In Re: Amendments to the Florida Supreme Court Approved Family Law Forms - Nomenclature

Supreme Court of Florida
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No. SC17-1948
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IN RE: AMENDMENTS TO THE FLORIDA SUPREME COURT
APPROVED FAMILY LAW FORMS—NOMENCLATURE.

[February 1, 2018]

PER CURIAM.

Pursuant to the procedures approved by this Court in Amendments to the

Florida Family Law Rules of Procedure & Family Law Forms, 810 So. 2d 1, 13-14

(Fla. 2000), this Court has internally reviewed the Florida Supreme Court

Approved Family Law Forms and has determined that amendments to the existing

forms are needed in light of the United States Supreme Court’s decision in

Obergefell v. Hodges, 135 S. Ct. 2584 (2015), and other recent statutory and rule

amendments. Input on these issues was received from the Advisory Workgroup on

the Florida Supreme Court Approved Family Law Forms, which provided valuable

assistance. We have jurisdiction,1 and amend the forms as follows.

1. See art. V, § 2(a), Fla. Const.
 First, in response to the United States Supreme Court’s decision in

Obergefell, we amend multiple forms to replace gendered terms with gender-

neutral terms, so that the same forms are appropriate for use in the context of both

opposite-sex and same-sex marriages. Next, we amend several existing forms to

ensure that clear, concise, and consistent language is used across similar forms, and

the General Instructions and Glossary to the forms to reflect recent changes to the

forms and to harmonize various definitions contained in the forms with those

contained in the Glossary. We also amend several existing final judgment forms to

separate factual findings from decretal ones, and we amend various forms to reflect

recent amendments to the Florida Family Law Rules of Procedure, adopted in In re

Amendments to Florida Family Law Rules of Procedure, 214 So. 3d 400 (Fla.

2017).

Additionally, we add language addressing parental consent to a child’s

mental health treatment to several parenting plan forms in accordance with recent

amendments to section 61.13(2)(b)3.a., Florida Statutes (2017). See ch. 2016-241,

§ 81, at 67-68, Laws of Fla. Finally, we adopt two new forms for use in

proceedings commenced pursuant to sections 61.09 and 61.10, Florida Statutes

(2017): 12.904(a)(2) (Petition for Support and Parenting Plan Unconnected with

Dissolution of Marriage with Dependent Minor Children) and 12.994(a)(2) (Final

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Judgment for Support and Parenting Plan Unconnected with Dissolution of

Marriage).

The amended and new forms are hereby adopted as set forth in the appendix

to this opinion, fully engrossed. The amendments to the forms shall become

effective immediately upon the release of this opinion and may be accessed and

downloaded from the Florida State Court’s website at

http://www.flcourts.org/resources-and-services/court-improvement/problem-

solving-courts/family-courts/family-law-forms.stml. By adoption of the amended

forms, we express no opinion as to their correctness or applicability. We also

direct that the amended forms be published for comment. Interested persons shall

have sixty days from the date of this opinion to file comments with the Court.2

2. All comments must be filed with the Court on or before April 2, 2018, as
well as a separate request for oral argument if the person filing the comment
wishes to participate in oral argument, which may be scheduled in this case. If
filed by an attorney in good standing with The Florida Bar, the comment must be
electronically filed via the Portal in accordance with In re Electronic Filing in the
Supreme Court of Florida via the Florida Courts E-Filing Portal, Fla. Admin. Order
No. AOSC13-7 (Feb. 18, 2013). If filed by a non-lawyer or a lawyer not licensed
to practice in Florida, the comment must be electronically filed via e-mail in
accordance with In re Mandatory Submission of Electronic Copies of Documents,
Fla. Admin. Order No. AOSC04-84 (Sept. 13, 2004). Electronically filed
documents must be submitted in Microsoft Word 97 or higher. Any person unable
to submit a comment electronically must mail or hand-deliver the originally signed
comment to the Florida Supreme Court, Office of the Clerk, 500 South Duval
Street, Tallahassee, Florida 32399-1927; no additional copies are required or will
be accepted.

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 It is so ordered.

LABARGA, C.J., and PARIENTE, LEWIS, QUINCE, CANADY, POLSTON,
and LAWSON, JJ., concur.

THE FILING OF A MOTION FOR REHEARING SHALL NOT ALTER THE
EFFECTIVE DATE OF THESE AMENDMENTS.

Original Proceeding – Florida Supreme Court Approved Family Law Forms

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 FAMILY LAW FORMS, COMMENTARY, AND INSTRUCTIONS
GENERAL INFORMATION FOR SELF-REPRESENTED LITIGANTS
(02/18)
You should read this General Information thoroughly before taking any other steps to file your case or
represent yourself in court. Most of this information is not repeated in the attached forms. This
information should provide you with an overview of the court system, its participants, and its processes.
It should be useful whether you want to represent yourself in a pending matter or have a better
understanding of the way family court works. This is not intended as a substitute for legal advice from
an attorney. Each case has its own particular set of circumstances, and an attorney may advise you of
what is best for you in your individual situation.

These instructions are not the only place that you can get information about how a family case works.
You may want to look at other books for more help. The Florida Statutes, Florida Family Law Rules of
Procedure, Florida Rules of Civil Procedure, and other legal information or books may be found at the
public library or in a law library at your county courthouse or a law school in your area. If you are filing a
petition for Name Change and/or Adoption, these instructions may not apply.

If the word(s) is printed in bold, this means that the word is being emphasized. Throughout these
instructions, you will also find words printed in bold and underlined. This means that the definitions of
these words may be found in the glossary of common family law terms at the end of this general
information section.

Commentary

1995 Adoption. To help the many people in family law court cases who do not have attorneys to
represent them (pro se litigants), the Florida Supreme Court added these simplified forms and directions
to the Florida Family Law Rules of Procedure. The directions refer to the Florida Family Law Rules of
Procedure or the Florida Rules of Civil Procedure. Many of the forms were adapted from the forms
accompanying the Florida Rules of Civil Procedure. Practitioners should refer to the committee notes
for those forms for rule history.

The forms were adopted by the Court pursuant to Family Law Rules of Procedure, 667 So. 2d 202 (Fla.
1995); In re Petition for Approval of Forms Pursuant to Rule 10-1.1(b) of the Rules Regulating the Florida
Bar—Stepparent Adoption Forms, 613 So. 2d 900 (Fla. 1992); Rules Regulating the Florida Bar—Approval
of Forms, 581 So. 2d 902 (Fla. 1991).

Although the forms are part of these rules, they are not all inclusive and additional forms, as necessary,
should be taken from the Florida Rules of Civil Procedure as provided in Florida Family Law Rules of
Procedure. Also, the following notice has been included to strongly encourage individuals to seek the
advice, when needed, of an attorney who is a member in good standing of the Florida Bar.

1997 Amendment. In 1997, the Florida Family Law Forms were completely revised to simplify and
correct the forms. Additionally, the appendices were eliminated, the instructions contained in the
appendices were incorporated into the forms, and the introduction following the Notice to Parties was
created. Minor changes were also made to the Notice to Parties set forth below.

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 NOTICE TO PARTIES WHO ARE NOT REPRESENTED BY AN ATTORNEY WHO IS A
MEMBER IN GOOD STANDING OF THE FLORIDA BAR

If you have questions or concerns about these forms, instructions, commentary, the use of the forms,
or your legal rights, it is strongly recommended that you talk to an attorney. If you do not know an
attorney, you should call the lawyer referral service listed in the yellow pages of the telephone book
under “Attorney.” If you do not have the money to hire an attorney, you should call the legal aid
office in your area.

Because the law does change, the forms and information about them may have become outdated.
You should be aware that changes may have taken place in the law or court rules that would affect
the accuracy of the forms or instructions.

In no event will the Florida Supreme Court, The Florida Bar, or anyone contributing to the production
of these forms or instructions be liable for any direct, indirect, or consequential damages resulting
from their use.

FAMILY LAW PROCEDURES

Communication with the court. Ex parte communication is communication with the judge with only one
party present. Judges are not allowed to engage in ex parte communication except in very limited
circumstances, so, absent specific authorization to the contrary, you should not try to speak with or
write to the judge in your case unless the other party is present or has been properly notified. If you
have something you need to tell the judge, you must ask for a hearing and give notice to the other
party or file a written statement in the court file and send a copy of the written statement to the
other party.

Filing a case. A case begins with the filing of a petition. A petition is a written request to the court for
some type of legal action. The person who originally asks for legal action is called the petitioner and
remains the petitioner throughout the case.

A petition is given to the clerk of the circuit court, whose office is usually located in the county
courthouse or a branch of the county courthouse. A case number is assigned and an official court file is
opened. Delivering the petition to the clerk’s office is called filing a case. A filing fee is usually required.

The Florida Rules of Judicial Administration now require that petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file a petition or
other pleadings, motions, and documents electronically; however, they are not required to do so.
If you choose to file your petition electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the circuit within which you file.
The rules and procedures should be carefully read and followed.

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Service of the original petition or supplemental petition. When one party files a petition, motion, or
other pleading, the other party must be “served” with a copy of the document. This means that the
other party is given proper notice of the pending action(s) and any scheduled hearings. The person
against whom the original legal action is being requested is called the respondent, because he or she is
expected to respond to the petition. The respondent remains the respondent throughout the case.

Personal service of the petition and summons on the respondent by a deputy sheriff or private process
server is required in all original petitions and supplemental petitions, unless constructive service is
permitted by law. Personal service may also be required in other actions by some judges.

Constructive Service. If you absolutely do not know where the other party to your case lives or if the
other party resides in another state, you may be able to use constructive service; however, if
constructive service is used, other than granting a divorce, the court may only grant limited relief, which
cannot include either alimony or child support. For more information on constructive service, see
Notice of Action for Dissolution of Marriage (No Child or Financial Support), Florida Supreme Court
Approved Family Law Form 12.913(a)(1), Notice of Action for Family Cases with Minor Child(ren),
Florida Supreme Court Approved Family Law Form 12.913(a)(2), Affidavit of Diligent Search and Inquiry,
Florida Family Law Rules of Procedure Form 12.913(b), and Affidavit of Diligent Search, Florida Family
Law Rules of Procedure Form 12.913(c).. Additionally, 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 is very complex and you
may wish to consult an attorney regarding these issues.

Forms for service of process are included in the Florida Family Law Forms, along with more detailed
instructions and information regarding service. The instructions to those forms should be read carefully
to ensure that you have properly served the other party. If proper service is not obtained, the court
cannot hear your case. Service must be in accordance with Florida Rule of Judicial Administration
2.516.

Subsequent Service: Other than the original or supplemental petitions, any time you file additional
pleadings or motions in your case, you must provide a copy to the other party and include a certificate
of service. Likewise, the other party must provide you with copies of everything that he or she files. If
the other party is represented by an attorney, you should serve the attorney unless service upon the
other party is required by the court.

Electronic Service. After the initial service of process of the petitioner or supplemental petition by the
Sheriff or certified process server, the Florida Rules of Judicial Administration now require that all
documents required or permitted to be served on the other party must be served by electronic mail (e-
mail) except in certain circumstances. You must strictly comply with the format requirements set forth
in the Rules of Judicial Administration. If you elect to participate in electronic service, which means
serving or receiving pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal,
you must review Florida Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org
through the link to the Rules of Judicial Administration provided under either Family Law Forms: Getting
Started, or Rules of Court in the A-Z Topical Index.

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SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

Default. After being served with a petition or counterpetition, the other party has 20 days to file a
response. If a response to a petition is not filed, the petitioner may file a Motion for Default, Florida
Supreme Court Approved Family Law Form 12.922(a), with the clerk. This means that you may proceed
with your case and set a final hearing, and a judge will make a decision, even if the other party will not
cooperate. For more information, see rule 12.080(c), Florida Family Law Rules of Procedure.

Answer and Counterpetition. After being served, the respondent has 20 days to file an answer
admitting or denying each of the allegations contained in the petition. In addition to an answer, the
respondent may also file a counterpetition. In a counterpetition, the respondent may request the same
or some other relief or action not requested by the petitioner. If the respondent files a counterpetition,
the petitioner should then file an Answer to Counterpetition, Florida Supreme Court Approved Family
Law Form 12.903(d), and either admit or deny the allegations in the respondent’s counterpetition.

Mandatory disclosure. Rule 12.285, Florida Family Law Rules of Procedure, requires each party in a
dissolution of marriage to exchange certain information and documents, and file a Family Law Financial
Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). Failure to make this required
disclosure within the time required by the Florida Family Law Rules of Procedure may allow the court to
dismiss the case or to refuse to consider the pleadings of the party failing to comply. This requirement
also must be met in other family law cases, except adoptions, simplified dissolutions of marriage,
enforcement proceedings, contempt proceedings, and proceedings for injunctions for domestic or
repeat violence. The Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of
Procedure Form 12.932, lists the documents that must be given to the other party. For more
information see rule 12.285, Florida Family Law Rules of Procedure, and the instructions to the
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form
12.932.

Parenting Plan. If your case involves minor or dependent child(ren), a Parenting Plan shall be approved
or established by the court. 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). The Parenting Plan shall be developed and agreed to by the parents and approved by a court.
If the parents cannot agree, or if the agreed Parenting Plan is not approved, the court must establish a
Parenting Plan. The Parenting Plan shall contain a time-sharing schedule and should address the issues
regarding the child(ren)’s education, health care, and physical, social, and emotional well-being.

Setting a hearing or trial. Generally, the court will have hearings on motions, final hearings on
uncontested or default cases, and trials on contested cases. Before setting your case for final hearing
or trial, certain requirements such as completing mandatory disclosure and filing certain papers and
having them served on the other party must be met. These requirements vary depending on the type of
General Information for Self-Represented Litigants (02/18)
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case and the procedures in your particular jurisdiction. For further information, you should refer to the
instructions for the type of form you are filing.

Next, you must obtain a hearing or trial date so that the court may consider your request. You should
ask the clerk of court, or family law intake staff about the local procedure for setting a hearing or trial,
which you should attend. These family law forms contain orders and final judgments, which the judge
may use. You should ask the clerk of court or family law intake staff if you need to bring one of these
forms with you to the hearing or trial. 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.

The shaded areas below explain different parts of family law forms. Although each form you use may
not contain each part explained below, all forms contain a case style which identifies the judicial circuit
and county in Florida in which the case is filed, the division within that circuit to which the case is
assigned, the parties in the case, and the number of the case. Some, but not all, forms require that the
person signing the form state under oath that what he or she claims in the form is true; those particular
forms must be signed in the presence of either a deputy clerk of the court or a notary public who
witnesses your signature before notarizing the form. Most forms contain a nonlawyer clause which
requests certain information be provided by any person who is not licensed to practice law in the State
of Florida who has helped you to complete the form.

Each form that provides a blank space will have instructions on how to fill in the blank. Please follow all
instructions which ask for specific information. Often these instructions appear in italics.

IN THE CIRCUIT COURT OF THE (1) JUDICIAL CIRCUIT,
IN AND FOR (2) COUNTY, FLORIDA

Case No.: (3)
Division: (4)
(5) ,
Petitioner,
and

(6) ,
Respondent.

Line 1 The clerk of court can tell you the number of your judicial circuit. Type or print it here.
Line 2 Type or print your county name on line (2).
Line 3 If you are filing an initial petition or pleading, the Clerk of the Court will assign a case number after
the case is filed. You should type or print this case number on all papers you file in this case.
Line 4 The clerk of the court can tell you the name of the division in which your case is being filed, and
you should type or print it here. Divisions vary from court to court. For example, your case may
be filed in the civil division, the family division, or the juvenile division.
Line 5 Type or print the legal name of the person who originally filed the case on line 5. This person is
the petitioner because he/she is the one who filed the original petition.

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Line 6 Type or print the other party’s legal name on line 6. The other party is the respondent because
he/she is responding to the petition.

Some forms require that your signature be witnessed. If so, you must sign the form in the presence of a
notary public or deputy clerk (employee of the clerk of the court’s office). When signing the form, you
must have a valid photo identification unless the notary knows you personally. You should completely
fill in all lines (1 & 3–8) except 2 with the requested information, if applicable. Line 2, the signature line,
must be signed in the presence of the notary public or deputy clerk.

DO NOT SIGN OR FILL IN THE PART OF THE FORM WHICH ASKS FOR THE NOTARY’S OR CLERK’S
SIGNATURE. This section of the form is to be completed by either the deputy clerk or the notary public
who is witnessing your signature.

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: (1)

______________________(2)____________________
Signature of Petitioner
Printed Name: (3) _______________
Address: (4) ________________
City, State, Zip: (5)
Telephone Number: (6)
Fax Number: (7)
Designated E-mail Address(es): __(8)________________
_____________________________________________

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

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Nonlawyer Clause. The section below should be completed by anyone who helps you fill out these
forms but is not an attorney who is a member in good standing of The Florida Bar, which means that he
or she is not licensed to practice law in Florida.

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the: {either Petitioner or Respondent; or Husband or Wife}
This form was completed with the assistance of:
{name of individual}________(1)_______________________________________________________,
{name of business} _____________(2)___________________________________________________,
{address} (3) ___________________________________________,
{city} (4)___________,{state} (5)_______, {zip code}__(6)__,{telephone number} _(7)___________.

Line 1 The nonlawyer who helps you should type or print his or her name on line 1.
Lines 2–7 The nonlawyer’s business name, address, (including street, city, state, zip code, and
telephone number) should be typed or printed on lines 2–7.

In addition, a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), should
be completed if a nonlawyer assists you. The disclosure is available as a family law form and should be
completed before the nonlawyer helps you. This is to be sure that you understand the role and
limitations of a nonlawyer. You and the nonlawyer should keep a copy of this disclosure for your
records.

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 FAMILY LAW GLOSSARY OF COMMON TERMS AND DEFINITIONS
Note: The following definitions are intended to be helpful, BUT they are not intended to constitute
legal advice or address every possible meaning of the term(s) contained in this glossary.

Affidavit - a written statement in which the facts stated are sworn or affirmed to be true.
Alimony-spousal support which may be ordered by the court in a proceeding for dissolution of marriage.
Types of alimony include: bridge-the-gap, durational, rehabilitative, or retroactive, and may be either
temporary or permanent. The court may order periodic payments, payments in lump sum, or both. In
determining whether to award alimony, the court must determine whether either party has an actual
need for alimony and whether the other party has the ability to pay. The court must consider the
factors set forth in section 61.08, Florida Statutes, and must make certain written findings. An alimony
award may not leave the paying party with significantly less net income than that of the receiving party
without written findings of exceptional circumstances.
Answer - written response by a respondent that states whether he or she admits (agrees with) or denies
(disagrees with) the allegations in the petition. Any allegations not specifically denied are considered to
be admitted.
Appeal - asking a district court of appeal to review the decision in your case. There are strict procedural
and time requirements for filing an appeal.
Asset - everything owned by you or your spouse, including property, cars, furniture, bank accounts,
jewelry, life insurance policies, businesses, or retirement plans. An asset may be marital or nonmarital,
but that distinction is for the court to determine if you and your spouse do not agree.
Attorney - a person with special education and training in the field of law who is a member in good
standing of The Florida Bar and licensed to practice law in Florida. An attorney is the only person who is
allowed to give you legal advice. An attorney may file your case and represent you in court, or just
advise you of your rights before you file your own case. In addition to advising you of your rights, an
attorney may tell you what to expect and help prepare you for court. In family law matters, you are not
entitled to a court-appointed lawyer, like a public defender in a criminal case. However, legal assistance
is often available for those who are unable to hire a private attorney. You may consult the yellow pages
of the telephone directory for a listing of legal aid or lawyer referral services in your area, or ask your
local clerk of court or family law intake staff what services are available in your area. You may also
obtain information from the Florida Supreme Court’s Internet site located at http://www.flcourts.org.
Bond - money paid to the clerk of court by one party in a case, to be held and paid to an enjoined party
in the event that the first party causes loss or damage of property as a result of wrongfully enjoining the
other party.
Beneficiary Designation-Florida law provides that a beneficiary designation made by or on behalf of a
party providing for the payment or transference of an asset or benefit upon his or her death to the other
spouse is void when the final judgment dissolving or declaring a marriage invalid is signed, unless the
final judgment specifically states otherwise. Federal law and other statutory provisions may also apply.
This includes, but is not limited to, such assets as life insurance policies, annuities, employee benefit
plans, individual retirement accounts, and payable-on-death accounts. Whether or not to continue a
beneficiary designation is a complex area of the law and you may wish to consult with an attorney.

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Bridge-the-Gap Alimony-spousal support which is ordered to assist a party to make the transition from
being married to being single. Bridge-the-Gap alimony is designed to assist a party with legitimate,
identifiable short-time needs; its length cannot exceed two years and it cannot be modified.
Central Depository-the office of the clerk of court that is responsible for collecting and disbursing court
ordered alimony and child support payments. The depository also keeps payment records and files
judgments if support is not paid.
Certificate of Service - a document that must be filed whenever a form you are using does not contain a
statement for you to fill in showing to whom you are sending copies of the form. Florida Supreme Court
Approved Family Law Form 12.914 is the certificate of service form and contains additional instructions.
Certified Copy - a copy of an order or final judgment, certified by the clerk of the circuit court to be an
authentic copy.
Certified Mail - mail which requires the receiving party to sign as proof that they received it.
Child Support - money paid from one parent to the other for the benefit of their dependent or minor
child(ren).
Clerk of the Circuit Court - elected official in whose office papers are filed, a case number is assigned,
and case files are maintained. The clerk’s office usually is located in the county courthouse.
Concurrent Custody-(for the purposes of a petition filed pursuant to chapter 751, Florida Statutes)
means that an eligible extended family member is awarded custodial rights to care for a child or children
concurrently with the child(ren)’s parent or parents.
Constructive Service - notification of the other party by newspaper publication or posting of notice at
designated places when the other party cannot be located for personal service. You may also be able to
use constructive service when the other party lives in another state. Constructive service is also called
“service by publication.” However, when constructive service is used, the relief the Court may grant is
limited; that relief cannot include either alimony or child support. For more information on service, see
the instructions for Florida Family Law Rules of Procedure Forms 12.910(a) and 12.913(b) and Florida
Supreme Court Approved Family Law Forms 12.913(a)(1) and (2).
Contested Issues - any or all issues upon which the parties are unable to agree and which must be
resolved by the judge at a hearing or trial.
Contingent Asset - an asset that you may receive or get later, such as income, tax refund, accrued
vacation or sick leave, a bonus, or an inheritance.
Contingent Liability - a liability that you may owe later, such as payments for lawsuits, unpaid taxes, or
debts that you have agreed or guaranteed to pay if someone else does not.
Counterpetition - a written request to the court for legal action, which is filed by a respondent after
being served with a petition.
Custody Order – a judgment or order incorporating a 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. ss. 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.
Default - a failure of a party to respond to the pleading of another party. This failure to respond may
allow the court to decide the case without input from the party who did not appear or respond.
Delinquent - late.

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Dependent Child(ren) - child(ren) who depend on their parent(s) for support either because they are
under the age of 18, have a mental or physical disability that prevents them from supporting
themselves, or are in high school, between the ages of 18 and 19, and performing in good faith with a
reasonable expectation of graduation before the age of 19.
Deputy Clerk - an employee of the office of the clerk of court, which is usually located in the county
courthouse or a branch of the county courthouse.
Dissolution of Marriage - divorce; a court action to end a marriage.
Durational Alimony-spousal support which is ordered to provide economic assistance for a set period of
time following a marriage of short or moderate duration or following a marriage of long duration if there
is no ongoing need for support on a permanent basis. Durational alimony terminates upon the death of
either party or upon remarriage of the party receiving support. It may be modified or terminated, but
cannot exceed the length of a marriage.
Electronic Communication – Contact, other than face-to-face contact, facilitated by tools such as
telephones, electronic mail or email, webcams, video-conferencing equipment and software or other
wired or wireless technologies, or other means of communication to supplement fact-to face contact
between a parent and that parent’s minor child.
Enjoined - prohibited by the court from doing a specific act.
Ex Parte - communication with the judge by only one party. In order for a judge to speak with either
party, the other party must have been properly notified and have an opportunity to be heard. If you
have something you wish to tell the judge, you should ask for a hearing or file information in the clerk of
court’s office, with certification that a copy was sent to the other party.
Extended Family Member-(for the purposes of a petition filed pursuant to chapter 751, Florida Statutes)
is a person who is either:
1) A relative of a minor child within the third degree by blood or marriage to the parent; OR
2) The stepparent of a minor child if the stepparent is currently married to the parent of the child
and is not a party in a pending dissolution, separate maintenance, domestic violence, or other
civil or criminal proceeding in any court of competent jurisdiction involving one or both of the
child’s parents as an adverse party.
Family Law Intake Staff - a court’s employee(s) who is (are) available to assist you in filing a family law
case. Family law intake staff are not attorneys and cannot give legal advice. They may only assist you
with filling out the form(s). Your local clerk’s office can tell you if your county has such assistance
available.
Filing - delivering a petition, response, motion, or other pleading in a court case to the clerk of court’s
office.
Filing Fee - an amount of money, set by law, that the petitioner must pay when filing a case. If you
cannot afford to pay the fee, you must file an Application for Determination of Civil Indigent Status, to
ask the clerk to file your case without payment of the fee. This form can be obtained from the clerk’s
office.
Final Hearing - trial in your case.
Financial Affidavit - a sworn statement that contains information regarding your income, expenses,
assets, and liabilities.
Final Judgment - a written document signed by a judge and recorded in the clerk of the circuit court’s
office that contains the judge’s decision in your case.
Guardian ad Litem - a neutral person who may be appointed by the court to evaluate or investigate your
child’s situation, and file a report with the court about what is in the best interests of your child(ren).
Guardians do not “work for” either party. The guardian may interview the parties, visit their homes,

General Information for Self-Represented Litigants (02/18)
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visit the child(ren)’s school(s) and speak with teachers, or use other resources to make their
recommendation.
Hearing - a legal proceeding before a judge or designated officer (general magistrate or hearing officer)
on a motion.
Health Insurance-coverage under a fee-for-service arrangement, health care maintenance organization,
or preferred provider organization, and other types of coverage available to either parent, under which
medical services could be provided to a minor or dependent child.
Judge - an elected official who is responsible for deciding matters on which you and the other parties in
your case are unable to agree. A judge is a neutral person who is responsible for ensuring that your case
is resolved in a manner which is fair, equitable, and legal. A judge is prohibited by law from giving you
or the other party any legal advice, recommendations, or other assistance, and may not talk to either
party unless both parties are present, represented, or at a properly scheduled hearing.
Judicial Assistant - the judge’s personal staff assistant.
Liabilities - everything owed by you or your spouse, including mortgages, credit cards, or car loans. A
liability may be marital or nonmarital, but that distinction is for the court to determine if you and your
spouse do not agree.
Lump Sum Alimony - money ordered to be paid by one spouse to another in a limited number of
payments, often a single payment.
Mandatory Disclosure - items that must be disclosed by both parties except those exempted from
disclosure by Florida Family Law Rule 12.285.
Marital Asset - generally, anything that you and/or your spouse acquired or received (by gift or
purchase) during the marriage. For example, something you owned before your marriage may be
nonmarital. An asset may only be determined to be marital by agreement of the parties or
determination of the judge.
Marital Liability - generally, any debt that you and/or your spouse incurred during the marriage. A debt
may only be determined to be nonmarital by agreement of the parties or determination of the judge.
Mediator - a person who is trained and certified to assist parties in reaching an agreement before going
to court. Mediators do not take either party’s side and are not allowed to give legal advice. They are
only responsible for helping the parties reach an agreement and putting that agreement into writing. In
some areas, mediation of certain family law cases may be required before going to court.
Modification - a change made by the court in an order or final judgment.
Motion - a request made to the court, other than a petition.
No Contact - a court order directing a party not speak to, call, send mail to, visit, or go near his or her
spouse, ex-spouse, child(ren), or other family member.
Nonlawyer - a person who is not a member in good standing of The Florida Bar.
Nonmarital Asset - generally, anything owned separately by you or your spouse. An asset may only be
determined to be nonmarital by either agreement of the parties or determination of the judge.
Nonmarital Liability - generally, any debt that you or your spouse incurred before your marriage or
since your separation. A debt may only be determined to be nonmarital by either agreement of the
parties or determination of the judge.
Nonparty - a person who is not the petitioner or respondent in a court case.
Notary Public - a person authorized to witness signatures on court related forms.
Obligee - a person to whom money, such as child support or alimony, is owed.
Obligor - a person who is ordered by the court to pay money, such as child support or alimony.

General Information for Self-Represented Litigants (02/18)
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Order - a written decision, signed by a judge and filed in the clerk of the circuit court’s office, that
contains the judge’s decision on part of your case, usually on a motion.
Original Petition - see Petition.
Parenting Course - a class that teaches parents how to help their child(ren) cope with divorce and other
family issues.
Parenting Plan – a document created to govern the relationship between the parents relating to the
decisions that must be made regarding the minor child(ren). The Parenting Plan must contain a time-
sharing schedule for the parents and child(ren) and shall address the issues concerning the minor
child(ren). The issues concerning the minor child(ren) may include, but are not limited to, the
child(ren)’s education, health care, and physical, social, and emotional well-being. In creating the Plan,
all circumstances between the parents, including their historic relationship, domestic violence, and
other factors must be taken into consideration. The Parenting Plan must be developed and agreed to by
the parents and approved by the court. If the parents 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.
Parenting Plan Recommendation – A nonbinding recommendation concerning one or more elements of
a Parenting Plan made by a court-appointed mental health practitioner or other professional designated
pursuant to either section 61.20 or 61.401, Florida Statutes, or Florida Family Law Rule of Procedure
12.363.
Party - a person involved in a court case, either as a petitioner or respondent.
Paternity Action - A lawsuit used to determine whether a designated individual is the father of a specific
child or children.
Payor - an employer or other person who provides income to an obligor.
Permanent Alimony - spousal support ordered to provide for the needs and necessities of life as they
were established during the marriage for a party who lacks the financial ability to meet his or her needs
and necessities after dissolution of marriage. Permanent alimony is paid at a specified, periodic rate
until: modification by a court order; the death of either party; or the remarriage of the party receiving
alimony, whichever occurs first. Permanent alimony requires consideration of the factors set forth in
section 61.08(2), Florida Statutes, and must include certain written findings by the court.
Personal Service - when a summons and a copy of a petition (or other pleading) that has been filed with
the court are delivered by a deputy sheriff or private process server to the other party. Personal service
is required for all petitions and supplemental petitions.
Petition - a written request to the court for legal action, which begins a court case.
Petitioner - the person who originally files a petition that begins a court case. The Petitioner remains the
Petitioner throughout the duration of the case.
Pleading - a formal, written statement of exactly what a party wants the court to do in a lawsuit or court
action.
Pro Se or Self-Represented Litigant - a person who appears in court without the assistance of a lawyer.
Pro Se Coordinator - see Family Law Intake Staff.
Rehabilitative Alimony - spousal support ordered to be paid for a limited period of time to allow one of
the parties an opportunity to complete a plan of education or training, according to a rehabilitative plan
accepted by the court, so that he or she may better support himself or herself after dissolution of
marriage.
Relocation- a change in the location of the principal residence of a parent or other person in accordance
with section 61.13001, Florida Statutes.

General Information for Self-Represented Litigants (02/18)
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Respondent - the person who is served with a petition requesting some legal action against him or her.
The Respondent remains the Respondent throughout the duration of the case.
Scientific Paternity Testing - a medical test to determine the biological father of a child.
Service - the delivery of legal documents to a party. Service must be in accordance with Florida Rule of
Judicial Administration 2.516.
Shared Parental Responsibility - an arrangement under which both parents have full parental rights and
responsibilities for their child(ren), and the parents make major decisions affecting the welfare of the
child(ren) jointly. Shared Parental Responsibility is presumptive in Florida.
Sole Parental Responsibility - a parenting arrangement under which the responsibility for the minor
child(ren) is given to one parent by the court, with or without rights of time-sharing to the other parent.
State Disbursement Unit- the unit established and operated by the Title IV-D agency to provide one
central address for the collection and disbursement of child support payments made in both
Department of Revenue and non-Department of Revenue cases, in which the obligation is paid through
an income deduction order.
Supervised Time-Sharing- a parenting arrangement under which time-sharing between a parent and his
or her child(ren) is supervised by either a friend, family member, or a supervised visitation center.
Supplemental Petition - a petition that may be filed by either party after the judge has made a decision
in a case and a final judgment or order has been entered. For example, a supplemental petition may be
used to request that the court modify the previously entered final judgment or order.
Supportive Relationship-a relationship, defined in section 61.14(1)(b)1, Florida Statutes, existing
between an obligee who receives alimony and a person with whom that obligee resides.
Time-Sharing Schedule – a timetable that must be included in the Parenting Plan that specifies the time,
including overnights and holidays, that a minor child or children will spend with each parent. The time-
sharing schedule shall either be developed and agreed to by the parents of a minor child or children and
is approved by the court, or established by the court if the parents cannot agree, or if their agreed-upon
schedule is not approved by the court.
Trial - the final hearing in a contested case.
Uncontested - any and all issues on which the parties are able to agree and which are part of a marital
settlement agreement.

General Information for Self-Represented Litigants (02/18)
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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.901(b)(1),
PETITION FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR
MINOR CHILD(REN)
(02/18)

When should this form be used?

This form should be used when you are filing for a dissolution of marriage, and you and your spouse have
a dependent or minor child(ren) together, or a spouse is pregnant. You 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 a spouse 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. Because you are filing the petition in this
proceeding, you may also be referred to as the petitioner and your spouse as the respondent.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

What should I do next?

For your case to proceed, you must properly notify your spouse of the petition. If you know where your
spouse lives, you should use personal service. If you absolutely do not know where your spouse 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, which cannot include either spousal support (alimony) or child support.
For more information on constructive service, see Notice of Action for Family Cases with Minor
Child(ren), Florida Supreme Court Approved Family Law Form 12.913(a)(2), and Affidavit of Diligent
Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(c). 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) and
Affidavit of Military Service, Florida Supreme Court Approved Family Law Form 12.912(b). 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.

Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
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If personal service is used, your spouse 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 contact 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 contact 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 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.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving pleadings
by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of
Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of
Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the
A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
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To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

Special notes...

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:

 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 your spouse’s 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 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), (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.

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
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
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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. Both parents are required to provide financial support for their minor or dependent
child(ren); however, the court may order one parent to pay child support 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.

Alimony. Alimony may be awarded to a spouse if the judge finds that one spouse has an actual need for
it and also finds that the other spouse has the ability to pay. 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 permanent alimony, bridge-the-gap alimony,
durational alimony, and/or rehabilitative alimony. If alimony is awarded, the judge may order periodic
payments, payments in lump sum, or both.

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
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
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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 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 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 one of the
following: 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 Disclosure from Nonlawyer, Florida Family Law
Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these
forms also must put his or her name, address, and telephone number on the bottom of the last page of
every form he or she helps you complete.

Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
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 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
In re: The Marriage of:

______________________________,
Petitioner,

and

_______________________________,
Respondent.

PETITION FOR DISSOLUTION OF MARRIAGE WITH
DEPENDENT OR MINOR CHILD(REN)
I, {full legal name} , the
Petitioner, being sworn, certify that the following statements are true:

1. JURISDICTION/RESIDENCE
_____Petitioner _____ Respondent _____ Both has (have) lived in Florida for at least 6
months before the filing of this Petition for Dissolution of Marriage.
2. Petitioner _____ is or _____ is not a member of the military service.
Respondent _____ is or _____ 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)
Place of marriage: {county, state, country} __________________________________________

4. DEPENDENT OR MINOR CHILD(REN)
{Choose all that apply}
a. _____ Petitioner is pregnant. Baby is due on: {date} _____
b. _____ Respondent is pregnant. Baby is due on: {date} ________________________
c. _____ 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) (02/18)
- 23 -
 d. ___ The minor child(ren) born or conceived during the marriage who are not common to both
parties are:

Name Birth date
______________________________________________________________________________
______________________________________________________________________________

The birth parent (s) of the above minor child(ren) is (are): {name and address}
______________________________________________________________________________
______________________________________________________________________________

e.___ 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) {choose only one} _____ is filed with this petition 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.

OR

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.

OR

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), filed in this case.

Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
- 24 -
 {Indicate 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 ____Respondent should be awarded an interest in the other spouse’s
property because:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

SECTION II. SPOUSAL SUPPORT (ALIMONY)

1. ____ Petitioner ____Respondent forever gives up any right to spousal support (alimony)
from the other spouse.

OR

2. ____ Petitioner _____Respondent requests that the Court order the other spouse to pay the
following spousal support (alimony) and claims that he or she has an actual need for the support
that he or she is requesting and that the other spouse has the ability to pay that support.
Spousal support (alimony) is requested in the amount of $________________ every: _____
week _____ other week _____ month, or _____ other ____________________beginning {date}
________________ and continuing until {date or event} ___________________________.

Explain why the Court should order _____Petitioner _____Respondent to pay, and any specific
request(s) for type of alimony (temporary, permanent, bridge-the-gap, durational, rehabilitative,
and/or lump sum):

.

3. _____Other provisions relating to alimony, including any tax treatment and consequences:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

4. _____ Petitioner requests life insurance on the other spouse’s life, provided by that spouse, to
secure such support.
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
- 25 -
SECTION III. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING

1. The minor child(ren) currently reside(s) with _____ Petitioner _____ Respondent _____ 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 parents;

b. ____ awarded solely to _____ Petitioner _____ Respondent. 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). For purposes of a Parenting Plan, the Petitioner will be referred
to as {name or designation}____________________, and the Respondent will be referred to as
{name or designation}_________________________________. 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
{Choose only one} _____ have _____ have not agreed to the Parenting Plan.

b. _____Each child will have time-sharing with both parents as follows: __________________
_____________________________________________________________________
_____________________________________________________________________
____________________________________________________________________________
(_____ Indicate if a separate sheet is attached.)

c. .____ The court should establish a Parenting Plan with the following provisions for:
{Insert name or designation of the appropriate parent in the space provided}
____ No time-sharing for Parent _____________
____ Limited time-sharing with Parent __________
____ Supervised Time-Sharing for Parent ___________Parent___________;
____ Supervised or third-party exchange of the child(ren).
____ Explain:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

4. Explain why this request is in the best interests of the child(ren):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
- 26 -
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, is (are) in high school, and 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 and understands that a 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. ____ Petitioner
b. ____ Respondent.

5. _____Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid:
{Choose only one}
a. ____by Petitioner;
b. ____by Respondent;
c. ____equally by the spouses {each spouse pays 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 the other
spouse.

Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
- 27 -
SECTION V. OTHER
1. Petitioner requests to be known by the following former legal name, which was:
{former legal name}:___________________________________________________________.

2. Other relief {specify} ____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

SECTION VI. 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:
{Indicate 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. ______ adopting or establishing 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 Petitioner’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 understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
petition and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated_________________________ _____________________________________________
Signature of Petitioner
Printed Name: ________________________________
Address: ______________________________________
City, State, Zip: _________________________________
Telephone Number: _____________________________
Fax Number: __________________________________________
Designated E-mail Address(es): ____________________
_____________________________________________

STATE OF FLORIDA
COUNTY OF ____________________
Sworn to or affirmed and signed before me on __________ by _________________________________.

_____________________________________________
NOTARY PUBLIC or DEPUTY CLERK

Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
- 28 -
 _____________________________________________
{Print, type, or stamp commissioned name of notary or
deputy clerk.}
____ Personally known
____ Produced identification
Type of identification produced ________________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the Petitioner.
This form was completed with the assistance of:
{name of individual}_______________________________________________________________,
{name of business} ________________________________________________________________,
{address} ________________________________________________________________________,
{city}________________ {state}_____, {zip code}________, {telephone number} _______________.

Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
- 29 -
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)
(02/18)
When should this form be used?

