________________________________________
     _________________________________________________________________________________________________
     beginning {date} ______________, and continuing until further court order or until
     {date/event} ____________________________________________________________________,
     {explain} _______________________________________________________________________.
     If the temporary child support ordered deviates from the guidelines by more than 5%, the
     factual findings which support that deviation are: ________________________________________.
     __________________________________________________________________________
     __________________________________________________________________________.
  3. Retroactive Child Support.
     [Choose if applies]
     ( ) Mother ( ) Father shall pay to the other party the temporary retroactive child support of
     $ __________, as of {date} ___________. This amount shall be paid in the amount of
     $ __________ per month, payable in accordance with Obligor's employer's payroll cycle, and in
     any event at least once a month ( ) other {explain} ______________________________
     ___________________________________________________________________________________________
     beginning {date} _________________, until paid in full including statutory interest.
  4. Insurance.
     [Choose all that apply]
     Health/Dental insurance. ( ) Mother ( ) Father shall be required to temporarily maintain
     ( ) health ( ) 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 cards
     showing coverage to the other party.
     OR
     ( ) Health ( ) dental insurance is not reasonable in cost and accessible to the child(ren) at this
     time.
     Reasonable and necessary uninsured medical/dental/prescription drug costs for the minor
     child(ren) shall temporarily be assessed as follows:
     ( ) Shared equally by both parents.
     ( ) Prorated according to the child support guideline percentages.
*1233
     ( ) Other {explain}: _____________________________________________________
     ___________________________________________________________________________________
     As to these uninsured medical/dental/prescription drug expenses, the party who incurs the
     expense shall submit request for reimbursement to the other party within 30 days, and the
     other party, within 30 days of receipt, shall submit the applicable reimbursement for that
     expense, according to the schedule of reimbursement set out in this paragraph.
  5. Life Insurance (to secure payment of support). To secure the temporary child support
     obligations in this order,( ) Petitioner ( ) Respondent ( ) Each party shall temporarily
     maintain life insurance coverage, in an amount of at least $ ________, on ( ) his life ( ) her
     life ( ) his/her life naming the ( ) minor child(ren) as the beneficiary (ies) OR naming the
     ( ) Mother Father ( ) other {name}: ______________________________________________
     as trustee for the minor child(ren), so long as reasonably available. The obligation to maintain
     the life insurance coverage shall continue until the Court orders otherwise or until {date/event}
     ______________________________________________________________________________
     ______________________________________________________________________________
  6. IRS Income Tax Deduction(s). The assignment of any tax deduction for the child(ren) shall be as
     follows: _______________________________________________________________________
     ________________________________________________________________________________
  7. Other provisions relating to temporary child support: ________________
     _________________________________________________________________________________
SECTION VI. METHOD OF PAYMENT
Obligor shall pay any temporary court-ordered child support/alimony and arrears, if any, as follows:
  1. State Disbursement Unit.
     [Choose if applies]
     a. ___ Obligor shall pay temporary court-ordered support directly to the State Disbursement
        Unit, along with any applicable service charge.
     b. ___ Both parties have requested and the court finds that it is in the best interests of the
         child(ren) that temporary support payments need not be directed through the State
         Disbursement Unit. However, either party may subsequently apply, pursuant to section
         61.13(1)(d)3, Florida Statutes, to require payments through the State Disbursement Unit.
  2. Income Deduction.
     [Choose if applies]
     _____ Immediate. Obligor shall pay through income deduction, pursuant to a separate Income
     Deduction Order which shall be effective immediately. Obligor is individually responsible for
*1234
     paying this temporary support obligation until all of said support is deducted from Obligor's
     income. Until temporary support payments are deducted from Obligor's paycheck, Obligor is
     responsible for making timely payments directly to the State Disbursement Unit or the Obligee,
     as previously set forth in this order.
     _____ 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 in cases of modification,
     AND
     ( ) there is an agreement by the Obligor to advise the central governmental depository of
     any change in payor and health insurance OR ( ) there is a signed written agreement
     providing an alternative arrangement between the Obligor and the Obligee.
  3. Bonus/one-time payments. ( ) 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 Obligee pursuant to the payment
      method prescribed above.
  4. Other provisions relating to method of payment. ___________________
     ______________________________________________________________________________
     ______________________________________________________________________________
     ______________________________________________________________________________
SECTION VII. TEMPORARY ATTORNEY FEES, COSTS, AND SUIT MONEY
  1. ___ ( ) Petitioner's ( ) Respondent's request(s) for temporary attorney fees, costs, and suit
     money is (are) denied because __________________________________________________
     ________________________________________________________________________________.
  2. ___ The Court finds there is a need for and an ability to pay temporary attorney fees, costs, and
     suit money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the other party
     $ ______ in temporary attorney fees, and $ ________ in costs. The Court further finds that
     the temporary attorney fees awarded are based on the reasonable rate of $________ per hour
     and ________ reasonable hours. Other provisions relating to temporary attorney fees, costs,
*1235
     and suit money are as follows: ___________________________________________
     __________________________________________________________________________
     __________________________________________________________________________
SECTION VIII. OTHER PROVISIONS
Other Provisions: __________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
DONE AND ORDERED at __________________, Florida on {date} ____________.
                                               ________________________________
                                               CIRCUIT JUDGE
     A copy of the {name of document(s)} ___________________________ was [Choose one
only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the parties listed below on
{date} ____________.
Petitioner (or his or her attorney)
Respondent (or his or her attorney)
State Disbursement Unit
Other: ____________________________

*1236 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.947(c), MOTION FOR TEMPORARY SUPPORT WITH NO DEPENDENT OR MINOR CHILD(REN)(10/11)
When should this form be used?
This form may be used by:
(1) the respondent or the petitioner in a pending dissolution of marriage action. For you to use this form, a petition for dissolution of marriage must have already been filed. You should use this form to ask the court to award any of the following: temporary use of assets; temporary exclusive use of the marital home; temporary responsibility for liabilities/debts; temporary spousal support (alimony); and other relief.
OR
(2) the petitioner in a pending action for support unconnected with a dissolution. For you to use this form, a petition for support unconnected with a dissolution of marriage must have already been filed. You should use this form to ask the court to award temporary spousal support (alimony).
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 the petition for dissolution of marriage was filed and keep a copy for your records.

What should I do next?
A copy of this form, along with all of the other forms required with this motion, must be mailed or hand delivered to the other party in your case. When you have filed all of the required forms, you are ready to set a hearing on your motion. You should check with the clerk, family law intake staff, or judicial assistant for information on the local procedure for scheduling a hearing. When you know the date and time of your hearing, you should notify the other party using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.

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. Words in bold underline in these instructions are defined there. For further information, see chapter 61, Florida Statutes, rule 12.285, Florida Family Law Rules of Procedure, and rule 1.610, Florida Rules of Civil Procedure.

Special notes ...
If you use paragraph 1.c of this form to ask the court to enter a temporary injunction, the court may require you to post a bond.
With this form you must also file the following, if not already filed:
 Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This must be filed within 45 days if not filed at the time of the petition.)
 Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
 Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932.
Temporary Order ... These family law forms contain a Temporary Support Order with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(d), which *1237 the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing.
Nonlawyer. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1238
                 IN THE CIRCUIT COURT OF THE __________________ JUDICIAL CIRCUIT,
                    IN AND FOR ______________________________ COUNTY, FLORIDA
                                                        Case No: ________________________
                                                        Division: ________________________
_________________________________,
                       Petitioner,
               and
_________________________________,
                       Respondent.
MOTION FOR TEMPORARY SUPPORT WITH NO DEPENDENT OR MINOR CHILD(REN)
     ( ) Petitioner ( ) Respondent requests that the Court enter an order granting the following
temporary support:
   [Complete all that apply]
1. Assets and Liabilities.
   a. ___ Award temporary exclusive use and possession of the marital home. {address} ________
      ______________________________________________________________________________
      The Court should do this because: ____________________________________________
      ______________________________________________________________________________
      ______________________________________________________________________________
   b. ___ Award temporary use and possession of marital assets. {Specify, without using account
      numbers} ___________________________________________________________________
      _________________________________________________________________________________
      _________________________________________________________________________________
      _________________________________________________________________________________
      The Court should do this because: _______________________________________________
      _________________________________________________________________________________
      _________________________________________________________________________________.
   c. ___ Enter a temporary injunction prohibiting the parties from disposing of any marital assets,
      other than ordinary and usual expenses. {Explain}
      __________________________________________________________________________________
      __________________________________________________________________________________
      __________________________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.947(c), Motion for Temporary Support with No Dependent
or Minor Child(ren)(10/11)
*1239
      _____________________________________________________________________________
      The Court should do this because: ___________________________________________
      _____________________________________________________________________________
      _____________________________________________________________________________
      _____________________________________________________________________________
    d. ___ Require temporary payment of specific marital debts. {Explain, without using account
       numbers}
       ____________________________________________________________________________
       ____________________________________________________________________________
       ____________________________________________________________________________
       ____________________________________________________________________________
       ____________________________________________________________________________
       The Court should do this because: __________________________________________
       ____________________________________________________________________________
       ____________________________________________________________________________
  2. Support. Award temporary spousal support/alimony of $ ___________ per month.
     The Court should do this because: ____________________________________________
     ______________________________________________________________________________
     ______________________________________________________________________________
  3. Attorney's fees and costs.
     a. ___ Award temporary attorney's fees of $ __________.
     b. ___ Award temporary costs of $ __________.
     The Court should do this because: _____________________________________________
     ________________________________________________________________________________
     ________________________________________________________________________________
  4. Other Relief. {specify} ____________________________________
     ________________________________________________________________________________
     ________________________________________________________________________________
     ________________________________________________________________________________
     ________________________________________________________________________________
  5. A completed Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of
     Procedure Form 12.932, is filed with this motion or has already been filed with the Court.
  6. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form
     12.902(j), if required, is filed with this motion or has already been filed with the Court.
*1240
        I request that the Court hold a hearing on this matter and grant the relief specifically requested
and any other relief this Court may deem just and proper.
        I certify that a copy of this document was [Choose only one] ( ) mailed ( ) faxed and mailed
( ) hand delivered to the person(s) listed below on {date} ______________________________
Other party or his/her attorney:
Name: ______________________________________
Address: ___________________________________
City, State, Zip: __________________________
Fax Number: ________________________________
                                                  _____________________________________________
                                                  Signature of Party or his/her attorney
                                                  Printed Name: ________________________________
                                                  Address: _____________________________________
                                                  City, State, Zip: ____________________________
                                                  Telephone Number: ____________________________
                                                  Fax Number: __________________________________
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 the petitioner, fill out this form.
*1241
                IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
                    IN AND FOR ______________________________ COUNTY, FLORIDA
                                                      Case No: ________________________
                                                      Division: _______________________
_________________________________,
                       Petitioner,
           and
_________________________________,
                       Respondent.
TEMPORARY SUPPORT ORDER WITH NO DEPENDENT OR MINOR CHILD(REN)
    This cause came before this Court for a hearing on a Motion for Temporary Support with No
Dependent or Minor Child(ren). The Court, having reviewed the file and heard the testimony, makes
these findings of fact and ORDERS as follows:
    The Court has jurisdiction over the subject matter and the parties.
SECTION I. MARITAL ASSETS AND LIABILITIES
A. Injunction.
   1. ( ) Petitioner ( ) Respondent is (are) prohibited and enjoined from disposing of any marital
      assets without the written permission of the other party or a court order. If checked here ( ),
      the person(s) prohibited and enjoined from disposing of any marital assets may continue to pay
      all ordinary and usual expenses.
   2. The Court may enforce compliance with the terms of this injunction through civil and/or indirect
      criminal contempt proceedings, which may include arrest, incarceration, and/or the imposition
      of a fine.
   3. Violation of this injunction may constitute criminal contempt of court.
   4. Bond. This order is conditioned upon ( ) Petitioner ( ) Respondent posting bond in the sum of
       $ _________ with the clerk of this Court.
B. Temporary Use of Assets.
    1. The assets listed below are temporarily determined to be marital assets. Each party shall
       temporarily have the use of, as his/her own, the assets awarded in this section, and the other
       party shall temporarily have no further use of said assets. Any personal property not listed
*1242
     below shall be for the use of party currently in possession of that item(s), and he or she may
     not dispose of that item(s) without the written permission of the other party or a court order.