This form may be used when you are filing for a dissolution of marriage, and you and your spouse have
marital assets and/or marital liabilities, but you do not have any minor or dependent children and neither
of you is pregnant. You 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 cannot file a Petition 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 spousal 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. Because you are filing the petition in this
proceeding, you may also be referred to as the petitioner and your spouse as the respondent.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

What should I do next?

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 which cannot include spousal support (alimony). For more information on

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) (02/18)
- 30 -
constructive service, see Notice of Action for Dissolution of Marriage (No Child or Financial Support),
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 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) and Affidavit
of Military Service, Florida Supreme Court Approved Family Law Form 12.912(b). 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, your spouse 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 contact 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 contact 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 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.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving

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) (02/18)
- 31 -
pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review
Florida Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link
to the Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules
of Court in the A-Z Topical Index

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

Special notes...

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.)
 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.)

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) (02/18)
- 32 -
Alimony. Alimony may be awarded to a spouse if the judge finds that one spouse has an actual need for
it and also finds that the other spouse has the ability to pay. 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 permanent alimony, bridge-the-gap alimony,
durational alimony, and/or rehabilitative alimony. If alimony is awarded, the judge may order periodic
payments, payments in lump sum, or both.

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 spouses 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 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 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.

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) (02/18)
- 33 -
 IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA

Case No: ________________________
In re: The Marriage of: Division: ________________________

_________________________________,
Petitioner,
and

_________________________________,
Respondent.

PETITION FOR DISSOLUTION OF MARRIAGE WITH PROPERTY
BUT NO DEPENDENT OR MINOR CHILD(REN)

I, {full legal name} ______________________________________________________, the
Petitioner, being sworn, certify that the following statements are true:

1. JURISDICTION/RESIDENCE
_____ Petitioner _____ Respondent _____ Both has (have) lived in Florida for at least 6 months before
the filing of this Petition for Dissolution of Marriage.

2. Petitioner _____ is or _____ is not a member of the military service.
Respondent _____ is or _____ 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}
Place of marriage: {county, state, country} ____________________________________________

4. THERE ARE NO MINOR (under 18) OR DEPENDENT CHILD(REN) COMMON TO BOTH PARTIES AND
NEITHER SPOUSE IS 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:

_____ The marriage is irretrievably broken.
OR
_____ 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) (02/18)
- 34 -
SECTION I. MARITAL ASSETS AND LIABILITIES

1.____ There are no marital assets or liabilities.

OR

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. {Indicate 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 _____ the other spouse’s property
because:______________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________.

SECTION II. SPOUSAL SUPPORT (ALIMONY)

1. _____ Petitioner forever gives up any right to spousal support (alimony) from the other spouse.

OR

2. _____ Petitioner requests that the Court order the other spouse to pay the following spousal support
(alimony) and claims that he or she has an actual need for the support that he or she is requesting and
that the other spouse 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 the other spouse to pay and any specific request(s) for type of
alimony (temporary, permanent, bridge-the-gap, durational, rehabilitative, and/or lump sum):
_________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.
3._____Other provisions relating to alimony including any tax treatment and consequences:
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) (02/18)
- 35 -
 ____________________________________________________________________________
____________________________________________________________________________
_____________________________________________________________________________.

4._____ Petitioner requests life insurance on the other spouse’s life, provided by that spouse, to secure
such support.

SECTION III. OTHER

_____Petitioner requests to be known by the following former legal name, which was {former legal
name} ___________________________________________________________.

Other relief {specify}:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________.

SECTION IV. 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:
[Indicate all that apply]

_____ distributing marital assets and liabilities as requested in Section I of this petition;
_____ awarding spousal support (alimony) as requested in Section II of this petition;
_____ restoring Petitioner’s former name as requested in Section III of this petition;
_____ awarding other relief as requested in Section III of this petition; and any other terms the Court
deems necessary.

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) (02/18)
- 36 -
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
petition and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated: ______________________ _____________________________________________
Signature of Petitioner
Printed Name: _________________________________
Address: ______________________________________
City, State, Zip: _________________________________
Telephone Number: _____________________________
Fax Number: __________________________________
Designated E-mail Address(es): ____________________

STATE OF FLORIDA
COUNTY OF ____________________

Sworn to or affirmed and signed before me on ____________ by ________________________________

_____________________________________________
NOTARY PUBLIC or DEPUTY CLERK

_____________________________________________
{Print, type, or stamp commissioned name of notary or
deputy clerk.}
____Personally known
____Produced identification
____Type of identification produced ________________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the Petitioner.
This form was completed with the assistance of:
{name of individual} ___________________________________________________________________,
{name of business} ____________________________________________________________________,
{address} ____________________________________________________________________________,
{city} _______________,{state} _____{zip code}___________,{telephone number} _________________.

Florida Supreme Court Approved Family Law Form 12.901(b)(2), Petition for Dissolution of Marriage with Property
but No Dependent or Minor Child(ren) (02/18)
- 37 -
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
(02/18)

When should this form be used?

This form may be used when you are filing for a dissolution of marriage, and you and your spouse have
no marital assets or marital liabilities, no minor or dependent children, neither spouse is seeking spousal
support (alimony), and neither spouse is pregnant. You 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 cannot file a Petition for a Simplified
Dissolution of Marriage if any of the following are true:

 Either you or your spouse is seeking spousal 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. Because you are filing the petition in this
proceeding, you may also be referred to as the petitioner and your spouse as the respondent.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

What should I do next?

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, which cannot include spousal support (alimony). For more
information on constructive service, see Notice of Action for Dissolution of Marriage (No Child or
Instructions to Florida Supreme Court Approved Law Form 12.901(b)(3), Petition for Dissolution of Marriage with
No Dependent or Minor Child(ren) or Property (02/18)
- 38 -
Financial Support), 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 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) and Affidavit of Military Service, Florida Supreme Court Approved Family Law Form
12.912(b). 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, your spouse 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 contact 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 contact 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 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.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving pleadings
by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of
Instructions to Florida Supreme Court Approved Law Form 12.901(b)(3), Petition for Dissolution of Marriage with
No Dependent or Minor Child(ren) or Property (02/18)
- 39 -
Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of
Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the
A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

Special notes...

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 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.
Instructions to Florida Supreme Court Approved Law Form 12.901(b)(3), Petition for Dissolution of Marriage with
No Dependent or Minor Child(ren) or Property (02/18)
- 40 -
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.

Instructions to Florida Supreme Court Approved Law Form 12.901(b)(3), Petition for Dissolution of Marriage with
No Dependent or Minor Child(ren) or Property (02/18)
- 41 -
 IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA

In re: The Marriage of: 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
Petitioner, certify that the following statements are true:

1. JURISDICTION/RESIDENCE
_____ Petitioner _____ Respondent _____ Both has (have) lived in Florida for at least 6 months
before the filing of this Petition for Dissolution of Marriage.

2. Petitioner _____ is or _____ is not a member of the military service.
Respondent _____ is or _____ is not a member of the military service.

3. MARRIAGE HISTORY
Date of marriage: {month, day, year} ________________________________________________
Place of marriage: {county, state, country}_____________________________________________

4. THERE ARE NO MINOR (under 18) OR DEPENDENT CHILD(REN) COMMON TO BOTH PARTIES AND
NEITHER SPOUSE IS 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:

a. _____ The marriage is irretrievably broken.

OR
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 Law Form 12.901(b)(3), Petition for Dissolution of Marriage with No Dependent
or Minor Child(ren) or Property (02/18)
- 42 -
7. THERE ARE NO MARITAL ASSETS OR LIABILITIES.

8. PETITIONER FOREVER GIVES UP ANY RIGHTS TO SPOUSAL SUPPORT (ALIMONY) FROM THE OTHER
SPOUSE.

9. _____Petitioner requests to be known by the following former legal name, which was {former legal
name} __________________________________________________________.

10. Other relief {specify}: ________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.

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:

[Indicate all that apply]
1. ____ restoring Petitioner’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.

Florida Supreme Court Approved Law Form 12.901(b)(3), Petition for Dissolution of Marriage with No Dependent
or Minor Child(ren) or Property (02/18)
- 43 -
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
petition and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated: ______________________ _____________________________________________
Signature of Petitioner
Printed Name: _________________________________
Address: ______________________________________
City, State, Zip: _________________________________
Telephone Number: _____________________________
Fax Number: __________________________________
Designated E-mail Address(es): ____________________
_____________________________________________

STATE OF FLORIDA
COUNTY OF ____________________

Sworn to or affirmed and signed before me on ____________ by _______________________________.

_____________________________________________
NOTARY PUBLIC or DEPUTY CLERK

_____________________________________________
{Print, type, or stamp commissioned name of notary or
deputy clerk.}
_____ Personally known
_____ Produced identification
_____ Type of identification produced ________________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the Petitioner
This form was completed with the assistance of:
{name of individual} _________________________________________________________________,
{name of business} __________________________________________________________________,
{address} __________________________________________________________________________,
{city} ______________,{state} _____,{zip code}___________,{telephone number} ________________.

Florida Supreme Court Approved Law Form 12.901(b)(3), Petition for Dissolution of Marriage with No Dependent
or Minor Child(ren) or Property (02/18)
- 44 -
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.902(d)
UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT
(UCCJEA) AFFIDAVIT
(02/18)

When should this form be used?

This form should be used in any case involving parental responsibility for, custody of, or time-sharing or
visitation with, any minor child(ren). This affidavit is required even if the parental responsibility for,
custody of, or time-sharing or visitation with, the minor child(ren) is not in dispute.

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 it with the clerk of the circuit court in the
county where the petition was filed and keep a copy for your records.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed

What should I do next?

A copy of this form must be mailed, e-mailed, or hand delivered to the other party in your case, if it is
not served on him or her with your initial papers.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving pleadings
by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of
Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of

Instructions for Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction
and Enforcement Act (UCCJEA) Affidavit (02/18)
- 45 -
Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the
A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

Where can I look for more information?

Before proceeding, you should read General Information for Self-Represented Litigants found at the
beginning of these forms. The words that are in bold underline in these instructions are defined there.
For further information, see sections 61.501-61.542, Florida Statutes.

Special notes...

With this form, you must also file a Notice of Confidential Information within Court Filing, Florida Rules
of Judicial Administration Appendix to Rule 2.420 Form.

Effective October 1, 2008, terms such as custodial parent, noncustodial parent, primary residential
parent, secondary residential parent, and visitation were removed from Chapter 61, Florida Statutes;
however, because the UCCJEA uses the terms, custody and visitation, they are included in this form.
Parents must develop a Parenting Plan that includes, among other things, their time-sharing schedule
with the minor child(ren). If the parents cannot agree, a parenting plan will be established by the Court.

If you are the petitioner in an injunction for protection against domestic violence case and you have filed
a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form
12.980(h), you should write confidential in any space on this form that would require you to write the
address where you are currently living.

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.

Instructions for Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction
and Enforcement Act (UCCJEA) Affidavit (02/18)
- 46 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
,
Petitioner,

and

,
Respondent.

UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT
(UCCJEA) AFFIDAVIT

I, {full legal name} ____________, being sworn, certify that the following
statements are true:

1. The number of minor child(ren) subject to this proceeding is . The name, place of
birth, birth date, and sex of each child; the present address, periods of residence, and places
where each child has lived within the past five (5) years; and the name, present address, and
relationship to the child of each person with whom the child has lived during that time are:

THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # 1 :

Child’s Full Legal Name:
Place of Birth: Date of Birth: Sex:

Child’s Residence for the past 5 years:
Dates Address (including city and Name and present address of Relationship
(From/To) state) where child lived person child lived with to child

/present*

____/____

____/____

____/____

____/____

Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement
Act (UCCJEA) Affidavit (02/18)
- 47 -
 ____/____

* If you are the petitioner in an injunction for protection against domestic violence case and you have
filed a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form
12.980(h), you should write confidential in any space on this form that would require you to enter the
address where you are currently living.

THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # :

Child’s Full Legal Name:
Place of Birth: Date of Birth: Sex:
Child’s Residence for the past 5 years:
Dates Address (including city and Name and present address of Relationship
(From/To) state) where child lived person child lived with to child

/present

____/____

____/____

____/____

____/____

____/____

THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # :

Child’s Full Legal Name:
Place of Birth: Date of Birth: Sex:
Child’s Residence for the past 5 years:
Dates Address (including city and Name and present address of Relationship
(From/To) state) where child lived person child lived with to child

/present

____/____

____/____

____/____

Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement
Act (UCCJEA) Affidavit (02/18)
- 48 -
 ____/____

____/____

2. Participation in custody or time-sharing proceeding(s):
[Choose only one]
______ I HAVE NOT participated as a party, witness, or in any capacity in any other litigation or
custody proceeding in this or any other state, jurisdiction, or country, concerning parental
responsibility for, custody of, or time-sharing or visitation with a child subject to this proceeding.

______ I HAVE participated as a party, witness, or in any capacity in any other litigation or
custody proceeding in this or another state, jurisdiction, or country, concerning parental
responsibility for, custody of, or time-sharing or visitation with a child subject to this proceeding.
Explain:
a. Name of each child:
b. Type of proceeding:
c. Court and state:
d. Date of court order or judgment (if any):

3. Information about custody or time-sharing proceeding(s):
[Choose only one]
______ I HAVE NO INFORMATION of any parental responsibility, custody, time-sharing, or
visitation proceeding pending in a court of this or any other state, jurisdiction, or country
concerning a child subject to this proceeding.

______ I HAVE THE FOLLOWING INFORMATION concerning a parental responsibility, custody,
time-sharing, or visitation proceeding pending in a court of this or another state concerning a
child subject to this proceeding, other than set out in item 2. Explain:
a. Name of each child involved in said litigation:
b. Type of proceeding:
c. Court and state:
d. Date of court order or judgment (if any):
e. Case Number: _______________________________________________________________

4. Persons not a party to this proceeding:
[Choose only one]
______ I DO NOT KNOW OF ANY PERSON in this or any other state, jurisdiction, or country, who
is not a party to this proceeding and who has physical custody or claims to have parental
responsibility for, custody of, or time-sharing or visitation with respect to any child subject to
this proceeding.

______ I KNOW THAT THE FOLLOWING NAMED PERSON(S), not a party to this proceeding, has
(have) physical custody or claim(s) to have parental responsibility for, custody of, or time-
sharing or visitation with respect to any child subject to this proceeding:

Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement
Act (UCCJEA) Affidavit (02/18)
- 49 -
 a. Name and address of person:

_____ has physical custody
_____ claims parental responsibility or custody rights
_____ claims time-sharing or visitation
Name of each child:
Relationship to child, if any: _______________________________________________________

b. Name and address of person:

_____ has physical custody
_____ claims parental responsibility or custody rights
_____ claims time-sharing or visitation
Name of each child:
Relationship to child, if any: _______________________________________________________

c. Name and address of person:

_____ has physical custody
_____ claims parental responsibility or custody rights
_____claims time-sharing or visitation
Name of each child:
Relationship to child, if any: _______________________________________________________

5. Knowledge of prior child support proceedings:
[Choose only one]
_____The child(ren) described in this affidavit are NOT subject to existing child support order(s)
in this or any other state, jurisdiction, or country.

_____The child(ren) described in this affidavit are subject to the following existing child support
order(s):
a. Name of each child: ______________________________________________________
b. Type of proceeding: ______________________________________________________
c. Court and address: _______________________________________________________
d. Date of court order/judgment (if any): ___________________________________________
e. Amount of child support ordered to be paid and by whom:

6. I acknowledge that I have a continuing duty to advise this Court of any parental responsibility,
custody, time-sharing or visitation, child support, or guardianship proceeding (including
dissolution of marriage, separate maintenance, child neglect, or dependency) concerning the
child(ren) in this state or any other state about which information is obtained during this
proceeding.

7. A completed Notice of Confidential Information within Court Filing, Florida Rules of Judicial
Administration Appendix to Rule 2.420 Form, is filed with this Affidavit.

Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement
Act (UCCJEA) Affidavit (02/18)
- 50 -
I certify that a copy of this document was _____ e-served _____ 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:
Designated E-mail Address(es):____________________
_______________________________

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:
Designated E-mail Address(es):____________________
_____________________________________________

STATE OF FLORIDA
COUNTY OF ________________________

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

__________________________________________________
[Print, type, or stamp commissioned name of notary or clerk.]
__ Personally known
__ Produced identification
Type of identification produced _______________________________________

Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement
Act (UCCJEA) Affidavit (02/18)
- 51 -
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the {choose only one} _____ Petitioner _____ Respondent
This form was completed with the assistance of:
{name of individual} _________________________________________________________________,
{name of business} ____________________________________________________________________,
{address} ____________________________________________,
{city} _____________,{state} ___, {zip code}____________, {telephone number}________________.

Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement
Act (UCCJEA) Affidavit (02/18)
- 52 -
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.902(f)(1)
MARITAL SETTLEMENT AGREEMENT FOR DISSOLUTION OF MARRIAGE
WITH DEPENDENT OR MINOR CHILD(REN)
(02/18)

When should this form be used?

This form should be used when a Petition for Dissolution of Marriage with Dependent or Minor
Child(ren), Florida Supreme Court Approved Family Law Form 12.901(b)(1), has been filed and the parties
have reached an agreement on some or all of the issues at hand.

This form should be typed or printed in black ink. Both parties must sign the agreement 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).

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

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.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial

Instructions for Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for
Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)
- 53 -
Administration. . If you elect to participate in electronic service, which means serving or receiving
pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida
Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the
Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court
in the A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

Special notes...

With this form you must also file a Child Support Guidelines Worksheet, Florida Family Law Rules of
Procedure Form 12.902(e), if not already filed.

This form does not act to transfer title to the property. Such transfer must be done by deed or
supplemental final judgment.

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.

Instructions for Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for
Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)
- 54 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:

In re: The Marriage of:

,
Petitioner,

and

,
Respondent.

MARITAL SETTLEMENT AGREEMENT FOR DISSOLUTION OF MARRIAGE
WITH DEPENDENT OR MINOR CHILD(REN)

We, {Petitioner’s full legal name}_______________________________________________, and
{Respondent’s full legal name},__________________________________, being sworn, certify that the
following statements are true:

1. We were married to each other on {date} .

2. Because of irreconcilable differences in our marriage (no chance of staying together), we have
made this agreement to settle once and for all what we owe to each other and what we can expect
to receive from each other. Each of us states that nothing has been held back, that we have
honestly included everything we could think of in listing our assets (everything we own and that
is owed to us) and our debts (everything we owe), and that we believe the other has been open
and honest in writing this agreement.

3. We have both filed a Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form
12.902(b) or (c). Because we have voluntarily made full and fair disclosure to each other of all our
assets and debts, we waive any further disclosure under rule 12.285, Florida Family Law Rules of
Procedure.

4. Each of us agrees to execute and exchange any papers that might be needed to complete this
agreement, including deeds, title certificates, etc.

SECTION I. MARITAL ASSETS AND LIABILITIES
A. Division of Assets. We divide our assets (everything we own and that is owed to us) as follows: Any
personal item(s) not listed below is (are) the property of the party currently in possession of the
item(s).

Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
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 1. Petitioner shall receive as his/her own and Respondent shall have no further rights or
responsibilities regarding these assets:

ASSETS: DESCRIPTION OF ITEM(S) PETITIONER SHALL RECEIVE
Please describe each item as clearly as possible.
You do not need to list account numbers. Where applicable, include whether the Current Fair
name on any title/deed/account described below is in one spouse’s name, or in Market Value
both spouses’ names.

Cash (on hand) $
Cash (in banks/credit unions)

Stocks/Bonds
____________

Notes (money owed to you in writing)

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

Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
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 ASSETS: DESCRIPTION OF ITEM(S) PETITIONER SHALL RECEIVE
Please describe each item as clearly as possible.
You do not need to list account numbers. Where applicable, include whether the Current Fair
name on any title/deed/account described below is in one spouse’s name, or in Market Value
both spouses’ names.

Collectibles

Jewelry

Life insurance (cash surrender value)

Sporting and entertainment (T.V., stereo, etc.) equipment

Other assets

Total Assets to Petitioner $

2. Respondent shall receive as his/her own and Petitioner shall have no further rights or
responsibilities regarding these assets:

ASSETS: DESCRIPTION OF ITEM(S) RESPONDENT SHALL RECEIVE Current Fair
Please describe each item as clearly as possible. Market Value
You do not need to list account numbers. Where applicable, include whether the
name on any title/deed/account described below is in one spouse’s name, or in
both spouses’ names.
Cash (on hand) $
Cash (in banks/credit unions)

Stocks/Bonds ____________

Notes (money owed to you in writing)

Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
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 ASSETS: DESCRIPTION OF ITEM(S) RESPONDENT SHALL RECEIVE Current Fair
Please describe each item as clearly as possible. Market Value
You do not need to list account numbers. Where applicable, include whether the
name on any title/deed/account described below is in one spouse’s name, or in
both spouses’ names.

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

Life insurance (cash surrender value)

Sporting and entertainment (T.V., stereo, etc.) equipment

Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
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 ASSETS: DESCRIPTION OF ITEM(S) RESPONDENT SHALL RECEIVE Current Fair
Please describe each item as clearly as possible. Market Value
You do not need to list account numbers. Where applicable, include whether the
name on any title/deed/account described below is in one spouse’s name, or in
both spouses’ names.

Other assets

Total Assets to Respondent $

B. Division of Liabilities/Debts. We divide our liabilities (everything we owe) as follows:
1. Petitioner shall pay as his/her own the following and will not at any time ask Respondent to pay
these debts/bills:

LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY PETITIONER
Please describe each item as clearly as possible. You do not need to list
account numbers. Where applicable, include whether the name on any Current
mortgage, note, or account described below is in one spouse’s name or in Monthly Amount
both spouses’ names. Payment Owed
Mortgages on real estate: (Home) $ $
(Other)
_________ _________
Charge/credit card accounts

Auto loan
Auto loan
Bank/credit union loans

Money you owe (not evidenced by a note)

Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
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 LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY PETITIONER
Please describe each item as clearly as possible. You do not need to list
account numbers. Where applicable, include whether the name on any Current
mortgage, note, or account described below is in one spouse’s name or in Monthly Amount
both spouses’ names. Payment Owed

Judgments

Other

Total Debts to Be Paid by Petitioner $ $

2. Respondent shall pay as his/her own the following and will not at any time ask Petitioner to pay
these debts/bills:

LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY RESPONDENT
Please describe each item as clearly as possible. You do not need to list
account numbers. Where applicable, include whether the name on any Current
mortgage, note or account described below is in one spouse’s name, or in Monthly Amount
both spouses’ names. Payment Owed
Mortgages on real estate: (Home) $ $
(Other)
__________ _________
Charge/credit card accounts

Auto loan
Auto loan
Bank/credit union loans

Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
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 LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY RESPONDENT
Please describe each item as clearly as possible. You do not need to list
account numbers. Where applicable, include whether the name on any Current
mortgage, note or account described below is in one spouse’s name, or in Monthly Amount
both spouses’ names. Payment Owed
Money you owe (not evidenced by a note)

Judgments

Other

Total Debts to Be Paid by Respondent $ $

C. Contingent Assets and Liabilities (listed in Section III of our Family Law Financial Affidavits) will be
divided as follows:

.

D. Beneficiary Designation {Complete only if beneficiary designations continue after entry of Final
Judgment of Dissolution of Marriage.}

_____The spouses agree that the designation providing for the payment or transfer at death of an interest
in the assets set forth below to or for the benefit of the deceased party’s former spouse SHALL NOT BE
VOID as of the date of entry of the Final Judgment of Dissolution of Marriage.

The Final Judgment of Dissolution of Marriage shall provide that the designations set forth below remain
in full force and effect:

_____1. The _____Petitioner _____Respondent shall acquire or maintain the following assets for the
benefit of the other spouse or child(ren) to be paid upon his/her death outright or in trust. This provision
only applies if other assets fulfilling such requirement for the benefit of the other spouse or child(ren) do

Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
- 61 -
not exist upon his/her death and unless precluded by statute. {Describe the assets with specificity}:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________.
_____2. The _____Petitioner _____Respondent shall not unilaterally terminate or modify the ownership
of the following assets, or their disposition upon his/her death. {Describe the assets with specificity}:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________.

SECTION II. SPOUSAL SUPPORT (ALIMONY) (If you have not agreed on this matter, write n/a on the lines
provided.)

1. ____Each of us forever gives up any right to spousal support (alimony) that we may have.
OR
2. _____ Petitioner _____ Respondent (hereinafter “Obligor”) agrees to pay spousal support
(alimony) in the amount of $ ______every _____ week _____ other week _____month, or
_____ other _____________________, beginning {date} _______________________and
continuing until {date or event} ___________________________________________________.
Explain type of alimony (such as, permanent, bridge-the-gap, durational, rehabilitative, and/or
lump sum) and any other specifics: __________________________________________________

3. _____ Other provisions relating to alimony, including any tax treatment and consequences:
_____________________________________________________________________________
_____________________________________________________________________________.

4. Life insurance in the amount of $____________ to secure the above support, will be provided by
the Obligor.

SECTION III. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING

1. The parties’ minor child(ren) are:
Name Birth date

Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
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 2. The parties shall have time-sharing and parental responsibility in accordance with the Parenting
Plan attached as Exhibit _____.

SECTION IV. CHILD SUPPORT

1. _____ Petitioner ____ Respondent (hereinafter “Obligor”) will pay child support, under Florida’s
child support guidelines, section 61.30, Florida Statutes, to the other parent. The Child Support
Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), is completed and
attached.
Child support established at the rate of $_________ per month for the ______children {total
number of parties’ minor or dependent children} shall be paid commencing_________________
{month, day, year} and terminating ___________________ {month, day, year}. Child support
shall be paid in the amount of $ __________ per ___________ {week, month, other} which is
consistent with the Obligor’s current payroll cycle.

Upon the termination of the obligation of child support for one of the parties’ children, child
support in the amount of $____________ for the remaining ____ children {total number of
remaining children} shall be paid commencing____________________ {month, day, year} and
terminating ________________________________________ {month, day, year}. This child
support shall be paid in the amount of $ ________ per ___________ {week, month, other}
consistent with Obligor’s current payroll cycle.

{Insert schedule for the child support obligation, including the amount, and commencement
and termination dates, for the remaining minor or dependent children, which shall be payable
as the obligation for each child ceases. Please indicate whether the schedule _____ appears
below or _____ is attached as part of this form}
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

The Obligor shall pay child support until all the minor or dependent child(ren): reach the age of
18; become emancipated, marry, join the armed services, die, or become self-supporting; or
until further order of the court or agreement of the parties. The child support obligation shall
continue beyond the age of 18 and until high school graduation for any child who is: dependent
in fact; between the ages of 18 and 19; and is still in high school, performing in good faith with a
reasonable expectation of graduation before the age of 19.

Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
- 63 -
 If the child support amount above deviates from the guidelines by 5% or more, explain the
reason(s) here:
______________________________________________________________________________

2. Retroactive Child Support or Arrearages.
There is currently retroactive child support in the amount of $_________________. There is an
arrearage of previously ordered unpaid child support in the amount of $______________.
The total of $ ___ in retroactive and unpaid child support shall be paid at the rate of
$ ____________every _____week _____ other week _____month,
beginning {date} ________________, until paid in full including statutory interest.

3. Health Insurance.
_____ Petitioner _____ Respondent will maintain health insurance for the parties’ minor
child(ren). The party providing coverage will provide insurance cards to the other party showing
coverage.

OR
_____ Health insurance is either not reasonable in cost or accessible to the child(ren) at this time.
Any uninsured/ unreimbursed medical costs for the minor child(ren) shall be assessed as follows:
a. _____Shared equally by the spouses. {each spouse pays one-half}
b. _____Prorated according to the child support guideline percentages.
c. _____Other {explain}: __________________________________________________
As to these uninsured/unreimbursed medical expenses, the party who incurs the expense shall
submit a 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.

4. Dental Insurance.
_____ Petitioner ____ Respondent will maintain dental insurance for the parties’ minor child(ren).
The party providing coverage will provide insurance cards to the other party showing coverage.

OR
_____ Dental insurance is either not reasonable in cost or accessible to the child(ren) at this time.
Any uninsured/ unreimbursed dental costs for the minor child(ren) shall be assessed as follows:
a. _____Shared equally by the spouses. {each spouse pays one-half}
b. _____Prorated according to the child support guideline percentages.
c. _____Other {explain}: __________________________________________________
As to these uninsured/unreimbursed dental expenses, the party who incurs the expense shall
submit a request for reimbursement to the other party within 30 days, and the other party, within

Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
- 64 -
 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. _____ Petitioner _____ Respondent will maintain life insurance for the benefit of
the parties’ minor child(ren) in the amount of $ ____________ until the youngest child turns 18,
becomes emancipated, marries, joins the armed services, or dies.

6. IRS Income Tax Exemption(s). The assignment of any tax exemptions for the child(ren) shall be
as follows: {explain} __________________________________________________________
_________________________________________________________________________
The other parent will convey any applicable IRS form regarding the income tax exemption.

7. Other provisions relating to child support (e.g., uninsured medical/dental expenses, health or
dental insurance, life insurance to secure child support, orthodontic payments, college fund, etc.):

SECTION V. OTHER

.

SECTION VI. We have not agreed on the following issues:

.

Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
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I certify that I have been open and honest in entering into this settlement agreement. I am satisfied
with this agreement and intend to be bound by it.

Dated:
Signature of Petitioner
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es): __________________
__________________________________________

STATE OF FLORIDA
COUNTY OF ________________________

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

[Print, type, or stamp commissioned name of notary or
clerk.]
_ Personally known
_ Produced identification
Type of identification produced

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the Petitioner
This form was completed with the assistance of:
{name of individual} ____________________________________________________________,
{name of business} _____________________________________________________________,
{address} _____________________________________________________,
{city} _______________,{state} ___,{zip code}__________, {telephone number} ___.

Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
- 66 -
I certify that I have been open and honest in entering into this settlement agreement. I am satisfied
with this agreement and intend to be bound by it.

Dated:
Signature of Respondent
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es): __________________
STATE OF FLORIDA
COUNTY OF ___________________________

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

[Print, type, or stamp commissioned name of notary or
clerk.]
_ Personally known
_ Produced identification
Type of identification produced ____________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the Respondent
This form was completed with the assistance of:
{name of individual}_______________________________________________________,
{name of business} ________________________________________________________,
{address} _____________________________________________________,
{city} , {state} __, {zip code}_________, {telephone number} ________________.

Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.902(f)(2)
MARITAL SETTLEMENT AGREEMENT FOR DISSOLUTION OF MARRIAGE
WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN)
(02/18)

When should this form be used?

This form should be used when a Petition for Dissolution of Marriage with Property but no Dependent
or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.901(b)(2), has been filed and
the parties have reached an agreement on some or all of the issues at hand.

This form should be typed or printed in black ink. Both parties must sign the agreement 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).

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

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.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or

Instructions for Florida Supreme Court Approved Family Law Form 12.902(f)(2), Marital Settlement Agreement for
Dissolution of Marriage with Property but No Dependent or Minor Child(ren) (02/18)
- 68 -
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving pleadings
by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of
Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of
Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the
A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

Special notes...

This form does not act to transfer title to the property. Such transfer must be done by deed or
supplemental final judgment.

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.

Instructions for Florida Supreme Court Approved Family Law Form 12.902(f)(2), Marital Settlement Agreement for
Dissolution of Marriage with Property but No Dependent or Minor Child(ren) (02/18)
- 69 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
In re: The Marriage of:

_________________,
Petitioner,

and

______________,
Respondent.

MARITAL SETTLEMENT AGREEMENT FOR DISSOLUTION OF MARRIAGE
WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN)
We, {Petitioner’s full legal name}_____________________________________________, and
{Respondent’s full legal name} __________________________________________, being sworn, certify
that the following statements are true:

1. We were married to each other on {date} .

2. Because of irreconcilable differences in our marriage (no chance of staying together), we have
made this agreement to settle once and for all what we owe to each other and what we can
expect to receive from each other. Each of us states that nothing has been held back, that we
have honestly included everything we could think of in listing our assets (everything we own and
that is owed to us) and our debts (everything we owe), and that we believe the other has been
open and honest in writing this agreement.

3. We have both filed a Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form
12.902(b) or (c). Because we have voluntarily made full and fair disclosure to each other of all
our assets and debts, we waive any further disclosure under rule 12.285, Florida Family Law
Rules of Procedure.

4. Each of us agrees to execute and exchange any papers that might be needed to complete this
agreement, including deeds, title certificates, etc.
SECTION I. MARITAL ASSETS AND LIABILITIES
A. Division of Assets. We divide our assets (everything we own and that is owed to us) as follows: Any
personal item(s) not listed below is the property of the party currently in possession of the item(s).
1. Petitioner shall receive as his/her own and Respondent shall have no further rights or
responsibilities regarding these assets:
Florida Supreme Court Approved Family Law Form 12.902(f)(2), Marital Settlement Agreement for Dissolution of
Marriage with Property but No Dependent or Minor Child(ren) (02/18)
- 70 -
 ASSETS: DESCRIPTION OF ITEM(S) PETITIONER SHALL RECEIVE
Current Fair
Please describe each item as clearly as possible. You do not need to list account
Market Value
numbers. Where applicable, include whether the name on any title/deed/account
described below is in one spouse’s name or both spouses’ names.
Cash (on hand) $
Cash (in banks/credit unions)

Stocks/Bonds

Notes (money owed to you in writing)

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

Life insurance (cash surrender value)

Sporting and entertainment (T.V., stereo, etc.) equipment

Other assets

Florida Supreme Court Approved Family Law Form 12.902(f)(2), Marital Settlement Agreement for Dissolution of
Marriage with Property but No Dependent or Minor Child(ren) (02/18)
- 71 -
 Total Assets to Petitioner $

2. Respondent shall receive as his/her own and Petitioner shall have no further rights or
responsibilities regarding these assets:

Florida Supreme Court Approved Family Law Form 12.902(f)(2), Marital Settlement Agreement for Dissolution of
Marriage with Property but No Dependent or Minor Child(ren) (02/18)
- 72 -
 ASSETS: DESCRIPTION OF ITEM(S) RESPONDENT SHALL RECEIVE Current Fair
Please describe each item as clearly as possible. You do not need to list account numbers. Where Market Value
applicable, include whether the name on any title/deed/account described below is in one
spouse’s name or both spouses’ names.
Cash (on hand) $
Cash (in banks/credit unions)

Stocks/Bonds
_______________

Notes (money owed to you in writing)

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

Florida Supreme Court Approved Family Law Form 12.902(f)(2), Marital Settlement Agreement for Dissolution of
Marriage with Property but No Dependent or Minor Child(ren) (02/18)
- 73 -
Life insurance (cash surrender value)

Sporting and entertainment (T.V., stereo, etc.) equipment

Other assets

Total Assets to Respondent $

Florida Supreme Court Approved Family Law Form 12.902(f)(2), Marital Settlement Agreement for Dissolution of
Marriage with Property but No Dependent or Minor Child(ren) (02/18)
- 74 -
 B. Division of Liabilities/Debts. We divide our liabilities (everything we owe) as follows:
1. Petitioner shall pay as his/her own the following and will not at any time ask Respondent to pay
these debts/bills:
LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY PETITIONER
Please describe each item as clearly as possible. You do not need to list Current
Monthly
account numbers. Where applicable, include whether the name on any Amount
Payment
mortgage, note, or account described below is in one spouse’s name or in Owed
both spouses’ names.
Mortgages on real estate: (Home) $ $
(Other)
___________ __________
Charge/credit card accounts

Auto loan
Auto loan
Bank/credit union loans

Money you owe (not evidenced by a note)

Judgments

Other

Total Debts to Be Paid by Petitioner $ $

2. Respondent shall pay as his/her own the following and will not at any time ask Petitioner to pay
these debts/bills:

Florida Supreme Court Approved Family Law Form 12.902(f)(2), Marital Settlement Agreement for Dissolution of
Marriage with Property but No Dependent or Minor Child(ren) (02/18)
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 LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY RESPONDENT
Please describe each item as clearly as possible. You do not need to list Current
Monthly
account numbers. Where applicable, include whether the name on any Amount
Payment
mortgage, note, or account described below is in one spouse’s name or in Owed
both spouses’ names.
Mortgages on real estate: (Home) $ $
(Other)
___________ __________
Charge/credit card accounts

Auto loan
Auto loan
Bank/credit union loans

Money you owe (not evidenced by a note)

Judgments

Other

Total Debts to Be Paid by Respondent $ $

C. Contingent Assets and Liabilities (listed in Section III of our Family Law Financial Affidavits) will be
divided as follows:

.

D. Beneficiary Designation {Complete only if beneficiary designations continue after entry of Final
Judgment of Dissolution of Marriage.}

_____The spouses agree that the designation providing for the payment or transfer at death of an interest
in the assets set forth below to or for the benefit of the deceased party’s former spouse SHALL NOT BE
VOID as of the date of entry of the Final Judgment of Dissolution of Marriage.

Florida Supreme Court Approved Family Law Form 12.902(f)(2), Marital Settlement Agreement for Dissolution of
Marriage with Property but No Dependent or Minor Child(ren) (02/18)
- 76 -
The Final Judgment of Dissolution of Marriage shall provide that the designations set forth below remain
in full force and effect:

_____1. The _____Petitioner _____Respondent shall acquire or maintain the following assets for the
benefit of the other spouse or child(ren) to be paid upon his/her death outright or in trust. This provision
only applies if other assets fulfilling such requirement for the benefit of the other spouse or child(ren) do
not exist upon his/her death and unless precluded by statute. {Describe the assets with specificity}:
___________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.

_____2. The _____Petitioner _____Respondent shall not unilaterally terminate or modify the ownership
of the following assets, or their disposition upon his/her death. {Describe the assets with specificity}:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
____________________________________________________________________________________.

SECTION II. SPOUSAL SUPPORT (ALIMONY) (If you have not agreed on this matter, write n/a on the
lines provided.)

1. ____ Each of us forever gives up any right to spousal support (alimony) that we may have.

OR

2. _____Petitioner _____ Respondent (hereinafter “Obligor”) agrees to pay spousal support
(alimony) in the amount of $ _______every _____week _____other week _____ month, or
______ other ______________beginning {date} ___________________________ and
continuing until {date or event}____________ .

Explain type of alimony (permanent, bridge-the-gap, durational, rehabilitative, and/or lump
sum) and any other specifics:

3. _____Other provisions relating to alimony, including any tax treatment and consequences:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

4. _____ Petitioner _____ Respondent will provide life insurance in the amount of $ ____________
to secure the above support.
Florida Supreme Court Approved Family Law Form 12.902(f)(2), Marital Settlement Agreement for Dissolution of
Marriage with Property but No Dependent or Minor Child(ren) (02/18)
- 77 -
SECTION III. OTHER

______________________________________________________________________________
______________________________________________________________________________.

SECTION IV. We have not agreed on the following issues:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

Florida Supreme Court Approved Family Law Form 12.902(f)(2), Marital Settlement Agreement for Dissolution of
Marriage with Property but No Dependent or Minor Child(ren) (02/18)
- 78 -
I certify that I have been open and honest in entering into this settlement agreement. I am satisfied
with this agreement and intend to be bound by it.

Dated: ________ ___________ ______________
Signature of Petitioner
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es): ____________________
_____________________________________________

STATE OF FLORIDA
COUNTY OF ______________

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

[Print, type, or stamp commissioned name of notary or
clerk.]
_____ Personally known
_____ Produced identification
Type of identification produced ______________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the Petitioner
This form was completed with the assistance of: _________________________________________,
{name of individual} ________________________________________________________________,
{name of business} __________________________________________________________________,
{address} _________________________________________________,
{city} _______________, {state} , {zip code}__________, {telephone number} __________.

Florida Supreme Court Approved Family Law Form 12.902(f)(2), Marital Settlement Agreement for Dissolution of
Marriage with Property but No Dependent or Minor Child(ren) (02/18)
- 79 -
I certify that I have been open and honest in entering into this settlement agreement. I am satisfied
with this agreement and intend to be bound by it.

Dated:
Signature of Respondent
Printed name:__________________________________
Address:______________________________________
City, State, Zip:_________________________________
Telephone number:_____________________________
Fax number____________________________________________
Designated E-mail Address(es): ____________________
_____________________________________________

STATE OF FLORIDA
COUNTY OF _______

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

[Print, type, or stamp commissioned name of notary or
clerk.]
_____ Personally known
_____ Produced identification
Type of identification produced ____________________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the Respondent
This form was completed with the assistance of:
{name of individual} _____________________________________________________________,
{name of business} _______________________________________________________________,
{address} ___________ __________________________________________________,
{city} ___________ ,{state} ____, {zip code}__________, {telephone number} ____________.

Florida Supreme Court Approved Family Law Form 12.902(f)(2), Marital Settlement Agreement for Dissolution of
Marriage with Property but No Dependent or Minor Child(ren) (02/18)
- 80 -
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.902(i),
AFFIDAVIT OF CORROBORATING WITNESS
(02/18)

When should this form be used?

This form may be used to corroborate residency in a dissolution of marriage proceeding. To get a
dissolution (divorce) in Florida, either party must have lived in Florida for at least 6 months before filing
the petition. Residency may be corroborated by a valid Florida’s driver’s license, Florida identification
card, or voter’s registration card (issue date of document must be at least 6 months before the date the
case is actually filed with the clerk of the circuit court), or the testimony or affidavit of someone other
than you or your spouse. This form is used to corroborate residency by affidavit. The person signing this
form must know that you have lived in the State of Florida for at least 6 months before the date you filed
your petition for dissolution of marriage.

This form should be typed or printed in black ink, and signed in the presence of 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 you records.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

What should I do next?

A copy of this form must be mailed, e-mailed, or hand delivered to the other party in your case, if it is not
served on him or her with your initial papers.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving pleadings
by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of
Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of

Instructions for Florida Supreme Court Approved Family Law Form 12.902(i), Affidavit of Corroborating Witness
(02/18)
- 81 -
Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the
A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

Where can I look for more information?

Before proceeding, you should read General Information for Self-Represented Litigants found at the
beginning of these forms. The words that are in “bold underline” in these instructions are defined there.
For further information, see chapter 61, Florida Statutes.

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.

Instructions for Florida Supreme Court Approved Family Law Form 12.902(i), Affidavit of Corroborating Witness
(02/18)
- 82 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
In re: The Marriage of:

,
Petitioner,

and

,
Respondent.

AFFIDAVIT OF CORROBORATING WITNESS
I, {full legal name} __, being sworn, certify that the following
statements are true: I have known {name} ________ since
{approximate date} ; to the best of my understanding the petition in this action was
filed on {date} _____; and I know of my own personal knowledge that this person has
resided in the State of Florida for at least 6 months immediately prior to the date of filing of the petition.

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 Corroborating Witness
Printed Name:
Address:
City, State, Zip:
Telephone 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.]

Florida Supreme Court Approved Family Law Form 12.902(i), Affidavit of Corroborating Witness (02/18)
- 83 -
____ Personally known
____ Produced identification
Type of identification produced

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks]
This form was prepared for the: {choose only one} _____ Affiant _____ Petitioner _____Respondent
This form was completed with the assistance of:
{name of individual} ____________________________________________,
{name of business} _______________________________________________________________,
{address} _______________________________________,
{city} ________ ,{state} _____, {zip code}___________, {telephone number} ______.

Florida Supreme Court Approved Family Law Form 12.902(i), Affidavit of Corroborating Witness (02/18)
- 84 -
 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY
LAW FORM 12.903(a)
ANSWER, WAIVER, AND REQUEST FOR COPY OF FINAL JUDGMENT OF
DISSOLUTION OF MARRIAGE
(02/18)

When should this form be used?

This form should be used when you have been served with a petition for dissolution of marriage
and you do not wish to contest it or appear at a hearing. If you file this form, you are admitting all
of the allegations in the petition, saying that you do not need to be notified of or appear at the final
hearing, and that you would like a copy of the final judgment mailed to you.
This form should be typed or printed in black ink, and your signature should be witnessed by a
notary public or deputy clerk. After completing this form, you should sign the form before a notary
public. 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. The person filing the petition in a dissolution of
marriage proceeding is also referred to as the petitioner and his or her spouse as the respondent.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents
be filed electronically except in certain circumstances. Self-represented litigants may file petitions or
other pleadings or documents electronically; however, they are not required to do so. If you choose
to file your pleadings or other documents electronically, you must do so in accordance with Florida
Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in
which you file. The rules and procedures should be carefully read and followed.

What should I do next?
You have 20 days to answer after being served with your spouse’s petition. A copy of this form,
along with all of the other forms required with this answer and waiver, must be mailed, e-mailed, or
hand delivered to your spouse.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required
or permitted to be served on the other party must be served by electronic mail (e-mail) except in

Instructions for Florida Supreme Court Approved Family Law Form 12.903(a), Answer, Waiver, and Request for
Copy of Final Judgment of Dissolution of Marriage (02/18)
- 85 -
certain circumstances. You must strictly comply with the format requirements set forth in the
Rules of Judicial Administration. If you elect to participate in electronic service, which means
receiving pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must
review Florida Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org
through the link to the Rules of Judicial Administration provided under either Family Law Forms:
Getting Started, or Rules of Court in the A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail,
the procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law
Form 12.915, and you must provide your e-mail address on each form on which your signature
appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General),
Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail
Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial
Administration 2.516.

Where can I look for more information?
Before proceeding, you should read General Information for Self-Represented Litigants found at
the beginning of these forms. 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 may also file the following:

 Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida
Supreme Court Approved Family Law Form 12.902(d), if the case involves a dependent or
minor child(ren).
 Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form
12.902(e), if the case involves a dependent or minor child(ren). (If you do not know your
spouse’s income, you may file this worksheet after your spouse’s financial affidavit has
been served on you).
 Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor
Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1), 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), if you have
reached an agreement on any or all of the issues.

Instructions for Florida Supreme Court Approved Family Law Form 12.903(a), Answer, Waiver, and Request for
Copy of Final Judgment of Dissolution of Marriage (02/18)
- 86 -
  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. By filing this answer and waiver, you are agreeing to any
parenting plan and time-sharing requests in the petition. 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 a 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 answer
to the 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. By filing this answer and waiver, you are agreeing to any requests for child support in
the petition. Both parents are required to provide financial support for their minor or dependent
child(ren); however, the court may order one parent to pay child support 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

Instructions for Florida Supreme Court Approved Family Law Form 12.903(a), Answer, Waiver, and Request for
Copy of Final Judgment of Dissolution of Marriage (02/18)
- 87 -
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. By filing this answer and waiver, you are agreeing to any requests for alimony in the
petition. Alimony may be awarded to a spouse if the judge finds that one spouse has an actual need
for it and also finds that the other spouse has the ability to pay. If you want alimony, you must
request it in writing in a counterpetition and should not use this form. If you do not request
alimony in writing before the final hearing, it is waived (you may not request it later). You may
request permanent alimony, bridge-the-gap alimony, durational alimony, and/or rehabilitative
alimony. If alimony is awarded, the judge may order periodic payments, lump sum payments. Or
both.

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. By filing this answer and waiver, you are agreeing to any
requests in the petition regarding division of assets and liabilities.

Final Judgment. You should receive a copy of the Final Judgment in the mail. If, for some reason
you do not, you should contact the clerk’s office to request a copy. It is important for you to review
a copy of the Final Judgment in your case to see what happened and to know what you must do and
what you are entitled to receive.

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.

Instructions for Florida Supreme Court Approved Family Law Form 12.903(a), Answer, Waiver, and Request for
Copy of Final Judgment of Dissolution of Marriage (02/18)
- 88 -
 IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA

Case No: ________________________
Division: ________________________
In re: the Marriage of:

_________________________________,
Petitioner ,
and

_________________________________,
Respondent

ANSWER, WAIVER, AND REQUEST FOR COPY OF FINAL JUDGMENT OF
DISSOLUTION OF MARRIAGE

I, {full legal name} ____, being sworn, certify that the following
information is true:

1. I answer the Petition for Dissolution of Marriage filed in this action and admit all the allegations.
By admitting all of the allegations in the petition, I agree to all relief requested in the petition
including any requests regarding parenting and time-sharing, child support, alimony, distribution
of marital assets and liabilities, and temporary relief.

2. I hereby waive notice of hearing as well as all future notices in connection with the Petition for
Dissolution of Marriage, as filed and also waive my appearance at the final hearing.

3. I request that a copy of the Final Judgment of Dissolution of Marriage entered in this case be
provided to me at the address below.

4. If this case involves minor child(ren), 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 answer.

5. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form
12.902(j), is filed with this answer.

6. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b)
or (c), _____ is filed with this answer or _____ will be timely filed.

Florida Supreme Court Approved Family Law Form 12.903(a), Answer, Waiver, and Request for Copy of Final
Judgment of Dissolution of Marriage (02/18)
- 89 -
I certify that a copy of this document was _____ mailed _____ faxed and mailed _____ e-mailed
_____hand delivered to the person(s) listed below on {date} __________________________.

Other party or his/her attorney:
Name: _______________________________________
Address: _____________________________________
City, State, Zip: ________________________________
Fax Number: _________________________________
Designated E-mail Address(es):___________________
___________________________________________

I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
answer and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated: ______________________ _______________________________________
Signature of Respondent
Printed Name: ___________________________
Address: _______________________________
City, State, Zip: __________________________
Telephone Number: ________________________
Fax Number: _____________________________
Designated E-mail Address(es): _______________
_______________________________________

STATE OF FLORIDA
COUNTY OF ____________________

Sworn to or affirmed and signed before me on __________ by ___________________________.

_______________________________________
NOTARY PUBLIC or DEPUTY CLERK

_______________________________________
[Print, type, or stamp commissioned name of notary or
deputy clerk.]
_____ Personally known
_____ Produced identification
_____ Type of identification produced ________________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the: {choose only one} __________Respondent
This form was completed with the assistance of:
{name of individual} _______________________________________________________________,
{name of business} ________________________________________________________________,
{address} ________________________________________________________________________,
{city} ______________, {state} ____, {zip code}, __________, {telephone number} _____________.

Florida Supreme Court Approved Family Law Form 12.903(a), Answer, Waiver, and Request for Copy of Final
Judgment of Dissolution of Marriage (02/18)
- 90 -
 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED
FAMILY LAW FORM 12.903(b)
ANSWER TO PETITION FOR DISSOLUTION OF MARRIAGE
(02/18)

When should this form be used?

This form should be used when you are responding to a petition for dissolution of marriage and you
wish to admit or deny all of the allegations in the petition but you do not plan to file a
counterpetition seeking relief. You can use this form to answer any petition for dissolution of
marriage, whether or not there are minor 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 the petition was filed and keep a copy for your records. This must be
done within 20 days of receiving the petition.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents
be filed electronically except in certain circumstances. Self-represented litigants may file petitions or
other pleadings or documents electronically; however, they are not required to do so. If you choose
to file your pleadings or other documents electronically, you must do so in accordance with Florida
Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in
which you file. The rules and procedures should be carefully read and followed.

What should I do next?

A copy of this form, along with all of the other forms required with this answer, must be mailed, e-
mailed, or hand delivered to the other party in your case. You have 20 days to answer after being
served with the other party’s petition. After you file your answer, the case will generally proceed in
one of the following two ways:

UNCONTESTED... If you file an answer that agrees with everything in the other party’s petition and
you have complied with mandatory disclosure and filed all of the required papers, either party may
contact the clerk, family law intake staff, or judicial assistant to set a final hearing. If you request
the 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.

Instructions for Florida Supreme Court Approved Family Law Form 12.903(b), Answer to Petition for
Dissolution of Marriage (02/18)
- 91 -
CONTESTED... If you file an answer which disagrees with or denies anything in the petition, and 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. See chapter 61, Florida Statutes, for more information.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required
or permitted to be served on the other party must be served by electronic mail (e-mail) except in
certain circumstances. You must strictly comply with the format requirements set forth in the
Rules of Judicial Administration. If you elect to participate in electronic service, which means
serving or receiving pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing
Portal, you must review Florida Rule of Judicial Administration 2.516. You may find this rule at
www.flcourts.org through the link to the Rules of Judicial Administration provided under either
Family Law Forms: Getting Started, or Rules of Court in the A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail,
the procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law
Form 12.915, and you must provide your e-mail address on each form on which your signature
appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General),
Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail
Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial
Administration 2.516.
Special notes...

With this form, you may also need to file the following:

Instructions for Florida Supreme Court Approved Family Law Form 12.903(b), Answer to Petition for
Dissolution of Marriage (02/18)
- 92 -
  Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida
Supreme Court Approved Family Law Form 12.902(d), if the case involves a dependent or
minor child(ren).
 Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), if
the case involves a dependent or minor child(ren). (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).
 Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor
Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1), or 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), 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.)

Parenting 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 the entry of a 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 answer
to the 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.

Instructions for Florida Supreme Court Approved Family Law Form 12.903(b), Answer to Petition for
Dissolution of Marriage (02/18)
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  Shared Parental Responsibility
 Sole Parental Responsibility
 Supervised Time-Sharing
 No contact
 Parenting Plan
 Parenting Plan Recommendation
 Time-Sharing Schedule

Child Support. Both parents are required to provide financial support for their minor or dependent
child(ren); however, the court may order one parent to pay child support 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.

Alimony. Alimony may be awarded to a spouse if the judge finds that one spouse has an actual
need for it and that the other spouse has the ability to pay. If you want alimony, you must request
it in writing in a counterpetition. Florida Supreme Court Approved Family Law Form 12.903(c)(1)
(with dependent or minor child(ren)), or Florida Supreme Court Approved Family Law Form
12.903(c)(2) (no dependent or minor child(ren)). If you do not request alimony in writing before
the final hearing, it is waived (you may not request it later). You may request permanent alimony,
bridge-the-gap alimony, durational alimony, and/or rehabilitative alimony. If alimony is awarded,
the judge may order periodic payments, payments in lump sum, or both.

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, any parenting plan and time-sharing schedule, 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 time-sharing with child(ren), temporary child

Instructions for Florida Supreme Court Approved Family Law Form 12.903(b), Answer to Petition for
Dissolution of Marriage (02/18)
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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),
or, if there are no dependent or minor child(ren), 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 these forms.

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), 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). Both parties 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 Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form
12.990(c)(1), and 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 Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren)
(Uncontested), Florida Supreme Court Approved Family Law Form 12.990(b)(1), 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), or Final Judgment of Dissolution of
Marriage with No Property and No Dependent or Minor Child(ren), Florida Supreme Court
Approved Family Law Form 12.990(b)(3). You should contact 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.

Instructions for Florida Supreme Court Approved Family Law Form 12.903(b), Answer to Petition for
Dissolution of Marriage (02/18)
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 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

In re: The Marriage of
Case No.:
Division:
,
Petitioner,

and

,
Respondent.

ANSWER TO PETITION FOR DISSOLUTION OF MARRIAGE
I, {full legal name} ____________________________________________, Respondent, being sworn,
certify that the following information is true:

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 allegations raised in the following paragraphs due to
lack of information: {indicate section and paragraph number} ___________________
___________________________________________________________________________

4. If this case involves a dependent or minor child(ren), 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 answer.

5. If this case involves a dependent or minor child(ren), a completed Child Support Guidelines
Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), is [choose one only]
____ filed with this answer or ____ will be filed after the other party serves his or her financial
affidavit.

6. If necessary a completed Notice of Social Security Number, Florida Supreme Court Approved
Family Law Form 12.902(j), is filed with this answer.

7. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form
12.902(b) or (c), [Choose only one] ____ is filed with this answer or ____ will be timely filed.

Florida Supreme Court Approved Family Law Form 12.903(b), Answer to Petition for Dissolution of Marriage
(02/18)
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I certify that a copy of this document was ( ) mailed ( ) faxed and mailed ( ) e-mailed ( ) hand
delivered to the person(s) listed below on {date} _____________________.

Petitioner or his/her attorney:
Name:
Address:
City, State, Zip:
Fax Number:
Designated E-mail Address(es):__________________
__________________________________________

I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
answer and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated:
Signature of Respondent
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es):_______________
_______________________________________

STATE OF FLORIDA
COUNTY OF __________________________

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

[Print, type, or stamp commissioned name of notary or
clerk.]
Personally known
Produced identification
Type of identification produced

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the Respondent.
This form was completed with the assistance of:
{name of individual} _______________________________________________________________,
{name of business} _________________________________________________________________,
{address} __________________________________________,
{city} ______,{state} ___, {zip code}_________, {telephone number} __________.
Florida Supreme Court Approved Family Law Form 12.903(b), Answer to Petition for Dissolution of Marriage
(02/18)
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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)
(02/18)

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. The person filing the petition
in a dissolution of marriage proceeding is also referred to as the petitioner and his or her spouse as the
respondent. The person filing a counterpetition is also referred to as the counterpetitioner and his or
her spouse as the counterrespondent.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

What should I do next?

You have 20 days to answer after being served with your spouse’s petition. A copy of this form must be
mailed, e-mailed, or hand delivered to your spouse. 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 contact the clerk, family law
intake staff, or judicial assistant to set a final hearing. If you request the hearing, you must notify the

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) (02/18)
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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 issue 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.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving pleadings
by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of
Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of
Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the
A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

Special notes...

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) (02/18)
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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 your spouse’s income, you may file this worksheet after your spouse’s 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 12.9.995(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.

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) (02/18)
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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. Both parents are required to provide financial support for their minor or dependent
child(ren); however, the court may order one parent to pay child support 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.

Alimony. Alimony may be awarded to a spouse if the judge finds that one spouse has an actual need for
it and that the other spouse has the ability to pay. 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 permanent alimony, bridge-the-gap alimony, durational
alimony, and/or rehabilitative alimony. If alimony is awarded, the judge may order periodic payments,
payments in lump sum, or both.

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

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) (02/18)
- 101 -
proposed Parenting Plan may be filed. If you and your spouse cannot agree, 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 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.

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 contact 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.

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) (02/18)
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 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
In re: the Marriage of:

,
Petitioner/Counter-Respondent,

and

,
Respondent/Counter-Petitioner.

ANSWER TO PETITION AND COUNTERPETITION FOR DISSOLUTION
OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN)
I, {full legal name} _____ __, Respondent/Counter-
Petitioner being sworn, certify that the following information is true:

ANSWER TO PETITION
1. I agree with 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 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
_____ Respondent/Counter-Petitioner _____ Petitioner/Counter-Respondent _____Both has
(have) lived in Florida for at least 6 months before the filing of this Petition for Dissolution of
Marriage.

2. Respondent/Counter-Petitioner _____ is or _____ is not a member of the military service.
Petitioner/Counter-Respondent _____ is or _____ is not a member of the military service.

Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and Counterpetition for
Dissolution of Marriage with Property with Dependent or Minor Child(ren) (02/18)
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 3. MARRIAGE HISTORY
Date of marriage: {month, day, year} ____________________________________________
Date of separation: {month, day, year} _____________________ (_____Indicate if approximate)
Place of marriage: {county, state, country} _________________________________

4. DEPENDENT OR MINOR CHILD(REN)
[Indicate all that apply]

a. _____ Respondent/Counter-Petitioner is pregnant. Baby is due on: {date}

b. __Petitioner/Counter-Respondent is pregnant. Baby is due on: {date}________________

c. _____The minor (under 18) child(ren) common to both parties are:

Name Birth date
_________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

d. _____The minor child(ren) born or conceived during the marriage who are not common to
both parties are:

Name Birth date
___________________________________________________________________________
____________________________________________________________________________

The birth parent(s) of the above minor child(ren) is (are) {name and address}

e. _____ 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.
Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and Counterpetition for
Dissolution of Marriage with Property with Dependent or Minor Child(ren) (02/18)
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 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.

8. This counterpetition for dissolution of marriage should be granted because:

a. _____The marriage is irretrievably broken.

OR

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

1. ____There are no marital assets or liabilities.

OR

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.
[Indicate 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. Counter-Petitioner should be awarded an interest in the other spouse’s property because:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________.

SECTION II. SPOUSAL SUPPORT (ALIMONY)

1. Respondent/Counter-Petitioner forever gives up any right to spousal support (alimony) from the
other spouse.

Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and Counterpetition for
Dissolution of Marriage with Property with Dependent or Minor Child(ren) (02/18)
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 OR

2. Respondent/Counter-Petitioner requests that the Court order the other spouse to pay the
following spousal support (alimony) and claims that he or she has an actual need for the support
that he or she is requesting and that the other spouse has the ability to pay that support. Spousal
support (alimony) is requested in the amount of $______________ every _____ week _____ other
week _____ month, or ____ other ________________, beginning {date}_____________________
and continuing until {date or event} _____________________________________________.

Explain why the Court should order Petitioner/Counter-Respondent to pay, and any specific
request(s) for type of alimony (temporary, permanent, bridge-the-gap, durational, rehabilitative,
and/or lump sum): _______________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________.

3. _____Other provisions relating to alimony including any tax treatment and consequences:
_______________________________________________________________________________
______________________________________________________________________________.

4. _____ Respondent/Counter-Petitioner requests life insurance on the other spouse’s life, provided
by that spouse, to secure such support.

SECTION III. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING

1. The minor child(ren) currently reside(s) with
_____Respondent/ Counter-Petitioner
_____ Petitioner/Counter-Respondent
_____ 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 parents.

b. _____awarded solely to _____ Respondent/Counter-Petitioner _____ Petitioner/Counter-
Respondent. Shared parental responsibility would be detrimental to the child(ren) because:
________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________.

Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and Counterpetition for
Dissolution of Marriage with Property with Dependent or Minor Child(ren) (02/18)
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 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). For the purposes of a Parenting Plan, the Respondent/Counter-
Petitioner will be referred to as {name or designation} _______________________ and the
Petitioner/Counter-Respondent will be referred to as {name or designation} ________________.
The Counter-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. _____Each child will have time-sharing with both parents as follows:

(_____ Indicate if a separate sheet is attached.)

c. _____The court should establish a Parenting Plan with the following provisions for:
{Insert the name of designation of the appropriate parent in the space provided.}
_____ No time-sharing for Parent________________
_____ Limited time-sharing with Parent _________________
_____ Supervised time-sharing for Parent_______________
_____ 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
[Indicate all that apply]

1. Respondent/Counter-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} ___________
Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and Counterpetition for
Dissolution of Marriage with Property with Dependent or Minor Child(ren) (02/18)
- 107 -
 b. _____ the date of the filing of this petition.
c. _____other {date} ________________________{explain} _________________________
________________________________________________________________________

2. Respondent/Counter-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; is (are) in high school, and 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/Counter-Petitioner requests that the Court award a child support amount that is
more than or less than Florida’s child support guidelines and understands that a 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/Counter-Petitioner requests that medical/dental insurance for the minor child(ren)
be provided by:
[Choose only one]
a. _____Respondent/Counter-Petitioner

b. _____Petitioner/Counter-Respondent

5. Respondent/Counter-Petitioner requests that uninsured medical/dental expenses for the
child(ren) be paid:
[Choose only one]
a. _____ by Respondent/Counter-Petitioner
b. _____ by Petitioner/Counter-Respondent
c. _____ by both spouses equally (each spouse pays 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. Counter-Petitioner requests that life insurance to secure child support be provided by:

a. _____ Respondent/Counter-Petitioner
b. _____Petitioner/Counter-Respondent
c. _____ Both.

SECTION V. OTHER
Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and Counterpetition for
Dissolution of Marriage with Property with Dependent or Minor Child(ren) (02/18)
- 108 -
 1. Respondent/Counter-Petitioner requests to be known by the following former legal name,
which was {former full legal name} : ________________________________________________.

2. Other relief {specify}: ____________________________________________________________

SECTION VI. REQUEST
(This section summarizes what you are asking the Court to include in the final judgment of dissolution of
marriage.)
I request that the Court enter an order dissolving the marriage and:
[Indicate 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. _____ adopting or establishing 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 Counter-Petitioner’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 _____ mailed _____ faxed and mailed _____ e-mailed
_____ hand-delivered to the person(s) listed below on {date} ___________________________.

Petitioner/Counter-Respondent or his/her attorney:
Name:
Address:
City, State, Zip:
Fax Number:
Designated E-mail Address(es):__________________
__________________________________________

Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and Counterpetition for
Dissolution of Marriage with Property with Dependent or Minor Child(ren) (02/18)
- 109 -
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.

_____________________________________________
Signature of Respondent/Counter-Petitioner
Printed Name: _______________________________
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es): ___________________
_____________________________________________

STATE OF FLORIDA
COUNTY OF __________________________

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

{Print, type, or stamp commissioned name of notary or
clerk.}
__ Personally known
__ Produced identification
Type of identification produced _________________________________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the Respondent/Counter-Petitioner
This form was completed with the assistance of:
{name of individual}________________________________________________________________,
{name of business} _________________________________________________________________,
{address} __________________________________________________,
{city} _____________,{state} _____,{zip code}__________, {telephone number} ___________________.

Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and Counterpetition for
Dissolution of Marriage with Property with Dependent or Minor Child(ren) (02/18)
- 110 -
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)
(02/18)
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. The person filing the petition
in a dissolution of marriage proceeding is also referred to as the petitioner and his or her spouse as the
respondent. The person filing the counterpetition is referred to as the counterpetitioner and his or her
spouse as the counterrespondent.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

What should I do next?

You have 20 days to answer after being served with your spouse’s petition. A copy of this form must be
mailed, e-mailed, or hand delivered to your spouse. After you file an answer and counterpetition your
case will then generally proceed as follows:

Your spouse is required to answer your counterpetition within 20 days using an Answer to
Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).

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) (02/18)
- 111 -
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 contact 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 issue raised in the
petition or counterpetition. If you are unable to settle the disputed issues, either spouse 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.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving
pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review
Florida Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link
to the Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules
of Court in the A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

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) (02/18)
- 112 -
 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
(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 one spouse if the judge finds that one spouse has an actual need
for it and also finds that the other spouse has the ability to pay. 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 permanent alimony, bridge-the-gap
alimony, durational alimony, and/or rehabilitative alimony. If alimony is awarded, the judge may order
periodic payments, payments in lump sum, or both.

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 of
you 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.
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) (02/18)
- 113 -
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 contact 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.

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) (02/18)
- 114 -
 IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA

Case No:________________________
Division:________________________
In re: the Marriage of

_________________________________,
Petitioner/Counter-Respondent,
and

_______________________________
Respondent/Counter-Petitioner.

ANSWER TO PETITION AND COUNTERPETITION FOR DISSOLUTION OF
MARRIAGE WITH PROPERTY BUT NO DEPENDENT OR MINOR
CHILD(REN)

I, {full legal name} ______________________________________________________,
Respondent/Counter-Petitioner being sworn, certify that the following information is true:

ANSWER TO PETITION
1. I agree with 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 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
_____Respondent/Counter-Petitioner _____ Petitioner/Counter-Respondent _____ Both has

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 (02/18)
- 115 -
 (have) lived in Florida for at least 6 months before the filing of this Petition for Dissolution of
Marriage.

2. Respondent/Counter-Petitioner _____ is or _____ is not a member of the military service.
Petitioner/Counter-Respondent _____ is or _____ 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)
Place of marriage: {county, state, country}____________________________________________

4. THERE ARE NO MINOR (UNDER 18) OR DEPENDENT CHILD(REN) COMMON TO BOTH PARTIES AND
NEITHER SPOUSE IS 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:

a. _____ The marriage is irretrievably broken.

OR

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.
[Indicate 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/Counter-Petitioner should be awarded an interest in the other spouse’s property

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 (02/18)
- 116 -
 because:
____________________________________________________________________________
_____________________________________________________________________________
____________________________________________________________________________.

SECTION II. SPOUSAL SUPPORT (ALIMONY)

1. Respondent/Counter-Petitioner forever gives up any right to spousal support (alimony) from the
other spouse.

OR
2. Respondent/Counter-Petitioner requests that the Court order the other spouse to pay the
following spousal support (alimony) and claims that he or she has an actual need for the support
that he or she is requesting and that the other spouse has the ability to pay that support. Spousal
support (alimony) is requested in the amount of $_______________ every _____ week _____
other week _____ month, _____ other __________beginning {date} _______________________
and continuing until {date or event} _________________________________________________.

Explain why the Court should order Petitioner/Counter-Respondent to pay, and any specific
request(s) for type of alimony (temporary, permanent, bridge-the-gap, durational, rehabilitative,
and/or lump sum):
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
_______________________________________________________________________________.

3. _____Other provisions relating to alimony including any tax treatment or consequences:
________________________________________________________________________________
________________________________________________________________________________
_______________________________________________________________________________.

4. Respondent/Counter-Petitioner requests life insurance on the other spouse’s life, provided by that
spouse, to secure such support.

SECTION III. OTHER
1. Respondent/Counter-Petitioner requests to be known by the following former legal name, which
was {former legal name}________________________________________________________.

2. Other relief {specify}:
_______________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

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 (02/18)
- 117 -
 ________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
SECTION IV. REQUEST (This section summarizes what you are asking the Court to include in the final
judgment of dissolution of marriage.)
Respondent/Counter-Petitioner requests that the Court enter an order dissolving the marriage and:
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 Respondent/Counter-Petitioner’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 certify that a copy of this document was _____ mailed _____ faxed and mailed
_____ e-mailed _____ hand delivered to the person(s) listed below on {date}____________________.

Petitioner/Counter-Respondent or his/her attorney:
Printed Name: ________________________________
Address: _____________________________________
City, State, Zip: ________________________________
Fax Number: ____________________________________
Designated E-mail Address(es):______________________

I understand that I am swearing or affirming under oath to the truthfulness of the claims made in
this answer and counterpetition and that the punishment for knowingly making a false statement
includes fines and/or imprisonment.

Dated: ______________________ ____________________________________________
Signature of Respondent/Counter-Petitioner
Printed Name: ______________________________
Address:_____________________________________
City, State, Zip:________________________________
Telephone Number:___________________________
Fax Number: _________________________________
Designated E-mail Address(es): __________________
____________________________________________
STATE OF FLORIDA
COUNTY OF ____________________

Sworn to or affirmed and signed before me on ___________ by _______________________________.

___________________________________________

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 (02/18)
- 118 -
 NOTARY PUBLIC or DEPUTY CLERK
____________________________________________
{Print, type, or stamp commissioned name of notary or
deputy clerk.}
____ Personally known
____ Produced identification
____ Type of identification produced ________________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the Respondent/Counter-Petitioner
This form was completed with the assistance of:
{name of individual} _____________________________________________________________,
{name of business} ______________________________________________________________,
{address} ______________________________________________________________________,
{city} ____________,{state} _____,{zip code}__________,{telephone number} __________________.

Florida Supreme Court Approved Family Law Form 12.903(c)(2) Answer to Petition and Counterpetition for
Dissolution of Marriage with Property but No Dependent or Minor Children (02/18)
- 119 -
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.903(c)(3)
ANSWER TO PETITION AND COUNTERPETITION FOR DISSOLUTION OF
MARRIAGE WITH NO DEPENDENT OR MINOR CHILD(REN) OR PROPERTY
(02/18)
When should this form be used?

This form should be used when you are responding to a petition for dissolution of marriage with no
dependent or minor child(ren) or property 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 such as restoring your former name.

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.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

What should I do next?

You have 20 days to answer after being served with the other party’s petition. A copy of this form must
be mailed, e-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 contact 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.

Instructions for Florida Supreme Court Approved Family Law Form 12.903(c)(3), Answer to Petition and
Counterpetition for Dissolution of Marriage with No Dependent or Minor Child(ren) or Property (02/18)
- 120 -
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.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving
pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida
Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the
Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court
in the A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

Special notes...

With this form, you must also file the following:

Instructions for Florida Supreme Court Approved Family Law Form 12.903(c)(3), Answer to Petition and
Counterpetition for Dissolution of Marriage with No Dependent or Minor Child(ren) or Property (02/18)
- 121 -
  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 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. By using this form, you are forever giving up your rights to spousal support (alimony) from
petitioner. Alimony may be awarded to a spouse if the judge finds that one spouse has an actual need
for it and that the other spouse has the ability to pay. If you want alimony, you must request it in
writing in your counterpetition. (See the other answer and counterpetition forms for the appropriate
form.) If you do not request alimony in writing before the final hearing, it is waived (you may not
request it later).

Marital/Nonmarital Assets and Liabilities. By using this form, you are stating that there are no marital
assets and/or liabilities.

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 contact 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.

Instructions for Florida Supreme Court Approved Family Law Form 12.903(c)(3), Answer to Petition and
Counterpetition for Dissolution of Marriage with No Dependent or Minor Child(ren) or Property (02/18)
- 122 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
In re: The Marriage of:

,
Petitioner/Counter-Respondent,

and

,
Respondent/Counter-Petitioner

ANSWER TO PETITION AND COUNTERPETITION FOR DISSOLUTION OF
MARRIAGE WITH NO DEPENDENT OR MINOR CHILD(REN) OR
PROPERTY

I, {full legal name} , Respondent/Counter-
Petitioner, being sworn, certify that the following information is true:

ANSWER TO PETITION
l. 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 NO DEPENDENT OR
MINOR CHILD(REN) OR PROPERTY

1. JURISDICTION/RESIDENCE
_____Respondent/Counter-Petitioner _____Petitioner/Counter-Respondent _____ Both has
(have) lived in Florida for at least 6 months before the filing of this Petition for Dissolution of

Florida Supreme Court Approved Family Law Form 12.903(c)(3), Answer to Petition and Counterpetition for
Dissolution of Marriage with No Dependent or Minor Child(ren) or Property (02/18)
- 123 -
 Marriage.

2. Respondent/Counter-Petitioner _____ is or _____ is not a member of the military service.
Petitioner/Counter-Respondent _____ is or _____ is not a member of the military service.

3. MARRIAGE HISTORY
Date of marriage: {month, day, year}
Place of marriage: {city, state, country}
Date of separation: {month, day, year} (_____Indicate if approximate)

4. THERE ARE NO MINOR (under 18) OR DEPENDENT CHILD(REN) COMMON TO BOTH PARTIES
AND NEITHER SPOUSE IS 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:

a. _____The marriage is irretrievably broken.

OR

b. _____One of the parties has been adjudged mentally incapacitated for a period of 3 years
before the filing of this counterpetition. A copy of the Judgment of Incapacity is attached.

7. THERE ARE NO MARITAL ASSETS OR LIABILITIES.
8. RESPONDENT/COUNTER-PETITIONER FOREVER GIVES UP ANY RIGHTS TO SPOUSAL SUPPORT
(ALIMONY) FROM PETITIONER/COUNTER-RESPONDENT.
9. _____Respondent/Counter-Petitioner wants to be known by the former legal name, which
was {former legal name} .
10. Other relief {specify}:

REQUEST (This section summarizes what you are asking the Court to include in the final judgment of
dissolution of marriage.)

Florida Supreme Court Approved Family Law Form 12.903(c)(3), Answer to Petition and Counterpetition for
Dissolution of Marriage with No Dependent or Minor Child(ren) or Property (02/18)
- 124 -
Respondent/Counter-Petitioner requests that the Court enter an order dissolving the marriage and:
1. ______restoring Respondent/Counter-Petitioner’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 certify that a copy of this document was _____ mailed _____ faxed and mailed _____e-mailed
_____ hand delivered to the person(s) listed below on {date} _______________________________.

Petitioner/Counter-Respondent or his/her attorney:
Name:
Address:
City, State, Zip: ______
Fax Number:
Designated E-mail Address(es):____________________
______________________________________________

I understand that I am swearing or affirming under oath to the truthfulness of the claims made in
this answer and counterpetition and that the punishment for knowingly making a false statement
includes fines and/or imprisonment.

Dated:
Signature of Respondent/Counter-Petitioner
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Addresses: ___________________
____________________________________________

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

Florida Supreme Court Approved Family Law Form 12.903(c)(3), Answer to Petition and Counterpetition for
Dissolution of Marriage with No Dependent or Minor Child(ren) or Property (02/18)
- 125 -
 or clerk.]
__ Personally known
__ Produced identification
Type of identification produced _____________________________
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the Respondent/Counter-Petitioner
This form was completed with the assistance of:
{name of individual} ________________________________________________________________,
{name of business} _________________________________________________________________,
{address} _________________________________________,
{city} __________,{state} ___,{zip code}_________, {telephone number} ________________.

Florida Supreme Court Approved Family Law Form 12.903(c)(3), Answer to Petition and Counterpetition for
Dissolution of Marriage with No Dependent or Minor Child(ren) or Property (02/18)
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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.903(d)
ANSWER TO COUNTERPETITION
(02/18)

When should this form be used?

This form should be used by a petitioner to respond to the respondent’s counterpetition. You should
use this form to admit or deny the allegations contained in the 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 file the original with the clerk of the circuit court in
the county where the case is filed and keep a copy for your records.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

What should I do next?

You have 20 days to answer after being served with the other party’s counterpetition. A copy of this form
must be mailed, e-mailed, or hand delivered to the other party.

To proceed with your case, you should refer to the instructions to your petition regarding setting a case
for trial under UNCONTESTED and CONTESTED.

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.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified

Instructions for Florida Supreme Court Approved Family Law Form 12.903(d), Answer to Counterpetition (02/18)
- 127 -
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving
pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida
Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the
Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court
in the A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

Special notes...

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.

Instructions for Florida Supreme Court Approved Family Law Form 12.903(d), Answer to Counterpetition (02/18)
- 128 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
In re: The Marriage of:

_________________________________ ,
Petitioner/Counter-Respondent,

and

_________________________________,
Respondent/Counter-Petitioner.

ANSWER TO COUNTERPETITION

I, {full legal name} , Petitioner/Counter-Respondent, being sworn,
certify that the following information is true:

1. I agree with Respondent as to the allegations raised in the following numbered paragraphs in the
Counterpetition and, therefore, admit those allegations: {indicate section and paragraph number}
.

2. I disagree with Respondent as to the allegations raised in the following numbered paragraphs in
the Counterpetition and, therefore, deny those allegations: {indicate section and paragraph
number}
.

3. I am currently unable to admit or deny the following paragraphs due to lack of information:
{indicate section and paragraph number} _____________________
.

I certify that a copy of this document was _____mailed _____ faxed and mailed _____ e-mailed
_____hand-delivered to the person(s) listed below on {date} ____________________________.

Respondent/Counter-Petitioner or his/her attorney:
Name:
Address:
City, State, Zip:
Fax Number:
Designated E-mail Address(es):_____________________
Florida Supreme Court Approved Family Law Form 12.903(d), Answer to Counterpetition (02/18)
- 129 -
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
answer and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated:
__________________________
________________________________________
Signature of Petitioner/Counter-Respondent
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es): ____________________
_____________________________________________

STATE OF FLORIDA
COUNTY OF _______

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

[Print, type, or stamp commissioned name of notary or
clerk.]
_ Personally known
_ Produced identification
Type of identification produced ______________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the Petitioner/Counter-Respondent
This form was completed with the assistance of:
{name of individual} __________________________________________________________________,
{name of business} ___________________________________________________________________,
{address} _________________________________________________,
{city} ____________,{state} ___,{zip code}_____________, {telephone number}________________.

Florida Supreme Court Approved Family Law Form 12.903(d), Answer to Counterpetition (02/18)
- 130 -
 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY
LAW FORM 12.903(e),
ANSWER TO SUPPLEMENTAL PETITION
(02/18)

When should this form be used?