-------------------------------------------------------------------------------------
|                                                 |  Wife Shall   | Husband    |
|                                                 |      Have     | Shall Have |
|           ASSETS: DESCRIPTION OF ITEM(S)         |  Temporary     | Temporary  |
|                                                 |      Use       |   Use      |
|-------------------------------------------------|----------------|------------|
| Automobiles                                     |                |            |
|-------------------------------------------------|----------------|------------|
|-------------------------------------------------|----------------|------------|
|-------------------------------------------------|----------------|------------|
|-------------------------------------------------|----------------|------------|
| Furniture & furnishings in home                 |                |            |
|-------------------------------------------------|----------------|------------|
|-------------------------------------------------|----------------|------------|
|-------------------------------------------------|----------------|------------|
|-------------------------------------------------|----------------|------------|
|-------------------------------------------------|----------------|------------|
|-------------------------------------------------|----------------|------------|
|-------------------------------------------------|----------------|------------|
| Furniture & furnishings elsewhere               |                |            |
|-------------------------------------------------|----------------|------------|
|-------------------------------------------------|----------------|------------|
|-------------------------------------------------|----------------|------------|
|-------------------------------------------------|----------------|------------|
| Jewelry                                         |                |            |
|-------------------------------------------------|----------------|------------|
| Business interests                              |                |            |
|-------------------------------------------------|----------------|------------|
|-------------------------------------------------|----------------|------------|
| Other Assets                                    |                |            |
--------------------------------------------------------------------------------

C. Temporary Responsibility for Liabilities/Debts.
    1. The liabilities listed below are temporarily determined to be marital. Each party shall pay as his
       or her own the marital liabilities indicated below and shall keep said payments current. The
       other party shall temporarily have no further responsibility for the payment of these debts.

*1243
-----------------------------------------------------------------------------------------
|                                                 |  Current   |           |            |
|           LIABILITIES: DESCRIPTION OF DEBT(S)    |  Amount    |  Wife     | Husband    |
|                                                 |   Owed     | Shall Pay  | Shall Pay  |
|-------------------------------------------------|------------|-----------|------------|
| Mortgages on real estate: (home)                |$           |$          |$           |
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
| Charge/credit card accounts                     |            |           |            |
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
| Auto loan                                       |            |           |            |
|-------------------------------------------------|------------|-----------|------------|
| Auto loan                                       |            |           |            |
|-------------------------------------------------|------------|-----------|------------|
| Bank/Credit Union loans                         |            |           |            |
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
| Money owed (not evidenced by a note)            |            |           |            |
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
| Other                                           |            |           |            |
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|

SECTION II. TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME
     [Choose all that apply]
     1. ___ ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the
        dwelling located at: {address} ___________________________________________
        ___________________________________________________________________________________
        until {date or event} ____________________________________________________
        ___________________________________________________________________________________.
*1244
   2. ___ ( ) Petitioner ( ) Respondent may make a visit to the premises described in the paragraph
      above for the purpose of obtaining his or her clothing and items of personal health and hygiene
      and to obtain any items awarded in this order. This visit shall occur after notice to the person
      granted temporary exclusive use and possession of the dwelling and at the earliest convenience
      of both parties.
   3. ___ Other: ________________________________________________________________________
      ___________________________________________________________________________________
      ___________________________________________________________________________________
SECTION III. TEMPORARY ALIMONY
  1. ( ) The Court denies the request(s) for temporary alimony. OR
     ( ) The Court finds that there is a need for, and that ( ) Petitioner ( ) Respondent,
     hereinafter Obligor, has/had the present ability to pay, temporary alimony as follows:
     [Choose all that apply]
     a. ___ Temporary Periodic. Obligor shall pay temporary periodic alimony to Obligee in the
        amount of $ __________ per month, payable ( ) in accordance with Obligor's employer's
        payroll cycle, and in any event, at least once a month ( ) other {explain} ___
        ________________________________________________________________________________,
        beginning {date} ________ This temporary periodic alimony shall continue until modified
        by court order, the death of either party, or until, {date/event} _________________,
        whichever occurs first.
     b. ___ Lump Sum. Obligor shall pay temporary lump sum alimony to Obligee in the amount of
        $ __________. This amount shall be paid as follows: __________________________________
        ______________________________________________________________________________________
        ______________________________________________________________________________________
     c. ___ Rehabilitative. Obligor shall pay temporary rehabilitative alimony to Obligee in the
        amount of $ __________ per month, payable ( ) in accordance with Obligor's employer's
        payroll cycle, and in any event, at least once a month ( ) other {explain} _______________
        beginning {date} ___________. This temporary rehabilitative alimony shall continue until
        modified by court order, the death of either party or until {date/event} ______________,
        whichever occurs first. The temporary rehabilitative plan presented demonstrated the
        following:
        _________________________________________________________________________________
        _________________________________________________________________________________
        _________________________________________________________________________________
        _________________________________________________________________________________
        _________________________________________________________________________________.
     d. ___ Retroactive. Obligor shall pay retroactive alimony in the amount of $ _________ for
        the period of {date} __________ through {date} _________, which shall be paid pursuant
        to paragraph 3 below.
*1245
   2. Reasons for Awarding/Denying Temporary Alimony Award. The reasons for awarding/denying
      temporary alimony are as follows:
      a. ___ length of the marriage of the party receiving temporary alimony: ______ years;
      b. ___ age of party receiving temporary alimony: _____________;
      c. ___ health of party receiving temporary alimony: ( ) excellent ( ) good ( ) poor ( )
         other ______________________________________________________________________;
      d. ___ other factors __________________________________________________________
         _____________________________________________________________________________
         _____________________________________________________________________________
         _____________________________________________________________________________
         ___ Please indicate here if additional pages are attached.
  3. Retroactive Alimony. ( ) Petitioner ( ) Respondent shall pay to the other party the temporary
      retroactive alimony of $__________, as of {date} __________ This amount shall be paid in the
      amount of $__________ per month, payable in accordance with Obligor's employer's payroll
      cycle, and in any event at least once a month ( ) other {explain} ____________________
      _______________________________________________________________________________________________,
      beginning {date} __________, until paid in full including statutory interest.
  4. Insurance.
     [Choose all that apply]
   a. ___ Health Insurance. ( ) Petitioner ( ) Respondent shall temporarily be required to pay
      health insurance premiums for the other party not to exceed $__________ per month. Further,
      ( ) Petitioner ( ) Respondent shall pay any uninsured medical costs for the other party not
      exceed $__________ per year. As to these uninsured medical expenses, the party who is
      entitled to reimbursement of the uninsured medical expense shall submit request for
      reimbursement to the other party within 30 days, and the other party shall, within 30 days after
      receipt, submit the applicable reimbursement for that expense.
   b. ___ Life Insurance (to secure payment of support). To secure the temporary alimony
      obligations set forth in this order, the Obligor shall temporarily maintain life insurance coverage
      on his/her life naming the Obligee as the sole irrevocable beneficiary, so long as reasonably
      available. This temporary insurance shall be in the amount of at least $__________ and shall
      remain in effect until this temporary obligation for alimony terminates.
  5. Other provisions relating to temporary alimony: _________________________
      ____________________________________________________________________________________
      ____________________________________________________________________________________
SECTION IV. METHOD OF PAYMENT
Obligor shall pay any temporary court-ordered alimony and arrears, if any, as follows:
   1. State Disbursement Unit.
      [Choose if applies]
      a. ___ Obligor shall pay temporary court-ordered support directly to the State Disbursement
*1246
         Unit, along with any applicable service charge.
      b. ___ Both parties have requested and the court finds that it is in the best interests that
         temporary support payments need not be directed through the State Disbursement Unit.
         However, either party may subsequently apply to the depository pursuant to section
         61.13(1)(d)3, Florida Statutes, to require payments through the State Disbursement Unit.
  2. Income Deduction.
     [Choose if applies]
     a. ___ Immediate. Obligor shall pay through income deduction, pursuant to a separate Income
        Deduction Order which shall be effective immediately. Obligor is individually responsible for
        paying this temporary support obligation until all of said support is deducted from Obligor's
        income. Until support payments are deducted from Obligor's paycheck, Obligor is
        responsible for making timely payments directly to the State Disbursement Unit or the
        Obligee, 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: there are no minor child(ren) common to the parties,
                                      AND
       there is proof of timely payment of a previously ordered obligation without an income
       deduction order in cases of modification,
                                    AND
        ( ) there is an agreement by the Obligor to advise the State Disbursement Unit of any
        change in payor and health insurance OR ( ) there is a signed written agreement providing
        an alternative arrangement between the Obligor and the Obligee.
   3. Bonus/one-time payments. ( ) 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 Obligee pursuant to the
      payment method prescribed above.
   4. Other provisions relating to method of temporary payment: _________________
       _____________________________________________________________________________________
       _____________________________________________________________________________________
SECTION V. TEMPORARY ATTORNEY FEES, COSTS, AND SUIT MONEY
   1. ___ ( ) Petitioner's ( ) Respondent's request(s) for temporary attorney fees, costs, and suit
      money is (are) denied because _______________________________________________________
      ____________________________________________________________________________________.
*1247
   2. ___ The Court finds there is a need for and an ability to pay temporary attorney fees, costs, and
      suit money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the other party
      $ _________ in temporary attorney fees, and $__________ in costs. The Court further finds
      that the temporary attorney fees awarded are based on the reasonable rate of $__________
      per hour and ___________________________________________________________________________
      reasonable hours. Other provisions relating to temporary attorney fees, costs, and suit money
      are as follows: _______________________________________________________________________
      _______________________________________________________________________________________
      _______________________________________________________________________________________
SECTION VI. OTHER PROVISIONS
Other Provisions: _________________________________________________________________
     _________________________________________________________________________________________
     _________________________________________________________________________________________
DONE AND ORDERED in _______________________, Florida on {date} __________________.,
                                         __________________________________________________
                                         CIRCUIT JUDGE
COPIES TO:
Petitioner (or his or her attorney)
Respondent (or his or her attorney)
State Disbursement Unit
Other: ____________________________

*1248 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.983(a), PETITION TO DETERMINE PATERNITY AND FOR RELATED RELIEF (10/11)

When should this form be used?
This form should be used by a birth mother or father to ask the court to establish paternity, a time-sharing schedule, and/or child support of a minor child or children. This means that you are trying to legally establish who is the father of the child(ren).
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.

What should I do next?
For your case to proceed, you must properly notify the respondent 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, you may use constructive service. However, if constructive service is used, the court may only grant limited relief. You should seek legal advice on constructive service in a paternity case. For more information see chapter 49, Florida Statutes, or you may contact Child Support Enforcement at the Florida Department of Revenue if you need assistance with your case.
If personal service is used, the respondent has 20 days to answer after being served with your petition. Your case will then generally proceed in one of the following three 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. 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 other party 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.
UNCONTESTED ... If the respondent files an answer that agrees with everything in your petition or an answer and waiver, and you have complied with mandatory disclosure and 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 other party 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 the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure, completed the scientific paternity testing, if necessary, and filed all of the required papers. Then you should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.983(d).