This form should be used when you are responding to a supplemental petition for modification of
Parenting Plan, time-sharing schedule, child support, or alimony. This form is used to admit or deny
all of the allegations in the supplemental petition if you do not plan to file a counterpetition. There
is no form for a counterpetition to a supplemental petition in these Family Law Forms. If you want to
file a counterpetition to a supplemental petition you will need to either seek legal assistance or create
a form yourself. You may construct an answer and counterpetition using the pertinent sections
contained in the Answer to Petition and Counterpetition for Dissolution of Marriage with
Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.903(c)(1), or
Answer to Petition and Counterpetition for Dissolution of Marriage with Property but No
Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.903(c)(2).

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 case was filed and keep a copy for your records. This must be done
within 20 days of receiving the supplemental petition.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents
be filed electronically except in certain circumstances. Self-represented litigants may file petitions or
other pleadings or documents electronically; however, they are not required to do so. If you choose
to file your pleadings or other documents electronically, you must do so in accordance with Florida
Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in
which you file. The rules and procedures should be carefully read and followed.

What should I do next?

A copy of this form, along with all of the other forms required with this answer, must be mailed, e-
mailed, or hand delivered to the other party in your case. Regardless of whether you file a
counterpetition, you have 20 days to answer after being served with the other party’s supplemental
petition. After you file your answer, the case will generally proceed in one of the following two ways:

Instructions for Florida Supreme Court Approved Family Law Form 12.903(e), Answer to Supplemental Petition
(02/18)
- 131 -
UNCONTESTED. If you file an answer that agrees with everything in the other party’s supplemental
petition and you have complied with mandatory disclosure and filed all of the required papers, either
party may contact 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. If you file an answer which disagrees with or denies anything in the supplemental
petition, and 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. If you request the hearing, 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. See chapter 61, Florida Statutes, for more information.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required
or permitted to be served on the other party must be served by electronic mail (e-mail) except in
certain circumstances. You must strictly comply with the format requirements set forth in the Rules
of Judicial Administration. If you elect to participate in electronic service, which means serving or
receiving pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must
review Florida Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org
through the link to the Rules of Judicial Administration provided under either Family Law Forms:
Getting Started, or Rules of Court in the A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail,
the procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law
Form 12.915, and you must provide your e-mail address on each form on which your signature
appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General),
Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail

Instructions for Florida Supreme Court Approved Family Law Form 12.903(e), Answer to Supplemental Petition
(02/18)
- 132 -
Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial
Administration 2.516.

Special notes...

With this form, you may also need to file the following:

 Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida
Supreme Court Approved Family Law Form 12.902(d), if the case involves child(ren).
 Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e),
if child support is an issue. (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), or 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).
 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).
(This must be filed within 45 days of service of the supplemental petition on you, if not filed
at the time you file your 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 supplemental petition on
you, if not filed at the time of you file your answer, unless you and the other party have agreed
not to exchange these documents.)

Parenting and Time-Sharing. If you and the other party 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 may be required prior to entry of a 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

Instructions for Florida Supreme Court Approved Family Law Form 12.903(e), Answer to Supplemental Petition
(02/18)
- 133 -
supplemental 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. Both parents are required to provide financial support for their minor or dependent
children; however, the court may order one parent to pay child support 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 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 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 parental responsibility and time-sharing
with child(ren), child support or alimony, you may file a Motion for Temporary Support with
Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(a) or, if
you need temporary relief regarding alimony and there are no dependent or minor child(ren), 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 these
forms.

Settlement Agreement. If you and the other party are able to reach an agreement on any or all of
the issues, you should file a Settlement Agreement. 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), 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). Both parties 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 Forms. These family law forms contain a Supplemental Final Judgment Modifying

Instructions for Florida Supreme Court Approved Family Law Form 12.903(e), Answer to Supplemental Petition
(02/18)
- 134 -
Parental Responsibility, Visitation, or Parenting Plan/Time-Sharing Schedule or Other Relief, Florida
Supreme Court Approved Family Law Form 12.993(a), a Supplemental Final Judgment Modifying
Child Support, Florida Supreme Court Approved Family Law Form 12.993(b), and a Supplemental Final
Judgment Modifying Alimony, Florida Supreme Court Approved Family Law Form 12.993(c), which
the judge may use, as appropriate. You should contact 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.

Instructions for Florida Supreme Court Approved Family Law Form 12.903(e), Answer to Supplemental Petition
(02/18)
- 135 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
,
Petitioner,

and

,
Respondent.

ANSWER TO SUPPLEMENTAL PETITION

I, {full legal name} , being sworn, certify that
the following information is true:

1. I agree with the allegations raised in the following numbered paragraphs in the Supplemental
Petition and, therefore, admit those allegations: {indicate section and paragraph number}
___________________________________________________________________________.

2. I disagree with the allegations raised in the following numbered paragraphs in the
Supplemental 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} .

4. If not previously filed in this case, a completed Family Law Financial Affidavit, Florida Family
Law Rules of Procedure Form 12.902(b) or (c) _____, is filed with this answer, or _____will be
timely filed.

5. If not previously filed in this case, a completed Notice of Social Security Number, Florida
Supreme Court Approved Family Law Form 12.902(j), is filed with this answer.

6. __{If applicable} This case involves minor child(ren), and 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 answer.

7. __{If applicable} This case involves child support, and a completed Child Support
Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e),_____ is filed
or _____ will be timely filed with the court.

Florida Supreme Court Approved Family Law Form 12.903(e), Answer to Supplemental Petition (02/18)
- 136 -
I certify that a copy of this document was _____ mailed _____faxed and mailed _____ e-mailed
_____hand delivered to the person(s) listed below on {date} .

Other Party or his/her attorney:
Name:
Address:
City, State, Zip: ______
Fax Number:
Designated E-mail Address(es):__________________
__________________________________________

I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
answer and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated:
Signature of Party
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es):__________________
__________________________________________

STATE OF FLORIDA
COUNTY OF ________________________

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

[Print, type, or stamp commissioned name of notary or
clerk.]
__ Personally known
__ Produced identification
Type of identification produced _____________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the {choose one} _____ Petitioner ______ Respondent.
This form was completed with the assistance of:
{name of individual} _________________________________________________________,
{name of business} __________________________________________________________,
{address} ___________________________________,
{city} ____,{state} __, {zip code}______________, {telephone number} .

Florida Supreme Court Approved Family Law Form 12.903(e), Answer to Supplemental Petition (02/18)
- 137 -
 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED
FAMILY LAW FORM 12.904(a)(1),
PETITION FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF
MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN)
(02/18)

When should this form be used?

This form may be used to ask the court to enter a support order if 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. Because you
are filing this petition, you are also referred to as the petitioner and your spouse as the
respondent.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and
documents be filed electronically except in certain circumstances. Self-represented litigants
may file petitions or other pleadings or documents electronically; however, they are not
required to do so. If you choose to file your pleadings or other documents electronically, you
must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must
follow the procedures of the judicial circuit in which you file. The rules and procedures should
be carefully read and followed.

What should I do next?

Instructions for Florida Supreme Court Approved Family Law Form 12.904(a)(1) Petition for Support
Unconnected with Dissolution of Marriage with Dependent or Minor Children (02/18)
- 138 -
 For your case to proceed, you must properly notify your spouse of the petition. Because this
petition concerns child support and alimony, you should use personal service. If your spouse
is in the military service of the United States, additional steps for service may be required. See
Memorandum for Certificate of Military Service, Florida Supreme Court Approved Family
Law Form 12.912(a) and Affidavit of Military Service, Florida Supreme Court Approved Family
Law Form 12.912(b). Service on a spouse who is in the military can be complicated; therefore,
you may wish to consult an attorney regarding this issue.

Your spouse 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 contact 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 contact 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 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 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 section 61.09, Florida Statutes.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION
Instructions for Florida Supreme Court Approved Family Law Form 12.904(a)(1) Petition for Support
Unconnected with Dissolution of Marriage with Dependent or Minor Children (02/18)
- 139 -
After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required
or permitted to be served on the other party must be served by electronic mail (e-mail) except in
certain circumstances. You must strictly comply with the format requirements set forth in the Rules
of Judicial Administration. If you elect to participate in electronic service, which means serving or
receiving pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must
review Florida Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org
through the link to the Rules of Judicial Administration provided under either Family Law Forms:
Getting Started, or Rules of Court in the A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail,
the procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law
Form 12.915, and you must provide your e-mail address on each form on which your signature
appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General),
Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail
Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial
Administration 2.516.

Special notes...

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 your
Instructions for Florida Supreme Court Approved Family Law Form 12.904(a)(1) Petition for Support
Unconnected with Dissolution of Marriage with Dependent or Minor Children (02/18)
- 140 -
 spouse’s income, you may file this worksheet after your spouse’s financial affidavit has been
served on you.)

Alimony. Alimony may be awarded to a spouse if the judge finds that one spouse has an actual need
for it and that the other spouse has the ability to pay. 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 permanent alimony, bridge-the-gap
alimony, durational alimony, and/or rehabilitative alimony. If alimony is awarded, the judge may
order periodic payments, payments in lump sum, or both.

Child Support. Both parents are required to provide financial support for their minor or
dependent children; however, the court may order one parent to pay child support 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 Forms. 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.

Instructions for Florida Supreme Court Approved Family Law Form 12.904(a)(1) Petition for Support
Unconnected with Dissolution of Marriage with Dependent or Minor Children (02/18)
- 141 -
 IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA

In re: the Marriage of: 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 Petitioner, being sworn,
certify that the following statements are true:

1. JURISDICTION
_____ Petitioner _____ Respondent ____ 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 _____ is or _____ is not a member of the military service.
Respondent _____ is or _____ 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).
Place of marriage: {county, state, country} ______________________________________.

4. MINOR CHILD(REN)
[Indicate all that apply]

a____Petitioner is pregnant. The baby is due on: {date} ______________

b.____Respondent is pregnant. The baby is due on: {date}_____________________________

c. ____The minor (under 18) child(ren) common to both parties, conceived or born during
the marriage, are:

Florida Supreme Court Approved Family Law Form 12.904(a)(1), Petition for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)
- 142 -
 Name Birth Date
___________
___________
___________________________________________________________________________
___________________________________________________________________________

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), 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 filed with this petition or _____ will be timely filed.

7. A completed Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure
Form 12.902(e), _____ is filed with this petition, or _____ will be timely 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)

1. Petitioner does not request spousal support (alimony) from Respondent at this time.

OR

2. Respondent has the ability to contribute to Petitioner’s support and has failed to do so.
Petitioner requests that the Court order Respondent to pay spousal support (alimony) to
Petitioner, who claims that he or she has an actual need for the support that he or she is
requesting. Spousal support (alimony) is requested in the amount of $ ____________ every
_____ week _____ other week _____ month, or _____ other _________________, beginning
{date}__________________, and continuing until {date or event}_____________________
___________________________________________________________________________.

Florida Supreme Court Approved Family Law Form 12.904(a)(1), Petition for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)
- 143 -
 Explain why the Court should order Respondent to pay and any specific request(s) for type of
alimony (temporary, permanent, rehabilitative, bridge-the-gap, durational, and/or lump
sum): ______________________________________________________________________

.

3. _____Other provisions relating to alimony including any tax treatment and consequences:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

4. Petitioner requests life insurance on Respondent’s life, provided by Respondent, to secure
such support.

SECTION II. CHILD SUPPORT
1. Respondent has the ability to contribute to the support of his or her minor child(ren) and has
failed to do so.

[Indicate all that apply]
2.______ Petitioner requests that the Court award child support as determined by Florida’s child
support guidelines, section 61.30, Florida Statutes.

3. _____Petitioner requests that the Court award child support to be paid beyond the age of 18
years by Respondent 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, is (are) in high school and is (are) between the ages of 18
and 19; said child(ren) is (are) performing in good faith with a reasonable expectation
of graduation before the age of 19.

4._____ Petitioner requests that medical/dental insurance for the minor child(ren) be provided
by: [Choose only one]
a. ____ Petitioner .

b. ____ Respondent.

5._____ Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid:
[Choose only one]

a. ____ by Petitioner
Florida Supreme Court Approved Family Law Form 12.904(a)(1), Petition for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)
- 144 -
 b. ____ by Respondent

c. ____ equally (each spouse pays 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 Respondent.

SECTION III. OTHER RELIEF

SECTION IV. 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:
[Indicate 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 items the
Court deems necessary.

Florida Supreme Court Approved Family Law Form 12.904(a)(1), Petition for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)
- 145 -
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
petition and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated:
Signature of Petitioner
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es):__________________
__________________________________________

STATE OF FLORIDA
COUNTY OF ________________________

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

[Print, type, or stamp commissioned name of notary or
clerk.]
__ Personally known
__ Produced identification
Type of identification produced _____________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the {choose one} _____ Petitioner ______ Respondent.
This form was completed with the assistance of:
{name of individual} _________________________________________________________,
{name of business} __________________________________________________________,
{address} ___________________________________,
{city} ____,{state} __, {zip code}______________, {telephone number} .

Florida Supreme Court Approved Family Law Form 12.904(a)(1), Petition for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)
- 146 -
 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY
LAW FORM 12.904(a)(2),
PETITION FOR SUPPORT AND PARENTING PLAN UNCONNECTED
WITH DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR
CHILD(REN)
(02/18)

When should this form be used?

This form may be used to ask the court to enter a support order if your spouse has the ability to
contribute to you and your minor child(ren), but has failed to do so. It may also be used to
establish a Parenting Plan with a time-sharing schedule. 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 or debts. It only deals with alimony, child
support, and Parenting Plans.

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. Because you are filing
this petition, you are also referred to as the petitioner and your spouse as the respondent.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and
documents be filed electronically except in certain circumstances. Self-represented litigants may
file petitions or other pleadings or documents electronically; however, they are not required to
do so. If you choose to file your pleadings or other documents electronically, you must do so in
accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures
of the judicial circuit in which you file. The rules and procedures should be carefully read and
followed.

What should I do next?

For your case to proceed, you must properly notify your spouse of the petition. Because this
petition concerns child support and alimony, you should use personal service. If your spouse is
in the military service of the United States, additional steps for service may be required. See
Memorandum for Certificate of Military Service, Florida Supreme Court Approved Family Law
Instructions for Florida Supreme Court Approved Family Law Form 12.904(a)(2), Petition for Support and Parenting
Plan Unconnected with Dissolution of Marriage (02/18)
- 147 -
 Form 12.912(a) and Affidavit of Military Service, Florida Supreme Court Approved Family Law
Form 12.912(b). Service on a spouse who is in the military can be complicated; therefore, you may
wish to consult an attorney regarding this issue.

Your spouse 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 contact 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 contact 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 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 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 section 61.09, Florida Statutes.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or
certified process server, the Florida Rules of Judicial Administration now require that all
documents required or permitted to be served on the other party must be served by electronic
mail (e-mail) except in certain circumstances. You must strictly comply with the format
requirements set forth in the Rules of Judicial Administration. If you elect to participate in
electronic service, which means serving or receiving pleadings by electronic mail (e-mail), or

Instructions for Florida Supreme Court Approved Family Law Form 12.904(a)(2), Petition for Support and Parenting
Plan Unconnected with Dissolution of Marriage (02/18)
- 148 -
 through the Florida Courts E-Filing Portal, you must review Florida Rule of Judicial Administration
2.516. You may find this rule at www.flcourts.org through the link to the Rules of Judicial
Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the
A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-
mail, the procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law
Form 12.915, and you must provide your e-mail address on each form on which your signature
appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General),
Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-
mail Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of
Judicial Administration 2.516.

Special notes...

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 your
spouse’s income, you may file this worksheet after your spouse’s financial affidavit has been
served on you.)

 Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a), (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.

Instructions for Florida Supreme Court Approved Family Law Form 12.904(a)(2), Petition for Support and Parenting
Plan Unconnected with Dissolution of Marriage (02/18)
- 149 -
 Alimony. Alimony may be awarded to a spouse if the judge finds that one spouse has an actual
need for it and that the other spouse has the ability to pay. 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 permanent alimony,
bridge-the-gap alimony, durational alimony, and/or rehabilitative alimony. If alimony is
awarded, the judge may order periodic payments, payments in lump sum, or both.

Child Support. Both parents are required to provide financial support for their minor or
dependent children; however, the court may order one parent to pay child support 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.

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 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
Instructions for Florida Supreme Court Approved Family Law Form 12.904(a)(2), Petition for Support and Parenting
Plan Unconnected with Dissolution of Marriage (02/18)
- 150 -
 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 Forms. 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.

Instructions for Florida Supreme Court Approved Family Law Form 12.904(a)(2), Petition for Support and Parenting
Plan Unconnected with Dissolution of Marriage (02/18)
- 151 -
 IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA

In re: the Marriage of: Case No: ________________________
Division: ________________________

_________________________________,
Petitioner,
and

_________________________________,
Respondent.

PETITION FOR SUPPORT AND PARENTING PLAN UNCONNECTED
WITH DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR
CHILD(REN)
I, {full legal name} _____________________________________, the Petitioner, being sworn,
certify that the following statements are true:

1. JURISDICTION
_____ Petitioner _____ Respondent ____ Both live in Florida at the filing of this Petition for
Support and Parenting Plan Unconnected with Dissolution of Marriage, which is filed pursuant to
section 61.09, Florida Statutes.

2. Petitioner _____ is or _____ is not a member of the military service.
Respondent _____ is or _____ 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).
Place of marriage: {county, state, country} ______________________________________.

4. MINOR CHILD(REN)
[Indicate all that apply]
a. ____Petitioner is pregnant. The baby is due on: {date} ____________

b. _____Respondent is pregnant. The baby is due on: {date}______________________________

c.____The minor (under 18) child(ren) common to both parties, conceived or born during the
marriage, are:

Florida Supreme Court Approved Family Law Form 12.904(a)(2), Petition for Support and Parenting Plan
Unconnected with Dissolution of Marriage (02/18)
- 152 -
 Name Birth date

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

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), 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 filed with this petition or _____ will be timely filed.

7. A completed Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form
12.902(e), _____ is filed with this petition, or _____ will be timely 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)

1. Petitioner does not request spousal support (alimony) from Respondent at this time.

OR

2. Respondent has the ability to contribute to Petitioner’s support and has failed to do so. Petitioner
requests that the Court order Respondent to pay spousal support (alimony) to Petitioner, who 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, or
______other __________, 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, bridge-the-gap, durational, and/or lump sum): ____________

_____________________________________________________________________________ .

3. _____Other provisions relating to alimony including any tax treatment and consequences:
Florida Supreme Court Approved Family Law Form 12.904(a)(2), Petition for Support and Parenting Plan
Unconnected with Dissolution of Marriage (02/18)
- 153 -
 ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

4. Petitioner requests life insurance on the other spouse’s life, provided by that spouse, to secure such
support.

SECTION II. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING

1. The minor child(ren) currently reside(s) with _____ Petitioner _____ Respondent _____ Other:
{explain} _______________________________________________________________________

2. Parental Responsibility. It is in the child(ren)’s best interests that parental responsibility be:
{Choose only one}
c. ____ shared by both parents;

d. ____ awarded solely to _____ Petitioner _____ Respondent . 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). For purposes of a Parenting Plan, the Petitioner will be referred
to as {name or designation}____________________, and the Respondent will be referred to as
{name or designation}_________________________________. 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
{Choose only one} _____ have _____ have not agreed to the Parenting Plan.

b. _____Each child will have time-sharing with both parents as follows: __________________
_____________________________________________________________________
_____________________________________________________________________
____________________________________________________________________________
(_____ Indicate if a separate sheet is attached.)

c. ____ The court should establish a Parenting Plan with the following provisions for:
{Insert name or designation of the appropriate parent in the space provided}
____ No time-sharing for Parent _____________
____ Limited time-sharing with Parent __________
____ Supervised Time-Sharing for Parent ___________Parent___________;
____ Supervised or third-party exchange of the child(ren).
____ Explain:
______________________________________________________________________________
_____________________________________________________________________________
______________________________________________________________________________.

4. Explain why this request is in the best interests of the child(ren): ___________________________

Florida Supreme Court Approved Family Law Form 12.904(a)(2), Petition for Support and Parenting Plan
Unconnected with Dissolution of Marriage (02/18)
- 154 -
 __________________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________________________________________

SECTION III. CHILD SUPPORT

1. Respondent has the ability to contribute to the support 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.

[Indicate all that apply]
2.______ Petitioner requests that the Court award child support as determined by Florida’s child
support guidelines, section 61.30, Florida Statutes.

3. _____Petitioner requests that the Court award child support to be paid beyond the age of 18 years
by Respondent 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, is (are) in high school and is (are) between the ages of 18 and
19; said child(ren) is (are) performing in good faith with a reasonable expectation of
graduation before the age of 19.

4._____ Petitioner requests that medical/dental insurance for the minor child(ren) be provided by:
[Choose only one]
c. ____ Petitioner.

d. ____ Respondent.

5._____ Petitioner requests that uninsured medical/dental expenses for the
child(ren) be paid: [Choose only one]

f. ____ by Petitioner

g. ____ by Respondent

h. ____ equally (each spouse pays one-half)

i. __according to the percentages in the Child Support Guidelines Worksheet, Florida
Family Law Rules of Procedure Form 12.902(e).

j. _ Other {explain}: ___________________________________________________.

6. _____ Petitioner requests that life insurance to secure child support be provided by:
______ Respondent
_____ both spouses.
Florida Supreme Court Approved Family Law Form 12.904(a)(2), Petition for Support and Parenting Plan
Unconnected with Dissolution of Marriage (02/18)
- 155 -
SECTION IV. OTHER RELIEF

SECTION V. 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:
{Indicate all that apply}

1.____ awarding spousal support (alimony) as requested in Section I of this petition;

2. ____ adopting or establishing a Parenting Plan containing provisions for parental responsibility and
time-sharing for the dependent or minor child(ren), as requested in Section II of this petition;

3.____ establishing child support for the minor child(ren), as requested in Section III of this petition;

4. ____ awarding other relief as requested in Section IV of this petition; and any other items the
Court deems necessary.

Florida Supreme Court Approved Family Law Form 12.904(a)(2), Petition for Support and Parenting Plan
Unconnected with Dissolution of Marriage (02/18)
- 156 -
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
petition and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated: ___________________
_____________________________________________
Signature of Petitioner
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es): __________________
__________________________________________
STATE OF FLORIDA
COUNTY OF

Sworn to or affirmed and signed before me on by .

______________________________________
NOTARY PUBLIC or DEPUTY CLERK
_______________________________________
{[Print, type, or stamp commissioned name of
notary or deputy clerk.}
_ Personally known
__ Produced identification
Type of identification produced ___________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the Petitioner
This form was completed with the assistance of:
{name of individual}_______________________________________________________________,
{name of business} _________________________________________________________________,
{address} ________________________________________________________________________,
{city} ____________, {state} ____, {zip code}____________, {telephone number} _______________.

Florida Supreme Court Approved Family Law Form 12.904(a)(2), Petition for Support and Parenting Plan
Unconnected with Dissolution of Marriage (02/18)
- 157 -
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)
(02/18)

When should this form be used?

This form may be used if 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. Because you are filing the petition in this
proceeding, you are referred to as the petitioner and your spouse as the respondent.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

What should I do next?

For your case to proceed, you must properly notify your spouse of the petition. Because this petition
concerns alimony, you should use personal service. 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) and
Affidavit of Military Service, Florida Supreme Court Approved Family Law Form 12.912(b). Service on a
spouse who is in the military can be complicated; therefore, you may wish to consult an attorney
regarding this issue.

Your spouse has 20 days to answer after being served with your petition. Your case will then generally
proceed in one of the following three ways:

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) (02/18)
- 158 -
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 contact 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 contact 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 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 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 section 61.09, Florida Statutes.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving
pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida
Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the
Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court
in the A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
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) (02/18)
- 159 -
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

Special notes...

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 one spouse has an actual need for
it and that the other spouse has the ability to pay. 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 permanent alimony, bridge-the-gap alimony,
durational alimony, and/or rehabilitative alimony. If alimony is awarded, the judge may order periodic
payments, payments in lump sum, or both.

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 Forms. These family law forms contain a Final Judgment of Support Unconnected with
Dissolution of Marriage with No Dependent or Minor 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.

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) (02/18)
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 IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA

In re: the Marriage of: 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] Petitioner, being sworn, certify that the following statements are true:

1. JURISDICTION
_____ Petitioner _____ Respondent _____ 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 _____ is or _____ is not a member of the military service.
Respondent _____ is or _____ 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 filed with this petition or _____ will be timely filed.

5. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form
12.902(j), _____is filed with this petition or _____ will be timely filed.

SECTION I. SPOUSAL SUPPORT (ALIMONY)

1. _____Respondent has the ability to contribute to Petitioner’s support and has failed to do so.
Petitioner requests that the Court order Respondent to pay spousal support (alimony) to Petitioner,
who claims that he or she has an actual need for the support that he or she is requesting. Spousal
support (alimony) is requested in the amount of $__________every _____ week _____ other week
_____ month, or _____ other _______________ 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) (02/18)
- 161 -
 Explain why the Court should order Respondent to pay and any specific request(s) for type of
alimony (temporary, permanent, bridge-the-gap, durational, rehabilitative, and/or lump sum):
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.

2. _____ Other provisions relating to alimony including any tax treatment and consequences:
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.
3. ____ Petitioner requests life insurance on Respondent’s life, provided by that spouse, to secure
such support.

SECTION II. OTHER RELIEF
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

SECTION III. 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:
[Indicate all that apply]
1.____ awarding spousal support (alimony) pursuant to Section I of this petition;

2.____ awarding other relief as specified in Section II of this petition; and any other terms the Court
deems necessary.

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) (02/18)
- 162 -
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
petition and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated: ______________________ _____________________________________________
Signature of Petitioner
Printed Name: _________________________________
Address: ______________________________________
City, State, Zip: _________________________________
Telephone Number: _____________________________
Fax Number: __________________________________
Designated E-mail Addresses):_____________________
_____________________________________________

STATE OF FLORIDA
COUNTY OF ____________________

Sworn to or affirmed and signed before me on ____________ by _______________________________.

_____________________________________________
NOTARY PUBLIC or DEPUTY CLERK

_____________________________________________
[Print, type, or stamp commissioned name of notary or
deputy clerk.]
____ Personally known
____ Produced identification
____ Type of identification produced ________________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the: {choose only one} Petitioner
This form was completed with the assistance of:
{name of business} ________________________________________________________________,
{address} _________________________________________________________________________,
{city} __________________,{state} _____, {zip code}__________, {telephone number} _____________.

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) (02/18)
- 163 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:

In Re: The Marriage of:

,
Petitioner,

and

,
Respondent.

TEMPORARY ORDER OF SUPPORT, TIME-SHARING, AND OTHER RELIEF
WITH DEPENDENT OR MINOR CHILD(REN)

This cause came before this Court for a hearing on a Motion for Temporary Support, Time-Sharing, and
Other Relief 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
indicated 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 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
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing and
Other Relief with Dependent or Minor Child(ren) (02/18)
- 164 -
 a court order.
ASSETS: DESCRIPTION OF ITEM(S) Petitioner Respondent
(Please describe each item as clearly as possible. You do not have to list Shall Have Shall Have
account numbers.) 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.
LIABILITIES: DESCRIPTION OF DEBT(S)
(Please describe each item as clearly as possible. You do not have Current
to list account numbers.) Amount Petitioner Respondent
Owed Shall Pay Shall Pay
Mortgages on real estate: (home) $ $ $

_______ _______ __________
Charge/credit card accounts

Auto loan
Auto loan
Bank/Credit Union loans

Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing and
Other Relief with Dependent or Minor Child(ren) (02/18)
- 165 -
 LIABILITIES: DESCRIPTION OF DEBT(S)
(Please describe each item as clearly as possible. You do not have Current
to list account numbers.) Amount Petitioner Respondent
Owed Shall Pay Shall Pay

Money owed (not evidenced by a note)

Other

SECTION II. TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME
[Indicate 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:
____________________________________________________________________

SECTION III. TEMPORARY PARENTAL RESPONSIBILITY AND TIME-SHARING WITH DEPENDENT OR
MINOR CHILD(REN) {Insert the name or designation of each parent in the spaces provided below}

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

Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing and
Other Relief with Dependent or Minor Child(ren) (02/18)
- 166 -
 3. Temporary Parental Responsibility for the Minor Child(ren).
{Choose only one}{Insert the name or designation of each parent in the space provided}
a. _____ The parties shall have temporary shared parental responsibility for the parties’
minor child(ren).

b. _____Parent ___________________ 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. _____ Parent __________________ 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:
{Choose only one}{Insert the name or designation of each parent in the space provided.}

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}
_________________________________________________________________________
_________________________________________________________________________.

Parent {name or designation}_____________________________’s Temporary Time-
Sharing Schedule.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________.

Parent {name or designation}_______________________________’s Temporary Time-
sharing Schedule.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________.
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing and
Other Relief with Dependent or Minor Child(ren) (02/18)
- 167 -
 c. _____ Time-sharing in accordance with the temporary Parenting Plan attached as
Exhibit _____.

d. _____ Parent {name or designation} ___________________ 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. {If applicable}
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:
{Insert the appropriate information in the space provided.}

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/time-sharing 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
_____Parent {name or designation} ____________________________
_____Both parents.

6. Communication Arrangements, Parental Responsibility and Time-sharing with Minor
Child(ren). {Indicate if applicable}

a. ______ 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}

b. _____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 indicated below, shall
also apply. {Indicate all that apply}
{Insert the name or designation of each parent in the space provided.}

a. _____ The parties shall temporarily exchange the child(ren) at the following location(s):

Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing and
Other Relief with Dependent or Minor Child(ren) (02/18)
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 b. _____Parent {name or designation} ______________ 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). Parent {name or
designation} _________________ 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
_____ Parent {name or designation} __________________
______ Both parents from 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).

SECTION IV. TEMPORARY ALIMONY

1. _____ The Court denies the request(s) for temporary alimony.

OR

2. _____ 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:
{Indicate 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}
,
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing and
Other Relief with Dependent or Minor Child(ren) (02/18)
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 beginning {date} ______________. This temporary periodic alimony shall continue until
modified by court order, the death of either party, or until, ________________________,
{date or event} whichever occurs first.

b. _____ Retroactive. Obligor shall pay retroactive alimony in the amount of
$ for the period of {date} ____ through
{date} ______________, which shall be paid pursuant to paragraph 4 below.

3. 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 _____ other_________________________________________________________;
d. _____ other factors _________________________________________________________
_________________________________________________________________________

________ Please indicate here if additional pages are attached.

4. 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, or _____ other {explain}

beginning: {date} _________, until paid in full including statutory
interest.

5. Insurance.
{Indicate 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
reasonable and necessary 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 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.

6. _____Other provisions relating to temporary alimony including any tax treatment and
consequences:_________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing and
Other Relief with Dependent or Minor Child(ren) (02/18)
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 ____________________________________________________________________________ .

SECTION V. TEMPORARY CHILD SUPPORT

1. The Court finds that there is a need for temporary child support and that the _____ Petitioner
_____ Respondent (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 _____ Petitioner _____ Respondent are correct

OR

The Court makes the following findings:
Petitioner’s net monthly income is $ ____.
Respondent’s net monthly income is $ _____.
Monthly child care costs are $ _______.
Monthly health/dental insurance costs are $ __.

2. Amount.

Child support established at the rate of $_________per month for the _____children {total
number of minor or dependent children} shall be paid commencing ___________________
{month, day, year} and terminating _________________________ {month, day, year}. Child
support shall be paid in the amount of $__________ per ________ {week, month, other}
which is consistent with the Obligor’s current payroll cycle.

Upon the termination of the obligation of child support for one of the parties’ children, child
support in the amount of $________ for the remaining ______ children {number of remaining
children} shall be paid commencing _________________ {month, day, year} and terminating
_______________________ {month, day, year}. This child support shall be paid in the amount
of $ _______ per _________ {week, month, other} consistent with Obligor’s current payroll
cycle.

{Insert schedule for the child support obligation, including the amount, and commencement
and termination dates, for the remaining minor or dependent children, which shall be
payable as the obligation for each child ceases. Please indicate whether the schedule
____appears below or____ is attached as part of this form}
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
____________________________________________________________________________.

The Obligor shall pay child support until all of the minor or dependent children: reach the age
of 18; become emancipated, marry, join the armed services, die, or become self-supporting;
or until further order of the court or agreement of the parties. The child support obligation
shall continue beyond the age of 18 and until high school graduation for any child who is
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing and
Other Relief with Dependent or Minor Child(ren) (02/18)
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 dependent in fact, between the ages of 18 and 19, and is still in high school performing in
good faith with a reasonable expectation of graduation before age 19.

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.
{Indicate if applicable}
_____Petitioner _____ Respondent 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, or _____ other {explain} _______________
beginning {date} , until paid in full including statutory interest.

4. Insurance.
[Indicate all that apply]

_____Health/Dental Insurance. _____ Petitioner _____ Respondent 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 or 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.
_____ 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, in an amount of at least $ ______, on _____ his/her life
naming the _____ minor child(ren) as the beneficiary (ies) OR naming the
_____Petitioner _____ Respondent _____other {name}: ______________________ as trustee
for the minor child(ren), so long as reasonably available. The obligation to maintain the life

Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing and
Other Relief with Dependent or Minor Child(ren) (02/18)
- 172 -
 insurance coverage shall continue until the Court orders otherwise or until {date/event}
____________________________________________________________________________.

6. IRS Income Tax Exemption(s). The assignment of any tax exemption 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. Place of Payment

a. _____ Obligor shall pay temporary court-ordered support directly to either the State
Disbursement Unit or the central depository, as required by statute, along with any fee
required by statute.

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 either the State
Disbursement Unit or the central depository at this time; however, either party may
subsequently apply, pursuant to section 61.13(1)(d)3, Florida Statutes, to require
payments through either the State Disbursement Unit or the central depository.

2. Income Deduction.

_____ 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 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
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing and
Other Relief with Dependent or Minor Child(ren) (02/18)
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 _____ there is an agreement by the Obligor to advise the Title IV-D agency, the clerk of court,
and the Obligee of any change in Payor and/or health insurance

OR
_____ there is a signed written agreement providing an alternative arrangement between the
Obligor and the Obligee and, at the option of the IV-D agency, by the IV-D agency in IV-D cases
in which there is an assignment of support rights to the state, reviewed and entered in the
record by the court.

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 the Obligee pursuant to the payment
method prescribed above.
4. Other provisions relating to method of payment. ____________________________________

SECTION VII. TEMPORARY ATTORNEY’S FEES, COSTS, AND SUIT MONEY

1. _____Petitioner’s _____Respondent’s request(s) for temporary attorney’s fees, costs, and suit
money is (are) denied because ____________________________________________________

OR

2. _____ The Court finds there is a need for and an ability to pay temporary attorney’s fees, costs,
and suit money. _____ Petitioner _____ Respondent is hereby ordered to pay to the other party
$ in temporary attorney’s fees, and $ _ in costs. The Court further finds
that the temporary attorney’s fees awarded are based on the reasonable rate of
$ per hour and reasonable hours. Other provisions relating to
temporary attorney’s fees, costs, and suit money are as follows: _________________________

.

SECTION VIII. OTHER PROVISIONS

Other Provisions:

.

DONE AND ORDERED in _______________________, Florida on {date} _______________________.

CIRCUIT JUDGE
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing and
Other Relief with Dependent or Minor Child(ren) (02/18)
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I certify that a copy of this {name of document(s)} __________________________________________
was ____ mailed ____ faxed and mailed ____ e-mailed ____ hand-delivered to the parties or entities
listed below on {date}______________________.

by _______________________________________
{Clerk of court or designee}

Petitioner (or his or her attorney)
Respondent (or his or her attorney)
State Disbursement Unit
Central depository
Other:

Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing and
Other Relief with Dependent or Minor Child(ren) (02/18)
- 175 -
 IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA

Case No: _____________________
Division: _____________________

In Re: The Marriage of:

_________________________________,
Petitioner,
and

_________________________________,
Respondent.

ORDER FOR TEMPORARY SUPPORT AND OTHER RELIEF
WITH NO DEPENDENT OR MINOR CHILD(REN)
This cause came before this Court for a hearing on a Motion for Temporary Support and Other Relief
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; however,
_____Petitioner _____Respondent 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
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.

Florida Supreme Court Approved Family Law Form 12.947(d), Temporary Order of Support and Other Relief with
No Dependent or Minor Child(ren) (02/18)
- 176 -
 ASSETS: DESCRIPTION OF ITEM(S) Petitioner Respondent
(Please describe each item as clearly as possible. You do not need to list Shall Have Shall Have
account numbers.) 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.
LIABILITIES: DESCRIPTION OF DEBT(S)
(Please describe each item as clearly as possible. You do not Current
need to list account numbers.) Amount Petitioner Respondent
Owed Shall Pay Shall Pay
Mortgages on real estate: (home) $ $ $

_______ _______ _________
Charge/credit card accounts

Florida Supreme Court Approved Family Law Form 12.947(d), Temporary Order of Support and Other Relief with
No Dependent or Minor Child(ren) (02/18)
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 LIABILITIES: DESCRIPTION OF DEBT(S)
(Please describe each item as clearly as possible. You do not Current
need to list account numbers.) Amount Petitioner Respondent
Owed Shall Pay Shall Pay

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
{Indicate 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:

.

Florida Supreme Court Approved Family Law Form 12.947(d), Temporary Order of Support and Other Relief with
No Dependent or Minor Child(ren) (02/18)
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SECTION III. TEMPORARY ALIMONY
1. _____ The Court denies the request(s) for temporary alimony.

OR

2. _____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:
{Indicate 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, or _____ other {explain}
_____________________________________________________________________
beginning {date} _____________. This temporary periodic alimony shall continue until
modified by court order, the death of either party, or until {date or event}
_________________whichever occurs first.

b. _____ Retroactive. Obligor shall pay retroactive alimony in the amount of $__________ for
the period of {date} ___________________ through {date} _______________________,
which shall be paid pursuant to paragraph 4 below.

3. 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
_____ other ____________________________________________________;
d._____ other factors

____ Please indicate here if additional pages are attached.

4. 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.

5. Insurance.
[Indicate 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 reasonable and
necessary uninsured medical costs for the other party not exceed $_____________per year.
Florida Supreme Court Approved Family Law Form 12.947(d), Temporary Order of Support and Other Relief with
No Dependent or Minor Child(ren) (02/18)
- 179 -
 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 any existing 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.

6. _____ Other provisions relating to temporary alimony including any tax treatment and
consequences:
_____________________________________________________________________________

.

SECTION IV. METHOD OF PAYMENT

Obligor shall pay any temporary court-ordered alimony and arrears, if any, as follows:
1. Place of Payment.
[Indicate if applies]
a. _____ Obligor shall pay temporary court-ordered support directly to either the State
Disbursement Unit or the central depository, as required by statute, along with any fee
required by statute.

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 either the State Disbursement
Unit or the central depository at this time; however, either party may subsequently apply,
pursuant to section 61.13(1)(d)3, Florida Statutes, to require payments through either the
State Disbursement Unit or the central depository.

2. Income Deduction.
[If applicable]
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
Florida Supreme Court Approved Family Law Form 12.947(d), Temporary Order of Support and Other Relief with
No Dependent or Minor Child(ren) (02/18)
- 180 -
 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 Title IV-D agency, the clerk of
court, and the Obligee of any change in Payor and/or health insurance
OR
_____ there is a signed written agreement providing an alternative arrangement between
the Obligor and the Obligee and, at the option of the IV-D agency, by the IV-D agency in IV-
D cases in which there is an assignment of support rights to the state, reviewed and entered
in the record by the court.

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 the Obligee pursuant to the payment
method prescribed above.

4. Other provisions relating to method of temporary payment: ___________________________

.