*1249 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 742, 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.
More than one child of the same alleged father may be listed on a single petition. However, if you are filing a paternity action involving more than one possible father, a separate petition must be filed for each alleged father.
If the respondent files an answer denying that the person named in the petition is the child(ren)'s father, one of you should file a Motion for Scientific Paternity Testing, Florida Supreme Court Approved Family Law Form 12.983(e). This is used to ask the court to order a scientific test to determine who is the child(ren)'s father.
If the father signed papers at the hospital acknowledging that he was the father, paternity was established as a matter of law. This should be indicated on page 2, section 9a on this form.
If the paternity of a child who was conceived or born during a marriage is at issue, the court may appoint a guardian ad litem to assist the court in this matter and to protect the rights of child.
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 Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
 Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c).
 Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days, if not filed with the petition, unless you and the other party have agreed not to exchange these documents.)
 Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). (If you do not know the other party's income, you may file this worksheet after his or her financial affidavit has been filed.)
 Parenting Plan, Florida Supreme Court Approved Family Law Form, 12.995(a), 12.995(b), or 12.995(c). If the parents have reached an agreement, a signed and notarized Parenting Plan should be attached. If the parents have not reached an agreement, a proposed Parenting Plan may be filed.
Parenting Plan and Time-Sharing. If the parties are unable to agree on parenting arrangements and a time-sharing schedule, a judge will decide as part of establishing a Parenting Plan. The judge will decide the parenting arrangements and time-sharing based on the child(ren)'s best interests. Regardless of whether there is an agreement between the parties, the court reserves jurisdiction to modify issues relating to minor or dependent child(ren).
The judge may request a parenting plan recommendation or appoint a guardian *1250 ad litem in your case. This means that a neutral person will review your situation and report to the judge concerning parenting issues. The purpose of such intervention is to be sure that the best interests of the child(ren) are being served. For more information, you may consult sections 61.401-61.405, Florida Statutes.
Listed below are some terms with which you should become familiar before completing your petition. If you do not fully understand any of the terms below or their implications, you should speak with an attorney before going any further.
 Shared Parental Responsibility
 Sole Parental Responsibility
 Supervised Time-Sharing
 No contact
 Parenting Plan
 Parenting Plan Recommendation
 Time-Sharing Schedule
Many circuits require that parents of a minor or dependent child(ren) who are involved in dissolution or paternity actions attend mediation before being allowed to schedule a final hearing. A parenting course must be completed prior to entry of the final judgment. You should check with your local clerk of court's office, family law intake staff, or judicial assistant for more information on the parenting course and mediation requirements in your area.
Child Support. The court may order one parent to pay child support to assist the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent.
Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents. You should file a financial affidavit, and the other parent will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid. Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations.
Final Judgments. These family law forms contain a Final Judgment of Paternity, Florida Supreme Court Approved Family Law Form 12.983(g), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1251
             IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
                   IN AND FOR ______________________________ COUNTY, FLORIDA
                                                    Case No: ________________________
                                                    Division: _______________________
_________________________________,
                       Petitioner,
               and
_________________________________,
                       Respondent.
            PETITION TO DETERMINE PATERNITY AND FOR RELATED RELIEF
     Petitioner, {full legal name} ____________________________, being sworn, certifies that the
following information is true:
     This is an action for paternity and to determine parental responsibility, time-sharing, and child
support under chapter 742, Florida Statutes.
SECTION I.
1. Petitioner is the [ ] mother [ ] father of the following minor child(ren):
             Name                     Birth date
    (1). ____________________________________________________________________
    (2). ____________________________________________________________________
    (3). ____________________________________________________________________
    (4). ____________________________________________________________________
    (5). ____________________________________________________________________
    (6). ____________________________________________________________________
2. Petitioner's current address is: {street address, city, state} _________________
   __________________________________________________________________________.
3. Respondent's current address is: {street address, city, state}
   ____________________________________________________________________________
4. Both parties are over the age of 18.
5. Petitioner [Choose only one] ( ) is ( ) is not a member of the military service.
   Respondent [Choose only one] ( ) is ( ) is not a member of the military service.
Florida Supreme Court Approved Family Law Form 12.983(a), Petition to Determine Paternity and for Related
Relief (10/11)
*1252
6. Neither Petitioner nor Respondent is mentally incapacitated.
7. A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida
   Supreme Court Approved Family Law Form 12.902(d), is filed with this petition.
8. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form
   12.902(j), is filed with this petition.
9. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b)
   or(c), is, or will be, filed.
10. Paternity Facts.
    [Choose only one]
    a. ___ Paternity has previously been established as a matter of law.
    b. ___ The parties engaged in sexual intercourse with each other in the month(s) of {list month(s)
       and year(s}} ____________in {city and state} ________________________________________
    c. As a result of the sexual intercourse, [ ] Petitioner [ ] Respondent conceived and gave birth to
       the minor child(ren) named in paragraph 1. [ ] Petitioner [ ] Respondent is the natural father
       of the minor child(ren). The mother [ ] was [ ] was not married at the time of the conception
       and/or birth of the minor child(ren) named in paragraph 1. If the mother was married, the
       name and address of her husband at the time of conception and/or birth is:
       _____________________________________________________________________________
       _____________________________________________________________________________
SECTION II. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING
1. The minor child(ren) currently reside(s) with [ ] Mother [ ]Father [ ] Other: {explain} _______
   _________________________________________________________________________________
2. Parental Responsibility. It is in the child(ren)'s best interests that parental responsibility be:
   [Choose only one]
   a. ___ shared by both Father and Mother.
   b. ___ awarded solely to [ ] Father [ ] Mother. Shared parental responsibility would be
      detrimental to the child(ren) because: ____________________________________
      ___________________________________________________________________________
      ___________________________________________________________________________
      ___________________________________________________________________________
3. Parenting Plan and Time-Sharing. It is in the best interests of the child(ren) that the family be
     ordered to comply with a Parenting Plan that [ ] includes [ ] does not include parental time-sharing
     with the child(ren). The Petitioner states that it is in the best interests of the child(ren) that:
     [Choose only one]
   a. ___ The attached proposed Parenting Plan should be adopted by the court.
          The parties [ ] have [ ] have not agreed to the Parenting Plan.
   b. ___ The court should establish a Parenting Plan with the following provisions:
      [ ] No time-sharing for the         [] Father [ ] Mother
      [ ] Limited time-sharing with the     [ ] Father [ ] Mother
      [ ] Supervised time-sharing for the   [ ] Father [ ] Mother.
*1253
      [ ] Supervised or third-party exchange of the child(ren).
      [ ] Time-sharing schedule as follows:
    ______________________________________________________________________________
    ______________________________________________________________________________
    ______________________________________________________________________________
    Explain why this schedule is in the best interests of the child(ren): ________
    ______________________________________________________________________________
    ______________________________________________________________________________
    ______________________________________________________________________________
4. The minor child(ren) should
   [Choose only one]
   a. ___ retain his/her (their) present name(s).
   b. ___ receive a change of name as follows:
          present name(s)                        be changed to
   (1). ________________________________          (1). ___________________________
   (2). ________________________________          (2). ___________________________
   (3). ________________________________          (3). ___________________________
   (4). ________________________________          (4). ___________________________
   (5). ________________________________          (5). ___________________________
   (6). ________________________________          (6). ___________________________
   c. The name change would be in the best interest of the child(ren) because: _______
      ______________________________________________________________________________
SECTION III. CHILD SUPPORT
[Choose as applicable]
1. ___ Petitioner requests that the Court award child support as determined by Florida's child support
   guidelines, section 61.30, Florida Statutes. A completed Child Support Guidelines Worksheet,
   Florida Family Law Rules of Procedure Form 12.902(e), is, or will be, filed. Such support should be
   ordered retroactive to:
   [Choose only one]
   a. ___ the date when the parents did not reside together in the same household with the child, not
      to exceed a period of 24 months before the date of filing of this petition.
   b. ___ the date of the filing of this petition.
   c. ___ other: {date} ___________. {Explain} _______________________
      __________________________________________________________________________________
2. ___ Petitioner requests that the Court award a child support amount that is more than or less than
   Florida's child support guidelines. Petitioner understands that a Motion to Deviate from Child
   Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, must be completed
   before the Court will consider this request.
3. ___ Petitioner requests that medical/dental insurance for the minor child(ren) be provided by:
   [Choose only one]
   a. ___ Father.
   b. ___ Mother.
*1254
4. ___ Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid by:
   [Choose only one]
   a. ___ Father.
   b. ___ Mother.
   c. ___ Father and Mother each pay one-half.
   d. ___ Father and Mother each pay according to the percentages in the Child Support Guidelines
          Worksheet, Florida Family Law Rules of Procedure Form 12.902(e).
   e. ___ Other {explain}: __________________________________________________________
      ________________________________________________________________________________________
      ________________________________________________________________________________________
5. ___ Petitioner requests that life insurance to secure child support be provided by:
   [Choose only one]
   a. ___ Father.
   b. ___ Mother.
   c. ___ Both
6. ___ [ ] Petitioner [ ] Respondent [ ] Both has (have) incurred medical expenses in the amount of
   $ __________ on behalf of the minor child(ren), including hospital and other expenses incidental to
   the birth of the minor child(ren). There should be an appropriate allocation or apportionment of
   these expenses.
7. ___ [ ] Petitioner [ ] Respondent [ ] Both has (have) received past public assistance for this
   (these) minor child(ren).
PETITIONER'S REQUEST
1. Petitioner requests a hearing on this petition and understands that he or she must attend the
   hearing.
2. Petitioner requests that the Court enter an order that:
   [Choose all that apply]
   a. ____ establishes paternity of the minor child(ren), ordering proper scientific testing, if
       necessary;
   b. ____ adopts or establishes a Parenting Plan containing provisions for parental responsibility and
           time-sharing for the minor or dependent child(ren);
   d. ____ awards child support, including medical/dental insurance for the minor child(ren);
   e. ____ determines the appropriate allocation or apportionment of all expenses incidental to the
          birth of the child(ren), including hospital and medical expenses;
   f. ____ determines the appropriate allocation or apportionment of all other past, present, and
          future medical and dental expenses incurred or to be incurred on behalf of the minor
          child(ren);
   g. ____ changes the child(ren)'s name(s);
   h. ____ other relief as follows: __________________________________________________________
      ________________________________________________________________________________________
      ________________________________________________________________________________________
      ____________________________________________________________________________________ and
      grants such other relief as may be appropriate and in the best interests of the minor child(ren).
*1255
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: _____________________________________
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]
I, {full legal name and trade name of nonlawyer} _______________________________________,
a nonlawyer, whose address is {street} __________________, {city} _____________,
{state} _____________, {phone} ______, helped {name} ______________, who is
the petitioner, fill out this form.

*1256 INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.983(c), ANSWER TO PETITION AND COUNTERPETITION TO DETERMINE PATERNITY AND FOR RELATED RELIEF (10/11)

When should this form be used?
This form should be used when you are responding to a petition to determine paternity and asking the court for something different than what was in the petition, such as parental responsibility, time-sharing, and child support. The answer is used to admit or deny the allegations contained in the petition, and the counterpetition is used to ask for whatever you want the court to do for you. The other party has 20 days to answer your counterpetition after being served with your counterpetition.
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 then file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records.

What should I do next?
You have 20 days to file an answer or answer and counterpetition to the other party's petition. A copy of this form, along with all of the other forms required with this answer and counterpetition, must be mailed or hand delivered to the other party in your case.
If you deny that the person named in the petition is the child(ren)'s father, a Motion for Scientific Paternity Testing Florida Supreme Court Approved Family Law Form 12.983(e), should be filed. This is used to ask the court to order a scientific test to determine who is the child(ren)'s father.
After you file an answer and counterpetition, the case will then generally proceed as follows:
UNCONTESTED. This case is uncontested if you and the other party agree on all issues raised in the petition and the counterpetition. If this is the case, and you and the other party have complied with mandatory disclosure and filed all of the required papers, either party may call the clerk, family law intake staff, or judicial assistant to set a final hearing. If you request the hearing, you must notify the other party 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. This case is contested if you and the other party disagree on any issues raised in the petition or counterpetition. If you are unable to settle the disputed issues, either party may file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. 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).

Where can I look for more information?
Before proceeding, you should read General Information for Self-Represented Litigants for some basic information. The words that are in bold underline in these instructions are defined there. For further information, see chapter 742, Florida Statutes.

*1257 Special notes ...
If the child(ren)'s father signed papers at the hospital acknowledging that he was the father, paternity was established as a matter of law. This should be checked on page 2, section 9a of the counterpetition part of this form. With this answer, you must file the following:
 Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d).
 Notice of Social Security Number Florida Supreme Court Approved Family Law Form 12.902(j).
 Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This must be filed within 45 days of service of the petition on you if not filed with this answer.)
 Certificate of Compliance with Mandatory Disclosure Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days of service of the petition on you, if not filed with this answer, unless you and the other party have agreed not to exchange these documents.)
 Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). (If you do not know the other party's income, you may file this worksheet after his or her financial affidavit has been filed.)
 Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a), 12.995(b), or (c). If the parents have reached an agreement, a signed and notarized Parenting Plan should be attached. If the parents have not reached an agreement, a proposed Parenting Plan may be filed.
Many jurisdictions may require the completion of mediation before a final hearing may be set. A parenting course must be completed prior to entry of the final judgment. You should contact the office of your local clerk of court, family law intake staff, or the judicial assistant about requirements for parenting courses or mediation where you live.
Parenting Plan and Time-Sharing. If the parties are unable to agree on parenting arrangements and a time-sharing schedule, a judge will decide as part of establishing a Parenting Plan. The judge will decide the parenting arrangements and time-sharing schedule based on the child(ren)'s best interests. Regardless of whether there is an agreement between the parties, the court reserves jurisdiction to modify issues relating to minor child(ren).
The judge may request a parenting plan recommendation or appoint a guardian ad litem in your case. This means that a neutral person will review your situation and report to the judge concerning parenting issues. The purpose of such intervention is to be sure that the best interests of the child(ren) is being served. For more information, you may consult section 61.401 and 61.405, Florida Statutes.
Listed below are some terms with which you should become familiar before completing your answer and counterpetition. If you do not fully understand any of the terms below or their implications, you should speak with an attorney before going any further.
 Shared Parental Responsibility
 Sole Parental Responsibility
 Supervised Time-Sharing
 No contact
 Parenting Plan
 Parenting Plan Recommendations
 Time-Sharing Schedule
*1258 Child Support. The court may order one parent to pay child support to assist the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent.
Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents. You should file a financial affidavit, and the other parent will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid. Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations.
Parenting Plan. In all cases involving minor or dependent child(ren), a Parenting Plan shall be approved or established by the court. If the parties have reached an agreement, you should file a Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a), 12.995(b), or 12.995(c), which addresses the time-sharing schedule for the child(ren). If you have not reached an agreement, a proposed Parenting Plan may be filed. A Parenting Plan will be established by the court.
Final Judgments. These family law forms contain a Final Judgment of Paternity, Florida Supreme Court Approved Family Law Form 12.983(g), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1259
              IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
                  IN AND FOR ______________________________ COUNTY, FLORIDA
                                                      Case No: _____________________
                                                      Division: ____________________
_________________________________,
                       Petitioner,
            and
_________________________________,
                       Respondent.
  ANSWER TO PETITION AND COUNTERPETITION TO DETERMINE PATERNITY AND
                     FOR RELATED RELIEF
    I, {full legal name} ______________________________________, Respondent,
being sworn, certify that the following information is true:
                       ANSWER TO PETITION
1. I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the
   Petition and, therefore, admit those allegations: {indicate section and paragraph number}
   ___________________________________________________________________________________
   ___________________________________________________________________________________.
2. I disagree with Petitioner as to the allegations raised in the following numbered paragraphs in the
   Petition and, therefore, deny those issues: {indicate section and paragraph number}
   ___________________________________________________________________________________
   ___________________________________________________________________________________.
3. I currently am unable to admit or deny the following paragraphs due to lack of information: {indicate
   section and paragraph number} __________________________________________________
   _____________________________________________________________________________________.
                 COUNTERPETITION TO DETERMINE PATERNITY
                       AND FOR RELATED RELIEF
SECTION I. PATERNITY
    1. Respondent is the [ ] mother [ ] father of the following minor child(ren):
           Name                      Birth Date
       (1). __________________________________________________________________________
       (2). __________________________________________________________________________
       (3). __________________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and Counterpetition to Determine
Paternity and for Related Relief (10/11)
*1260
       (4). __________________________________________________________________________
       (5). __________________________________________________________________________
       (6). __________________________________________________________________________
   2. Petitioner's current address is: {street address, city, state}
      ______________________________________________________________________________
      ______________________________________________________________________________.
   3. Respondent's current address is: {street address, city, state}
      ______________________________________________________________________________
      ______________________________________________________________________________.
   4. Both parties are over the age of 18.
   5. Petitioner [Choose only one] ( ) is ( ) is not a member of the military service.
      Respondent [Choose only one] ( ) is ( ) is not a member of the military service.
   6. Neither Petitioner nor Respondent is mentally incapacitated.
   7. A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida
      Supreme Court Approved Family Law Form 12.902(d), is filed with this counterpetition.
   8. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law
       Form 12.902(j), is filed with this counterpetition.
   9. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form
      12.902(b) or (c), [ ] is,or [ ] will be, filed.
   10. Paternity Facts.
       [Choose only one]
       a. ___ Paternity has previously been established as a matter of law.
       b. ___ The parties engaged in sexual intercourse with each other in the month(s) of {list
          month(s) and year(s)} ____________, in: {city and state}
          _______________________________________________________________________.
          As a result of the sexual intercourse, [ ] Petitioner [ ] Respondent conceived and gave
          birth to the minor child(ren) named in paragraph 1. [ ] Petitioner [ ] Respondent is the
          natural father of the minor child(ren). The mother [ ] was [ ] was not married at the time
          of the conception and/or birth of the minor child(ren) named in paragraph I. If the mother
          was married, the name and address of her husband at the time of conception and/or birth
          is: ________________________________________________________________________
          ____________________________________________________________________________.
SECTION II. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING
    1. The minor child(ren) currently reside(s) with [ ] Mother [ ] Father [ ] Other: {explain} _____
Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and Counterpetition to Determine
Paternity and for Related Relief (10/11)
*1261
_______________________________________________________________________________.
2. Parental Responsibility. It is in the child(ren)'s best interests that parental responsibility be:
   [Choose only one]
   a. ___ shared by both Father and Mother.
   b. ___ awarded solely to [ ] Father [ ] Mother. Shared parental responsibility would be
          detrimental to the child(ren) because:_________________________________________
      _______________________________________________________________________________
      _______________________________________________________________________________
      _______________________________________________________________________________.
3. Parenting Plan and Time-Sharing. It is in the best interests of the child(ren) that the family be
   ordered to comply with a Parenting Plan that [ ] includes [ ] does not include parental time-sharing
   with the child(ren). The Respondent states that it is in the best interests of the
   child(ren) that:
   [Choose only one]
   a. ___ The attached proposed Parenting Plan should be adopted by the court.
      The parties [ ] have [ ] have not agreed to the Parenting Plan.
   b. ___ The court should establish a Parenting Plan with the following provisions:
      [ ] No time-sharing for the         [ ] Father [ ] Mother.
      [ ] Limited time-sharing with the   [ ] Father [ ] Mother.
      [ ] Supervised time-sharing for the [ ] Father [ ] Mother
      [ ] Supervised or third-party exchange for the child(ren).
      [ ] Time-sharing schedule as follows:
   _______________________________________________________________________________
   _______________________________________________________________________________
   _______________________________________________________________________________.
4. Explain why this request is in the best interest of the child(ren):________________
   _______________________________________________________________________________
   _______________________________________________________________________________
   _______________________________________________________________________________
   _______________________________________________________________________________
   _______________________________________________________________________________
5. The minor child(ren) should:[Choose only one]
   a. retain his/her (their) present name(s).
   b. receive a change of name as follows:
*1262
            present name(s)               be changed to
   (1)._________________________ (1)._________________________
   (2)._________________________ (2)._________________________
   (3)._________________________ (3)._________________________
   (4)._________________________ (4)._________________________
   (5)._________________________ (5)._________________________
   (6)._________________________ (6)._________________________
SECTION III. CHILD SUPPORT
   [Choose all that apply]
   1. Respondent requests that the court award child support as determined by Florida's child
      support guidelines, section 61.30, Florida Statutes. A completed Child Support Guidelines
      Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), is, or will be, filed. Such
      support should be ordered retroactive to:
      [Choose only one]
      a. ___ the date when the parents did not reside together in the same household with the child,
         not to exceed a period of 24 months before the date of filing of this counterpetition.
      b. ___ the date of the filing of this petition.
      c. ___ other: {date}______________. {Explain} _____________________________
         ___________________________________________________________________________
   2. ___ Respondent requests that the Court award a child support amount that is more than or less
      than Florida's child support guidelines. Respondent understands that a Motion to Deviate from
      Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, must be
      completed before the Court will consider this request.
   3. ___ Respondent requests that medical/dental insurance for the minor child(ren) be provided by:
      [Choose only one]
      a. ___ Father.
      b. ___ Mother.
   4. ___ Respondent requests that uninsured medical/dental expenses for the child(ren) be paid by:
      [Choose only one]
      a. ___ Father.
      b. ___ Mother.
      c. ___ Father and Mother each pay one-half.
      d. ___ Father and Mother each pay according to the percentages in the Child Support
         Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e).
      e. ___ Other {explain}: ___________________________________________________
             ____________________________________________________________________
             ____________________________________________________________________.
*1263
5. ___ Respondent requests that life insurance to secure child support be provided by:
   [Choose only one]
   a. ___ Father.
   b. ___ Mother.
   c. ___ Both.
6. ___ [ ] Petitioner [ ] Respondent [ ] Both has (have) incurred medical expenses in the
   amount of $______ on behalf of the minor child(ren), including hospital and other expenses
   incidental to the birth of the minor child(ren). There should be an appropriate allocation or
   apportionment of these expenses.
7. ___ [ ] Petitioner [ ] Respondent [ ] Both has (have) received past public assistance for this
   (these) minor child(ren).
RESPONDENT'S REQUEST
   1. Respondent requests a hearing on this petition and understands that he or she must attend the
      hearing.
   2. Respondent requests that the Court enter an order that:
      [Choose all that apply]
      a. ___ establishes paternity of the minor child(ren), ordering proper scientific testing, if
         necessary;
      b. ___ establishes a Parenting Plan containing provisions for parental responsibility and time-sharing
         for the minor or dependent child(ren);
      c. ___ awards child support, including medical/dental insurance, for the minor child(ren);
      d. ___ determines the appropriate allocation or apportionment of all expenses incidental to the
         birth of the child(ren), including hospital and medical expenses;
      e. ___ determines the appropriate allocation or apportionment of all other past, present, and
         future medical and dental expenses incurred or to be incurred on behalf of the minor
         child(ren);
      f. ___ changes the child(ren)'s name(s); and
      g. ___ other relief as follows:_____________________________________________________
         _________________________________________________________________________________
         _________________________________________________________________________________
         ___________________________________________________________________________; and
         grants such other relief as may be appropriate and in the best interests of the minor
         child(ren).
*1264
     I certify that a copy of this document was [Choose only one] ( ) mailed ( ) faxed and mailed
( ) hand-delivered to the person(s) listed below on {date}___________________.
Petitioner or his/her attorney:
Name:____________________
Address:_________________
City, State, Zip:________
Fax Number:______________
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
answer and counterpetition and that the punishment for knowingly making a false statement includes
fines and/or imprisonment.
Dated:____________________
                                              ___________________________________________
                                              Signature of Respondent/Counterpetitioner
                                              Printed Name: _____________________________
                                              Address:___________________________________
                                              City, State, Zip:__________________________
                                              Telephone Number:__________________________
                                              Fax Number:________________________________
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]
I, {full legal name and trade name of nonlawyer}___________________________________,
a nonlawyer, whose address is {street}_______________, {city}_____________,
{state}______________, {phone}______________, helped {name}_________,
who is the respondent, fill out this form.

*1265 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.995(a), PARENTING PLAN (10/11)

When should this form be used?
A Parenting Plan is required in all cases involving time-sharing with minor child(ren), even when time-sharing is not in dispute. The Parenting Plan must be developed and agreed to by the parents and approved by the court. If the parties cannot agree to a Parenting Plan or if the parents agreed to a plan that is not approved by the court, a Parenting Plan will be established by the court with or without the use of parenting plan recommendations. This form or a similar form should be used in the development of a Parenting Plan. If the case involves supervised time-sharing, the Safety Focused Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(b) or a similar form should be used. If the case involves relocation, pursuant to Section 61.13001, Florida Statutes, then a Relocation/Long Distance Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(c) or a similar form should be used.
This form should be typed or printed in black ink. Please either delete or strike-through terms or paragraphs that are inappropriate or in applicable to your agreement. If an agreement has been reached, both parties must sign the Parenting Plan and have their signatures witnessed by a notary public or deputy clerk. After completing this form, you should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. You should then refer to the instructions for your petition, answer, or answer and counterpetition concerning the procedures for setting a hearing or trial (final hearing). If the parents have not reached an agreement, a proposed Parenting Plan may be filed by either parent at the time of or any time prior to the final hearing. If an agreed Parenting Plan is not filed by the parties, the court shall establish a Plan.

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 61, Florida Statutes, and the instructions for the petition and/or answer that were filed in this case.