SECTION V. TEMPORARY ATTORNEY’S FEES, COSTS, AND SUIT MONEY

1. _____ Petitioner’s _____ Respondent’s request(s) for temporary attorney’s fees, costs, and suit
money is (are) denied because
.

OR

2. _____ The Court finds there is a need for and an ability to pay temporary attorney’s fees, costs,
and suit money. _____ Petitioner _____ Respondent is hereby ordered to pay to the other party
$__________ in temporary attorney’s fees, and $__________ in costs. The Court further finds
that the temporary attorney’s 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:

.

Florida Supreme Court Approved Family Law Form 12.947(d), Temporary Order of Support and Other Relief with
No Dependent or Minor Child(ren) (02/18)
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DONE AND ORDERED in __________________________, Florida, on {date} ______________________.

____________________________________________
CIRCUIT JUDGE

I certify that a copy of this {name of document}____________________________________________
was ____ mailed ____ faxed and mailed ____ e-mailed ____ hand-delivered to the parties or entities
listed below on {date}___________________________.

by___________________________________
{Clerk of court or designee}

Petitioner (or his or her attorney)
Respondent (or his or her attorney)
State Disbursement Unit
Other:

Florida Supreme Court Approved Family Law Form 12.947(d), Temporary Order of Support and Other Relief with
No Dependent or Minor Child(ren) (02/18)
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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY
LAW FORM 12.950(a)
AGREEMENT FOR RELOCATION WITH MINOR CHILD(REN)
(02/18)

When should this form be used?

This form should be used when the parents and every other person entitled to access to,
visitation, or time-sharing with the minor child(ren) are in agreement and are asking the court to
permit the relocation of the child(ren)’s principal residence. “Other Person” means an individual
who is not the parent, but with whom the child resides pursuant to court order, or who has the
right of access to, time-sharing with, or visitation with the child(ren). This form can be used at any
time after either a petition or supplemental petition to relocate has been filed and the parties
reach an agreement; OR can be used when the parties are in agreement and there is an existing
cause of action, judgment, or decree of record pertaining to the child(ren)’s residence or time-
sharing schedule. Either an agreement for relocation or a petition to relocate is required when:

1. You plan to relocate the child(ren)’s residence more than 50 miles from the child(ren)’s
principal residence at the time of the last order which established or modified either a
Parenting Plan or time-sharing schedule or at the time of filing of the pending action.

2. The court has not already entered an order granting permission to relocate.

3. The relocation will be for a period of 60 consecutive days or more, not including any absence
for purposes of vacation, education, or health care for the child(ren).

4. Your order or final judgment defining custody, primary residence, the Parenting Plan, or time-
sharing was entered before October 1, 2009 and the order does not expressly govern the
relocation of the child(ren); or was entered on or after October 1, 2009, or your case was
pending on October 1, 2009.

5. If the visitation or time-sharing schedule will change due to the relocation, a Parenting Plan
with a time-sharing schedule must be included with the Agreement. Regardless of whether
there is an agreement, the court reserves jurisdiction to modify issues relating to the minor
child(ren).

This form should be typed or printed in black ink. You must fill in all sections of the form. If you
are an “other person” entitled to access, visitation, or time-sharing with the child(ren), substitute
your name for a Parent in the form and “parties” for “parents.” After completing the form, you
should sign the form before a notary public or deputy clerk.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and
documents be filed electronically except in certain circumstances. Self-represented litigants may
Instructions for Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation
with Minor Child(ren) (02/18)
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file petitions or other pleadings or documents electronically; however, they are not required to
do so. If you choose to file your pleadings or other documents electronically, you must do so in
accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures
of the judicial circuit in which you file. The rules and procedures should be carefully read and
followed.
What should I do next?

For your case to proceed, you must properly notify the court by filing the original of the
Agreement and a Motion for Order Permitting Relocation by Agreement, Florida Supreme Court
Approved Family Law Form, 12.950 (b), with the clerk of the circuit court of one of the following:
the circuit court which has jurisdiction in accordance with the Uniform Child Custody Jurisdiction
and Enforcement Act; the circuit court in the county in which either parent and the child(ren)
reside; or the circuit court in which the original action was adjudicated. If the order was entered
in another state, or if the child(ren) live(s) in another state, you should speak with an attorney
about where to file this form. You should file the original with the clerk of the circuit court and
keep a copy for your records.

If the issue of the child(ren)’s physical residence is already before the court in an ongoing
proceeding or through a judgment issued by the court, the court may enter an order adopting the
Agreement without holding a hearing once both parties have signed it and neither has requested
a hearing. When a hearing is not timely requested, the court shall presume that relocation is in
the best interest of the child(ren) and may adopt the Agreement without holding a hearing.

If one or more of the parties to the Agreement timely requests a hearing in writing within 10 days
after the date the Agreement is filed with the court, then you must notify the other party(ies) 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. The court will then enter an order after
the hearing.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or
certified process server, the Florida Rules of Judicial Administration now require that all
documents required or permitted to be served on the other party must be served by electronic
mail (e-mail) except in certain circumstances. You must strictly comply with the format
requirements set forth in the Rules of Judicial Administration. If you elect to participate in
electronic service, which means serving or receiving pleadings by electronic mail (e-mail), or
through the Florida Courts E-Filing Portal, you must review Florida Rule of Judicial Administration
2.516. You may find this rule at www.flcourts.org through the link to the Rules of Judicial
Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the
A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-
mail, the procedures must always be followed once the initial election is made.

Instructions for Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation
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To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law
Form 12.915, and you must provide your e-mail address on each form on which your signature
appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General),
Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-
mail Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of
Judicial Administration 2.516.

Where can I look for more information?

Before proceeding, you should read “General Information for Self-Represented Litigants” found
at the beginning of these forms. The words that are in “bold underline” in these instructions are
defined there. For further information, see chapter 61, Florida Statutes.

If your case involves a modification of any provision relating to child support, you should also
check with the clerk of the circuit court in the county in which you are filing this Agreement for
Relocation to determine if any other forms must be filed.

If the parties agree to a modification of child support, the following forms should be filed with this
Agreement:

 A Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e),
 A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form
12.902(b) or (c).
 A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit,
Florida Supreme Court Approved Family Law Form 12.902(d).

Special notes...

The Agreement for Relocation with Minor Children must contain a Parenting Plan with a time-
sharing schedule. 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 that specifies the time that the minor child(ren) will spend with
each parent and every other person entitled to access or time-sharing,
 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, and any other activities,
 The methods and technologies that the parents will use to communicate with the child(ren),
and
 Any transportation arrangements related to access or time-sharing.

The best interests of the child(ren) is the primary consideration in the Parenting Plan. In creating
the Parenting Plan, all circumstances between the parties, including the parties’ 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
Instructions for Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation
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factors affecting the welfare and interest of the particular minor child(ren) and the
circumstances of the family as listed in s. 61.13(3), Florida Statutes.

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.

The Parenting Plan and time-sharing schedule may be set forth in the body of the Agreement for
Relocation with Minor Children or may be attached as a separate document. You may attach a
Relocation/Long-Distance Parenting Plan, Florida Supreme Court Approved Family Law Form
12.995(c), or similar form.

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.

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 must put his or her name, address, and telephone
number on the bottom of the last page of every form he or she helps you complete.

Instructions for Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation
with Minor Child(ren) (02/18)
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 IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA

Case No: __________________
Division: __________________

_________________________________,
Petitioner,
And

_________________________________,
Respondent.

AGREEMENT FOR RELOCATION WITH
MINOR CHILD(REN) ____ INCLUDING OR___ NOT INCLUDING
MODIFICATION OF CHILD SUPPORT
I, {full legal name} ____________________________________, Petitioner, referred to in the Parenting
Plan as Parent {name or designation} _______________________________________and I, {full legal
name} __________________________, Respondent, referred to in the Parenting Plan as Parent {name
or designation}___________________ being sworn, certify that the following information is true:

1. The parties to this action were granted a final judgment of:
_____ dissolution of marriage
_____ paternity
on {date} _________________________.
A copy of the final judgment and any modification(s) is/are attached.

2. {If Applicable}. The following other person is an individual who is not a parent, but with whom the
child resides pursuant to a court order, or who has the right of access to, time-sharing with, of
visitation with the child(ren)____________________________________.

3. Paragraph(s) ________________ of the ____ final judgment or ____ most recent modification
thereof describes the present custody, visitation, or time-sharing schedule.

4. The dependent or minor child(ren) referred to in this Agreement are:

Name(s) Birth Date(s)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation with Minor Child(ren)
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SECTION I. RELOCATION

A. Both parties consent and stipulate to the following terms regarding modification of the final
judgment or last modification thereof to allow Parent {name or designation} ______________
to relocate with the minor child (ren) and modify the terms regarding visitation or time-
sharing, with or without a hearing.

B. The following relocation information is true and correct:

1. The location of the intended new residence, including the state, city, and physical address,
if known, is: ________________________________________________________________
____________________________________________________________________

2. The mailing address of the new physical residence, if not the same as the physical address,
is: __________________________________________________________.

3. The telephone number of the intended new residence, if known is:
is:__________________.

4. The date of the intended move or proposed relocation is:_______________

SECTION II: JURISDICTION

A. The United States is the country of habitual residence of the child(ren).

B. The State of Florida is the child(ren)’s home state for the purposes of the Uniform Child Custody
Jurisdiction and Enforcement Act.

C. 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.

D. Other: _____________________________________________________________.

SECTION III: PARENTAL RESPONSIBILITY AND TIME-SHARING SCHEDULE {Choose only one}

A. _____Parental Responsibility and Time-Sharing shall remain the same as previously set out in
the: {choose only one}
______ Final Judgment of Dissolution;

______ Final Judgment of Paternity;

______ Other {title of supplemental order of judgment}____________________
_________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation with Minor Child(ren)
(02/18)
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 dated {date of order or judgment}______________________ and will continue without
modification;

OR

B. ____The parties shall comply with the Parenting Plan which is attached and incorporated herein
as Exhibit ______.

OR

C. _____The parties shall comply with the following Parenting Plan and time-sharing schedule set
forth below.

Parental Responsibility, Parenting Plan, and Time-Sharing Schedule

1. Parental Responsibility {Choose only one}
{Insert the name or designation of the appropriate parent or other person}

______ Sole Parental Responsibility.
It is in the best interests of the child(ren) that Parent {name or designation} _____________
shall have sole authority to make major decisions for the child(ren.) It is detrimental to the
child(ren) for the parents to share decision-making because: _____________________
_______________________________________________________________________.

______ 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.

______ 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:

Education/Academic
decisions Parent_________ Parent__________ Other
Person________
Non-emergency Other
health care Parent__________ Parent___________ Person________
Parent__________ Parent___________ Other
Person
________________ _________
Other
________________ Parent__________ Parent___________ Person________

Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation with Minor Child(ren)
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 2. Day-to-Day Decisions

Unless otherwise specified in this Parenting 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 the 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. Education

a. School Designation . For purposes of school boundary determination and registration, Parent
___________________’s address shall be designated.

b. Private or Home Schooling.{If Applicable} The following provisions are made regarding private or
home schooling:
___________________________________________________________________________________
________________________________________

c. School Calendar
If necessary, on or before ________ of each year, both parents should obtain a copy of the school
calendars 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: {Indicate all that apply}
____ the oldest child
____ the youngest child
____ the school calendar for ______________ County
____ the school calendar for _________________ School

d. 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 end on the first day of regularly scheduled classes after
the holiday or break.

e. Other: _____________________________________________________
___________________________________________________________.

4. Extracurricular Activities

{Indicate all that apply} {Insert the name or designation of the parent or other person}.
_____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.
Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation with Minor Child(ren)
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_____The costs of the extra-curricular activities shall be paid by:
Parent_________________ ______%
Parent_________________ _______ %

_____The uniforms and equipment required for the extra-curricular activities shall be paid by:
Parent_______________________%
Parent________________ ________%

____Other: _____________________________________________

5. Information Sharing.
{The following shall apply unless the court orders otherwise}

Unless otherwise prohibited by law, both parents shall have access to medical and school records
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 and mailing address, and contact
telephone number(s) 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: _______________________________________________________________________

6. Time-Sharing Schedule:
{Insert the name or designation of each parent or other person. There must be a time-sharing schedule
for each parent or other person.

a. Weekday and Weekend Schedule:
The following schedule shall apply beginning on {date} _____________ with Parent {insert name
of parent or other person}_____________________________________ and continue as follows:

Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation with Minor Child(ren)
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 i. The child(ren) shall spend time with Parent {name or designation}_ ____________________
on the following dates and times:

WEEKENDS: ____ Every ____ Every Other ____ Other (Specify):
_______________________________________________________
From_______________________ to _________________________

WEEKDAYS: {Specify days} _______________________________
From _________________________ to ______________________

OTHER: {Specify} _________________________________________

ii. The child(ren) shall spend time with Parent {name or designation} ___________ on the
following dates and times:

WEEKENDS: ____ Every ____ Every Other ____ Other {specify}:
_______________________________________________________
From_____________________ to ____________________________

WEEKDAYS: {Specify days} __________________________________
From __________________ to _______________________________

OTHER: {specify} ______________________________________________________
____________________________________________________________________

iii. {If applicable} The child(ren) shall spend time with the Other Person {name or designation}
____________ on the following dates and times:

WEEKENDS: ____ Every ____ Every Other ____ Other {specify}:
_____________________________________________________
From ________________________to_______________________

WEEKDAYS: {Specify days}__________________________________
From ________________________to_________________________

OTHER: {specify} _________________________________________

b. Please indicate below 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.

______ There is a different time-sharing schedule for the following child(ren) in Attachment
______.

__________________________________, and _________________________________.
{Name of Child} {Name of Child}

Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation with Minor Child(ren)
(02/18)
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 c. 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 the name or designation of the appropriate parent or the other person, to
indicate where the child(ren) will be for the specific holiday. Provide the beginning and
ending times. If a holiday is not specified as even, odd, or every year with one parent, then the
emain with the parent in accordance with the regular schedule

Holidays Even Years Odd Years Every Year Begin/End Time
New Year’s Day {name} {name} {name} {from/to}
Martin Luther King Wknd
President’s Day Wknd
Easter
Passover
Mother’s Day
Memorial Day Wknd
Father’s Day
4th of July
Labor Day Weekend
Rosh Hashanah
Yom Kippur
Columbus Day Wknd
Veteran’s Day
Thanksgiving
Hanukkah
Christmas
Other _______________
Children’s Birthday’s

d. Winter Break

Winter Break
{Choose only one}{Insert the name or designation of parent or other person.}

_____Parent {name or designation} ______________ 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

Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation with Minor Child(ren)
(02/18)
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 for the second portion of the Winter Break. The parties shall alternate the arrangement each
year.

_____Parent {name or designation} ______________ shall have the child(ren) for the entire
Winter Break during _____ odd-numbered years _____ even-numbered years _____ every year.

_____Other: _________________________________________________________

Specific Winter Holidays
If not addressed above, specific Winter Holidays such as Christmas, New Year’s Eve, Hanukkah,
Kwanzaa, etc. shall be shared as follows: ___________________________________________
______________________________________________________________________

e. Spring Break
{Choose only one} {Insert the name or designation of parent or other person}

_____The parents shall follow the regular schedule.

_____The parents shall alternate the entire Spring Break with Parent {name or designation}
__________ having the child(ren) during the _____ odd-numbered _____ even-numbered
years.

_____Parent {name or designation}______________
shall have the child(ren) for the entire Spring Break every year.

______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 with the second half going to the
parent whose weekend falls during the second half.

____ Other: ____________________________________________________

f. Summer Break
{Choose only one}{Insert the name or designation of parent or other person}

_____ The parents shall follow the regular time-sharing schedule through the summer.

_____ Parent [name or designation} ____________ 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, Parent{name or designation} _____ _____ shall have the child(ren)
from _______________ before after school is out until___________________. The other
parent shall have the child(ren) for the second half of the summer break. The parents shall
alternate the first and second halves of Summer Break each year unless otherwise agreed.
During the extended periods of time-sharing, the other parent shall have the
child(ren)_______________________.

Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation with Minor Child(ren)
(02/18)
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_____ Other: _______________________________________________.

7. Number of Overnights:
{Insert name or designation of parent or other person}
Based upon the time-sharing schedule, Parent {name or designation} ___________________
has a total of _____ overnights per year and Parent {name or designation} _______________
has a total of _____ overnights per year. Note: The two numbers must equal 365.

8. Schedule Changes {Indicate 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 ______________________________________________.

9. Transportation and Exchange of Children
{Insert the name or designation of the parent or other person}

Both parents shall have the child(ren) ready on time with sufficient clothing packed and ready
at the agreed upon time of exchange. All necessary information and medicines will accompany
the child(ren).

The parties shall exchange travel information and finalize travel plans at least _______ days in
advance of the date of travel. Except in cases of emergency, any parent requesting a change
of travel plans after the date of finalization shall be solely responsible for any additional costs.

a. Automobile Transportation and 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} {Insert the name or designation of parent or other person}

_____Parent {name or designation} ___________________ shall provide all transportation.

_____Parent {name or designation} ___________________ shall pick up the child(ren) at the
beginning of the visit and the other parent shall pick up the child(ren) at the end of the visit.
The exchange shall take place:

_____At the parents’ homes unless otherwise agreed

Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation with Minor Child(ren)
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 _____At the following location unless the parties agree in advance to a different
place________________________________________________________.

____The parents shall meet at the following central location:
______________________________________________________________.

_____Other: ____________________________________________________.

b. Airplane and Other Public Transportation and Exchange

Airline regulations govern the age at which a child may fly unescorted. An older child or
children may fly under such regulations as each airline may establish.

Airline reservations should be made well in advance, and preferably non-stop.

All flight information shall be sent to the other party(ies) at least _____days in advance of the
flight by the party purchasing the tickets.

If the child(ren) are flying accompanied by a party, the parent picking up the child(ren) shall
exchange the child(ren) with the other parent at ________________________and the parent
returning the child(ren) shall exchange the child(ren)
at______________________________________________.

If the exchange is to be made at the airport, the party flying in to pick up or drop off the
child(ren) from/to the airport must notify the other party of any flight delays.

Unless otherwise agreed in advance, if the child(ren) are flying unaccompanied, the parent
taking the child(ren) to the airport must call the other parent immediately upon departure to
notify the other parent that the child(ren) is/are arriving, and the parent who meets the
child(ren) must immediately notify the other parent upon the child(ren)’s arrival. {Indicate all
that apply}

_____Until a child reaches the age of _______, the parties agree that the child(ren) shall
take a direct flight and/or fly accompanied by _________________________________.

_____Once a child reaches the age of ______ the child shall be permitted to fly accompanied
by an airline employee.

_____Once a child reached the age of ______ the child shall be permitted to fly
unescorted.

_____Other: __________________________________________________.

c. Costs of Airline and Other Public Transportation

The parents shall work together to purchase the most convenient and least expensive tickets.

Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation with Minor Child(ren)
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 Unless otherwise agreed or in the case of an unavoidable emergency, any costs incurred by a
missed travel connection shall be the sole responsibility of the parent who failed to timely
deliver the child(ren) to the missed connection.
{Indicate all that apply} {Insert name or designation of parent or other person}

_____ Transportation costs are included in the Child Support Worksheets and/or the Order for
Child Support and should not be included here.

_____ Parent _______________ shall pay ______% and Parent ________________ shall pay
______ % of the transportation costs.

_____ Parent_____________ shall pay ______% and Parent _______________ shall pay
_____% of the transportation costs for an adult to accompany the child(ren) during travel.

_____ If the parents are sharing travel costs, the non-purchasing parent shall reimburse the
other parent within ______ days of receipt of documentation establishing the travel costs.

_____ Other: ___________________________________________.

10. Foreign and Out-Of-State Travel
{Indicate 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 prior to 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(ren) ____________________
______________________________________________________________________.

_____ Other _________________________________________________________.

11. Other travel and exchange arrangements:
______________________________________________________________________________
____________________________________________________________________
____________________________________________________________________.

Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation with Minor Child(ren)
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 12. Communication

_____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 by: {Indicate all that apply}
_____in person
_____ by telephone
_____ by letter
_____ by e-mail
_____ Other:_____________________________________________________.

_____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 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: ___________________________________________________________.

13. Costs of Electronic Communication
The costs of electronic communication between parents and the minor child(ren) shall be
allocated as follows:
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________.

14. Designation for Other Legal Purposes
{Insert name or designation of parent or other person.}

The child(ren) named in this Parenting Plan are scheduled to reside the majority of the time
with Parent __________________. This majority designation is SOLELY for purposes of all
other state and federal laws which require such designation. This designation does not affect
either parent’s rights or responsibilities under this Relocation Agreement.

15. Changes or Modifications of the Parenting Plan

Temporary changes may be made informally without a written document. When the parents
do not agree, the Parenting Plan remains in effect until further order of the court.
Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation with Minor Child(ren)
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 Any substantial changes to the Parenting Plan must be sought through the filing of a
supplemental petition for modification.

16. 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
and assistance, such as Parenting Coordinators and Parenting Counselors, before filing a court
action.

SECTION IIV: CHILD SUPPORT AND INSURANCE
{Insert the name or designation of the appropriate parent in the spaces provided.}

1. Modification of Child Support
If the requested modification is granted, the parties:

_____agree that child support should be modified, consistent with the modification of the time-
sharing schedule

_____ agree that child support will NOT be modified.

2. Amount of Child Support

Parent {name or designation} _______________ (hereinafter “Obligor”) will pay child support,
under Florida’s child support guidelines, section 61.30, Florida Statutes, to the other parent.
The Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form
12.902(e), is completed and attached.

This parent shall be obligated to pay child support at the rate of $____________, per month for
the ______children {number of parties’ minor or dependent children} beginning {month, day,
year} ______________________ and terminating _______________________{month, day,
year}. Child support shall be paid in the amount of $______________ per ____________ {week,
month, other}, which is consistent with the Obligor’s current payroll cycle.

Upon the termination of the obligation of child support for one of the parties’ children, child
support in the amount of $________________ for the remaining________ children {total
number of remaining children} shall be paid beginning ____________________ {month, day,
year} and terminating ______________________ {month, day, year}. This child support shall
be paid in the amount of $________________ per _____________ {week, month, other}
consistent with the Obligor’s current payroll cycle.

{Insert schedule for the child support obligation, including the amount, and commencement
and termination dates, for the remaining minor or dependent children, which shall be
payable as the obligation for each child ceases. Please indicate whether the schedule either
______ appears below or _______is attached as part of this form.}

Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation with Minor Child(ren)
(02/18)
- 199 -
 The Obligor shall pay child support until all the minor or dependent children: reach the age of
18, become emancipated, marry, die, joins the armed services; or become self-supporting; or
until further order of the court or agreement of the parties. The child support obligation shall
continue beyond the age of 18, and until high school graduation for any child who is:
dependent in fact; between the ages of 18 and 19; and is still in high school, performing in
good faith with a reasonable expectation of graduation before the age of 19.

If the child support amount above deviates from the guidelines by 5% or more, explain the
reason(s) here: ______________________________________________________
_______________________________________________________________________
_______________________________________________________________________.

3. Retroactive Child Support and/or Arrearages.
a. ______ There is no retroactive child support or child support arrearage at the time of this
Agreement.

b. _____ Petitioner ______ Respondent shall pay child support to the other party in the
amount of:
$______________for retroactive child support, as of {date} __________________
$ _____________ for previously ordered unpaid child support, as of {date} _____________.
The total of $ ______________ in retroactive and unpaid child support shall be paid at the
rate of $ ______________every: ______ week _____ other week _____ month, beginning
{date} ______________, until paid in full including statutory interest.

4. Health Insurance.
{Choose one only} {Insert the name or designation of the parent or other person}

Parent {name or designation} __________________ will maintain health insurance for the
parties’ minor child(ren). The party providing health insurance will provide insurance cards to
the other party showing coverage.

OR

_____ Health insurance is either not reasonable in cost or accessible to the child(ren) at this
time. Any uninsured/ unreimbursed medical costs for the minor child(ren) shall be assessed
as follows

_____Shared equally by both parents.

_____Prorated according to the child support guideline percentages.

_____Other {explain}: ___________________________________________________

As to these uninsured/unreimbursed medical expenses, the party who incurs the expense shall
submit a 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.

Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation with Minor Child(ren)
(02/18)
- 200 -
 5. Dental Insurance.
{Choose only one} {Insert the name or designation of the parent or other person}

Parent {name or designation} _________________ will maintain dental insurance for the
parties’ minor child(ren). The party providing dental insurance will provide insurance cards to
the other party showing coverage.

OR

____ Dental insurance is either not reasonable in cost or available to the children at this time.
Any uninsured/unreimbursed dental costs for the minor child(ren) shall be assessed as
follows:

_____Shared equally by both parents.

_____Prorated according to the child support guideline percentages.

_____Other {explain}: ______________________________________________________

As to these uninsured/unreimbursed dental expenses, the party who incurs the expense shall
submit a 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.

6. Life Insurance. {Insert the name or designation of the parent or other person}

Parent {name or designation} ___________________shall be required to maintain life
insurance coverage for the benefit of the parties’ minor child(ren) in the amount of $
_________________ until the youngest child turns 18, becomes emancipated, marries, joins
the armed services, or dies.

SECTION VII: OTHER
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________
______________________________________________________________________________

Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation with Minor Child(ren)
(02/18)
- 201 -
I certify that I have been open and honest in entering into this relocation agreement. I am satisfied
with this agreement and intend to be bound by it.

Dated: ______________________ _______________________________________
Signature of Petitioner/Parent_______________
Printed Name: ___________________________
Address: _______________________________
City, State, Zip: __________________________
Telephone Number: ______________________
Fax Number: ___________________________
Designated E-mail Address(es):____________
___________________________________

STATE OF FLORIDA
COUNTY OF ____________________

Sworn to or affirmed and signed before me on __________ by ___________________________.

_______________________________________
NOTARY PUBLIC or DEPUTY CLERK

_______________________________________
[Print, type, or stamp commissioned name of notary or
deputy clerk.]
____ Personally known
____ Produced identification
____ Type of identification produced ________________________________

Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation with Minor Child(ren)
(02/18)
- 202 -
I certify that I have been open and honest in entering into this relocation agreement. I am satisfied
with this agreement and intend to be bound by it.

Dated: ______________________ _______________________________________
Signature of Respondent/Parent____________
Printed Name: ___________________________
Address: _______________________________
City, State, Zip: __________________________
Telephone Number: ______________________
Fax Number: ____________________________
Designated E-mail Address(es):____________
____________________________________

STATE OF FLORIDA
COUNTY OF ____________________

Sworn to or affirmed and signed before me on __________ by ___________________________.

_______________________________________
NOTARY PUBLIC or DEPUTY CLERK

_______________________________________
[Print, type, or stamp commissioned name of notary or
deputy clerk.]

____ Personally known
____ Produced identification
____ Type of identification produced ________________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill
in all blanks]
This form was prepared for the: {choose only one} _______Petitioner ______Respondent _____Other
Person.
This form was completed with the assistance of:
{name of individual} _______________________________________________________,
{name of business} __________________________________________________________,
{address} ____________________________________________________________________,
{city} ____________, {state}____,{ zip code} ___________,{telephone number} ______________.

Florida Supreme Court Approved Family Law Form 12.950(a), Agreement for Relocation with Minor Child(ren)
(02/18)
- 203 -
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.950(b)
MOTION FOR ORDER PERMITTING RELOCATION BY AGREEMENT
(02/18)

When should this form be used?

This form should be used when the parents and every other person entitled to access to, visitation, or
time-sharing with the minor child(ren) are in agreement and are asking the court to permit the
relocation of the child(ren). “Other Person” means an individual who is not the parent, but with whom
the child resides pursuant to court order, or who has the right of access to, time-sharing with, or
visitation with the child(ren). You may file a Motion for Order Permitting Relocation with Agreement if
the following are true:

 One of the parents or a person entitled to access to or time-sharing with the children wishes to
relocate the child(ren) to a residence more than 50 miles from the child(ren)’s principal place of
residence at the time of the last order establishing or modifying time-sharing or at time of filing of
the pending action.

 There is an existing cause of action, judgment, or decree of record pertaining to the child(ren)’s
residence or time sharing schedule.

 The parents and every other person entitled to access to or time-sharing with the children have
signed a written agreement, Agreement for Relocation with Minor Child(ren), Florida Supreme
Court Approved Family Law Form, 12.950(a), or similar form which:
1. Reflects the consent to the relocation;
2. Defines an access or time-sharing schedule for the non-relocating parent and any
other persons who are entitled to access or time-sharing; and
3. Describes, if necessary, any transportation arrangements related to access or time-
sharing.

 Your order regarding custody, primary residence, the parenting plan, time-sharing, or access to or
with the child(ren) was entered before October 1, 2009 and the order does not expressly govern the
relocation of the child(ren); was entered on or after October 1, 2009; or your case was pending on
October 1, 2009.

This form should be typed or printed in black ink. You must fill in all sections of the form. If you are an
“other person” entitled to access, visitation, or time-sharing with the child(ren), substitute your name
for Petitioner or Respondent in the form. After completing the form, you should sign the form before a
notary public or deputy clerk. You should file the form in the county where the original order or
judgment was entered. If the order or judgment was entered in another state, or if the child(ren) live(s)
in another state, you should speak with an attorney about where to file this form.

Instructions for Motion for Order Permitting Relocation by Agreement, Florida Supreme Court Approved Family
Law Form 12.950(b) (02/18)
- 204 -
 IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving pleadings
by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of
Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of
Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the
A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

What should I do next?
After completing this form, you should file the original with the clerk of the circuit court where there is
an existing cause of action, judgment, or decree of record pertaining to the child(ren)’s residence or
time-sharing schedule and keep a copy for your records. The original Agreement for Relocation with
Minor Child(ren) should be attached to Motion or filed with the clerk of the circuit court at the same
time.

If both parties agree, the court may ratify the Agreement without the necessity of an evidentiary
hearing. You should check with the clerk, family law intake staff, or judicial assistant for the proper way
to submit the Motion and a proposed Final Judgment/Supplemental Final Judgment Granting

Instructions for Motion for Order Permitting Relocation by Agreement, Florida Supreme Court Approved Family
Law Form 12.950(b) (02/18)
- 205 -
Relocation, Florida Supreme Court Approved Family Law Form 12.950(i), to the judge. If one or more of
the parties to the Agreement timely requests a hearing in writing within 10 days after the date the
Agreement is filed with the court, then you must notify the other party(ies) 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. The court will then enter an order after hearing. If a hearing is not
timely requested, the court shall presume that relocation is in the best interest of the child(ren) and may
ratify the Agreement without an evidentiary 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.

If your case involved a modification of any provision relating to child support, you should also check with
the clerk of the circuit court in the county in which you are filing the Motion for Order Permitting
Relocation with Minor Child(ren) and Agreement for Relocation with Minor Child(ren) to determine if
any other forms must be filed.

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 Former 12.900(a), before he or she helps you. A nonlawyer helping you
fill out these forms must put his or her name, address, and telephone number on the bottom of the last
page of every form he or she helps you complete.

Instructions for Motion for Order Permitting Relocation by Agreement, Florida Supreme Court Approved Family
Law Form 12.950(b) (02/18)
- 206 -
 IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA

Case No:________________________
Division:________________________

_________________________________,
Petitioner,
And

_________________________________,
Respondent.

MOTION FOR ORDER PERMITTING RELOCATION WITH AGREEMENT

We, Petitioner, {full legal name} __________________________________________________,
Respondent, {full legal name} ____________________________________________________, and/or
____________________________________________ {full legal name} of Other Person entitled to
Access or Time-Sharing with child(ren), being sworn, certify that the following information is true: {fill
in all blanks}

1. We are asking the Court to permit relocation of the minor child(ren) to a residence at least 50
miles from the child(ren)’s principal place of residence at the time of entry of the last order
establishing or modifying time-sharing, or at the time of filing of the pending action.

2. There is an existing cause of action, judgment, decree of record pertaining the child(ren)’s
residence or time-sharing schedule.

3. WE CONSENT TO THE RELOCATION OF THE MINOR CHILD(REN) to the following address:
_______________________________________________________________________________.

4. The dependent or minor child(ren) is (are):
Name(s) Birth Date(s)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

5. Agreement. A written Agreement for Relocation with Minor Child(ren), Florida Supreme Court
Approved Family Law Form 12.950(a) or similar form, is filed with this motion which reflects
consent to the relocation; defines an access or time-sharing schedule for the non-relocating
parent and any other persons who are entitled to access or time-sharing; and describes, if
necessary, any transportation arrangements related to access or time-sharing.

Motion for Order Permitting Relocation by Agreement, Florida Supreme Court Approved Family Law Form
12.950(b) (02/18)
- 207 -
 6. The specific reasons for the proposed relocation of the child(ren)
are:____________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Attach additional sheets if necessary.

7. This modification is in the best interests of the child (ren) because:
{explain}________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

8. Hearing. We seek ratification of the agreement by court order: {choose only one}
a._____ With hearing

b._____ Without hearing

9. 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 Agreement.

10. If not previously filed in this case, a completed Notice of Social Security Number, Florida Supreme
Court Approved Family Law Form 12.902(j), is filed with this Agreement.

Motion for Order Permitting Relocation by Agreement, Florida Supreme Court Approved Family Law Form
12.950(b) (02/18)
- 208 -
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in
this motion and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated: ______________________ _______________________________________
Signature of PETITIONER
Printed Name: ___________________________
Address: _______________________________
City, State, Zip:___________________________
Telephone Number: ______________________
Fax Number: ____________________________
Designated E-mail Address(es): _____________
______________________________________

STATE OF FLORIDA
COUNTY OF _______________________

Sworn to or affirmed and signed before me on ______________by ______________________

_____________________________________
NOTARY PUBLIC OR DEPUTY CLERK

_____________________________________
{Print, type, or stamp commissioned name of notary or
deputy clerk.}

_____ Personally known
_____ Produced identification
_____ Type of identification produced ___________________________

Motion for Order Permitting Relocation by Agreement, Florida Supreme Court Approved Family Law Form
12.950(b) (02/18)
- 209 -
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.950(c),
PETITION FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR
MINOR CHILD(REN) AND RELOCATION
(02/18)

When should this form be used?

This form should be used when you are filing for dissolution of marriage, there are dependent or minor
children, and pursuant to Section 61.13001, Florida Statutes:

1. You plan to relocate your residence more than 50 miles from the principal place of residence you
have at the time of filing this petition; and

2. The change of location is for at least 60 consecutive days, not including a temporary absence from
your principal place of residence for purposes of vacation, education or the provision of health
care for the minor child(ren).

You or your spouse must have lived in Florida for at least 6 months before filing for dissolution of marriage
in Florida.

This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in
the county where you live and keep a copy for your records.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving pleadings
by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of
Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of
Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the
A-Z Topical Index.
Instructions for Florida Supreme Court Approved Family Law Form 12.950(c) Petition for Dissolution of Marriage
with Dependent or Minor Child(ren) and Relocation (02/18)
- 210 -
SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

What should I do next?

For your case to proceed, you must properly notify your spouse and every other person entitled to access
or time-sharing with the child(ren) of the petition. “Other Person” means an individual who is not the
parent but with whom the child resides pursuant to court order, or who has the right of access to, time-
sharing with, or visitation with the child(ren). If you know where your spouse lives, you should use
personal service. If you absolutely do not know where your spouse lives, you may use constructive
service. You may also be able to use constructive service if your spouse or the other person 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 contact 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 contact 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 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
Instructions for Florida Supreme Court Approved Family Law Form 12.950(c) Petition for Dissolution of Marriage
with Dependent or Minor Child(ren) and Relocation (02/18)
- 211 -
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 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:

 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 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, Form 12.995(c). If the
Instructions for Florida Supreme Court Approved Family Law Form 12.950(c) Petition for Dissolution of Marriage
with Dependent or Minor Child(ren) and Relocation (02/18)
- 212 -
 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.

Updating Information. A parent or other person seeking to relocate has a continuing duty to provide
current and updated information required by the relocation statute when that information becomes
known.

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 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. Both parents are required to provide financial support for their minor or dependent
child(ren); however, the court may order one parent to pay child support 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.

Alimony. Alimony may be awarded to a spouse if the judge finds that one spouse has an actual need for
it and that the other spouse has the ability to pay. If you want alimony, you must request it in writing in
Instructions for Florida Supreme Court Approved Family Law Form 12.950(c) Petition for Dissolution of Marriage
with Dependent or Minor Child(ren) and Relocation (02/18)
- 213 -
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 permanent alimony, bridge-the-gap alimony, durational
alimony, and/or rehabilitative alimony. If alimony is awarded, the judge may order periodic payments,
payments in lump sum, or both.

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, relocation 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) and a
Motion for Temporary Relocation, Florida Supreme Court Approved Family Law From 12.950(e). For
more information, see the instructions for those forms.

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. As you are seeking to relocate, the Parenting Plan must include a post-
relocation schedule for access and time-sharing together with the necessary transportation
arrangements. 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), a Safety-Focused Parenting Plan, Florida
Supreme Court Approved Family Law Form 12.995(b), or a 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.

Instructions for Florida Supreme Court Approved Family Law Form 12.950(c) Petition for Dissolution of Marriage
with Dependent or Minor Child(ren) and Relocation (02/18)
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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.

Instructions for Florida Supreme Court Approved Family Law Form 12.950(c) Petition for Dissolution of Marriage
with Dependent or Minor Child(ren) and Relocation (02/18)
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 IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA

Case No: ________________________
Division: ________________________

In Re: The Marriage of

________________________________________,
Petitioner,
And

_______________________________________,
Respondent.

PETITION FOR DISSOLUTION OF MARRIAGE
WITH DEPENDENT OR MINOR CHILD(REN) AND RELOCATION

I, {full legal name} , the
Petitioner, being sworn, certify that the following statements are true:

1. JURISDICTION/RESIDENCE
_____ Petitioner _____ Respondent _____ Both Spouses has/have lived in Florida for at least six (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
Date of marriage: {month, day, year}________________________________________________.
Place of marriage: {city, county, state}_______________________________________________.
Date of separation: {month, day, year} _____________________ ______ (Indicate if approximate).
4. DEPENDENT OR MINOR CHILD(REN)
{Indicate all that apply}
a. _____ Petitioner is pregnant. Baby is due on: {date} __________________________
b. _____ Respondent is pregnant. Baby is due on: {date} _________________________________
c. ______ The minor (under 18) child(ren) common to both parties are:

Name(s) Birth Date(s)
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Florida Supreme Court Approved Family Law Form 12.950(c), Petition for Dissolution of Marriage with Dependent
or Minor Child(ren) and Relocation (02/18)
- 216 -
 d. _____The minor child(ren) born or conceived during the marriage who are not common to both
parties are:
Name(s) Birth Date(s)
______________________________________________________________________________
______________________________________________________________________________

The birth parent(s) of the above minor child(ren) is/are {name(s) and address(es)}:
_____________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

e. _____ 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(s) Birth Date(s)
______________________________________________________________________________
______________________________________________________________________________

5. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b)
or (c) {Choose only one}____ has been filed or ____ will be 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}
c. _____ The marriage is irretrievably broken.

OR

d. _____ 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 to this Petition.

SECTION I. MARITAL ASSETS AND LIABILITIES
{Choose only one}
1. _____ There are no marital assets or liabilities.

OR

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}

Florida Supreme Court Approved Family Law Form 12.950(c), Petition for Dissolution of Marriage with Dependent
or Minor Child(ren) and Relocation (02/18)
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 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 the other spouse’s property because:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

SECTION II. SPOUSAL SUPPORT (ALIMONY)
{Choose only one
1. _____ Petitioner forever gives up any right to spousal support (alimony) from Respondent.