Special notes ...
At a minimum, the Parenting Plan must describe in adequate detail:
 How the parties will share and be responsible for the daily tasks associated with the upbringing of the child(ren),
 The time-sharing schedule arrangements that specify the time that the minor child(ren) will spend with each parent,
 A designation of who will be responsible for any and all forms of health care, school-related matters, including the address to be used for school-boundary determination and registration, other activities, and
 The methods and technologies that the parents will use to communicate with the child(ren).
The best interests of the child(ren) is the primary consideration in the Parenting Plan. In creating the Parenting Plan, all circumstances between the parents, including their historic relationship, domestic violence, and other factors must be taken into consideration. Determination of the best interests *1266 of the child(ren) shall be made by evaluating all of the factors affecting the welfare and interest of the particular minor child(ren) and the circumstances of that family, as listed in section 61.13(3), Florida Statutes, including, but not limited to:
 The demonstrated capacity and disposition of each parent to facilitate and encourage a close and continuing parent-child relationship, to honor the time-sharing schedule, and to be reasonable when changes are required;
 The anticipated division of parental responsibilities after the litigation, including the extent to which parental responsibilities will be delegated to third parties;
 The demonstrated capacity and disposition of each parent to determine, consider, and act upon the needs of the child(ren) as opposed to the needs or desires of the parent;
 The length of time the child(ren) has lived in a stable, satisfactory environment and the desirability of maintaining continuity;
 The geographic viability of the parenting plan, with special attention paid to the needs of school-age children and the amount of time to be spent traveling to effectuate the parenting plan. This factor does not create a presumption for or against relocation of either parent with a child(ren);
 The moral fitness of the parents;
 The mental and physical health of the parents;
 The home, school, and community record of the child(ren);
 The reasonable preference of the child(ren), if the court deems the child(ren) to be of sufficient intelligence, understanding, and experience to express a preference;
 The demonstrated knowledge, capacity, and disposition of each parent to be informed of the circumstances of the minor child(ren), including, but not limited to, the child(ren)'s friends, teachers, medical care providers, daily activities, and favorite things;
 The demonstrated capacity and disposition of each parent to provide a consistent routine for the child(ren), such as discipline, and daily schedules for homework, meals, and bedtime;
 The demonstrated capacity of each parent to communicate with and keep the other parent informed of issues and activities regarding the minor child(ren), and the willingness of each parent to adopt a unified front on all major issues when dealing with the child(ren);
 Evidence of domestic violence, sexual violence, child abuse, child abandonment, or child neglect, regardless of whether a prior or pending action relating to those issues has been brought. If the court accepts evidence of prior or pending actions regarding domestic violence, sexual violence, child abuse, child abandonment, or child neglect, the court must specifically acknowledge in writing that such evidence was considered when evaluating the best interests of the child(ren);
 Evidence that either parent has knowingly provided false information to the court regarding any prior or pending action regarding domestic violence, sexual violence, child abuse, child abandonment, or child neglect;
 The particular parenting tasks customarily performed by each parent and the division or parental responsibilities before the institution of litigation and during the pending litigation, including the extent to which parenting responsibilities were undertaken by third parties;
*1267  The demonstrated capacity and disposition of each parent to participate and be involved in the child(ren)'s school and extracurricular activities;
 The demonstrated capacity and disposition of each parent to maintain an environment for the child(ren) which is free from substance abuse;
 The capacity and disposition of each parent to protect the child(ren) from the ongoing litigation as demonstrated by not discussing the litigation with the child(ren), not sharing documents or electronic media related to the litigation with the child(ren), and refraining from disparaging comments about the other parent to the child(ren); and
 The developmental stages and needs of the child(ren) and the demonstrated capacity and disposition of each parent to meet the child(ren)'s developmental needs.
This standard form does not include every possible issue that may be relevant to the facts of your case. The Parenting Plan should be as detailed as possible to address the time-sharing schedule. Additional provisions should be added to address all of the relevant factors. The parties should give special consideration to the age and needs of each child.
In developing the Parenting Plan, you may wish to consult or review other materials which are available at your local library, law library or through national and state family organizations.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1268
            IN THE CIRCUIT COURT OF THE_____________JUDICIAL CIRCUIT
                      IN AND FOR_______________COUNTY, FLORIDA
                                                     Case No:____________________
                                                     Division:___________________
____________________
         Petitioner,
     and
____________________
         Respondent.
                           PARENTING PLAN
This Parenting Plan is: (Choose only one)
[ ]   A Parenting Plan submitted to the court with the agreement of the parties.
[ ]   A proposed Parenting Plan submitted by or on behalf of:
      {Parent's Name}____________________.
[ ]   A Parenting Plan established by the court.
This Parenting Plan is: (Choose only one)
[ ]   A final Parenting Plan established by the court.
[ ]   A temporary Parenting Plan established by the court.
[ ]   A modification of a prior final Parenting Plan or prior final order.
   I. PARENTS
     Mother
     Name:______________________________________________________________
     Address:___________________________________________________________
     Telephone Number:__________________________________________________
     E-Mail:____________________________________________________________
     ( ) Address Unknown: (Please indicate here if mother's address is unknown)
     ( ) Address Confidential: (Please indicate here if mother's address and phone numbers are
         confidential pursuant to either a ( ) Final Judgment for Protection Against Domestic Violence, or
     ( ) Other court order_____________________________________________).
     Father
     Name:_______________________________________________________________
     Address:____________________________________________________________
     Telephone Number:___________________________________________________
     E-Mail:_____________________________________________________________
     ( ) Address Unknown: (Please indicate here if father's address is unknown)
Florida Supreme Court Approved Family Law Form 12,995(a), Parenting Plan (10/11)
*1269
( ) Address Confidential: (Please indicate here if father's address and phone numbers are
    confidential pursuant to either a ( ) Final Judgment for Protection Against Domestic Violence or
( ) Other court order)__________________________________________________).
II. CHILDREN: This parenting plan is for the following child(ren) born to, or adopted by the parties:
    (add additional lines as needed)
   Name                                          Date of Birth
   _________________________________________________________________________
   _________________________________________________________________________
   _________________________________________________________________________
   _________________________________________________________________________
   _________________________________________________________________________
III. JURISDICTION
The United States is the country of habitual residence of the child(ren).
The State of Florida is the child(ren)'s home state for the purposes of the Uniform Child Custody
Jurisdiction and Enforcement Act.
This Parenting Plan is a child custody determination for the purposes of the Uniform Child Custody
Jurisdiction and Enforcement Act, the international Child Abduction Remedies Act, 42 U.S.C.
Sections 11601 et seq., the Parental Kidnapping Prevention Act, and the Convention on the Civil
Aspects of International Child Abduction enacted at the Hague on October 25, 1980, and for all
other state and federal laws.
Other:___________________________________________________.
IV. PARENTAL RESPONSIBILITY AND DECISION MAKING
   1. Parental Responsibility (Choose only one)
   [ ] Shared Parental Responsibility.
       It is in the best interests of the child(ren) that the parents confer and jointly make all
       major decisions affecting the welfare of the child(ren). Major decisions include, but are
       not limited to, decisions about the child(ren)'s education, healthcare, and other
       responsibilities unique to this family.
   OR
   [ ] Shared Parental Responsibility with Decision Making Authority
       It is in the best interests of the child(ren) that the parents confer and attempt to agree
       on the major decisions involving the child(ren). If the parents are unable to agree, the
       authority for making major decisions regarding the child(ren) shall be as follows:
*1270
           Education/Academic decisions     [ ] Mother [ ] Father
           Non-emergency health care        [ ] Mother [ ] Father
           __________________               [ ] Mother [ ] Father
           __________________               [ ] Mother [ ] Father
           __________________               [ ] Mother [ ] Father
   OR
   [ ] Sole Parental Responsibility:
       It is in the best interests of the child(ren) that the [ ] Mother [ ] Father shall have sole
       authority to make major decisions for the child(ren.) It is detrimental to the child(ren) to
       have shared parental responsibility.
   2. Day-to-Day Decisions
       Unless otherwise specified in this plan, each parent shall make decisions regarding day-to-day
       care and control of each child, including the performance of daily tasks, while the child
       is with that parent. Regardless of the allocation of decision making in this Parenting Plan,
       either parent may make emergency decisions affecting the health or safety of the child(ren)
       when the child is residing with that parent. A parent who makes an emergency decision
       shall share the decision with the other parent as soon as reasonably possible.
   3. Extra-curricular Activities (Choose all that apply)
   [ ] Either parent may register the child(ren) and allow them to participate in the activity of
       the child(ren)'s choice.
   [ ] The parents must mutually agree to all extra-curricular activities.
   [ ] The parent with the minor child(ren) shall transport the minor child(ren) to and/or from
       all mutually agreed upon extra-curricular activities, providing all necessary uniforms and
       equipment within the parent's possession.
   [ ] The costs of the extra-curricular activities shall be paid by:
       Mother_______% Father_______%
   [ ] The uniforms and equipment required for the extra-curricular activities shall be paid by:
       Mother_______% Father_______%
   [ ] Other:________________________________________________ .
V. INFORMATION SHARING. Unless otherwise indicated or ordered by the Court:
*1271
       Unless otherwise prohibited by law, each parent shall have access to medical and school records
       and information pertaining to the child(ren) and shall be permitted to independently consult
       with any and all professionals involved with the child(ren). The parents shall cooperate with
       each other in sharing information related to the health, education, and welfare of the child(ren)
       and they shall sign any necessary documentation ensuring that both parents have access to said
       records.
       Each parent shall be responsible for obtaining records and reports directly from the school
       and health care providers.
       Both parents have equal rights to inspect and receive governmental agency and law
       enforcement records concerning the child(ren).
       Both parents shall have equal and independent authority to confer with the child(ren)'s
       school, day care, health care providers, and other programs with regard to the child(ren)'s
       educational, emotional, and social progress.
       Both parents shall be listed as "emergency contacts" for the child(ren).
       Each parent has a continuing responsibility to provide a residential, mailing, and contact address
       and contact telephone number to the other parent. Each parent shall notify the other parent in
       writing within 24 hours of any changes. Each parent shall notify the court in writing within seven
       (7) days of any changes.
       Other:________________________________________________________
       __________________________________________________________.
VI. SCHEDULING
   1. School Calendar
      If necessary, on or before__________of each year, both parents should obtain a copy
      of the school calendar for the next school year. The parents shall discuss the calendars and
      the time-sharing schedule so that any differences or questions can be resolved.
      The parents shall follow the school calendar of: (Choose all that apply)
      [ ] the oldest child
      [ ] the youngest child
      [ ] the school calendar for_____________ County
      [ ] the school calendar for_____________ School
   2. Academic Break Definition
      When defining academic break periods, the period shall begin at the end of the last
      scheduled day of classes before the holiday or break and shall start on the first day of
      regularly scheduled classes after the holiday or break.
*1272
    3. Schedule Changes (Choose all that apply)
       [ ] A parent making a request for a schedule change will make the request as soon as
           possible, but in any event, except in cases of emergency, no less than
           _________ before the change is to occur.
       [ ] A parent requesting a change of schedule shall be responsible for any additional child
           care, or transportation costs caused by the change.
       [ ] Other________________________________________________.
VII. TIME-SHARING SCHEDULE
   1. Weekday and Weekend Schedule
      The following schedule shall apply beginning on__________________with the
      [ ] Mother [ ] Father and continue as follows:
      A. The child(ren) shall spend time with the Mother on the following dates and times:
         WEEKENDS: [ ] Every [ ] Every Other [ ] Other (specify)____________________
         From___________________________ to____________________________
         WEEKDAYS: Specify days________________________________________
         From___________________________ to____________________________
         OTHER: (Specify)______________________________________________
         ______________________________________________________________
         ______________________________________________________________.
      B. The child(ren) shall spend time with the Father on the following dates and times:
         WEEKENDS: [ ] Every [ ] Every Other [ ] Other (specify)______________
         From_______________________ to ___________________________
         WEEKDAYS: Specify days________________________________________
         From___________________________ to ___________________________
         OTHER: (Specify)______________________________________________
         ______________________________________________________________
         ______________________________________________________________.
      C. Please indicate if there is a different time-sharing schedule for any child. Complete a
         separate Attachment for each child for whom there is a different time-sharing
         schedule.
*1273
       [ ] There is a different time-sharing schedule for the following child(ren) in
           Attachment____.
        ___________________, and___________________.
        (Name of Child)         (Name of Child)
   2. Holiday Schedule (Choose only one)
   [ ] No holiday time-sharing shall apply. The regular time-sharing schedule set forth above
       shall apply.
   [ ] Holiday time-sharing shall be as the parties agree.
   [ ] Holiday time-sharing shall be in accordance with the following schedule. The holiday
       schedule will take priority over the regular weekday, weekend, and summer schedules.
       Fill in the blanks with Mother or Father to indicate where the child(ren) will be for the
       holidays. Provide the beginning and ending times. If a holiday is not specified as even,
       odd, or every year with one parent, then the child(ren) will remain with the parent in
       accordance with the regular schedule
Holidays               Even Years  Odd Years  Every Year  Begin/End Time
Mother's Day           __________  _________  __________  __________________
Father's day           __________  _________  __________  __________________
President's Day        __________  _________  __________  __________________
Martin Luther King Day __________  _________  __________  __________________
Easter                 __________  _________  __________  __________________
Passover               __________  _________  __________  __________________
Memorial Day Weekend   __________  _________  __________  __________________
4th of July            __________  _________  __________  __________________
Labor Day Weekend      __________  _________  __________  __________________
Columbus Day Weekend   __________  _________  __________  __________________
Halloween              __________  _________  __________  __________________
Thanksgiving           __________  _________  __________  __________________
Veteran's Day          __________  _________  __________  __________________
Hanukkah               __________  _________  __________  __________________
Yom Kippur             __________  _________  __________  __________________
Rosh Hashanah          __________  _________  __________  __________________
Child(ren)'s Birthdays __________  _________  __________  __________________
__________             __________  _________  __________  __________________
__________             __________  _________  __________  __________________
This holiday schedule may affect the regular Time-Sharing Schedule. Parents may wish to specify
one or more of the following options:
*1274
       [ ] When the parents are using an alternating weekend plan and the holiday schedule
           would result in one parent having the child(ren) for three weekends in a row, the
           parents will exchange the following weekend, so that each has two weekends in a row
           before the regular alternating weekend pattern resumes.
       [ ] If a parent has the child(ren) on a weekend immediately before or after an unspecified
           holiday or non-school day, they shall have the child(ren) for the holiday or non-school
           day.
   3. Winter Break
      A. Entire Winter Break (Choose only one)
      [ ] The [ ] Mother [ ] Father shall have the child(ren) from the day and time school is
          dismissed until December____ at___ a.m./p.m in [ ]odd-numbered years [ ] even-numbered
          years [ ] every year. The other parent will have the children for the second
          portion of the Winter Break. The parties shall alternate the arrangement each year.
      [ ] The [ ] Mother [ ] Father shall have the child(ren) for the entire Winter Break during
          [ ] odd-numbered years [ ] even-numbered years [ ] every year.
      [ ] Other:_______________________________________________
                _______________________________________________
                _______________________________________________.
   B. Specific Winter Holidays
      If not addressed above, the specific Winter Holidays such as Christmas, New Year's Eve,
      Hanukkah, Kwanzaa, etc. and shall be shared as follows:
      ___________________________________________________________
      ___________________________________________________________
      ___________________________________________________________
      ___________________________________________________________.
   4. Spring Break (Choose only one)
      [ ] The parents shall follow the regular schedule.
      [ ] The parents shall alternate the entire Spring Break with the Mother having the
          child(ren) during the [ ]odd-numbered years [ ]even numbered years.
      [ ] The [ ] Father [ ] Mother shall have the child(ren) for the entire Spring Break every year.
*1275
       [ ] The Spring Break will be evenly divided. The first half of the Spring Break will go to the
           parent whose regularly scheduled weekend falls on the first half and the second half
           going to the parent whose weekend falls during the second half.
       [ ] Other:__________________________________________________.
   5. Summer Break (Choose only one)
      [ ] The parents shall follow the regular schedule through the summer.
      [ ] The [ ] Mother [ ] Father shall have the entire Summer Break from_________after
          school is out until____________before school starts.
      [ ] The parents shall equally divide the Summer Break. During [ ] odd-numbered years
          [ ] even numbered years, the [ ] Mother [ ] Father shall have the children from
          _______after school is out until________. The other parent shall have the child(ren)
          for the second one-half of the Summer Break. The parents shall alternate the first and
          second one-halves each year unless otherwise agreed. During the extended periods of
          time-sharing, the other parent shall have the child(ren)________________.
      [ ] Other:___________________________________________________________
          _________________________________________________________________.
   6. Number of Overnights:
      Based upon the time-sharing schedule, the Mother has a total of_____overnights per year
      and the Father has a total of_____overnights per year. Note: The two numbers must
      equal 365.
    7. [ ] If not set forth above, the parties shall have time-sharing in accordance with the
       schedule which is attached and incorporated herein.
VIII. TRANSPORTATION AND EXCHANGE OF CHILD(REN)
    1. Transportation (Choose only one)
       [ ] The [ ] Mother [ ] Father shall provide all transportation.
       [ ] The parent beginning their time-sharing shall provide transportation for the child(ren).
       [ ] The parent ending their time-sharing shall provide transportation for the child(ren).
       [ ] Other: __________________________________________________________.
*1276
   2. Exchange
      Both parents shall have the child(ren) ready on time with sufficient clothing packed and
      ready at the agreed upon time of exchange. If a parent is more than _____minutes late
      without contacting the other parent to make other arrangements, the parent with the
      child(ren) may proceed with other plans and activities. (Choose only one):
      [ ] Exchanges shall be at Mother's and Father's homes unless both parents agree to a
          different meeting place.
      [ ] Exchanges shall occur at ___________________________________________
          _____________________________________________________________unless both
          parties agree in advance to a different meeting place.
      [ ] Other: ________________________________________________________
   3. Transportation Costs (Choose only one)
      [ ] Transportation costs are included in the Child Support Worksheets and/or the Order for
          Child Support and should not be included here.
      [ ] The Mother shall pay ___% and the Father shall pay ____% of the transportation
          costs.
      [ ] Other:________________________________________________.
   4. Foreign and Out-Of-State Travel (Choose all that apply)
      [ ] Either parent may travel within the United States with the child(ren) during his/her
          time-sharing. The parent traveling with the child(ren) shall give the other parent at least
          ____days written notice before traveling out of state unless there is an emergency, and
          shall provide the other parent with a detailed itinerary, including locations and
          telephone numbers where the child(ren) and parent can be reached at least____days
          before traveling.
      [ ] Either parent may travel out of the country with the child(ren) during his/her time-sharing.
          At least ____days prior to traveling, the parent shall provide a detailed itinerary,
          including locations, and telephone numbers where the child(ren) and parent may be
          reached during the trip. Each parent agrees to provide whatever documentation is
          necessary for the other parent to take the child(ren) out of the country.
      [ ] If a parent wishes to travel out of the country with the child(ren), he/she shall provide
          the following security for the return of the child _____________________
          ________________________________________________________________________.
*1277
      [ ] Other______________________________________________.
   IX. EDUCATION
      1. School designation. For purposes of school boundary determination and registration, the
         [ ] Mother's [ ] Father's address shall be designated.
      2. (If Applicable) The following provisions are made regarding private or home schooling:
         ________________________________________________________________
         ________________________________________________________________
         _______________________________________________________________.
       3. Other. ________________________________________________________________
          ________________________________________________________________
          ________________________________________________________________.
   X. DESIGNATION FOR OTHER LEGAL PURPOSES
      The child(ren) named in this Parenting Plan are scheduled to reside the majority of the time with
      the [ ] Mother [ ] Father. This majority designation is SOLELY for purposes of all other state
      and federal laws which require such a designation. This designation does not affect either
      parent's rights and responsibilities under this Parenting Plan.
   XI. COMMUNICATION
      1. Between Parents
         All communications regarding the child(ren) shall be between the parents. The parents shall
         not use the child(ren) as messengers to convey information, ask questions, or set up
         schedule changes.
         The parents shall communicate with each other: (Choose all that apply)
         [ ] in person
         [ ] by telephone
         [ ] by letter
         [ ] by e-mail
         [ ] Other:____________________________________________________________.
      2. Between Parent and Child(ren)
         Both parents shall keep contact information current. Telephone or other electronic
         communication between the child(ren) and the other parent shall not be monitored by or
         interrupted by the other parent. "Electronic communication" includes telephones,
         electronic mail or e-mail, webcams, video-conferencing equipment and software or other
*1278
         wired or wireless technologies or other means of communication to supplement face to face
         contact.
         The child(ren) may have [ ] telephone [ ] e-mail [ ] other electronic communication in the
         form of_________________with the other parent: (Choose only one)
         [ ] Anytime
         [ ] Every day during the hours of____________________to_____________.
         [ ] On the following days __________________________________________
             during the hours of______________________________to_____________.
         [ ] Other:__________________________________________________________.
      3. Costs of Electronic Communication shall be addressed as follows:
          __________________________________________________________
          __________________________________________________________
          __________________________________________________________.
   XII. CHILD CARE (Choose only one)
     [ ]   Each parent may select appropriate child care providers
     [ ]   All child care providers must be agreed upon by both parents.
     [ ]   Each parent must offer the other parent the opportunity to care for the child(ren)
           before using a child care provider for any period exceeding______hours.
     [ ]   Other___________________________________________________________.
   XIII. CHANGES OR MODIFICATIONS OF THE PARENTING PLAN
      Temporary changes to this Parenting Plan may be made informally without a written document;
      however, if the parties dispute the change, the Parenting Plan shall remain in effect until further
      order of the court.
      Any substantial changes to the Parenting Plan must be sought through the filing of a
      supplemental petition for modification.
   XIV. RELOCATION
      Any relocation of the child(ren) is subject to and must be sought in compliance with section
      61.13001, Florida Statutes.
   XV. DISPUTES OR CONFLICT RESOLUTION
      Parents shall attempt to cooperatively resolve any disputes which may arise over the terms of
      the Parenting Plan. The parents may wish to use mediation or other dispute resolution methods
*1279
      and assistance, such as Parenting Coordinators and Parenting Counselors, before filing a court
      action.
   XVI. OTHER PROVISIONS
      _______________________________________________________________________
      _______________________________________________________________________
      _______________________________________________________________________
      _______________________________________________________________________
      _______________________________________________________________________
      _______________________________________________________________________
      _______________________________________________________________________.
                                SIGNATURE OF PARENTS
   I certify that I have been open and honest in entering into this Parenting Plan. I am satisfied
with this Plan and intend to be bound by it.
Dated:____________________             _____________________
                                       Signature of Mother
                                       Printed Name:__________________
                                       Address:_______________________
                                       City, State, Zip:______________
                                       Telephone Number:______________
                                       Fax Number:____________________
   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 ______________________
*1280
   I certify that I have been open and honest in entering into this Parenting Plan. I am satisfied
with this Plan and intend to be bound by it.
Dated:____________________             _____________________________
                                       Signature of Father
                                       Printed Name:____________________
                                       Address: ________________________
                                       City, State, Zip:________________
                                       Telephone Number:________________
                                       Fax Number:______________________
   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]
   I, {full legal name and trade name of nonlawyer}______________________________,
   a nonlawyer, whose address is {street}________________________________________,
   {city}__________________,{state}__________________,{phone}_____________,
   helped {name} _____, who is the [one only] ____ petitioner or___respondent, fill out this form

*1281 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.995(b), SAFETY-FOCUSED PARENTING PLAN (10/11)

When should this form be used?
A Parenting Plan is required in all cases involving minor child(ren). This form or a similar form should be used in cases when you feel your child(ren) cannot be safely alone with the other parent or if you believe shared parental responsibility presents a detriment to the child(ren). In this case, a Parenting Plan must be developed that allows time-sharing with any minor child(ren), while providing protection for the child(ren). If safety or supervised time-sharing is not a concern, Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a) or a similar form should be used. If the case involves relocation, pursuant to Section 61.13001, Florida Statutes, then Relocation/Long Distance Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(c) or a similar form should be used. The Parenting Plan must be developed and agreed to by the parents and approved by the court. If the parties cannot agree to a Parenting Plan or if the parents agreed to a plan that is not approved by the court, a parenting plan will be established by the court with or without the use of parenting plan recommendations.
This form should be typed or printed in black ink. If an agreement has been reached, both parties must sign the Parenting Plan and have their signatures witnessed by a notary public or deputy clerk. After completing this form, you should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. You should then refer to the instructions for your petition, answer, or answer and counterpetition concerning the procedures for setting a hearing or trial (final hearing). If the parents have not reached an agreement, a proposed Parenting Plan may be filed by either parent at the time of or any time prior to the final hearing. If an agreed Parenting Plan is not filed by the parties, the court shall establish a Plan.

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 61, Florida Statutes, and the instructions for the petition and/or answer that were filed in this case.