OR

2. _____ Petitioner requests that the Court order Respondent to pay spousal support (alimony) to
Petitioner, who claims that he or she has a need for the support that he or she is requesting and
that Respondent has the ability to pay that support. Spousal support (alimony) is requested in the
amount of $ ________ every _____ week _____ other week _____month, or _____ other
______________ beginning {date} _____________________ and continuing until {date or event}
_________________________________________________________________________________.

Explain why the Court should order the other spouse to pay and any specific request(s) for type of
alimony (temporary, permanent, bridge-the-gap, durational, rehabilitative, and/or lump sum):
________________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
__________________________________________________________________________________
______________________________________________________________________________.

{Indicate if applicable} _____ Petitioner requests life insurance on the other spouse’s life, provided
by that spouse, to secure such support.

SECTION III. RELOCATION

1. Petitioner seeks to relocate his/her residence to a place more than 50 miles from his/her place of
residence at the time of filing of the Petition. The change of location is for a period of at least
consecutive 60 days, not including a temporary absence from the principal residence for purposes of
vacation, education, or the provision of health care for the child(ren).

Florida Supreme Court Approved Family Law Form 12.950(c), Petition for Dissolution of Marriage with Dependent
or Minor Child(ren) and Relocation (02/18)
- 218 -
2. {If applicable} The following other person is an individual who is not a parent but with whom the
child resides pursuant to a court order, or who has the right of access to, time-sharing with, or
visitation with the child(ren)__________________________________________________________.

3. Pursuant to Section 61.13001(3), Florida Statutes, the following information is provided:

a. The location of the intended new residence, including the state, city, and physical address, if
known, is:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

b. The mailing address of the new physical residence, if not the same as the physical address, is:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

c. The home telephone number of the intended new residence, if known, is: _________________.

d. The date of the intended move or proposed relocation is: ______________________________.

e. The specific reasons for the proposed relocation are:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
Attach additional sheets, if necessary.

f. One of the reasons for the proposed relocation is a job
_____ Yes _____ No. A copy of the written job offer is attached to this Petition.

4. The relocation and time-sharing have been agreed to by the parties. {Choose only one} _____ Yes
_____ No. If yes, attach a copy of the Agreement for Relocation to the Petition.

Failure to obtain an Order prior to the relocation renders the petition to relocate legally insufficient.

SECTION IV. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING

1. The minor child(ren) currently reside(s) with _____ Petitioner _____ Respondent
_____ Other Person: {explain} ________________________________________________________.

2. Parental Responsibility.
It is in the child(ren)’s best interests that parental responsibility be: {Choose only one}

a.____ shared by both parents;

b.____ awarded solely to _____ Petitioner _____ Respondent. Shared parental responsibility
would be detrimental to the child(ren) because: ___________________________
______________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________.

Florida Supreme Court Approved Family Law Form 12.950(c), Petition for Dissolution of Marriage with Dependent
or Minor Child(ren) and Relocation (02/18)
- 219 -
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). For purposes
of a Parenting Plan, the Petitioner will be referred to as Parent {name or designation} __________
_____________, and the Respondent will be referred to as Parent {name or designation}
_________________________. 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: {Choose only one} _____ have _____ have not agreed to the Parenting Plan.

b. _____ Each child will have time-sharing with both parents as follows: __________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
(_____ Indicate if a separate sheet is attached.)

c. _____ The court should establish a Parenting Plan with the following provisions for:
{Insert name or designation of the appropriate parent in the space provided}
_____ No time-sharing for Parent ________________________
_____ Limited time-sharing with Parent ___________________
_____ Supervised Time-Sharing for Parent _________________
_____ Supervised or third-party exchange of the child(ren)
_____ Time-Sharing Schedule as follows:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

4. The proposed post-relocation transportation arrangements are as follows: _____________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.

5. Explain why the relocation time-sharing schedule is in the best interests of the child(ren): _________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.

SECTION V. CHILD SUPPORT
{Indicate 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} ______________________________________

Florida Supreme Court Approved Family Law Form 12.950(c), Petition for Dissolution of Marriage with Dependent
or Minor Child(ren) and Relocation (02/18)
- 220 -
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; is (are) in high school; between the ages of 18 and 19; and 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. ____ Petitioner
b.____ Respondent.

5. ____Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid:
{Choose only one}
a. _____by Petitioner;
b. _____by Respondent;
c. _____by the parties equally {each spouse pays 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. ____Petitioner;
b. ____Respondent;
c. ____Both.

SECTION VI. OTHER
1. _____ Petitioner requests to be known by the following former name, which was {full legal name}
_______________________________________________________________.

2. Other relief {specify}:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.
SECTION VII. REQUEST

Florida Supreme Court Approved Family Law Form 12.950(c), Petition for Dissolution of Marriage with Dependent
or Minor Child(ren) and Relocation (02/18)
- 221 -
{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:
{Indicate all that apply}
1. _____distribute marital assets and liabilities as requested in Section I of this petition;
2. _____award 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 IV of
this petition;
4. _____permit relocation in accordance with Section III of this petition;
5. _____establish child support for the dependent or minor child(ren) common to both parties, as
requested in Section V of this petition;
6. _____restore Petitioner’s former name as requested in Section VI of this petition;
7. _____award other relief as requested in Section VI of this petition; and any other terms the Court
deems necessary.

A RESPONSE TO THE PETITION OBJECTING TO THE RELOCATION MUST BE MADE IN WRITING, FILED
WITH THE COURT, AND SERVED ON THE SPOUSE SEEKING TO RELOCATE WITHIN 20 DAYS AFTER
SERVICE OF THIS PETITION TO RELOCATE. IF YOU FAIL TO TIMELY OBJECT TO THE RELOCATION, THE
RELOCATION WILL BE ALLOWED, UNLESS IT IS NOT IN THE BEST INTERESTS OF THE CHILD, WITHOUT
FURTHER NOTICE AND WITHOUT A HEARING.

The Response is in the form of an Answer and it must be sworn to under oath and must include the
specific factual basis supporting the reasons for objecting to the relocation, including a statement of the
amount of participation or involvement you currently have or have had in the life of the child(ren).

Florida Supreme Court Approved Family Law Form 12.950(c), Petition for Dissolution of Marriage with Dependent
or Minor Child(ren) and Relocation (02/18)
- 222 -
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
petition and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated: ______________________ _____________________________________________
Signature of Petitioner
Printed Name: _________________________________
Address: _____________________________________
City, State, Zip: ________________________________
Telephone Number: _____________________________
Fax Number: __________________________________
Designated E-mail Address(es):____________________
_____________________________________________
STATE OF FLORIDA
COUNTY OF ____________________

Sworn to or affirmed and signed before me on ____________ by _______________________________.

_____________________________________________
NOTARY PUBLIC or DEPUTY CLERK

_____________________________________________
[Print, type, or stamp commissioned name of notary or
deputy clerk.]
____ Personally known
____ Produced identification
____ Type of identification produced ________________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the Petitioner.
This form was completed with the assistance of:
{name of individual} ________________________________________________________________,
{name of business}__________________________________________________________________,
{address} _________________________________________________________________________,
{city} ________________,{state} ____, {zip code}__________,{telephone number} ______________.

Florida Supreme Court Approved Family Law Form 12.950(c), Petition for Dissolution of Marriage with Dependent
or Minor Child(ren) and Relocation (02/18)
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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.950(d)
SUPPLEMENTAL PETITION TO PERMIT RELOCATION WITH
MINOR OR DEPENDENT CHILD(REN)
(02/18)

When should this form be used?

This form should be used when you are asking the court to permit the relocation of your principal
residence and:

1. You plan to relocate your residence more than 50 miles from your principal residence at the time of
entry of the last order which established or modified primary residence, custody, visitation, or time-
sharing;

2. The court has not entered an order granting permission to relocate.

3. The relocation will be for a period of 60 consecutive days or more, not including any absence for
purposes of vacation, education, or health care for the child(ren).

4. Your order regarding custody, primary residence, visitation, time-sharing or parenting plan was
entered before October 1, 2009, and the order does not expressly govern the relocation of the
child(ren); was entered on or after October 1, 2006; or your case was pending on October 1, 2009.

This form should be typed or printed in black ink. You must fill in all sections of the form. After completing
the form, you should sign the form before a notary public or deputy clerk. You should file this form in the
county where the original order was entered. If the order was entered in another state, or if the child(ren)
live(s) in another state, you should speak with an attorney about where to file this form. You should file
the original with the clerk of the circuit court and keep a copy for your records.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain

Instructions for Florida Supreme Court Approved Family Law Form 12.950(d), Supplemental Petition to Permit
Relocation with Minor or Dependent Child(ren) (02/18)
- 224 -
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving pleadings
by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of
Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of
Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the
A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

What should I do next?

For your case to proceed, you must properly notify the other parent and every other person entitled to,
access, time-sharing, or visitation with the child(ren) in your case of the supplemental petition. “Other
Person” means an individual who is not the parent but with whom the child resides pursuant to court
order, or who has the right of access to, time-sharing with, or visitation with the child(ren). 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, the court may only
grant limited relief. For more information on constructive service, see Notice of Action For, Florida
Supreme Court Approved Family Law Form 12.913(a)(2), 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). The law
regarding constructive service and service on an individual in the military service is very complex. If you
have any questions about service, 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 contact 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 either an answer that agrees with everything in your
supplemental petition or an answer and waiver, and you have complied with mandatory disclosure and

Instructions for Florida Supreme Court Approved Family Law Form 12.950(d), Supplemental Petition to Permit
Relocation with Minor or Dependent Child(ren) (02/18)
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filed all of the required papers, you may contact 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 either 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 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 there is a domestic violence case and you want to keep your address confidential for safety reasons,
do not enter the address, telephone number, 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:

 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 other party’s income, you may file this worksheet after his or her financial affidavit
has been served on you.)
 Agreement for Relocation, if you have reached an agreement on any or all of the issues attach the
proposed Agreement For Relocation with Minor Child(ren). Florida Supreme Court Approved Family
Law 12.950(a). 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.
 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).

Instructions for Florida Supreme Court Approved Family Law Form 12.950(d), Supplemental Petition to Permit
Relocation with Minor or Dependent Child(ren) (02/18)
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 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 supplemental petition on the
respondent, if not filed at the time of the supplemental petition, unless you and the other party
have agreed not to exchange these documents.)

Updating Information. A parent or other person seeking to relocate has a continuing duty to provide
current and updated information required by the relocation statute when that information becomes
known.

Parenting and Time-Sharing. If you and the other parent and every other person entitled to access to or
time-sharing with the child(ren) are unable to agree on the 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 a time-sharing schedule based upon 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).

Failure to obtain an Order prior to relocation renders the supplemental petition to relocate legally
insufficient.

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.

If one has not already been completed, the court may require the completion of a parenting course
before a final hearing is set. You should contact the clerk, family law intake staff, or judicial assistant
about requirements for parenting courses or mediation where you live.

Child Support. Both parents are required to provide financial support for their minor or dependent
child(ren); however, the court may order one parent to pay child support 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 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 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 relocation of the minor child(ren), complete
paragraph eleven contained in the Supplemental Petition To Permit Relocation of Minor Child(ren).

Final Judgment Form. These family law forms contain a Final Judgment/Supplemental Final Judgment
Permitting Relocation, Florida Supreme Court Approved Family Law Form 12.950(i), 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,

Instructions for Florida Supreme Court Approved Family Law Form 12.950(d), Supplemental Petition to Permit
Relocation with Minor or Dependent Child(ren) (02/18)
- 227 -
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.

Instructions for Florida Supreme Court Approved Family Law Form 12.950(d), Supplemental Petition to Permit
Relocation with Minor or Dependent Child(ren) (02/18)
- 228 -
 IN THE CIRCUIT COURT OF THE ________________ JUDICIAL CIRCUIT,
IN AND FOR ________________________ COUNTY, FLORIDA

Case No: ________________________
Division: ________________________

_________________________________,
Petitioner,
And

_________________________________,
Respondent.

SUPPLEMENTAL PETITION TO PERMIT RELOCATION
WITH MINOR CHILD(REN)

I, {full legal name} _____________________________________, being sworn, certify that the
following information is true:

1. The parties to this action were granted a final judgment of:
_____ dissolution of marriage
_____ paternity
on {date} ________________.
A copy of the final judgment and any modification(s) is/are attached to this supplemental
petition.

2. {If applicable} The following other person is an individual who is not a parent but with
whom the child resides pursuant to court order, or who has the right of access to, time-
sharing with, or visitation with the
child(ren)__________________________________________.

3. Paragraph(s) _____________________ of the _____ final judgment or _____ most recent
modification thereof describes the present custody, visitation, and/or time-sharing ordered.

4. The parties ______have ______have not reached an agreement on relocation. If yes, a copy
of the agreement is attached to this supplemental petition.

5. The parties’ dependent or minor child(ren) is (are):
Name Birth Date

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Florida Supreme Court Approved Family Law Form 12.950(d), Supplemental Petition to Permit Relocation
with Minor or Dependent Child(ren) (02/18)
- 229 -
6. I seek to relocate my principal residence at least 50 miles from my principal residence
established in the final judgment or last modification thereof. This relocation is for a period
of 60 consecutive days or more, not including any absence for purposes of vacation,
education, or health care for the child(ren). Pursuant to Section 61.13001(3), Florida
Statutes, the following information is provided:

a. The location of the intended new residence, including the state, city, and physical
address, (if known), is:_____________________________________________________
________________________________________________________________________

b. The mailing address of the new physical residence, if not the same as the physical
address, is: ______________________________________________________________
________________________________________________________________________
________________________________________________________________________

c. The home telephone number of the intended new residence, (if known), is: __________

d. The date of the intended move or proposed relocation is: _________________________

7. The specific reasons for the proposed relocation are: ________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________.
Attach additional sheets if necessary.

8. One of the reasons for the proposed relocation is a job offer. {Choose only one} ____ Yes
_____ No. The job offer is in writing. {Choose only one} _____ Yes _____ No. A copy of the
written job offer is attached to this supplemental petition.

9. I ask the Court to modify access and time-sharing as follows:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________.

10. This modification is in the best interests of the child(ren) because: {explain} _____________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________.

Florida Supreme Court Approved Family Law Form 12.950(d), Supplemental Petition to Permit Relocation
with Minor or Dependent Child(ren) (02/18)
- 230 -
11. _____ {Indicate if applicable} If the requested modification is granted, I request that child
support be modified, consistent with the modification of visitation or time-sharing. A Child
Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e),
_____is, or ______will be filed.

12. I am requesting a temporary relief hearing to permit relocation prior to the final hearing.
{Choose only one} _____ Yes _____ No. If yes, explain why you cannot wait for a final
hearing date.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________.

Failure to obtain an Order prior to relocation renders the supplemental petition to relocate
legally insufficient.

13. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form
12.902(b) or (c), _____is, or _____will be, filed.

14. 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.

15. If not previously filed in this case, a completed Notice of Social Security Number, Florida
Supreme Court Approved Family Law Form 12.902(j), is filed with this petition.

16. Other: __________________________________________________________________
________________________________________________________________________.

A RESPONSE TO THE SUPPLEMENTAL PETITION OBJECTING TO RELOCATION MUST BE MADE IN
WRITING, FILED WITH THE COURT, AND SERVED ON THE PARENT OR OTHER PERSON SEEKING
TO RELOCATE WITHIN 20 DAYS AFTER SERVICE OF THIS SUPPLEMENTAL PETITION TO
RELOCATE. IF YOU FAIL TO TIMELY OBJECT TO THE RELOCATION, THE RELOCATION WILL BE
ALLOWED, UNLESS IT IS NOT IN THE BEST INTERESTS OF THE CHILD, WITHOUT FURTHER
NOTICE AND WITHOUT A HEARING.

A response is in the form of an Answer and it must be sworn to under oath and must include the
specific factual basis supporting the reasons for objecting to the relocation, including a
statement of the amount of participation or involvement you currently have or have had in the
life of the child(ren).

Florida Supreme Court Approved Family Law Form 12.950(d), Supplemental Petition to Permit Relocation
with Minor or Dependent Child(ren) (02/18)
- 231 -
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 Party
Printed Name: ___________________________
Address:________________________________
City, State, Zip:___________________________
Telephone Number:_______________________
Fax Number: ____________________________
Designated E-mail Address(es):_____________
_______________________________________
STATE OF FLORIDA
COUNTY OF ____________________

Sworn to or affirmed and signed before me on ____________ by _________________________.

_______________________________________
NOTARY PUBLIC or DEPUTY CLERK

_______________________________________
[Print, type, or stamp commissioned name of
notary or deputy clerk.]
____ Personally known
____ Produced identification
____ Type of identification produced ________________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS
BELOW: [fill in all blanks] This form was prepared for the _____Petitioner _____Respondent
This form was completed with the assistance of:
{name of individual} ____________________________________________________________,
{name of business}______________________________________________________________,
{address} _____________________________________________________________________,
{city} ______________,{state} ____, {zip code}________{telephone number} _______________.

Florida Supreme Court Approved Family Law Form 12.950(d), Supplemental Petition to Permit Relocation
with Minor or Dependent Child(ren) (02/18)
- 232 -
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.970(a)
PETITION FOR TEMPORARY CUSTODY BY EXTENDED FAMILY
(02/18)

When should this form be used?

This form should be used by an extended family member to obtain temporary custody of a child or
children pursuant to Chapter 751, Florida Statutes. This form should not be used if you are a parent
seeking to establish parental responsibility or time-sharing with a child or children.

An Extended Family Member is:
A relative of a minor child within the third degree by blood or marriage to the parent;
OR
The stepparent of a minor child if the stepparent is currently married to the parent of the child and is
not a party in a pending dissolution, separate maintenance, domestic violence, or other civil or criminal
proceeding in any court of competent jurisdiction involving one or both of the child(ren)’s parents as an
adverse party.

You may file a Petition for Temporary Custody if:
You have the signed, notarized consents of the child(ren)’s legal parents;
OR
You are an extended family member who is caring full time for the child(ren) in the role of a substitute
parent and with whom the child(ren) is (are) presently living.

If one of the minor child(ren)’s parents objects to the Petition, the court shall grant the Petition only
upon a finding, by clear and convincing evidence, that the child(ren)’s parent or parents are unfit to
provide for the care and control of the child(ren). In determining that a parent is unfit, the court must
find that the parent has abused, abandoned, or neglected the child(ren), as defined in Chapter 39,
Florida Statutes. If you do not have the parents’ consents you should consult a family law attorney
before you file your papers.

If you do not meet the qualifications above, you should talk to an attorney about other options. You
may also report any suspected abuse, abandonment, or neglect to the appropriate authorities.

This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in
the county where you live and keep a copy for your records.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of

Instructions for Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By
Extended Family (02/18)
- 233 -
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving
pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review
Florida Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link
to the Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules
of Court in the A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears.
Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme
Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida
Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

What should I do next?

IF YOU HAVE SIGNED AND NOTARIZED WAIVERS OF SERVICE OF PROCESS AND CONSENTS from the
child(ren)’s parents, and the case is uncontested, you may contact the clerk, family law intake staff, or
judicial assistant, to set a final hearing. You must notify the child(ren)’s parents of the hearing by using
a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other
appropriate notice of hearing form.

If one of the parents is deceased, you must file a certified copy of the proof of death.

IF YOU DO NOT HAVE SIGNED AND NOTARIZED WAIVERS OF SERVICE OF PROCESS AND CONSENTS from
the child(ren)’s parents, you must properly notify the parents of the petition. If you know where he or
she lives, you should use personal service. If you absolutely do not know where he or she lives after
conducting a diligent search, you may use constructive service. You must complete all of the searches
listed in the Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form
12.913(c), and file the form with the clerk. You should seek legal advice on constructive service as this is
a complicated area of the law. If the identity of one parent is unknown, you will need to seek legal
advice to determine the proper way to serve an unknown parent. For more information, see Chapter 49,
Florida Statutes.

Instructions for Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By
Extended Family (02/18)
- 234 -
If personal service is used, the parents have 20 days to answer after being served with your petition.
Your case will generally proceed in one of the following ways:

DEFAULT. If after 20 days, no answer has been filed, you may file a Motion for Default, Florida Supreme
Court Approved Family Law Form 12.922(a), with the clerk of court. You must file a Notice for Trial,
Florida Supreme Court Approved Family Law Form 12.924. Then, if you have filed all of the required
papers, you may contact the clerk, family law intake staff, or judicial assistant, to set a final hearing.
You must notify the child(ren)’s parents of the hearing by using a Notice of Hearing (General), Florida
Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.

CONTESTED. If either parent files an answer which disagrees with or denies anything in your petition,
and you are unable to settle the disputed issues, you must file a Notice for Trial, Florida Supreme Court
Approved Family Law Form 12.924, to request a final hearing. Some circuits may require the completion
of mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or
judicial assistant for instructions on how to set your case for trial (final hearing).

At any time, either or both of the child(ren)’s parents may petition the court to modify or terminate the
order granting temporary custody. The court shall terminate the order upon a finding that the parent is
a fit parent, or by the consent of the parties. The court may modify an order granting temporary
custody if the parties consent or if the modification is in the best interest of the child(ren).

Where can I look for more information?

Before proceeding, you should read General Information for Self-Represented Litigants found at the
beginning of these forms. The words that are in bold underline in these instructions are defined there.
For further information, see Chapter 751 and Chapter 39, Florida Statutes.

Special Notes. . .

If you do not have the money to pay the filing fee, you may obtain an application for Determination of
Civil Indigent Status, fill it out, and the clerk will determine whether you are eligible to have filing fees
deferred.

With this petition, you must file the following and provide a copy to the other party:

 Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme
Court Approved Family Law Form 12.902(d).
 Notice of Related Cases, Florida Family Law Rules of Procedure Form 12.900(h).
 Family Court Cover Sheet, Florida Family Law Rules of Procedure Form 12.928.
 Non-Military Affidavit, Florida Supreme Court Approved Family Law Form 12.912(b). (Required
only for obtaining a default on petitions that have been personally or constructively served. Not
required if both parents have signed a waiver and consent)

Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms

Instructions for Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By
Extended Family (02/18)
- 235 -
must also put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.

Instructions for Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By
Extended Family (02/18)
- 236 -
 IN THE CIRCUIT COURT OF THE ____________ JUDICIAL CIRCUIT,
IN AND FOR ___________________________ COUNTY, FLORIDA

Case No: _______________________
Division: _______________________

IN THE INTEREST OF

__________________________________,
Child(ren)

__________________________________,
Petitioner,
and
__________________________________,
Respondent/_______________________,

__________________________________,
Respondent/ _______________________.

PETITION FOR TEMPORARY CUSTODY BY EXTENDED FAMILY

Petitioner, {full legal name} _________________________________, being sworn, certifies that the
following information is true:

1. This is an action for temporary custody pursuant to Chapter 751, Florida Statutes.

2. Petitioner requests temporary custody of the following minor child(ren):
Name Date of Birth Current Address
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

3. Petitioner completed a Uniform Child Custody Jurisdiction and Enforcement Act Affidavit,
Florida Supreme Court Approved Family Law Form 12.902(d), which was filed with this Petition.
The affidavit includes the names and current addresses of the persons with whom the child(ren)
has(have) lived during the past 5 years, the places where the child(ren) has(have) lived during
the past 5 years, and information concerning any custody proceeding in this or any other state
with respect to the child(ren). If the Affidavit is not completely filled out, signed under oath,
and filed with the Petition, the case may be dismissed without hearing.

4. Petitioner is an extended family member who is: {Choose one only}
_____ Related to the minor child(ren) within the third degree by blood or marriage to a parent;

OR
Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family
(02/18)
- 237 -
 _____ The stepparent of the minor child(ren), is married to Respondent {full legal name}
_________________________________________________________________________
and is not a party in a pending dissolution, separate maintenance, domestic violence, or other
civil or criminal proceeding in any court of competent jurisdiction involving one or both of the
child(ren)’s parents as an adverse party.

5. Petitioner’s relationship to the minor child(ren) is: ____________________________________.

6. The residence and post office address of the Petitioner is: ______________________________
____________________________________________________________________________.

7. Petitioner is a proper person to be awarded temporary custody because: {Choose one only}
____ Petitioner has the signed, notarized consent from both of the child(ren)’s legal parents;

OR
____ Petitioner is caring full time for the child(ren) in the role of a substitute parent and the
child(ren) currently live with the Petitioner.

If Petitioner does not have the signed consents from both parents or is not caring for the
child(ren) full time as a substitute parent, Petitioner cannot obtain temporary custody under
Chapter 751, Florida Statutes. Petitioner should consult an attorney about other options.

8. The legal parents of the child(ren) are:
a. __________________________, whose current address is: __________________________
___________________________________________________________________________.

b. _______________________, whose current address is: ______________________________
___________________________________________________________________________

9. The Consents of Respondent {full legal name} ______________________________ and/or
Respondent {full legal name} _____________________________ is/are attached to the
Petition.

OR

{If Applicable} The Consent of Parent {full legal name} _________________ is not attached
because that parent is deceased. A certified copy of the proof of death is attached.

OR

Consent has NOT been obtained from the parents. The specific acts or omissions of the parents
which demonstrate that the parents have abused, abandoned, or neglected the child(ren) as
defined in Chapter 39, Florida Statutes are: (attach additional sheets if necessary) ___________
_____________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family
(02/18)
- 238 -
 10. Petitioner requests temporary custody be granted for the following period of time:
___________________________________________________________________________.
The reasons that support this request are: ___________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

11. It is in the best interests of the child(ren) that the Petitioner have temporary custody of the
child(ren) for the following reasons:
_________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________.

12. ORDER OF PROTECTION

a._____ Petitioner IS NOT aware of any temporary or permanent order for protection entered
on behalf of or against either parent, the Petitioner, or the child(ren) in Florida or any
other jurisdiction.

OR

b._____Petitioner IS aware of the following temporary or permanent orders for protection
entered on behalf of or against either parent, the Petitioner, or the child(ren) in Florida
or any other jurisdiction. The court entering the order and the case number is: _______
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________

13. TEMPORARY OR PERMANENT CHILD SUPPORT ORDERS

a._____ Petitioner IS NOT aware of any temporary or permanent orders for child support for the
minor child(ren).

OR

b._____Petitioner IS aware of the following temporary or permanent order for child support for
the minor child(ren). The court entering the order and the case number is: _________
_______________________________________________________________________
________________________________________________________________________
_______________________________________________________________________.

14. CHILD SUPPORT (Choose one only}
(You must have proof or waiver of service of process upon the parent(s) or a Waiver of Service
of Process and Consent for the court to consider an award for child support)

Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family
(02/18)
- 239 -
 a._____ Petitioner requests the court to order the parents to pay child support.

b._____Petitioner requests the court to redirect all or part of the parents’ existing child support
obligations to the Petitioner.
c._____ Petitioner requests the court to redirect all or part of the parents’ existing child support
obligations to the Petitioner, and to award the Petitioner retroactive child support.

15. Petitioner _____ requests _____ does not request that the court establish reasonable visitation
or a time-sharing schedule with the parents.

16. Other: ______________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________.

WHEREFORE, Petitioner requests that this Court grant the Petitioner temporary custody of the child(ren)
subject to this proceeding; award the Petitioner other relief as requested; and award any other relief
that 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 Code: ________________________
Telephone Number: _________________________
Fax Number: _______________________________
Designated E-Mail Address(es):__________________
__________________________________________
STATE OF FLORIDA
COUNTY OF __________________________

Sworn to or affirmed and signed before me on _____________ by ___________________________.

_______________________________________
NOTARY PUBLIC OR DEPUTY CLERK

________________________________________
{Print, type, or stamp commissioned name of notary or
deputy clerk.}
____ Personally known
____ Produced identification
Type of identification produced _________________________

Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family
(02/18)
- 240 -
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the Petitioner.
This form was completed with the assistance of:
{name of individual} ____________________________________________________________,
{name of business} _____________________________________________________________,
{address} _____________________________________________________________________,
{city} __________________, {state} ____, {zip code} ___________, {telephone number} _________.

Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family
(02/18)
- 241 -
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.970(b)
PETITION FOR CONCURRENT CUSTODY BY EXTENDED FAMILY
(02/18)

When should this form be used?

This form should be used by an extended family member to obtain concurrent custody of a child or
children pursuant to Chapter 751, Florida Statutes. This form should not be used if you are a parent
seeking to establish parental responsibility or time-sharing with a child or children. “Concurrent
custody” means that an eligible extended family member is awarded custodial rights to care for a child
or children concurrently with the child(ren)’s parent or parents.

An Extended Family Member is:
A relative of a minor child within the third degree by blood or marriage to the parent;
OR
The stepparent of a minor child if the stepparent is currently married to the parent of the child and is
not a party in a pending dissolution, separate maintenance, domestic violence, or other civil or criminal
proceeding in any court of competent jurisdiction involving one or both of the child(ren)’s parents as an
adverse party.

You may file a Petition for Concurrent Custody if:
You have the signed, notarized consents of the child(ren)’s legal parents;
OR
You are an extended family member who is caring full time for the child(ren) in the role of a substitute
parent and with whom the child(ren) is (are) presently living.

In addition, you must currently have physical custody of the child(ren) and have had physical custody of
the child(ren) for at least 10 days in any 30-day period within the last 12 months; and not have signed,
written documentation from a parent which is sufficient to enable you to do all the things necessary to
care for the child(ren).

If you do not meet the qualifications above, you should talk to an attorney about other options. You
may also report any suspected abuse, abandonment, or neglect to the appropriate authorities.

This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in
the county where you live and keep a copy for your records.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of

Instructions for Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By
Extended Family (02/18)
- 242 -
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving
pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review
Florida Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link
to the Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules
of Court in the A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears.
Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme
Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida
Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

What should I do next?

IF YOU HAVE SIGNED AND NOTARIZED WAIVERS OF SERVICE OF PROCESS AND CONSENTS from the
child(ren)’s parents, you may contact the clerk, family law intake staff, or judicial assistant, to set a
final hearing. You must notify the child(ren)’s parents of the hearing by using a Notice of Hearing
(General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of
hearing form.

If one of the parents is deceased, you must file a certified copy of the proof of death.

If one of the minor child(ren)’s parents objects to the Petition for Concurrent Custody in writing, the
court may not grant the petition even if the other parent consents, in writing, to the entry of the order.
If a parent objects, you have the option of converting the Petition to a Petition for Temporary Custody
by Extended Family, Florida Supreme Court Approved Family Law Form 12.970(a). If the Petition is not
converted into a Petition for Temporary Custody by Extended Family, it shall be dismissed without
prejudice.

At any time, the Petitioner or either or both of the child(ren)’s parents may move the court to terminate
the order granting concurrent custody. The court shall terminate the order upon a finding that either or
both of the child(ren)’s parents objects to the order. The fact that the order for concurrent custody has

Instructions for Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By
Extended Family (02/18)
- 243 -
been terminated does not preclude any person who is otherwise eligible to petition for temporary
custody from filing such petition.

Where can I look for more information?

Before proceeding, you should read General Information for Self-Represented Litigants found at the
beginning of these forms. The words that are in bold underline in these instructions are defined there.
For further information, see Chapter 751 and Chapter 39, Florida Statutes.

Special Notes. . .

If you do not have the money to pay the filing fee, you may obtain an application for Determination of
Civil Indigent Status, fill it out, and the clerk will determine whether you are eligible to have filing fees
deferred.

With this petition, you must file the following and provide a copy to the other party:
 Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme
Court Approved Family Law Form 12.902(d).
 Notice of Related Cases, Florida Family Law Rules of Procedure Form 12.900(h).
 Family Court Cover Sheet, Florida Family Law Rules of Procedure Form 12.928.
 Non-Military Affidavit, Florida Supreme Court Approved Family Law Form 12.912(b). (Required
only for obtaining a default on petitions that have been personally or constructively served. Not
required if both parents have signed a waiver and consent.)

Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms
must also put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.

Instructions for Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By
Extended Family (02/18)
- 244 -
 IN THE CIRCUIT COURT OF THE _______________ JUDICIAL CIRCUIT,
IN AND FOR _______________________________ COUNTY, FLORIDA

Case No: _______________________
Division: _______________________

IN THE INTEREST OF:

_________________________________,
Child(ren)

__________________________________,
Petitioner,
and
__________________________________,
Respondent/____________________,

__________________________________,
Respondent/ ______________________.

PETITION FOR CONCURRENT CUSTODY BY EXTENDED FAMILY
Petitioner, {full legal name} _________________________________, being sworn, certifies that the
following information is true:

1. This is an action for concurrent custody pursuant to Chapter 751, Florida Statutes.

2. Petitioner requests concurrent custody of the following minor child(ren):
Name Date of Birth Current Address
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

3. Petitioner completed a Uniform Child Custody Jurisdiction and Enforcement Act Affidavit, Florida
Supreme Court Approved Family Law Form 12.902(d), which was filed with this Petition. The
affidavit includes the names and current addresses of the persons with whom the child(ren) has
(have) lived during the past 5 years, the places where the child(ren) has(have) lived during the
past 5 years, and information concerning any custody proceeding in this or any other state with
respect to the child(ren). If the Affidavit is not completely filled out, signed under oath, and filed
with the Petition, the case may be dismissed without a hearing.

4. Petitioner is an extended family member who is: {Choose one only}
_____ Related to the minor child(ren) within the third degree by blood or marriage to a parent;
OR

Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody by Extended Family
(02/18)
- 245 -
 _____ The stepparent of the minor child(ren), is married to Respondent {full legal name}
___________________________________________ and is not a party in a pending dissolution,
separate maintenance, domestic violence, or other civil or criminal proceeding in any court of
competent jurisdiction involving one or both of the child(ren)’s parents as an adverse party.

5. Petitioner’s relationship to the minor child(ren) is: ____________________________________.

6. The residence and post office address of the Petitioner is: ______________________________
______________________________________________________________________________.

7. The legal parents are:
a. _____________________________________________, whose current address is:
_____________________________________________________________________;

b. _____________________, whose current address is: ____________________________
___________________________________________________________________________

8. Petitioner currently has physical custody of the child(ren) and has had physical custody of the
child(ren) for at least 10 days in any 30-day period within the last 12 months. Detail the time
periods during the past 12 months when the child(ren) have resided with the Petitioner:
______________________________________________________________________________
_____________________________________________________________________________
______________________________________________________________________________.

9. Petitioner does not have signed, written documentation from a parent which is sufficient to enable
the Petitioner to do all of the things necessary to care for the child(ren).

10. {If applicable} Describe the type of documents, if any, provided by the parent or parents which
enables the Petitioner to act on behalf of the child(ren): __________________________
______________________________________________________________________________.
These documents are attached to this Petition as Exhibit ________.

11. Petitioner is unable to obtain or undertake the following services or actions without an order of
custody:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

12. The Consents of Parent {full legal name} ______________ and/or Parent {full legal name}
_______________ is/are attached to the Petition.

OR

{If applicable} The Consent of Parent {full legal name} ________________________________ is
not attached because that parent is deceased. A certified copy of the proof of death is attached.

Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody by Extended Family
(02/18)
- 246 -
 13. Petitioner requests concurrent custody be granted for the following period of time: _________
_____________________________________________________________________________.
The reasons that support this request are: ___________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

14. It is in the best interests of the child(ren) that the Petitioner have concurrent custody of the
child(ren) for the following reasons: _____________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________

15. ORDER OF PROTECTION

a._____ Petitioner IS NOT aware of any temporary or permanent order for protection entered
on behalf of or against either parent, the Petitioner, or the child(ren) in Florida or any
other jurisdiction.

OR

b._____Petitioner IS aware of the following temporary or permanent orders for protection
entered on behalf of or against either parent, the Petitioner, or the child(ren) in Florida
or any other jurisdiction. The court entering the order and the case number is: _______
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________.

16. TEMPORARY OR PERMANENT CHILD SUPPORT ORDERS

a._____ Petitioner IS NOT aware of any temporary or permanent orders for child support for the
minor child(ren).

OR

b._____ Petitioner IS aware of the following temporary or permanent order for child support for
the minor child(ren). The court entering the order and the case number is: __________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________.

17. CHILD SUPPORT (If Petitioner is seeking child support) {Choose one only}
(You must have proof of service upon or waiver of process by the parent(s) or a Waiver of
Service of Process and Consent for the court to consider an award for child support)

a.____ Petitioner requests the court to order the parents to pay child support.

Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody by Extended Family
(02/18)
- 247 -
 b.____ Petitioner requests the court to redirect all or part of the parents’ existing child support
obligations to the Petitioner.

c.____ Petitioner requests the court to redirect all or part of the parents’ existing child support
obligations to the Petitioner, and to award the Petitioner retroactive child support.

18. Petitioner ____ requests _____ does not request that the court establish reasonable visitation or
a time-sharing schedule with the parents.

19. Other _________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

WHEREFORE, Petitioner requests that this Court grant the Petitioner concurrent custody of the
child(ren) subject to this proceeding; award the Petitioner other relief as requested; and award any
other relief that 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 Code: ________________________
Telephone Number: _________________________
Fax Number: _______________________________
Designated E-mail Address(es):_________________
_________________________________________
STATE OF FLORIDA
COUNTY OF __________________________

Sworn to or affirmed and signed before me on _______________ by ___________________________.

_______________________________________
NOTARY PUBLIC OR DEPUTY CLERK

________________________________________
Print, type, or stamp commissioned name of notary or
deputy clerk.
____ Personally known
____ Produced identification
Type of identification produced _________________________

Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody by Extended Family
(02/18)
- 248 -
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the Petitioner.
This form was completed with the assistance of:
{name of individual} ________________________________________________________________,
{name of business} ___________________________________________________________________,
{address} ___________________________________________________________________________,
{city} _________________, {state} _____, {zip code}__________, {telephone number} _______________.

Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody by Extended Family
(02/18)
- 249 -
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM, 12.970(c),
WAIVER OF SERVICE OF PROCESS AND CONSENT FOR TEMPORARY
CUSTODY BY EXTENDED FAMILY
(02/18)
This form is to be completed and signed by a parent who agrees to grant temporary custody of a minor
child or child(ren) to an extended family member and agrees to waive service of process. Service of
process occurs when a summons and a copy of the petition (or other pleading) that has been filed with
the court are delivered by a deputy or private process server.

An Extended Family Member is:
A relative of a minor child within the third degree by blood or marriage to the parent;
OR
The stepparent of a minor child if the stepparent is currently married to the parent of the child and is
not a party in a pending dissolution, separate maintenance, domestic violence, or other civil or criminal
proceeding in any court of competent jurisdiction involving one or both of the child(ren)’s parents as an
adverse party.

This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in
the county where the Petition for Temporary Custody by Extended Family, Florida Supreme Court
Approved Family Law Form 12.970(a) is filed and keep a copy for your records.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

Special notes. . .
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms
must also put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.

Instructions for Florida Supreme Court Approved Family Law Form, 12.970(c), Waiver of Service of Process and
Consent for Extended Custody by Extended Family (02/18)
- 250 -
 IN THE CIRCUIT COURT OF THE _______________ JUDICIAL CIRCUIT,
IN AND FOR _______________________________ COUNTY, FLORIDA

Case No: _______________________
Division: _______________________

IN THE INTEREST OF

_________________________________
Child(ren)

__________________________________,
Petitioner,
and
__________________________________,
Respondent/__________________,

__________________________________,
Respondent/___________________.

WAIVER OF SERVICE OF PROCESS AND CONSENT FOR TEMPORARY
CUSTODY BY EXTENDED FAMILY

I, {full legal name} ____________________________________________________, the legal parent of
{child(ren)’s name)s)} _____________________________________________, having received a copy of
the Petition for Temporary Custody by Extended Family filed herein and waived service of process, freely
and voluntarily consent to the Petition filed by: {Petitioner’s full legal name}
________________________________.