Special notes...
If you fear that disclosing your address would put you in danger, you should complete a Request for Confidential Filing of Address, Florida Supreme Court Approved Form 12.980(h), file it with the clerk of the circuit court and write confidential in the space provided in the Parenting Plan.
At a minimum, the Parenting Plan must describe in adequate detail:
 How the parties will share and be responsible for the daily tasks associated with the upbringing of the child(ren),
 The time-sharing schedule arrangements that specify the time that the minor child(ren) will spend with each parent,
 A designation of who will be responsible for any and all forms of health care, school-related matters, including the address to be used for school-boundary determination and registration, other activities, and
*1282  The methods and technologies that the parents will use to communicate with the child(ren).
The best interests of the child(ren) is the primary consideration in the Parenting Plan. In creating the Parenting Plan, all circumstances between the parents, including their historic relationship, domestic violence, and other factors must be taken into consideration. Determination of the best interests of the child(ren) shall be made by evaluating all of the factors affecting the welfare and interest of the particular minor child(ren) and the circumstances of that family, as listed in section 61.13(3), Florida Statutes, including, but not limited to:
 The demonstrated capacity and disposition of each parent to facilitate and encourage a close and continuing parent-child relationship, to honor the time-sharing schedule, and to be reasonable when changes are required;
 The anticipated division of parental responsibilities after the litigation, including the extent to which parental responsibilities will be delegated to third parties;
 The demonstrated capacity and disposition of each parent to determine, consider, and act upon the needs of the child(ren) as opposed to the needs or desires of the parent;
 The length of time the child(ren) has lived in a stable, satisfactory environment and the desirability of maintaining continuity;
 The geographic viability of the parenting plan, with special attention paid to the needs of school-age children and the amount of time to be spent traveling to effectuate the parenting plan. This factor does not create a presumption for or against relocation of either parent with a child(ren);
 The moral fitness of the parents;
 The mental and physical health of the parents;
 The home, school, and community record of the child(ren);
 The reasonable preference of the child(ren), if the court deems the child(ren) to be of sufficient intelligence, understanding, and experience to express a preference;
 The demonstrated knowledge, capacity, and disposition of each parent to be informed of the circumstances of the minor child(ren), including, but not limited to, the child(ren)'s friends, teachers, medical care providers, daily activities, and favorite things;
 The demonstrated capacity and disposition of each parent to provide a consistent routine for the child(ren), such as discipline, and daily schedules for homework, meals, and bedtime;
 The demonstrated capacity of each parent to communicate with and keep the other parent informed of issues and activities regarding the minor child(ren), and the willingness of each parent to adopt a unified front on all major issues when dealing with the child(ren);
 Evidence of domestic violence, sexual violence, child abuse, child abandonment, or child neglect, regardless of whether a prior or pending action relating to those issues has been brought. If the court accepts evidence of prior or pending actions regarding domestic violence, sexual violence, child abuse, child abandonment, or child neglect, the court must specifically acknowledge, in writing that such evidence was considered when evaluating the bests interests of the child(ren);
 Evidence that either parent has knowingly provided false information to the *1283 court regarding any prior or pending action regarding domestic violence, sexual violence, child abuse, child abandonment, or child neglect;
 The particular parenting tasks customarily performed by each parent and the division of parental responsibilities before the institution of litigation and during the pending litigation, including the extent to which parenting responsibilities were undertaken by third parties;
 The demonstrated capacity and disposition of each parent to participate and be involved in the child(ren)'s school and extracurricular activities;
 The demonstrated capacity and disposition of each parent to maintain an environment for the child(ren) which is free from substance abuse;
 The capacity and disposition of each parent to protect the child(ren) from the ongoing litigation as demonstrated by not discussing the litigation with the child(ren), not sharing documents or electronic media related to the litigation with the child(ren), and refraining from disparaging comments about the other parent to the child)ren); and
 The developmental stages and needs of the child(ren) and the demonstrated capacity and disposition of each parent to meet the child(ren)'s developmental needs.
This standard form does not include every possible issue that may be relevant to the facts of your case. The Parenting Plan should be as detailed as possible to address the time-sharing schedule. Additional provisions should be added to address all of the relevant factors. The parties should give special consideration to the age and needs of each child.
In developing the Parenting Plan, you may wish to consult or review other materials which are available at your local library, law library or through national and state family organizations.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1284
           IN THE CIRCUIT COURT OF THE_____________JUDICIAL CIRCUIT
                     IN AND FOR_______________COUNTY, FLORIDA
                                              Case No:_______________
                                              Division:______________
_____________________
           Petitioner,
      and
_____________________
           Respondent.
                      SAFETY-FOCUSED PARENTING PLAN
  This parenting plan is: (Choose only one)
          [ ]  A Parenting Plan submitted to the court with the agreement of the parties.
          [ ]  A proposed Parenting Plan submitted by or on behalf of:
               {parent's name}_____________________________________.
          [ ]  A Parenting Plan established by the court.
   This parenting plan is: (Choose only one)
          [ ]  A final Parenting Plan established by the court.
          [ ]  A temporary Parenting Plan established by the court.
          [ ]  A modification of a prior final Parenting Plan or prior final order.
      I. PARENTS
      Mother
      Name:____________________________________________________________
      Address:_________________________________________________________
      Telephone Number:________________________________________________
      E-Mail:__________________________________________________________
      ( ) Address Unknown: (Please indicate if mother's address is unknown)
      ( ) Address Confidential: (Please indicate if mother's address and phone numbers are
          confidential pursuant to either a ( ) Final Judgment for Protection Against Domestic
          Violence or
      ( ) Other court order ___________________________________________.)
      Father
      Name:____________________________________________________________
      Address:_________________________________________________________
      Telephone Number:________________________________________________
Florida Supreme Court Approved Family Law Form 12,995(b), Safety-Focused Parenting Plan (10/11)
*1285
       E-Mail:__________________________________________________________
      ( ) Address Unknown: (Please indicate if father's address is unknown)
      ( ) Address Confidential: (Please indicate if father's address and telephone numbers are
          confidential pursuant to either a ( ) Final Judgment for Protection Against Domestic
          Violence or
      ( ) Other court order______________________________________________.)
  II. CHILDREN: This parenting plan is for the following child(ren) born to, or adopted by the parties:
(add additional lines as needed)
     Name                                               Date of Birth
     _________________________________________________________________________
     _________________________________________________________________________
     _________________________________________________________________________
     _________________________________________________________________________
   III. JURISDICTION
      The United States is the country of habitual residence of the child(ren).
      The State of Florida is the child(ren)'s home state for the purposes of the Uniform Child Custody
      Jurisdiction and Enforcement Act.
      This Parenting Plan is a child custody determination for the purposes of the Uniform Child
      Custody Jurisdiction and Enforcement Act, the International Child Abduction Remedies Act, 42
      U.S.C. Section 11601 et seq., the Parental Kidnapping Prevention Act, and the Convention on the
      Civil Aspects of International Child Abduction enacted at the Hague on October 25, 1980, and for
      other state and federal laws.
      Other: __________________________________________________________.
   IV. PARENTAL RESPONSIBILITY (Choose only one)
      [ ] Sole Parental Responsibility
          It is in the best interests of the child(ren) that the [ ] Mother [ ] Father shall have sole
          authority to make major decisions for the child(ren.) It is detrimental to the child(ren)
          for the parents to have shared parental responsibility.
      [ ] Shared Parental Responsibility with Decision Making Authority
          It is in the best interests of the child(ren) that the parents confer and attempt to agree
          on the major decisions involving the child(ren). If the parents are unable to agree, the
          authority for making major decisions regarding the child(ren) shall be as follows:
*1286
             Education/Academic decisions   [ ] Mother [ ] Father
             Non-emergency health care      [ ] Mother [ ] Father
             ___________________________    [ ] Mother [ ] Father
             ___________________________    [ ] Mother [ ] Father
             ___________________________    [ ] Mother [ ] Father
         [ ] Other: {Explain} ______________________________________.
   V. TIME SHARING SCHEDULE (Choose only one)
      [ ] No Time-Sharing: The [ ] Mother [ ] Father shall have no contact with the child(ren)
          until further order of the court. All parenting decisions shall be made by the other
          parent.
      [ ] Supervised Time-Sharing: Whenever the child(ren) are with the [ ] Mother [ ] Father,
          the supervisor shall be present. The [ ] Mother [ ] Father has the right to spend time
          with the child(ren) even though the other parent will be making most, if not all, of the
          parenting decisions which are made on the child(ren)'s behalf. The time-sharing
          schedule shall be mutually agreed to between the parents, but not less than the
          schedule set forth below: (Choose only one)
      [ ] ____ hours per week. The place(s), and time(s) shall be set by the [ ] Mother
          [ ] Father.
      [ ] From _______ __ m. to __________ __ m, on the following day(s)
          ____________________________________________.
      [ ] Restricted Time-Sharing: the [ ] Mother [ ] Father shall have time-sharing with the
          following restrictions. (The restrictions should be described in detail such as time-sharing
          only in public places, no overnight visits, etc.) The time-sharing schedule shall
          be mutually agreed upon between the parents, but not less than the schedule set forth
          below:__________________________________________________________
          ________________________________________________________________
          ________________________________________________________________
          ________________________________________________________________.
      [ ] ___ hours per week. The place(s), and time(s) shall be set by the [ ] Mother [ ] Father.
      [ ] Other:___________________________________________________________.
   VI. SUPERVISOR AND SUPERVISION (Choose only one)
      1. Supervisor. The person supervising the time-sharing shall: (Choose only one)
*1287
       [ ] Be selected by the [ ] Mother [ ] Father.
       [ ] Be selected by the [ ] Mother [ ] Father, subject to the other parent's approval.
       [ ] Other:__________________________________________________.
   2. Restrictions or Level of Supervision:____________________________
      ____________________________________________________________________________
      ___________________________________________________________________________.
   3. Costs of Supervision
      [ ] The costs of the supervision shall be paid by the [ ] Mother [ ] Father
      [ ] Other:___________________________________________________.
   VII. LOCATION: (Choose only one)
      The [ ] Mother [ ] Father shall spend his/her time-sharing with the child(ren) at the following location(s):
      [ ]  Supervised visitation center (name and address of facility)__________________
           _________________________________________________________________________.
      [ ]  ______________________(location) or other location designated by the
           [ ] Mother [ ] Father
      [ ]  Any location designated by the [ ] Mother [ ] Father with the approval of the
           supervisor.
      [ ]  Other:_____________________________________________________.
   VIII. DESIGNATION FOR OTHER LEGAL PURPOSES
      1. The child(ren) named in this Safety-Focused Parenting Plan are scheduled to reside the
         majority of the time with the [ ] Mother [ ] Father. This majority designation is SOLELY for
         purposes of all other state and federal statutes which require such a designation. This
         designation does not affect either parent's rights and responsibilities under this parenting
         plan.
      2. For purposes of school boundary determination and registration, the [ ] Mother's
         [ ] Father's address shall be designated.
*1288
   IX. TRANSPORTATION AND EXCHANGE OF CHILD(REN)
      1. Transportation
         The child(ren) shall not be driven in a car unless the driver has a valid driver's license,
         automobile insurance, seat belts, and child safety seats as required by Florida law.
         The [ ] Mother [ ] Father or mutually agreed upon person shall be responsible for
         transporting the child(ren) to the exchange point. The child(ren) shall be picked up and/or
         returned to the exchange point by (Choose only one);
         [ ] The [ ] Mother [ ] Father with the supervisor present.
         [ ] The supervisor alone.
         [ ] Other:___________________________________________________.
      2. Exchange
         The exchange of the child(ren) shall occur at: (Choose all that apply)
         [ ] The site of the supervised visit.
         [ ] A monitored exchange location {specify name and address of facility}___________.
         ______________________________________________________________________________.
         [ ] Other: ___________________________________________________.
         [ ] The [ ] Mother [ ] Father is prohibited from coming to the exchange point.
   X. COMMUNICATION
      1. Between Parents (Choose only one)
         [ ] All communications regarding the child(ren) shall be between the parents. The parents
             shall not use the child(ren) as messengers to convey information, ask questions, or set
             up schedule changes.
             The parents shall communicate with each other: (Choose all that apply)
         [ ] in person
         [ ] by telephone
         [ ] by letter
         [ ] by e-mail
         [ ] Other:_____________________________________________________.
*1289
         [ ] No Communication. Unless otherwise prohibited by court order, all information and
             communication regarding the child(ren) shall be exchanged via or through
             ________________________________________________________________________________
      2. Between Parent and Child(ren)
        The [ ] Mother [ ] Father (Choose all that apply)
        [ ] Shall not telephone, write, or e-mail the child(ren) unless the contact is agreed to in
            advance by the other parent.
        [ ] May write or e-mail the child(ren) at any time. Each parent shall provide a contact
            address (and e-mail address if appropriate) to the other parent, unless other prohibited
            by court order.
        [ ] May call the child(ren) on the telephone___ times per week. The call shall last no more
            than____minutes and shall take place between____ __m. and_____ __m. Each
            parent shall provide a telephone number to the other parent, unless otherwise
            prohibited by court order or law.
        [ ] Long distance telephone calls made by the child(ren) to a parent shall be paid by_____
            ________________. Each parent shall provide a telephone number to the other
            parent, unless otherwise prohibited by court order or law.
        [ ] Other:____________________________________________________.
      3. Costs of Electronic Communication
        "Electronic communication" includes telephones, electronic mail or e-mail, webcams, video-conferencing
        equipment and software or other wired or wireless technologies or other
        means of communication to supplement face-to face contact.
        The costs of electronic communication shall be addressed as follows:
        __________________________________________________________________________
        __________________________________________________________________________
        _________________________________________________________________________.
   XI. ACCESS TO ACTIVITIES AND EVENTS
         The [ ] Mother [ ] Father (Choose only one)
         [ ] Shall not attend the child(ren)'s activities and events, including but not limited to,
             school, athletic, and extra-curricular activities and events.
         [ ] May attend the child(ren)'s school, athletic, and extra-curricular activities and events.
*1290
         [ ] The [ ] Mother [ ] Father must stay ____feet from the other parent and____feet from
             the child.
         [ ] Other___________________________________________________.
   XII. CHILD(REN)'S SAFETY
         The [ ] Mother [ ] Father shall follow the safety rules checked below. (Choose all that apply)
         [ ] There shall be no firearms in the home, car, or in the child(ren)'s presence during time-sharing.
         [ ] No alcoholic beverages shall be consumed from twenty-four (24) hours before the
             child(ren) arrive until they are returned to the other parent.
         [ ] The child(ren) shall not be disciplined by corporal punishment.
         [ ] The following person(s) present a danger to the child(ren:
             ___________________________________________________________
             ___________________________________________________________.
             Each parent shall ensure that during his/her time-sharing that this/these person(s):
             [ ] will not be present
             [ ] will not have contact with the child(ren)
         [ ] Other:______________________________________________________.
  XIII. CHANGES OR MODIFICATIONS OF THE PARENTING PLAN
      All changes to the Safety-Focused Parenting Plan must be pursuant to a court order.
  XIV. OTHER PROVISIONS
       ________________________________________________________________________
       ________________________________________________________________________
       ________________________________________________________________________
       ________________________________________________________________________
       ________________________________________________________________________
       ________________________________________________________________________
       _______________________________________________________________________.