I realize that by signing this document, I am consenting to the Petitioner having temporary legal custody
of the minor child(ren) and that such temporary custody is in the best interest of the child(ren). Upon
entry of an Order, the Petitioner shall be able to:

1. Consent to all necessary and reasonable medical and dental care for the child(ren), including
nonemergency surgery and psychiatric care;

2. Secure copies of the child(ren)’s records, held by third parties, that are necessary for the care of
the child(ren), including, but not limited to:
a. Medical, dental, and psychiatric records;
b. Birth Certificates and other records, and
c. Educational records.

3. Enroll the child(ren) in school and grant or withhold consent for the child(ren) to be tested or
placed in special school programs, including exceptional education; and

4. Do all other things necessary for the care of the child(ren).
Florida Supreme Court Approved Family Law Form 12.970(c), Waiver of Service of Process and Consent for
Temporary Custody By Extended Family (02/18)
- 251 -
I realize that the custody of my child(ren) by the Petitioner is temporary and that I may, at any time,
petition the court to return legal custody to me.

Dated: __________________ _________________________________________
Signature of Parent
Printed Name: _____________________________
Address: __________________________________
City, State, Zip Code: ________________________
Telephone Number: _________________________
Fax Number: _______________________________
Designated E-mail Address(es):_________________
_________________________________________
STATE OF FLORIDA
COUNTY OF __________________________________

Sworn to or affirmed and signed before me on _______________ by ___________________________.

_______________________________________
NOTARY PUBLIC OR DEPUTY CLERK

________________________________________
Print, type, or stamp commissioned name of notary or
deputy clerk.
____ Personally known
____ Produced identification
Type of identification produced _________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the {choose only one} _____ Petitioner _____ Respondent.
This form was completed with the assistance of:
{name of individual} ________________________________________________________________,
{name of business} _________________________________________________________________,
{address} _________________________________________________________________________,
{city} _________________, {state} _____, {zip code}________, {telephone number} ______________.

Florida Supreme Court Approved Family Law Form 12.970(c), Waiver of Service of Process and Consent for
Temporary Custody By Extended Family (02/18)
- 252 -
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM, 12.970(d),
WAIVER OF SERVICE OF PROCESS AND CONSENT FOR CONCURRENT
CUSTODY BY EXTENDED FAMILY
(02/18)

This form is to be completed and signed by a parent who agrees to grant concurrent custody of a minor
child or child(ren) to an extended family member and who agrees to waive service of process. Service
of process occurs when a summons and a copy of the petition (or other pleading) that has been filed
with the court are delivered by a deputy or private process server. “Concurrent custody” means that an
eligible extended family member is awarded custodial rights to care for a child or children concurrently
with the child(ren)’s parent or parents.

An Extended Family Member is:
A relative of a minor child within the third degree by blood or marriage to the parent;
OR
The stepparent of a minor child if the stepparent is currently married to the parent of the child and is
not a party in a pending dissolution, separate maintenance, domestic violence, or other civil or criminal
proceeding in any court of competent jurisdiction involving one or both of the child(ren)’s parents as an
adverse party.

This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in
the county where the Petition for Concurrent Custody by Extended Family, Florida Supreme Court
Approved Family Law Form 12.970(b) is filed and keep a copy for your records.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

Special notes. . .

Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms
must also put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.

Instructions for Florida Supreme Court Approved Family Law Form 12.970(d), Waiver of Service of Process and
Consent for Concurrent Custody by Extended Family (02/18)
- 253 -
 IN THE CIRCUIT COURT OF THE _______________ JUDICIAL CIRCUIT,
IN AND FOR _______________________________ COUNTY, FLORIDA

Case No: _______________________
IN RE: THE INTEREST OF Division: _______________________

__________________________________,
Petitioner,
and
__________________________________,
Respondent/_______________________,

__________________________________,
Respondent/_______________________.

WAIVER OF SERVICE OF PROCESS AND CONSENT FOR CONCURRENT
CUSTODY BY EXTENDED FAMILY

I, {full legal name}________________________________________________, the legal parent of
{child(ren)’s name(s)} _____________________________________, having received a copy of the
Petition for Concurrent Custody by Extended Family filed herein and waived service of process, freely
and voluntarily consent to the Petition filed by {Petitioner’s Name} ______________________________.

I realize that by signing this document, I am consenting to the Petitioner having temporary concurrent
custody of the minor child(ren) and that such concurrent custody is in the best interest of the child(ren).
Upon entry of an Order, the Petitioner shall be able to:

1. Consent to all necessary and reasonable medical and dental care for the child(ren), including
nonemergency surgery and psychiatric care;

2. Secure copies of the child(ren)’s records, held by third parties, that are necessary for the care of
the child(ren), including, but not limited to:
a. Medical, dental, and psychiatric records;
d. Birth Certificates and other records, and
e. Educational records.

3. Enroll the child(ren) in school and grant or withhold consent for the child(ren) to be tested or
placed in special school programs, including exceptional education; and

4. Do all other things necessary for the care of the child(ren).

Florida Supreme Court Approved Family Law Form 12.970(d), Waiver of Service of Process and Consent for
Concurrent Custody By Extended Family (02/18)
- 254 -
I realize that the concurrent custody of my child(ren) by the Petitioner is temporary and that I may, at
any time, petition the court to return legal custody to me.

Dated: __________________________ _________________________________________
Signature of Parent
Printed Name: _____________________________
Address: __________________________________
City, State, Zip Code: ________________________
Telephone Number: _________________________
Fax Number: _______________________________
Designated E-mail Address(es):_________________
_________________________________________
STATE OF FLORIDA
COUNTY OF __________________________

Sworn to or affirmed and signed before me on _______________ by ___________________________.

_________________________________________
NOTARY PUBLIC OR DEPUTY CLERK

_________________________________________
Print, type, or stamp commissioned name of notary or
deputy clerk.
____ Personally known
____ Produced identification
Type of identification produced _________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the {choose only one} _____ Petitioner _____ Respondent.
This form was completed with the assistance of:
{name of individual} _____________________________________________________________,
{name of business}_______________________________________________________________,
{address} _______________________________________________________________________,
{city} _________________, {state} _____, {zip code}__________, {telephone number} ___________.

Florida Supreme Court Approved Family Law Form 12.970(d), Waiver of Service of Process and Consent for
Concurrent Custody By Extended Family (02/18)
- 255 -
 IN THE CIRCUIT COURT OF THE _________________________ JUDICIAL CIRCUIT
IN AND FOR __________________________ COUNTY, FLORIDA

Case No: ______________________
Division: ______________________
IN THE INTEREST OF

_________________________________
Child(ren)

__________________________________,
Petitioner,
and
__________________________________,
Respondent/_________________,

__________________________________,
Respondent/___________________.

ORDER GRANTING PETITION FOR
TEMPORARY CUSTODY BY EXTENDED FAMILY

This case came before this Court for a hearing on a Petition for Temporary Custody by Extended
Family. The Court, having reviewed the file and heard the testimony, makes these findings of
fact and reaches these conclusions of law:

SECTION I. FINDINGS:

1. The Court has jurisdiction over the subject matter and the parties.

2. The minor child(ren) at issue in this matter are:
Name Date of Birth
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

3. The Petitioner, {full legal name} _______________________________________ is the
{extended family relationship}_____________________________________________ of
the child(ren).

4. Parent {full legal name}_________________________________________, referred to as
{name or designation} _______________________ of the child(ren):
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
- 256 -
 {Choose one only}
a.____ Filed a Waiver and Consent

b.____ Was served with the petition and failed to file an Answer

c.____ Is deceased as evidenced by: _________________________________________

d.____ Objected to the petition. Based upon clear and convincing evidence, the Court
finds that the Parent {name or designation} ________________________ is unfit
to provide for the care and control of the child(ren). Specifically, the Parent has
abused, abandoned, or neglected the child(ren) as defined in Chapter 39, Florida
Statutes. It is in the best interest of the child(ren) that the Petitioner have
temporary custody because: {facts in support of finding} ____________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
_________________________________________________________________.

5. Parent {full legal name} ____________________________________, referred to as,
{name or designation} _________________________________ of the child(ren):
{Choose one only}
a.____ Filed a Waiver and Consent

b.____ Was served with the petition and failed to file an Answer

c.____ Is deceased as evidenced by: _________________________________________

d.____ Objected to the petition. Based upon clear and convincing evidence, the Court
finds that Parent {name or designation} ________________________ is unfit to
provide for the care and control of the child(ren). Specifically, the Parent has
abused, abandoned, or neglected the child(ren) as defined in Chapter 39, Florida
Statutes. It is in the best interest of the child(ren) that the Petitioner have
temporary custody because: {facts in support of finding} ___________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________.

6. It is in the best interest of the child(ren) for the Petitioner to have temporary custody.

Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
- 257 -
SECTION II: TEMPORARY CUSTODY

1. The Petitioner, ________________________________________, is granted temporary
custody of the minor child(ren).

2. The Petitioner shall have all the rights and responsibilities of a legal parent.

3. The Petitioner is authorized to make all reasonable and necessary decisions for the minor
child(ren), including but not limited to:

a. Consent to all necessary and reasonable medical and dental care for the child(ren),
including nonemergency surgery and psychiatric care;

b. Secure copies of the child(ren)’s records, held by third parties, that are necessary
for the care of the child(ren), including, but not limited to: medical, dental, and
psychiatric records; birth certificates and other records; and educational records;

c. Enroll the child(ren) in school and grant or withhold consent for the child(ren) to
be tested or placed in special school programs, including exceptional education;
and

d. Do all other things necessary for the care of the child(ren).

SECTION III. TEMPORARY TIME-SHARING WITH MINOR CHILD(REN)
{Insert the name or designation of the appropriate parent in the spaces provided.}
The parent(s) shall have: {Choose one only}

1. ____ reasonable time-sharing with the minor child(ren) as agreed to by the parties,
subject to the following limitations: __________________________________________
_______________________________________________________________________.

2. ____ the following specified time-sharing schedule: {specify days and times} _______
______________________________________________________________________.
Parent {name or designation}_____________________’s Temporary Time-Sharing
Schedule.
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________.

Parent {name or designation} ___________________________’s Temporary Time-
Sharing Schedule.
_______________________________________________________________________

Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
- 258 -
 _______________________________________________________________________
_______________________________________________________________________.

3. ____ Time-Sharing in accordance with the temporary Parenting Plan attached as
Exhibit ____.

4. Parent {name or designation} ___________________ shall have No Contact with the
minor child(ren) until further order of the Court, due to existing conditions that are
detrimental to the welfare of the minor child(ren): {explain} _____________________
_______________________________________________________________________
_______________________________________________________________________.

SECTION IV. CHILD SUPPORT
{Insert the name or designation of the appropriate parent in the spaces provided.}
1. The Petitioner _____ did _____ did not request the establishment of child support.

2. If child support is requested, the parents have received personal or substituted service
of process, the petition requests an order for support of the child(ren), and there is
evidence of the parents’ ability to pay the support ordered. Parent(s) {name or
designation} ____________________________________ has the present ability to pay
child support. {Choose one only}

a. _____ The amounts in the Child Support Guidelines Worksheet, Florida Family Law
Rules of Procedure Form 12.902(e) filed by Parent(s) {name or designation}
____________________ are correct;
OR

b. _____ The Court makes the following findings:
Parent {name or designation} ___________________________’s net monthly income
is $____________, (Child Support Guidelines ____%).

Parent {name or designation} __________________________’s net monthly income
is $_____________, (Child Support Guidelines ____%)

Monthly child care costs are $_________________.
Monthly health/dental insurance costs are $_____________.
OR

c. Parent {name or designation}__________________ is currently ordered to pay child
support to the other parent in the amount of $_________ per _______________ as
established in the case of {style of case and number} __________________________.
_____ All of the child support or _____ a portion of the child support in the
amount of $____________ shall be redirected to the Petitioner.

Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
- 259 -
 3. Amount
a. Parent {name or designation}____________________’s Obligation
Parent {name or designation} ________________ shall be obligated to pay child
support at the rate of $________ per month for the ______ children {total number of
parties’ minor or dependent children} commencing __________________ {month,
day, year} and terminating ________________________ {month, day, year}.
Child support shall be paid in the amount of $___________ per ___________ {week,
month, other} which is consistent with Parent {name or designation}__________’s
current payroll cycle.

Upon the termination of the obligation of child support for one of the parties’
children, child support in the amount of $__________ for the remaining_______
children {total number of remaining children} shall be paid commencing
________________ {month, day, year} and terminating _______________________
{month, day, year}. This child support shall be paid in the amount of $____________
per ____________{week, month, other} consistent with Parent {name or designation}
______________’s current payroll cycle.

{Insert paragraph for the child support obligation, including the amount, and
commencement and termination dates, for the remaining minor or dependent
children, which shall be payable as the obligation for each child ceases.}

Parent {name or designation} ___________________ shall pay child support until all
minor or dependent children: reach the age of 18; become emancipated, marry, join
the armed services, die, or become self-supporting; or until further order of the court
or agreement of the parties. The child support obligation shall continue beyond the
age of 18 and until high school graduation for any child who is dependent in fact,
between the ages of 18 and 19, and is still in high school, performing in good faith
with a reasonable expectation of graduation before the age of 19.

If the child support ordered deviates from the guidelines more than 5%, the factual
findings which support that deviation are: __________________________________
_____________________________________________________________________
____________________________________________________________________.

b. Parent {name or designation} _________________’s Obligation
Parent {name or designation} ____________________ shall be obligated to pay child
support at the rate of $_________ per month for the ______ children {total number
of parties’ minor or dependent children} commencing _____________ {month, day,
year} and terminating _____________________ {month, day, year}. Child support
shall be paid in the amount of $_________ per _____________ {week, month, other}
consistent with Parent {name or designation} _________________’s current payroll
cycle.

Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
- 260 -
 Upon the termination of the obligation of child support for one of the parties’
children, child support in the amount of $___________ for the remaining ______
children {total number of remaining children} shall be paid commencing
_______________ {month, day, year} and terminating ________________________
{month, day, year}. This child support shall be paid in the amount of $____________
per _____________ {week, month, other} consistent with Parent {name or
designation} ______________’s current payroll cycle.

{Insert paragraph for the child support obligation, including the amount, and
commencement and termination dates, for the remaining minor or dependent
children which shall be payable as the obligation for each child ceases.}

Parent {name or designation} _____________ shall pay child support until all of the
minor or dependent children: reach the age of 18; become emancipated, marry, join
the armed services, die, or become self-supporting; or until further order of the court
or agreement of the parties. The child support obligation shall continue beyond the
age of 18 and until high school graduation for any child who is dependent in fact,
between the ages of 18 and 19, and is still in high school, performing in good faith
with a reasonable expectation of graduation before the age of 19.

If the child support ordered deviates from the guidelines more than 5%, the factual
findings which support that deviation are: __________________________________
____________________________________________________________________
____________________________________________________________________.

4. Retroactive Child Support and/or Arrearages
{If both parents are ordered to pay retroactive child support and/or arrearages, please
include a separate paragraph for each parent.}

a. _____Parent {name or designation} _______________________ shall pay retroactive
child support in the amount of $_______ as of {date} ________________ to the
Petitioner. The retroactive child support shall be paid in the amount of $________ per
month, payable _____ in accordance with the parent’s employer’s payroll cycle, and
in any event at least once per month, or _____other {explain} ________________
commencing {date} ______________________, until paid in full including statutory
interest.

b. _____ Parent {name or designation} _______________ owes child support arrearages
in the amount of $__________ as of {date} ________________ to the other parent.
The child support arrearages shall be paid in the amount of $_______ per month,
payable _____ in accordance with the parent’s employer’s payroll cycle, and in any
event at least once per month, or _____ other {explain} ________________________

Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
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 commencing {date} ______________________, until paid in full including statutory
interest.

5. Insurance
{Indicate all that apply}
a. Parent {name or designation} __________________ shall be required to maintain
_____ health and/or _____ dental insurance for the parties’ minor child(ren), so long
as reasonable in cost and accessible to the child(ren). The party providing insurance
shall be required to convey insurance cards demonstrating said coverage to the
Petitioner and other parent.

OR
_____ health and/or _____ dental insurance is either not reasonable in cost or
accessible to the child(ren) at this time.

b. ____ Reasonable and necessary uninsured medical/dental/prescription drug costs for
the minor child(ren) shall be assessed as follows:
_____ Shared equally by both parents.
_____ Prorated according to the child support guidelines percentages.
_____ Other {explain} ______________________________________________

As to these uninsured medical/dental/prescription drug expenses, the party who
incurs the expense shall submit a request for reimbursement to the parent or parents
within 30 days, and the parent or parents, within 30 days of receipt, shall submit the
applicable reimbursement for that expense.

SECTION V. METHOD OF PAYMENT

The parent(s) shall pay court-ordered child support and arrearages, if any, as follows:
1. Place of Payment

a. ____Parent(s) shall pay court-ordered support directly to either the State
Disbursement Unit or the central depository, as required by statute, along with any
fee required by statute.

OR

b. ____ The Petitioner and the Parent(s) have requested and the Court finds that it is in
the best interest of the child(ren) that support payments need not be directed
through either the State Disbursement Unit or the central depository at this time;
however, any party may subsequently apply, pursuant to section 61.13(1)(d)(3),
Florida Statutes, to require payment through either the State Disbursement Unit or
the central depository.
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
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 2. Income Deduction
(If applicable)
a. ____ Immediate.
_____ Parent {name or designation} _________________, and {if applicable}

_____ Parent {name or designation} ___________________________, hereinafter,
Obligor(s), shall pay through income deduction, pursuant to a separate Income
Deduction Order which shall be effective immediately. Obligor(s) is (are) individually
responsible for paying this support obligation until all of said support is deducted from
his/her income. Until support payments are deducted, the Obligor(s) is (are)
responsible for making timely payments directly to the State Disbursement Unit or
the Petitioner as previously set forth in this Order.

b. ____ Deferred. Income deduction is ordered this day, but it shall not be effective until
a delinquency of $_____________, or, if not specified, an amount equal to one
month’s obligation occurs. Income deduction is not being implemented immediately
based on the following findings: Income deduction is not in the best interests of the
child(ren) because: {explain} _____________________________________________
_____________________________________________________________________
____________________________________________________________________.
AND
There is proof of timely payment of a previously ordered obligation without an Income
Deduction Order,
AND
_____ there is an agreement by the Obligor(s) to advise the Title IV-D agency, the clerk
of court, and the Petitioner of any change in Payor(s) and/or health insurance OR
_____ there is a signed, written agreement providing an alternative arrangement
between the Petitioner and the Obligor(s) and, at the option of the IV-D agency, by
the IV-D agency in IV-D cases in which there is an assignment of support rights to the
state, reviewed and entered into the record by the court.

c. Bonus/one-time payments.
{Choose one only}

_____ All
_____ __________%
_____ No income paid in the form of a bonus or other similar one-time payment, up to
the amount of any arrearage or the remaining balance thereof owed pursuant to this
order, shall be forwarded to the Petitioner pursuant to the payment method prescribed
above.

d. Other provisions relating to method of payment: ___________________________

Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
- 263 -
 _______________________________________________________________________.

SECTION VI. ATTORNEY’S FEES, COSTS, AND SUIT MONEY
{Choose one only}

1. The ____ Petitioner’s _____Respondents’ request(s) for attorney’s fees, costs, and suit
money is (are) denied because ______________________________________________
_______________________________________________________________________.

2. ____ The Court finds there is a need for and ability to pay attorney’s fees, costs, and suit
money. _____ Petitioner _____ Respondent(s) is (are) ordered to pay the other party
$___________ in attorney’s fees, and $ ___________ in costs. The Court further finds
that the attorney’s fees are awarded based on the reasonable rate of
$________________ per hour and _________ reasonable hours. Other provisions
relating to attorney’s fees, costs, and suit money are as follows: ___________________
_______________________________________________________________________.

SECTION VII. OTHER PROVISIONS

1. Other Provisions ________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________.

2. The Court reserves jurisdiction to modify and enforce this Order for Temporary Custody.

DONE AND ORDERED in ______________________, Florida on {date} __________________

_____________________________
CIRCUIT JUDGE

I certify that a copy of this Order for Temporary Custody was _____ mailed _____ faxed and
mailed ____ e-mailed _____ hand-delivered to the parties and any entities listed below on {date}
_________________________.

by ________________________________
{Clerk of court or designee}.

Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
- 264 -
Petitioner (or his or her attorney)
Respondents (or his or her attorney(s))
_____State Disbursement Unit
_____Central Depository
_____Other _________________________________

Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
- 265 -
 IN THE CIRCUIT COURT OF THE _________________________ JUDICIAL CIRCUIT
IN AND FOR __________________________ COUNTY, FLORIDA

Case No: ______________________
Division: ______________________
IN THE INTEREST OF

________________________________
Child(ren)

__________________________________,
Petitioner,
and
__________________________________,
Respondent/_____________,

__________________________________,
Respondent/_______________.

ORDER GRANTING PETITION FOR
CONCURRENT CUSTODY BY EXTENDED FAMILY

This case came before this Court for a hearing on a Petition for Concurrent Custody by Extended
Family. The Court, having reviewed the file and heard the testimony, makes these findings of
fact and reaches these conclusions of law:

SECTION I. FINDINGS:

1. The Court has jurisdiction over the subject matter and the parties.

2. The minor child(ren) at issue in this matter are:
Name Date of Birth
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

3. The Petitioner, {full legal name} __________________________________________ is the
{extended family relationship}_______________________________ of the child(ren).

Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
- 266 -
 4. The Petitioner currently has physical custody of the child(ren) and has had physical custody
of the child(ren) for at least 10 days in any 30-day period within the last 12 months.

5. The Petitioner does not have signed, written documentation from the parent(s) which is
sufficient to enable the custodian to do all the things necessary to care for the child(ren)
which are available to custodians who have an order for temporary custody by extended
family.

6. Parent {full legal name} _________________________________ of the child(ren):
{Choose one only}
____ Filed a Waiver and Consent

____ Was served with the petition and failed to file an Answer

____ Is deceased as evidenced by: _______________________________________

7. Parent {full legal name} _________________________________ of the child(ren):
{Choose one only}
____ Filed a Waiver and Consent

____ Was served with the petition and failed to file an Answer

____ Is deceased as evidenced by: _______________________________________

8. It is in the best interest of the child(ren) for the Petitioner to have concurrent custody.

SECTION II: CONCURRENT CUSTODY

1. The Petitioner,__________________________________________________, is granted
concurrent custody of the minor child(ren).

2. The Petitioner shall have all the concurrent rights and responsibilities of a legal parent.

3. The Petitioner is authorized to make all reasonable and necessary decisions for the minor
child(ren), including but not limited to:

a. Consent to all necessary and reasonable medical and dental care for the child(ren),
including nonemergency surgery and psychiatric care;

b. Secure copies of the child(ren)’s records, held by third parties, that are necessary
for the care of the child(ren), including, but not limited to: medical, dental, and
psychiatric records; birth certificates and other records; and educational records;

Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
- 267 -
 c. Enroll the child(ren) in school and grant or withhold consent for the child(ren) to be
tested or placed in special school programs, including exceptional education; and

d. Do all other things necessary for the care of the child(ren).

SECTION III. CHILD SUPPORT
{Insert the name or designation of the appropriate parent in the space provided}
1. The Petitioner ____ did ____ did not request the establishment of child support.

2. ____ If child support is requested, the parents have received personal or substituted
service of process, the petition requests an order for support of the child(ren), and there
is evidence of the parents’ ability to pay the support ordered.
_____ Parent {name or designation} _______________ and {if applicable}
_____ Parent {name or designation} ___________________
has the present ability to pay child support.
{Choose one only}
a.____ The amounts in the Child Support Guidelines Worksheet, Florida Family Law Rules
of Procedure Form 12.902(e) filed by
_____Parent {name or designation} _____________________
_____ Parent {name or designation} _______________
are correct;
OR
b.____ The Court makes the following findings:
Parent {name or designation} _______________’s net monthly income is
$____________, (Child Support Guidelines ____%).

Parent {name or designation} ________________’s net monthly income is
$_____________, (Child Support Guidelines ____%)

Monthly child care costs are $_________________.
Monthly health/dental insurance costs are $_____________.
OR
c.____ _____Parent {name or designation} _______________ is currently ordered to pay
child support to the other parent in the amount of $__________ per ____________ as
established in the case of (style of case and number} ____________________________.
_____ All of the child support or _____ a portion of the child support in the amount of
$___________ shall be redirected to the Petitioner.

3. Amount
a. Parent {name or designation} __________________’s Obligation
Parent {name or designation} ________________ shall be obligated to pay child support
at the rate of $_______ per month for the _______children {total number of parties’

Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
- 268 -
 minor or dependent children} commencing _______________________ {month, day,
year} and terminating ________________________ {month, day, year}. Child support
shall be paid in the amount of $______________ per _____________ {week, month,
other} which is consistent with Parent {name or designation} ___________’s current
payroll cycle.

Upon the termination of child support for one of the parties’ children, child support in the
amount of $_____________ for the remaining _________ children {total number of
remaining children} shall be paid commencing __________________ {month, day, year}
and terminating _________________________ {month, day, year}. This child support
shall be paid in the amount of $_________ per _________ {week, month, other}
consistent with Parent {name or designation} ___________’s current payroll cycle.

{Insert paragraph for the child support obligation, including the amount, and
commencement and termination dates, for the remaining minor or dependent children,
which shall be payable as the obligation for each child ceases.}

Parent {name or designation} _______________ shall pay child support until all of the
minor or dependent children: reach the age of 18, become emancipated, marry, join the
armed services, die, or become self-supporting; or until further order of the court or
agreement of the parties. The child support obligation shall continue beyond the age of
18 and until high school graduation for any child who is dependent in fact, between the
ages of 18 and 19, and is still in high school, performing in good faith with a reasonable
expectation of graduation before the age of 19.

If the child support ordered deviates from the guidelines more than 5%, the factual
findings which support that deviation are: ____________________________________
_______________________________________________________________________
_______________________________________________________________________.

b. Parent {name or designation} __________________’s Obligation
Parent {name or designation} ________________ shall be obligated to pay child support
at the rate of $_________ per month for the ________children {total number of parties’
minor or dependent children} commencing______________________ {month, day, year}
and terminating __________________ {month, day, year}. Child support shall be paid in
the amount of $__________per ______________{week, month, other} consistent with
Parent {name or designation} ____________’s current payroll cycle.

Upon the termination of the obligation of child support for one of the parties’ children,
child support in the amount of $__________ for the remaining ______ children {total
number of remaining children} shall be paid commencing _____________________
{month, day, year} and terminating ________________________ month, day, year}. This
child support shall be paid in the amount of $______________ per _______________

Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
- 269 -
 {week, month, other} consistent with Parent {name or designation} _____________’s
current payroll cycle.

{Insert paragraph for the child support obligation, including the amount, and
commencement and termination dates, for the remaining minor or dependent children,
which shall be payable as the obligation for each child ceases.}

Parent {name or designation} ___________________ shall pay child support until all of
the minor or dependent children: reach the age of 18; become emancipated, marry, join
the armed services, die, or become self-supporting; or until further order of the court or
agreement of the parties. The child support obligation shall continue beyond the age of
18 and until high school graduation for any child who is dependent in fact, between the
ages of 18 and 19, and is still in high school, performing in good faith with a reasonable
expectation of graduation before the age of 19.

If the child support ordered deviates from the guidelines more than 5%, the factual
findings which support that deviation are:______________________________________
________________________________________________________________________
_______________________________________________________________________.

4. Retroactive Child Support and/or Arrearages
{If both parents are ordered to pay retroactive child support and/or arrearages, please
include a separate paragraph for each parent.}

a. _____ Parent {name or designation} ____________________________________
shall pay retroactive child support in the amount of $_______________ as of {date}
________________ to the Petitioner. The retroactive child support shall be paid in the
amount of $_______ per month, payable _____in accordance with the employer’s
payroll cycle, and in any event at least once per month _____ other {explain}
_________________commencing {date} _______________, until paid in full including
statutory interest.

b. _____ Parent {name or designation} _______________ _____owes child support
arrearages in the amount of $__________ as of {date} ________________ to the
other parent. The child support arrearages shall be paid in the amount of $_______
per month, payable _____ in accordance with the parent’s employer’s payroll cycle,
and in any event at least once per month, or ___other {explain} ________
commencing {date} _________________, until paid in full including statutory interest.

5. Insurance
{Indicate all that apply}
b. _____ Parent {name or designation} _____________________
_____ Parent {name or designation} ____________________

Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
- 270 -
 shall be required to maintain _____ health and/or _____ dental insurance for the
parties’ minor child(ren), so long as reasonable in cost and accessible to the child(ren).
The party providing insurance shall be required to convey insurance cards
demonstrating said coverage to the Petitioner and other parent.
OR
_____ health and/or _____ dental insurance is either not reasonable in cost or
accessible to the child(ren) at this time.

c. _____ Reasonable and necessary uninsured medical/dental/prescription drug
costs for the minor child(ren) shall be assessed as follows:
_____ Shared equally by both parents.
_____ Prorated according to the child support guidelines percentages.
_____ Other {explain} ____________________________________________

As to these uninsured medical/dental/prescription drug expenses, the party who
incurs the expense shall submit a request for reimbursement to the parent or
parents within 30 days, and the parent or parents, within 30 days of receipt, shall
submit the applicable reimbursement for that expense.

SECTION IV. METHOD OF PAYMENT

The parent(s) shall pay court-ordered child support and arrearages, if any, as follows:
1. Place of Payment

a. _____Parents shall pay court-ordered support directly to either the State
Disbursement Unit or the central depository, as required by statute, along with
any applicable fee required by statute.

OR

b. ____ The Petitioner and the Parents have requested and the court finds that it is
in the best interest of the child(ren) that support payments need not be directed
through either the State Disbursement Unit or the central depository at this time;
however, any party may subsequently apply, pursuant to section
61.13(1)(d)(3), Florida Statutes, to require payment through either the State
Disbursement Unit or the central depository.

2. Income Deduction
(If applicable)
a. _____ Immediate. _____Parent {name or designation} _____________ _____
Parent {name or designation} ___________, hereinafter, Obligor(s), shall pay
through income deduction, pursuant to a separate Income Deduction Order which

Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
- 271 -
 shall be effective immediately. Obligor(s) is(are) individually responsible for paying
this support obligation until all of said support is deducted from his/her income.
Until support payments are deducted, the Obligor(s) is (are) responsible for
making timely payments directly to the State Disbursement Unit or the Petitioner
as previously set forth in this Order.

b. _____ Deferred. Income deduction is ordered this day, but it shall not be effective
until a delinquency of $_____________, or, if not specified, an amount equal to
one month’s obligation occurs. Income deduction is not being implemented
immediately based on the following findings: Income deduction is not in the best
interests of the child(ren) because: {explain} __________________________
_______________________________________________________________
_______________________________________________________________.
AND
There is proof of timely payment of a previously ordered obligation without an
Income Deduction Order,
AND
_____ there is an agreement by the Obligor(s) to advise the Title IV-D agency, the
clerk of court, and the Petitioner of any change in Payor(s) and/or health insurance
OR

_____ there is a signed, written agreement providing an alternative arrangement
between the Petitioner and Obligor(s) and, at the option of the IV-D agency, by
the IV-D agency in IV-D cases in which there is an assignment of support rights to
the state, reviewed and entered into the record by the court.

c. Bonus/one-time payments.
{Choose one only}
_____ All
_____ __________%
_____ No income paid in the form of a bonus or other similar one-time payment,
up to the amount of any arrearage or the remaining balance thereof owed
pursuant to this order, shall be forwarded to the Petitioner pursuant to the
payment method prescribed above.

d. Other provisions relating to method of payment: _______________________
_________________________________________________________________
_________________________________________________________________.

SECTION V. ATTORNEY’S FEES, COSTS, AND SUIT MONEY
{Choose one only}

Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
- 272 -
 1. The _____ Petitioner’s _____ Respondents’ request(s) for attorney’s fees, costs, and suit
money is (are) denied because _____________________________________________
_____________________________________________________________________.

2. _____ The Court finds there is a need for and ability to pay attorney’s fees, costs, and suit
money. _____ Petitioner _____ Respondent(s) is (are) ordered to pay the other party
$_____________ in attorney’s fees, and $ ___________ in costs. The Court further finds that
the attorney’s fees are awarded based on the reasonable rate of $________________ per
hour and ______ reasonable hours. Other provisions relating to attorney’s fees, costs, and
suit money are as follows: __________________________
_______________________________________________________________________.

SECTION VI. OTHER PROVISIONS

1. Other Provisions _________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________.

2. The Court reserves jurisdiction to modify and enforce this Order for Concurrent Custody.

3. The granting of concurrent custody does not affect the ability of the child(ren)’s parent
or parents to obtain physical custody of the child(ren) at any time.

DONE AND ORDERED in _____________________, Florida on {date} ____________________

_____________________________
CIRCUIT JUDGE

I certify that a copy of this Order for Concurrent Custody was: _____ mailed _____ faxed and
mailed _____ e-mailed _____ hand-delivered to the parties and any entities listed below on
{date}________________________.

by____________________________.
{Clerk of court or designee}

Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
- 273 -
Petitioner (or his or her attorney)
Respondents (or his or her attorneys)
_____State Disbursement Unit
_____Central Depository
_____Other _________________________________

Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
- 274 -
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.981(c)(2),
STEPPARENT ADOPTION: CONSENT OF ADULT ADOPTEE’S SPOUSE
(02/18)

When should this form be used?

This form must be completed by the spouse of an adult who is being adopted.

This form should be typed or printed in black ink. After completing this form, the spouse of the adoptee
should sign the form before a notary public or deputy clerk. You should file the original with the clerk of
the circuit court in the county where the petition for adoption of an adult was filed and keep a copy for
your records.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleading or other document electronically, you must do so in accordance with Florida Rule of Judicial
Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. The
rules and procedures should be carefully read and followed.

Special notes...

Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these
forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Rules of
Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms also
must put his or her name, address, and telephone number on the bottom of the last page of every form
he or she helps you complete.

Instructions for Florida Supreme Court Approved Family Law Form 12.981(c)(2), Stepparent Adoption: Consent of
Adult Adoptee’s Spouse (02/18)
- 275 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.: _________________________
Division: _________________________
IN RE: THE ADOPTION OF

________________________ ,
{use name to be given to adult} Adoptee(s).

STEPPARENT ADOPTION: CONSENT OF ADULT ADOPTEE’S SPOUSE

1. I, {full legal name} ______________, am the spouse of
{full legal name} _________________________________________________, who Petitioner,
{full legal name} _________________________________________________ wishes to adopt.
2. I consent to the adoption of my spouse by Petitioner.
3. I understand my right to choose a person who does not have an employment, professional, or
personal relationship with the adoption entity or the prospective adoptive parents to be present
when this affidavit is executed and to sign it as a witness. The witness I selected is:
{full legal name}_______________________________________________________.

I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
consent and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated:
Signature of Spouse
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es): ____________________
_____________________________________________

Florida Supreme Court Approved Family Law Form 12.981(c)(2), Stepparent Adoption: Consent of Adult Adoptee’s
Spouse (02/18)
- 276 -
____________________________________ _______________________________________
Signature of Witness Signature of Witness
Printed Name: ________________________ Printed Name: _______
Business Address:_____________________ Business Address:______________________
Home Address: _______________________ Home Address: _______
___ _______________________________________
Driver’s License or Driver’s License or
State ID Card No.:_____________________ State ID Card No.:

STATE OF FLORIDA
COUNTY OF

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

{Print, type, or stamp commissioned name of notary or
deputy clerk.}

__ Personally known
___ Produced identification
Type of identification produced

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the ( ) stepparent ( ) adult adoptee’s spouse.
This form was completed with the assistance of:
{name of individual} ___________________________________________________________________,
{name of business} _____________________________________________________________________,
{address} ____________________________________________________________________________,
{city} ________________,{state} ______, {zip code}_________,{telephone number} ________________.

Florida Supreme Court Approved Family Law Form 12.981(c)(2), Stepparent Adoption: Consent of Adult Adoptee’s
Spouse (02/18)
- 277 -
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.982(a)
PETITION FOR CHANGE OF NAME (ADULT)
(02/18)

When should this form be used?

This form should be used when an adult wants the court to change his or her name. This form is not to
be used in connection with a dissolution of marriage or for adoption of child(ren). If you want a change
of name because of a dissolution of marriage or adoption of child(ren) that is not yet final, the change
of name should be requested as part of that case.

This form should be typed or printed in black ink and must be signed before a notary public or deputy
clerk. You 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?

Unless you are seeking to restore a former name, you must have fingerprints submitted for a state and
national criminal records check. The fingerprints must be taken in a manner approved by the Department
of Law Enforcement and must be submitted to the Department for a state and national criminal records
check. You may not request a hearing on the petition until the clerk of court has received the results of
your criminal history records check. The clerk of court can instruct you on the process for having the
fingerprints taken and submitted, including information on law enforcement agencies or service providers
authorized to submit fingerprints electronically to the Department of Law Enforcement. The process may
take several weeks and you will have to pay for the cost of processing the fingerprints and conducting the
state and national criminal history records check. Please note that the state and national criminal
records check must indicate whether you have registered as a sexual predator or a sexual offender and
you must also indicate on this petition whether you have ever been required to register as a sexual
predator under section 775.21, Florida Statutes, or as a sexual offender under section 943.0435, F.S.

Next, you must obtain a hearing date for the court to consider your request. If you are seeking to restore
a former name, a hearing on the petition MAY be held immediately after the petition is filed. The final
hearing on any other petition for a name change may be held immediately after the clerk of court receives
the results of your criminal history records check. You should ask the clerk of court, family law intake
staff, or judicial assistant about the local procedure for setting a hearing. You may be required to attend
the final hearing. Included in these forms is a Final Judgment of Change of Name (Adult), Florida Supreme
Court Approved Family Law Form 12.982(b), which the judge may use. You should contact the clerk, family
law intake staff, or judicial assistant, to see if you need to bring a final judgment form with you. If so, you
should type or print the heading, including the circuit, county, case number, division, and the parties’
names, and leave the rest blank for the judge to complete at your hearing or trial.

Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult)
(02/18)
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If the judge grants your petition, he or she will sign this order. This officially changes your name. The clerk
can provide you with certified copies of the signed order. There will be charges for the certified copies,
and the clerk can tell you the amount of the charges.
Where can I look for more information?

Before proceeding, you should read General Information for Self-Represented Litigants found at the
beginning of these forms. For further information, see Section 68.07, Florida Statutes.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration ow require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving
pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida
Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the
Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court
in the A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

Special notes...

Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult)
(02/18)
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The heading of the form calls for the name of the petitioner. Your current name should go there, as you
are the one who is asking the court for something. The judicial circuit, case number, and division may be
obtained from the clerk of court’s office when you file the petition.

It may be helpful to compile a list of all of the people and/or places that will need a copy of your final
judgment. This list may include the driver’s license office, social security office, banks, schools, etc. A list
will help you know how many copies of your order you should get from the clerk of court after your
hearing.

Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these
forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of
Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms also
must put his or her name, address, and telephone number on the bottom of the last page of every form
he or she helps you complete.

Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult)
(02/18)
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 IN THE CIRCUIT COURT OF THE ____________JUDICIAL CIRCUIT,
IN AND FOR______________________COUNTY, FLORIDA

IN RE: THE NAME CHANGE OF:
Case No.: ________________________
Division: _________________________
_______________________________,
Petitioner.

PETITION FOR CHANGE OF NAME (ADULT)

I, {full legal name} _________________________________, being sworn, certify that the following
information is true:
1. My complete present name is: _______________________________________________________
I request that my name be changed to: ________________________________________________

2. I live in _________________ County, Florida, at {street address} _____________________________
_________________________________________________________________________________

3. I was born on {date}______________, in {city} _________________________, {county} __________,
{state} ______________________, {country} _________________.