*1291 SIGNATURE OF PARENTS
I certify that I have been open and honest in entering into this Parenting Plan. I am satisfied with this Plan and intend to be bound by it.
  Dated: __________________       ____________________________________________
                                  Signature of Mother
                                  Printed Name: ______________________________
                                  Address: ___________________________________
                                  City, State, Zip: __________________________
                                  Telephone Number: __________________________
                                  Fax Number: ________________________________
  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 _________________________________
*1292 I certify that I have been open and honest in entering into this Parenting Plan. I am satisfied with this Plan and intend to be bound by it.
  Dated: ___________________      _____________________________________________
                                  Signature of Father
                                  Printed Name: _______________________________
                                  Address: ____________________________________
                                  City, State, Zip: ___________________________
                                  Telephone Number: ___________________________
                                  Fax Number: _________________________________
  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]
I, {full legal name and trade name of nonlawyer} _________________________________________, a nonlawyer, whose address is {street} ________________________, {city} ______________, {state} ____________, {phone} _______________, helped {name} ___________________, who is the [one only] petitioner or ___ respondent, fill out this form.
NOTES
[1]  We have jurisdiction. See art. V, § 2(a), Fla. Const.; Fla. R. Jud. Admin. 2.140(d), (f).
[2]  See In re Revised Interim Policy on Elec. Release of Court Records, Fla. Admin. Order No. AOSC07-49 (Fla. Sept. 7, 2007) (providing revised interim policy for the electronic release of court records); In re Implementation of Report and Recommendations of the Comm. on Privacy and Court Records, Fla. Admin. Order No. AOSC06-20 (June 30, 2006) ("Admin. Order No. AOSC06-20") (recognizing that certain conditions, including rule amendments, must be met before goal of providing the public electronic access to court records can be achieved); see also In re Statewide Standards for Elec. Access to the Courts, Fla. Admin. Order No. AOSC09-30 (July 1, 2009) (adopting the Florida Supreme Court Statewide Standards for Electronic Access to the Courts in response to chapter 2009-61, section 16, Laws of Florida, which requested that the Court establish statewide e-filing standards to be used by the clerks of court to implement electronic filing); In re Amends. to Fla. Rules of Civil Pro., Fla. Rules of Jud. Admin., Fla. Rules of Crim. Pro., Fla. Probate Rules, Fla. Small Claims Rules, Fla. Rules of Juv. Pro., Fla. Rules of App. Pro., & Fla. Family Law Rules of Pro. Electronic Filing, No. SC11-399 (Fla. Petition filed Feb. 28, 2011) (Court considering proposed rule amendments to implement electronic filing of documents with courts).
[3]  See In re Fla. Courts Tech. Comm'n, Subcomm. on Access to Court Records, Fla. Admin. Order No. AOSC09-3 (Jan. 27, 2009) (directing commission to establish a Subcommittee on Access to Court Records to act as the successor to the Access Committee for the purpose of advancing rule proposals) ("Admin. Order No. AOSC09-3").
[4]  See Committee on Privacy and Court Records, Privacy, Access and Court Records: the Report and Recommendations of the Committee on Privacy and Court Records (2005) ("Privacy Committee Report").
[5]  Admin. Order No. AOSC06-20.
[6]  See Admin. Order AOSC06-20 at 1, 9.
[7]  The Court separately considered implementation recommendations concerning electronic access to court records contained in the Access Committee's final report and recommendations submitted in September 2008. See Committee on Access to Court Records, Final Report and Recommendations (2008).
[8]  See In re Comm. on Access to Court Records, Fla. Admin. Order No. AOSC06-27 (Aug. 21, 2006) ("Admin. Order AOSC06-27").
[9]  Privacy Committee Report, Recommendation Seven, at 53.
[10]  Privacy Committee Report, Recommendation Eight, at 54.
[11]  Privacy Committee Report, Recommendation Nine, at 55.
[12]  Privacy Committee Report, Recommendation Ten, at 56.
[13]  See Admin. Order AOSC06-20 at 19-20. Privacy Committee Recommendation Eight, addressing unauthorized filings, see Privacy Committee Report at 54, was referred to the Access Committee. The Access Committee was charged with studying the rules to "determine whether any sanctions [for unauthorized filings] need to be strengthened to further the goal of preventing gratuitous publication of extraneous and potentially damaging information." Admin. Order AOSC06-27 at 3.
[14]  See, e.g., In re Amends. to Fla. Rules of App. Pro., 2 So. 3d 89, 90 n. 1 (Fla.2008) (stating that proposed new rule 9.050 (Maintaining Privacy of Personal Data) was referred to Access Committee).
[15]  See Admin. Order No. AOSC09-3.
[16]  Subdivision (b) of the rule, which we adopt on an interim basis, exempts filings in criminal and traffic proceedings.
[17]  Privacy Committee Report, Recommendation Seven, at 53.
[18]  The Court previously adopted a number of amendments to Florida Rule of Judicial Administration 2.420 (Public Access to Judicial Branch Records) also proposed by the Access Committee to implement other Privacy Committee recommendations. See In re Amends. to Fla. Rule of Jud. Admin. 2.420 & Fla. Rules of App. Pro., 31 So. 3d 756 (amending Rule of Judicial Administration 2.420 to provide comprehensive procedures for identifying and segregating confidential information in court records, for sealing and unsealing court records, and for reviewing orders issued under the rule.)
[19]  The phrase "or authorized by statute, another rule, or court order" is meant to clarify that conflicting provisions of another rule of court, a statute, or a court order will control over the rule 2.425 requirements.
[20]  In proposing this prohibition, the Rules of Judicial Administration Committee recognized that the standard business and banking practice is to use the last four digits of such numbers, but the committee determined it would be best to completely preclude the filing of such numbers because of their confidential status under rule 2.420(d)(1)(B)(iii). We agree that these highly sensitive and otherwise confidential personal identifying numbers should not be filed, unless exempt from the rule 2.425(a) limitations as provided in the rule.
[21]  The composite comments of the Florida criminal justice organizations filed in this case include comments or resolutions in support of the exemption from the Florida Association of Criminal Defense Lawyers, the Miami-Dade County Association of Chiefs of Police, the Florida Prosecuting Attorneys Association, the Florida Public Defender Association, Inc., and the Florida Bar Criminal Law Section.
[22]  The Criminal Procedure Rules Committee should oversee this project, and the committees' joint report should be filed with the Court by December 1, 2011.
[23]  The Small Claims Rules Committee declined to offer conforming amendments to the Small Claims Rules. Rather, that committee asks the Court to postpone amending the Small Claims Rules until the committee has an opportunity to consider the version of rule 2.425 the Court adopts. Therefore, we defer adoption of pending amendments to the Small Claim Rules that are impacted by the adoption of rule 2.425 and have directed the Small Claims Rules Committee to use its fast-track procedures to file a report with conforming rule amendments by September 1, 2011. However, we adopt other pending amendments to the Small Claims Rules that will limit the filing of unnecessary personal information but are not directly affected by the adoption of new rule 2.425. They are new rule 7.140(e)(3), which requires the judge to assist an unrepresented party in the handling of private information, and forms 7.340 (Final Judgment) and 7.373 (Fact Information Sheet), which are amended to instruct that the Fact Information Sheet should not be filed with the Court.

We ask that in the future, when the Court seeks proposed rule amendments to address a given topic from a number of rules committees, each committee comply with the Court's request and individual committees not decline to act until proposals from other committees are acted upon. See, e.g., In re Amends. to Fla. Rules of Jud. Admin., Fla. Rules of Civil Pro., Fla. Rules of Crim. Pro., Fla. Rules of Civil Pro. for Involuntary Commitment of Sexually Violent Predators, Fla. Probate Rules, Fla. Rules of Traffic Court, Fla. Rules of Juv. Pro., Fla. Rules of App. Pro., & Fla. Family Law Rules of Pro.-Computation of Time, No. SC10-2299 (Fla. Petition filed Dec. 13, 2010) (Small Claims Rules Committee declining to propose amendments to Small Claims Rules until proposed Rule of Judicial Administration governing computation of time is adopted by the Court). Addressing all related proposals at the same time ensures consistency and conserves valuable judicial resources.
[24]  Although the general provisions of new rule 2.425 prohibit the inclusion of any portion of a social security number in a court filing, as noted above, requirements in other rules or forms, such as the requirement that the last four digits of a social security number be included in certain documents, control over conflicting requirements in the new rule.
[25]  We decline to adopt amendments to rules 3.211(c) (Competence to Proceed: Scope of Examination; Written Findings of Experts), 3.212(d) (Competence to Proceed: Hearing and Disposition; Release of Finding of Incompetence), 3.218(a) (Commitment of a Defendant Found Not Guilty by Reason of Insanity; Commitment; 6-Month Report), and 3.219(a) (Conditional Release; Release Plan) suggested by the Criminal Procedure Rules Committee. Instead, we amend those rules to provide: "The procedure for determinations of the confidential status of reports is governed by Rule of Judicial Administration 2.420." Further amendments to rule 2.420(d), which are urged in this case, were considered in In re Amends. to the Fla. Rule of Jud. Admin. 2.420, 68 So. 3d 228 (Fla.2011). See In re Implementation of Comm. on Privacy & Court Records Recommendations, No. SC08-2443 (Fla. order filed November 19, 2010) (stating that suggested amendments to rule 2.420(d)(1)(B) will be considered in case number SC10-2242).
[26]  Privacy Committee Report, Recommendation Ten, at 56.
[27]  "The Media Organizations" include: Orlando Sentinel Communications Company, publisher of the Orlando Sentinel, and Sun-Sentinel Publishing Company, publisher of the South Florida Sun-Sentinel.
[28]  Privacy Committee Report, Recommendation Nine, at 55.
[29]  The rules committee felt that the affidavit could be entered into evidence if necessary at the hearing and that only at that point is it necessary to include the affidavit in the court record.
[30]  See Amends. to the Fla. Family Law Rules of Procedure & Family Law Forms, 810 So. 2d 1, 14 (Fla.2000) (providing that Court will seek input from advisory workgroup when making more substantial changes to the Supreme Court Approved Family Law Forms).
[31]  We ask the rules committees, as part of their regular-cycle review, to conduct a thorough review of rules and forms not amended here to determine whether any of those rules or forms should to be amended to ensure consistency with the amendments we adopt here.