4. My parents’ full legal names are :
a. ___________________________________________
b. _______________________________
c. {If applicable} My parents’ maiden name(s) is/are: ____________________________
and __________________________________________________________________

5. I have lived in the following places since birth:
Dates (to/from) Address
_______/_________ ____________________________________________________
_______/_________ ____________________________________________________
_______/_________ ____________________________________________________
_______/_________ ____________________________________________________
(___ Please indicate here if you are continuing these facts on an attached page.)

6. Family
[Indicate all that apply]
a._____ I am not married.

b._____ I am married. My spouse’s full legal name is: _____________________________________

c._____ I do not have child(ren).

Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (02/18)
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 d._____ The name(s), age(s), and address(es) of my child(ren) are as follows {all children, including
those over 18, must be listed}:

Name {last, first, middle initial} Age Address, City, State
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
(______Please indicate here if you are continuing these facts on an attached page.)

7. Former names
[Indicate all that apply]
a. __My name has never been changed by a court.

b. __My name previously was changed by court order from ______________________________
to _____________________________________on {date} _______________________________,
by {court, city, and state} .
A copy of the court order is attached.

c. __My name previously was changed by marriage from_________________________________
to on {date} ,
in {city, county, and state} .
A copy of the marriage certificate is attached.

d. _I have never been known or called by any other name.

e. _I have been known or called by the following other name(s): {list name(s) and explain where
you were known or called by such name(s)} _________________________________________
__________________________________________________________________________________

8. Occupation
My occupation is: .
I am employed at: {company and address}
.
During the past 5 years, I have had the following jobs:

Dates (to/from) Employer and employer’s address
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
(_______Please indicate here if you are continuing these facts on an attached page.)
9. Business [Choose one only]
__ I do not own and operate a business.

__ I own and operate a business. The name of the business is: ___________________________

Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (02/18)
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 The street address is: .

My position with the business is: .

I have been involved with the business since: {date} .

10. Profession
[Choose one only]
_I am not in a profession.

_I am in a profession. My profession is: _________________________________________
I have practiced this profession:
Dates (to/from) Place and address
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
( _____ Please indicate here if you are continuing these facts on an attached page.)

11. Education
I have graduated from the following school(s):
Degree Date of
Received Graduation School
_________ _____________ __________________________________________________
_________ _____________ __________________________________________________
_________ _____________ __________________________________________________
(________ Please indicate here if you are continuing these facts on an attached page.)

12. Criminal History
Indicate all that apply
_ I have never been arrested for or charged with, pled guilty or nolo contendere to, or been found
to have committed a criminal offense, regardless of adjudication.

_ I have a criminal history. In the past I have been arrested for or charged with, pled guilty or
nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication.
The details of my criminal history are:

Date City/State Event (arrest, charge, plea, or adjudication)

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

I _____ have____have not ever been required to register as a sexual predator under section 775.21,
Florida Statutes.

Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (02/18)
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 I _____ have ______have not ever been required to register as a sexual offender under section
943.0435, Florida Statutes.

13. Bankruptcy
[Choose one only]
_I have never been adjudicated bankrupt.

_I was adjudicated bankrupt on {date} , in {city} ,
{county} , {state} .
(______ Please indicate here if you have filed additional bankruptcies, and explain on an attached
page.)

14. Creditor(s)’ Judgments
[Choose one only]
_I have never had a money judgment entered against me by a creditor.

_ The following creditor(s)’ money judgment(s) have been entered against me:

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

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

15. Fingerprints and Criminal History Records Check
Unless I am seeking to restore a former name, a copy of my fingerprints has been taken in a manner
approved by the Department of Law Enforcement and submitted for a state and national criminal
history records check. I understand that I cannot request a hearing on my Petition until the Clerk of
Court receives the results of the criminal history records check. I also understand that the state and
national records check must indicate whether I have registered as either a sexual predator or sexual
offender.

16. I have no ulterior or illegal purpose for filing this petition, and granting it will not in any manner invade
the property rights of others, whether partnership, patent, good will, privacy, trademark, or
otherwise.

17. My civil rights have never been suspended, or, if my civil rights have been suspended, they have been
fully restored.

Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (02/18)
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I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
petition and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated: ______________________ _____________________________________________
Signature of PETITIONER
Printed Name: _________________________________
Address: _____________________________________
City, State, Zip: ________________________________
Telephone Number: _____________________________
Fax Number: __________________________________
Designated E-Mail Address(es):____________________
_____________________________________________

STATE OF FLORIDA
COUNTY OF ____________________

Sworn to or affirmed and signed before me on ____________ by _______________________________.

_____________________________________________
NOTARY PUBLIC or DEPUTY CLERK

_____________________________________________
[Print, type, or stamp commissioned name of notary or
deputy clerk.]
____ Personally known
____ Produced identification
____ Type of identification produced ________________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared by the Petitioner.
This form was completed with the assistance of:_____________________________________________
{name of individual} ___________________________________________________________________,
{name of business}:____________________________________________________________________,
{address} ____________________________________________________________________________,
{city} ________________, {state}_____,{zip code}________,{telephone number} __________________.

Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (02/18)
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 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
IN RE: THE NAME CHANGE OF

___________________________________,
Petitioner.

FINAL JUDGMENT OF CHANGE OF NAME (ADULT)
This cause came before the Court on {date} , for a hearing on Petition for Change of
Name (Adult) under section 68.07, Florida Statutes, and it appearing to the Court that:

1. Petitioner is a bona fide resident of County, Florida;

2. Petitioner’s request is not for any ulterior or illegal purpose; and

3. Granting this petition will not in any manner invade the property rights of others, whether
partnership, patent, good will, privacy, trademark, or otherwise; it is

ORDERED that Petitioner’s present name, ____________________________________________,
is changed to ____________________________________________________________________,
by which Petitioner shall hereafter be known.

DONE and ORDERED ON ___________________ in ______________________________, Florida.

CIRCUIT JUDGE

I certify that a copy of the {name of document(s)} ____________________________________________
was _____ mailed _____ faxed and mailed _____ e-mailed _____ hand-delivered to the party(ies) listed
below on {date} __________________________________.

Petitioner (or his or her attorney)
Other: ___________________

Florida Supreme Court Approved Family Law Form 12.982(b), Final Judgment of Change of Name (Adult) (02/18)
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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.982(c)
PETITION FOR CHANGE OF NAME (MINOR CHILD(REN))
(02/18)

When should this form be used?

This form should be used when parents want the court to change the name of their minor child(ren). For
the purposes of this proceeding, a person under the age of 18 is a minor. This form is not to be used in
connection with an adoption, dissolution of marriage, or paternity action. If you want a change of name
for your child(ren) because of an adoption or paternity action that is not yet final, the change of name
should be requested as part of that case.

This form should be typed or printed in black ink and must be signed before a notary public or deputy
clerk. You should file the original with the clerk of the circuit court, in the county where you live and keep
a copy for your records. The Petition should only be completed by one Petitioner for one child. If you
wish to change the name of more than one child or if there is more than one Petitioner, you should
complete and file a Supplemental Form for Petition for Change of Name (Minor Child) for each child
and/or a Supplemental Form for Petition for Change of Name. The supplemental form(s) is an attachment
to the petition. Be sure that the bottom of each page of each supplemental form is initialed by the
petitioner(s).

What should I do next?

Unless you are seeking to restore a former name, each adult petitioner(s)’s fingerprints must be
submitted for a state and national criminal history records check. The fingerprints must be taken in a
manner approved by the Department of Law Enforcement. The fingerprints must be submitted to the
Department of Law Enforcement for a state and national criminal history records check. The Petitioner(s)
may not request a hearing on the Petition until the copy of the fingerprints are filed and the clerk of
court has received the results of the criminal history records check. The clerk of court can instruct you
on the process for having the fingerprints taken and submitted, including information on law enforcement
agencies or service providers authorized to submit fingerprints electronically to the Department of Law
Enforcement. The process may take several weeks and the parent or guardian of the minor must pay the
cost of processing the fingerprints and conducting the state and national history records check. Please
note that the state and national criminal records check must indicate whether you have registered as
either a sexual predator or a sexual offender and you must also indicate on this petition whether you
have ever been required to register as a sexual predator under section 775.21, Florida Statutes, or as a
sexual offender under section 943.0435, Florida Statutes.

If both parents agree to the change of name and live in the county where the change of name is sought,

Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor
Children) (02/18)
- 287 -
you may both file as petitioners. In this situation, service is not necessary, and you need only to set a
hearing. You should ask the clerk of court, family law intake staff, or judicial assistant about the local
procedure for setting a hearing.

If only one parent is a resident of the county where the change of name(s) is sought or only one parent
asks for the child(ren)’s name(s) to be changed, the other parent must be notified and his or her consent
obtained, if possible. If the other parent consents to the change of name, a Consent for Change of Name
(Minor Child(ren)), Florida Supreme Court Approved Family Law Form 12.982(d), should be filed.

If the other parent does not consent to the change of name, you may still have a hearing on the petition
if you have properly notified the other parent about your petition and the hearing. If you know where he
or she lives, you must use personal service. If you absolutely do not know where he or she lives, you may
use constructive service. For more information about personal and constructive service, you should refer
[to] the “General Instructions for Self-Represented Litigants” found at the beginning of these forms and
the instructions to Florida Family Law Rules of Procedure Forms 12.910(a) and 12.913(b) and Florida
Supreme Court Approved Family Law Form 12.913(a). However, the law regarding constructive service is
very complex and you may wish to consult an attorney regarding that issue.

Next, you must obtain a final hearing date for the court to consider your request. If you are seeking to
restore a former name, a hearing on the petition MAY be held immediately after the petition is filed. The
final hearing on any other petition for a name change may be held immediately after the clerk of court
receives the results of your criminal history records check. You should ask the clerk of court, family law
intake staff, or judicial assistant about the local procedure for setting a hearing. You may be required to
attend the hearing. Included in these forms is a Final Judgment of Change of Name (Minor Child(ren)),
Florida Supreme Court Approved Family Law Form 12.982(e), which may be used when a judge grants a
change of name for a minor child(ren). If you attend the hearing, you should take the final judgment with
you. You should complete the top part of the form, including the circuit, county, case number, division,
and the name(s) of the petitioner(s) and leave the rest blank for the judge to complete. It should be typed
or printed in black ink.

If the judge grants your petition, he or she will sign this order. This officially changes your child(ren)’s
name(s). The clerk can provide you with certified copies of the signed order. There will be charges for
the certified copies, and the clerk can tell you the amount of the charges.

Where can I look for more information?

Before proceeding, you should read “General Information for Self-Represented Litigants” found at the
beginning of these forms. For further information, see section 68.07, Florida Statutes.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other

Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor
Children) (02/18)
- 288 -
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving
pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida
Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the
Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court
in the A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

Special notes...

The heading of the form calls for the name(s) of the petitioner(s). This means the parent(s) who is (are)
requesting the change of their child(ren)’s name(s). The judicial circuit, case number, and division may be
obtained from the clerk of court’s office when you file the petition.

It may be helpful to compile a list of all of the people and places that will need a copy of the final judgment.
This list may include the driver’s license office, social security office, banks, schools, etc. A list will help
you know how many copies of your order you should get from the clerk of court after your hearing.

Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these
forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of
Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also
must put his or her name, address, and telephone number on the bottom of the last page of every form
he or she helps you complete.

Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor
Children) (02/18)
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 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
IN RE: THE NAME CHANGE OF

,
Petitioner,

,
Petitioner.

PETITION FOR CHANGE OF NAME (MINOR CHILD(REN))

I/We, {full legal name(s)} , being sworn, certify that the following
information is true:

I am/We are the birth or legal parent(s) or guardian of the minor child(ren) named in this petition.
[Choose only one]
____ There is only one minor child named in this petition.

____ There are {enter number of children} children named in this petition. The information on the
first child is entered below. I/We have attached the completed supplemental forms for each other child.

The adult petitioner(s)’s fingerprints have been taken in a manner approved by the Department of Law
Enforcement and submitted for a state and national criminal history records check. I /We understand
that I/we cannot request a hearing on my/our Petition until the clerk of court receives the results of
the criminal history records check. I/we also understand that the state and national records check must
indicate whether I/we have registered as either a sexual predator or a sexual offender.

A. THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # 1 :

1. The minor child’s complete present name is:

I/We request that this minor child’s name be changed to:

2. The minor child lives in County, Florida, at {street address}

Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren))
(02/18)
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 .

3. The minor child was born on {date} , in {city, county, state, country}
.

4. The minor child’s parents’ full legal names are:
a. __________________________________________ and

b. __________________________________________________________.

c. {If applicable} The minor child’s parents' maiden name(s) is/are: ___________________
and ________________________________________.

5. The minor child has lived in the following places since birth:
Dates (to/from) Address
_______/________ ______________________________________________________
_______/________ ______________________________________________________
_______/________ ______________________________________________________
_______/________ ______________________________________________________
_______/________ ______________________________________________________
(____ Please indicate here if you are continuing these facts on an attached page.)

6. [Choose one only]
_____ The minor child is not married.

_____ The minor child is married to: {full legal name} __________________________________.

7. [Choose one only]
_____ The minor child has no children.

_____ The minor child is the parent of the following child(ren):

Name {last, first, middle initial} Date of Birth
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(______Please indicate here if you are continuing these facts on an attached page.)

8. Former names.
[Indicate all that apply]

Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren))
(02/18)
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 _____ The minor child’s name has never been changed by a court.

_____ The minor child’s name previously was changed by court order from _______________
to on {date} ,
by {court, city, and state} .
A copy of the court order is attached.

_____ The minor child’s name previously was changed by marriage from _________________
to on {date} ,
in {city, county, and state} .
A copy of the marriage certificate is attached.

_____ The minor child has never been known or called by any other name.

_____ The minor child has been known or called by the following other name(s): {list name(s) and
explain where child was known or called by such name(s)} ______________________
_________________________________________________________________________
_________________________________________________________________________

9. The minor child is not employed in an occupation or profession, does not own and operate a
business, and has received no educational degrees. If the minor child has a job, explain:

______________________________________________________________________________

10. Criminal History
[Indicate all that apply]
_____ The minor child has never been arrested for or charged with, pled guilty or nolo
contendere to, or been found to have committed a criminal offense, regardless of
adjudication.

_____ The minor child has a criminal history. In the past, the minor child was arrested for or
charged with, pled guilty or nolo contendere to, or been found to have committed a
criminal offense, regardless of adjudication. The details of the criminal history are:

Date City/State Event (arrest, charge, plea, or adjudication)

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

_____ The minor child _____ has _____has not ever been required to register as a sexual predator
under section 775.21, Florida Statutes.

_____ The minor child _____has _____has not ever been required as a sexual offender under
section 943.0435, Florida Statutes.

Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren))
(02/18)
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 11. Money Judgments.
[Choose one only]
_____ The minor child has never been adjudicated bankrupt, and no money judgment has ever
been entered against him or her.

_____ The following money judgment(s) has been entered against him or her:

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

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

_____ PARENT _____ GUARDIAN

_____ A Supplemental Form has been attached for the other parent or petitioner.

1. My complete present name is: __________________________________________________
______________________________________________________________________________

2. I live in ________________ County, Florida, at {street address} ______________________
______________________________________________________________________________.

3. Bankruptcy
{Choose one only}

_____I have never been adjudicated bankrupt

_____I was adjudicated bankrupt on {date} ___________, in {city}_________________________
{county} ____________________, {state}________________.

(_____ Please indicate here if you have filed additional bankruptcies, and explain on an attached
page.

4. Creditor(s)’ Judgments
{Choose one only}
_____ I have never had a money judgment entered against me by a creditor.

_____The following creditor)s)’ money judgments have been entered against me:

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

Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren))
(02/18)
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 ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
(_____ Please indicate here if these facts are continued on an attached page.)

5. Criminal History
{Indicate all that apply}

_____ I have never been arrested for or charged with, pled guilty or nolo contendere to, or been
found to have committed a criminal offense, regardless of adjudication.

_____ I have a criminal history. In the past I have been arrested for or charged with, pled guilty or
nolo contendere to, or been found to have committed a criminal offense, regardless of
adjudication. The details of my criminal history are:

Date City/State Event (arrest, charge, plea, or adjudication)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(_____ Please indicate here if these facts are continued on an attached page.)

I _____ have _____ have not ever been required to register as a sexual predator under section
775.21, Florida Statutes.

I _____ have _____ have not ever been required to register as a sexual offender under section
943.0435, Florida Statutes.

6. I have no ulterior or illegal purpose for filing this petition, and granting it will not in any manner
invade the property rights of others, whether partnership, patent, good will, privacy, trademark,
or otherwise.

7. My civil rights have never been suspended, or, if ever suspended, they have been fully restored.

Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren))
(02/18)
- 294 -
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
petition and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated:
Signature of Petitioner
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-Mail Address(es)_____________________
_____________________________________________
STATE OF FLORIDA
COUNTY OF

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

[Print, type, or stamp commissioned name of notary or
clerk.]
______ Personally known
______ Produced identification
Type of identification produced

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the Petitioner.
This form was completed with the assistance of:
{name of individual}________________________________________________________________
{name of business}__________________________________________________________________
{address}__________________________________________________________________________
{city}_________________, {state}_______, {zip code}_____________{telephone number}__________.

Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren))
(02/18)
- 295 -
 ADULT SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME (MINOR CHILD(REN))

Case No.: ______________________________

THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER(S):
_____ PARENT _____ GUARDIAN

1. My complete present name is: __________________________________________________
______________________________________________________________________________

2. I live in ________________ County, Florida, at {street address} ___________________________
______________________________________________________________________________.

3. Bankruptcy
{Choose one only}
_____I have never been adjudicated bankrupt

_____I was adjudicated bankrupt on {date} ___________, in {city}_________________________
{county} ____________________, {state}________________.
(_____ Please indicate here if you have filed additional bankruptcies, and explain on an attached page.

4. Creditor(s)’ Judgments
{Choose one only}
_____ I have never had a money judgment entered against me by a creditor.

_____The following creditor)s)’ money judgments have been entered against me:

Date Amount Creditor Court entering judgment and case number If Paid {date}
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
(_____ Please indicate here if these facts are continued on an attached page.)

5. Criminal History
{Indicate all that apply}
_____ I have never been arrested for or charged with, pled guilty or nolo contendere to, or been
found to have committed a criminal offense, regardless of adjudication.

_____ I have a criminal history. In the past I have been arrested for or charged with, pled guilty or
nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication.
The details of my criminal history are:
Date City/State Event (arrest, charge, plea, or adjudication)
Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren))
(02/18)
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 _________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
(_____ Please indicate here if these facts are continued on an attached page.)

I _____ have _____ have not ever been required to register as a sexual predator under section
775.21, Florida Statutes.

I _____ have _____ have not ever been required to register as a sexual offender under section
943.0435, Florida Statutes.

6. I have no ulterior or illegal purpose for filing this petition, and granting it will not in any manner
invade the property rights of others, whether partnership, patent, good will, privacy, trademark, or
otherwise.

7. My civil rights have never been suspended, or, if ever suspended, they have been fully restored.

I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
petition and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated: ____ ____________________________________________
Signature of Petitioner
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-Mail Address(es)_____________________
_____________________________________________
STATE OF FLORIDA
COUNTY OF

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

[Print, type, or stamp commissioned name of notary or
clerk.]
___ Personally known
__ Produced identification

Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren))
(02/18)
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 Type of identification produced

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was completed for the Petitioner(s).
This form was completed with the assistance of:
{name of individual} ________________________________________________________________
{name of business} ___________________________________________________________________
{address} ___________________________________________________________________________
{city} ______________,{state} _____,{zip code} ___________{telephone number} _______________
.

Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren))
(02/18)
- 298 -
 MINOR CHILD # ________, continued

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

Case No.:

THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # :

1. Minor child’s complete present name is:
.
I/We request that minor child’s name be changed to:
.

2. The minor child lives in County, Florida, at {street address}
.

3. The minor child was born on {date} , in {city, county, state, country}
______________________________________________________________________________.

4. The minor child’s parents’ full legal name(s) are:
a. ___________________________________________________ and

b. ____________________________________________________

c. {If applicable} The minor child’s parent’s’ maiden name(s):
and____________________________________________.

5. The minor child has lived in the following places since birth:
Dates (to/from) Address
/
/
/
/
/
/
(____ Please indicate here if you are continuing these facts on an attached page.)

6. [Choose one only]
_____The minor child is not married.

_____The minor child is married to: {full legal name} .

7. [Choose one only]
_____The minor child has no children.

Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren))
(02/18)
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 MINOR CHILD # ________, continued

_____The minor child is the parent of the following child(ren):

Name {last, first, middle initial} Date of Birth
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(______Please indicate here if you are continuing these facts on an attached page.)

8. Former names
[Indicate all that apply]
_____The minor child’s name has never been changed by a court.

_____The minor child’s name previously was changed by court order from
to on {date} ,
by {court, city, and state} .
A copy of the court order is attached.

_____The minor child’s name previously was changed by marriage from
to on {date} ,
in {city, county, and state} .
A copy of the marriage certificate is attached.

____The minor child has never been known or called by any other name.

____The minor child has been known or called by the following other name(s): {list name(s) and
explain where child was known or called by such name(s)}
______________________________________________________________________________
______________________________________________________________________________

9. The minor child is not employed in an occupation or profession, does not own and operate a
business, and has received no educational degrees. If the minor child has a job, explain:

.

10. Criminal History
[Indicate all that apply]
_____The minor child has never been arrested for or charged with, pled guilty or nolo contendere
to or been found to have committed a criminal offense, regardless of adjudication.

_____The minor child has a criminal history. In the past, the minor child was arrested for or
Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren))
(02/18)
- 300 -
 MINOR CHILD # ________, continued

charged with, pled guilty or nolo contendere to, or been found to have committed a criminal
offense, regardless of adjudication. The details of the criminal history are:

Date City/State Event (arrest, charge, plea, or adjudication)

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

______ The minor child ______ has _____ has not ever been required to register as a sexual
predator under section 775.21, Florida Statutes.

_____ The minor child _____ has _____ has not ever been required to register as a sexual offender
under section 943.0435, Florida Statutes.

11. Money Judgments
[Choose one only]
_____ The minor child has never been adjudicated bankrupt, and no money judgment has ever
been entered against him or her.

_____ The following money judgment(s) has (have) been entered against him or her:

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

Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren))
(02/18)
- 301 -
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.982(d),
CONSENT FOR CHANGE OF NAME (MINOR CHILD(REN))
(02/18)

When should this form be used?

This form should be used when one parent consents to the other parent’s petition to change the name of
their minor child(ren). A parent who is not a petitioner in the case but is consenting to the change of
name should complete this form and sign it in front of a notary public or deputy clerk.

This form should be typed or printed in black ink. After this form is signed and notarized, you should file
it with the clerk of the circuit court in the county where the petition was filed and keep a copy for your
records. This form should be attached to the Petition for Change of Name (Minor Child(ren)), Florida
Supreme Court Approved Family Law Form 12.982(c), if obtained prior to the filing of the petition.
Otherwise, it may be filed separately after it has been completed.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

Where can I look for more information?

Before proceeding, you should read General Information for Self-Represented Litigants found at the
beginning of these forms. For further information see section 68.07, Florida Statutes, and the instructions
for Petition for Change of Name (Minor Child(ren)), Florida Supreme Court Approved Family Law Form
12.982(c), or Petition for Change of Name (Family), Florida Supreme Court Approved Family Law Form
12.982(f).

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.
Instructions for Florida Supreme Court Approved Family Law Form 12.982(d), Consent for Change of Name (Minor
Child(ren)) (02/18)
- 302 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
IN RE: THE NAME CHANGE OF

___________________,
Petitioner.

CONSENT FOR CHANGE OF NAME (MINOR CHILD(REN))

I, {full legal name} , being sworn, certify that the
following information is true:
I am the birth or legal parent of the minor child(ren) named in this case, and I give consent for the following
name changes:

Minor child(ren)’s complete present name(s): Minor child(ren)’s name(s) to be changed to:
(1) (1)
(2) (2)
(3) (3)
(4) (4)
(5) (5)
(6) (6)

Florida Supreme Court Approved Family Law Form 12.982(d), Consent for Change of Name (Minor Child(ren))
(02/18)
- 303 -
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
consent and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated: ___________________ ______________________________________________
Signature of Consenting Parent
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es): ____________________
_____________________________________________

STATE OF FLORIDA
COUNTY OF ____________________________

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

{Print, type, or stamp commissioned name of notary or
clerk.}
__Personally known
__Produced identification
Type of identification produced

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the: {choose one} _____ Petitioner _____Consenting Parent
This form was completed with the assistance of:
{name of individual} ___________________________________________________________________,
{name of business} _____________________________________________________________________,
{address} _____________________________________________________________________________,
{city} _______________, {state}_____,{zip code}_____________, {telephone number} .

Florida Supreme Court Approved Family Law Form 12.982(d), Consent for Change of Name (Minor Child(ren))
(02/18)
- 304 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT
IN AND FOR _COUNTY, FLORIDA

Case No.:
Division:
IN RE: THE NAME CHANGE OF

______,
Petitioner,

___________,
Petitioner.

FINAL JUDGMENT OF CHANGE OF NAME (MINOR CHILD(REN))

This cause came before the Court on {date} ______, for a hearing on Petition for
Change of Name under section 68.07, Florida Statutes, and it appearing to the Court that:

1. Petitioner(s) is (are) a bona fide resident(s) of County, Florida;

2. ___ Petitioners are the parents of the minor child(ren) named in the petition;

OR

___ Petitioner is the parent of the minor child(ren) named in the petition, and the other
parent has been properly notified and has either consented or failed to respond;

3.. Petitioner’s request is not for any ulterior or illegal purpose; and

4.. Granting this petition will not in any manner invade the property rights of others, whether
partnership, patent, good will, privacy, trademark, or otherwise; it is

ORDERED that the minor child(ren)’s
present name(s) be changed to
(1) (1)
(2) (2)
(3) (3)
(4) (4)
(5) (5)
(6) ______________________________________ (6)
by which they shall hereafter be known.

Florida Supreme Court Approved Family Law Form 12.982(e), Final Judgment of Change of Name (Minor Child(ren)
(02/18)
- 305 -
DONE and ORDERED ON in , Florida.

CIRCUIT JUDGE

I certify that a copy of the {name of documents(s)} ___________________________________ was
_____mailed _____ faxed and mailed _____ e-mailed _____ hand-delivered to the parties and any other
persons or entities listed below on {date} _________________________.

________________________________________
Clerk of Court, Designee, or Judicial Assistant

Petitioner(s) (or his, her, or their attorneys)
Other: _____________________________

Florida Supreme Court Approved Family Law Form 12.982(e), Final Judgment of Change of Name (Minor Child(ren)
(02/18)
- 306 -
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.982(f)
PETITION FOR CHANGE OF NAME (FAMILY)
(02/18)

When should this form be used?

This form should be used when the parents are married and the family wants the court to change its
name. This form is not to be used in connection with a dissolution of marriage, paternity, or adoption
action. If you want a change of name because of a dissolution of marriage, paternity, or adoption action
that is not yet final, the change of name should be requested as part of that case.

This form should be typed or printed in black ink and must be signed before a notary public or deputy
clerk. You should file the original with the clerk of the circuit court in the county where you live and keep
a copy for your records. The petition should only be completed for one adult. If you wish to change the
name(s) of another adult and/or any child(ren), you should complete and file with the clerk of court the
attached Adult and Child Supplemental Form(s) for Petition for Change of Name (Family) for each
additional family member. Be sure that the bottom of each page of each supplemental form is initialed.

What should I do next?
Unless you are seeking to restore a former name, each adult petitioner must have fingerprints
submitted for a state and national criminal history records check. The fingerprints must be taken in a
manner approved by the Department of Law Enforcement and must be submitted to the Department for
a state and national criminal history records check. You may not request a hearing on the petition until
the clerk of court has received the results of your criminal history records check. The clerk of court can
instruct you on the process for having the fingerprints taken and submitted, including information on law
enforcement agencies or service providers authorized to submit finger prints electronically to the
Department of Law Enforcement. The process may take several weeks and you will have to pay for the
cost of processing the fingerprints and conducting the state and national criminal history records check.
Please note that the state and national criminal records check must indicate whether you have
registered as either a sexual predator or a sexual offender and you must also indicate on this petition
whether you have ever been required to register as a sexual predator under section 775.21, Florida
Statutes, or as a sexual offender under section 943.0435, Florida Statutes.

If any of the children for whom you are requesting this change of name are not the legal children of both
adults filing this petition, you must obtain the consent of the legal parent(s). A parent not named as a
petitioner in this action may consent by submitting a Consent for Change of Name (Minor Child(ren)),
Florida Supreme Court Approved Family Law Form 12.982(d).

If the other parent does not consent to the change of name, you may still have a hearing on the petition

Instructions for Florida Supreme Court Approved Family Law Form 12.982(f), Petition for Change of Name (Family)
(02/18)
- 307 -
if you have properly notified the other parent about your petition and the hearing. If you know where he
or she lives, you must use personal service. If you absolutely do not know where he or she lives, you may
use constructive service. For more information about personal and constructive service, you should refer
to the “General Instructions for Self-Represented Litigants” found at the beginning of these forms and
the instructions to Florida Family Law Rules of Procedure Forms 12.910(a) and 12.913(b) and Florida
Supreme Court Approved Family Law Form 12.913(a). The law on constructive service is very complex
and you may wish to consult an attorney regarding constructive service.

Next, you must obtain a final hearing date for the court to consider your request. If you are seeking to
restore a former name, the final hearing on the petition MAY be held immediately after the petition is
filed. The final hearing on any other petition for a name change may be held immediately after the clerk
of court receives the results of your criminal history records check. You should ask the clerk of court,
family law intake staff, or judicial assistant about the local procedure for setting a hearing. You may be
required to attend the hearing. Included in these forms is a Final Judgment of Change of Name (Family),
Florida Supreme Court Approved Family Law Form 12.982(g), which may be used when a judge grants a
change of name for a family. If you attend the hearing, you should take the final judgment form with you.
You should complete the top part of this form, including the circuit, county, case number, division, the
name(s) of the petitioner(s) and leave the rest blank for the judge to complete. It should be typed or
printed in black ink.

If the judge grants your petition, he or she will sign this order. This officially changes your family’s name.
The clerk can provide you with certified copies of the signed order. There will be charges for the certified
copies, and the clerk can tell you the amount of the charges.

Where can I look for more information?

Before proceeding, you should read “General Information for Self-Represented Litigants” found at the
beginning of these forms. For further information, see section 68.07, Florida Statutes.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or

Instructions for Florida Supreme Court Approved Family Law Form 12.982(f), Petition for Change of Name (Family)
(02/18)
- 308 -
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving pleadings
by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of
Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of
Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the
A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

Special notes...

The heading of the form calls for the name(s) of the petitioner(s). This is (are) the parent(s) who is/are
requesting the change of their family’s name(s). The judicial circuit, case number, and division may be
obtained from the clerk of court’s office when you file the petition.

It may be helpful to compile a list of all of the people and places that will need a copy of the final judgment.
This list may include the driver’s license office, social security office, banks, schools, etc. A list will help
you know how many copies of your order you should get from the clerk of court after your hearing.

Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these
forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of
Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also
must put his or her name, address, and telephone number on the bottom of the last page of every form
he or she helps you complete.

Instructions for Florida Supreme Court Approved Family Law Form 12.982(f), Petition for Change of Name (Family)
(02/18)
- 309 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
IN RE: THE NAME CHANGE OF

,
Petitioner

,
Petitioner.

PETITION FOR CHANGE OF NAME (FAMILY)

I/We, {full legal name(s)} ____________________________________________________, being sworn,
certify that the following information is true:
There are {enter number} __ adults named in this petition. A supplemental form is attached for each
adult not set out below.

There are {enter number} __ children named in this petition. I am/We are the birth or legal parents
or guardian of the minor child(ren) named in this petition. I/We have attached a completed
supplemental form for each minor child.

Unless I am/We are seeking to restore a former name, a copy of the fingerprints of each adult person
seeking a name change in this petition has/have been taken in a manner approved by the Department of
Law Enforcement, and submitted for a state and national criminal history records check. I/We understand
that I/we cannot request a hearing on my/our Petition until the clerk of court receives the results of
the criminal history records check. I/We also understand that the state and national records check must
indicate whether I/We have registered as either a sexual predator or sexual offender.

THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER __________________________:
_____PARENT _____GUARDIAN

_____ A Supplemental Form has been attached for the other parent or petitioner.

1. My complete present name is:
.
I request that my name be changed to:
.

Florida Supreme Court Approved Family Law Form 12.982(f), Form for Petition for Change of Name (Family)
(02/18)
- 310 -
2. I live in ________________ County, Florida, at {street address}
.

3. I was born on {date} _____, in {city} , {county} ,
{state} ____, {country} .

4. My parents’ full legal names are:
a. ____________________________________and

b. ________________________________________

c. {If applicable} My parents’ maiden name(s) is/are: ______________________
and _______________________________________________.

5. I have lived in the following places since birth:

Dates (to/from) Address
/
/
/
/
/
/
/
/
(____ Please indicate here if you are continuing these facts on an attached page.)

6. Family
[Indicate all that apply]
_____ I am not married.

_____ I am married. My spouse’s full legal name is: .

_____ I do not have child(ren).

_____The name(s), age(s), and address(es) of my child(ren) are as follows (all children, including
those over 18, must be listed):
Name {last, first, middle initial} Age Address, City, State

Florida Supreme Court Approved Family Law Form 12.982(f), Form for Petition for Change of Name (Family)
(02/18)
- 311 -
 (____ Please indicate here if you are continuing these facts on an attached page.)
7. Former Names
[Indicate all that apply]
____My name has never been changed by a court.

____My name previously was changed by court order from
to on {date} ,
by {court, city, and state} .
A copy of the court order is attached.

_____My name previously was changed by marriage from
to on {date} ,
in {city, county, and state} .
A copy of the marriage certificate is attached.

_____I have never been known or called by any other name.

_____I have been known or called by the following other name(s): {list name(s) and explain where
you were known or called by such name(s)}

.

8. Occupation
My occupation is: .
I am employed at: {company and address}
.
During the past 5 years, I have had the following jobs:

Dates (to/from) Employer and employer’s address
/
/
/
/
/
/
(____ Please indicate here if you are continuing these facts on an attached page.)

9. Business
[Choose one only]
____I do not own and operate a business.

Florida Supreme Court Approved Family Law Form 12.982(f), Form for Petition for Change of Name (Family)
(02/18)
- 312 -
 ____I own and operate a business. The name of the business is: .
The street address is: .
My position with the business is: .
I have been involved with the business since: {date} .
10. Profession
[Choose one only]
____I am not in a profession.

____I am in a profession. My profession is: .
I have practiced this profession:

Dates (to/from) Place and address
___________________________________________________________________________
____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
(____ Please indicate here if you are continuing these facts on an attached page.)

11. Education
I have graduated from the following school(s):
Degree Date of
Received Graduation School

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

12. Criminal History
[Indicate all that apply]
_____ I have never been arrested for or charged with, pled guilty or nolo contendere to, or have
been found to have committed a criminal offense, regardless of adjudication.

_____ I have a criminal history. In the past I have been arrested for or charged with, pled guilty
or nolo contendere to, or been found to have committed a criminal offense, regardless of
adjudication. The details of my criminal history are:

Florida Supreme Court Approved Family Law Form 12.982(f), Form for Petition for Change of Name (Family)
(02/18)
- 313 -
 Date City/State Event (arrest, charge, plea, or adjudication)
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
________________________________________________________________________
(_____ Please indicate here if you are continuing these facts on an attached page.)

I _____ have ____have not ever been required to register as a sexual predator under section
775.21, Florida Statutes.

I _____ have ______have not ever been required to register as a sexual offender under section
943.0435, Florida Statutes.
13. Bankruptcy

[Choose one only]
____ I have never been adjudicated bankrupt.

____ I was adjudicated bankrupt on {date} , in {city} ,
{county} , {state} .
(____ Please indicate here if you have had additional bankruptcies, and explain on an attached
page.)

14. Creditor’s Judgments
[Choose one only]
____I have never had a money judgment entered against me by a creditor.

____The following creditor(s)’ money judgment(s) have been entered against me:
Date Amount Creditor Court entering judgment and case number {date} if Paid
____
____
____
____
(____ Please indicate here if these facts are continued on an attached page.)

15. Fingerprints and Criminal History Records Check
Unless I am seeking to restore a former name, a copy of my fingerprints has been taken in a
manner approved by the Department of Law Enforcement and submitted for a state and national
criminal history records check. I understand that I cannot request a hearing on my Petition until
the Clerk of Court receives the results of the criminal history records check.

16. I have no ulterior or illegal purpose for filing this petition, and granting it will not in any manner
invade the property rights of others, whether partnership, patent, goodwill, privacy, trademark,
Florida Supreme Court Approved Family Law Form 12.982(f), Form for Petition for Change of Name (Family)
(02/18)
- 314 -
 or otherwise.

17. My civil rights have never been suspended, or, if my civil rights have been suspended, they have
been fully restored.

I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
petition and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated:
Signature of Petitioner
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-Mail Address(es):____________________
_____________________________________________
STATE OF FLORIDA
COUNTY OF
Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY 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:

Florida Supreme Court Approved Family Law Form 12.982(f), Form for Petition for Change of Name (Family)
(02/18)
- 315 -
 [fill in all blanks] This form was prepared for the Petitioner(s).
This form was completed with the assistance of:
{name of individual} __________________________________________________________________,
{name of business}_____________________________________________________________________,
{address} _______________________________________________________________,
{city} ________________,{state} , {zip code}_________, {telephone number} .

Florida Supreme Court Approved Family Law Form 12.982(f), Form for Petition for Change of Name (Family)
(02/18)
- 316 -
ADULT SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME (FAMILY) Case No.: ___________

THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER______________________________:

_____ PARENT _____ GUARDIAN

1. My complete present name is: ____________

I request that my name be changed to: ______________________________________________

2. I live in ______ County, Florida, at {street address} __________________________
_____________________________________________________________________________.

3. I was born on {date} , in {city} , {county} _____________,
{state} , {country} ____________.

4. My parents’ full legal names are:
a. _________________________________ and.

b. _____________________________________.

c. {If applicable} My parents’ maiden name(s) is/are: ______________________________
and_________________________________________.

5. I have lived in the following places since birth:
Dates (to/from) Address
/
/
/
/
/
/
/
/
/
(____ Please indicate here if additional pages are attached.)

6. Family
[Indicate all that apply]
_____ I am not married.

_____I am married. My spouse’s full legal name is: .

_____ I do not have child(ren).

_____The name(s), age(s), and address(es) of my child(ren) are as follows (all children, including
those over 18, must be listed):
Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name
(Family) (02/18)
- 317 -
 Name {last, first, middle initial} Age Address, City, State

7. Former Names
[Indicate all that apply]

_____My name has never been changed by a court.

_____My name previously was changed by court order from______________________________
to on {date}
by {court, city, and state} .
A copy of the court order is attached.

_____My name previously was changed by marriage from _______________________________
to on {date}
in {city, county, and state} .
A copy of the marriage certificate is attached.

_____I have never been known or called by any other name.

_____I have been known or called by the following other name(s): {list name(s) and explain where
you were known or called by such name(s)} _____________________________________

8. Occupation
My occupation is: .

I am employed at: {company and address}
.
During the past 5 years, I have had the following jobs:
Dates (to/from) Employer and employer’s address
/
/
/
/
/
/
/
(____ Please indicate here if you are continuing these facts on an attached page.)

9. Business
[Indicate all that apply]
____ I do not own and operate a business.
Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name
(Family) (02/18)
- 318 -
PETITIONER # , continued

____ I own and operate a business. The name of the business is: .
The street address is: .

My position with the business is: ____________________________________________.

I have been involved with the business since: {date} .

10. Profession
[Indicate all that apply]
____I am not in a profession.

____I am in a profession. My profession is: .
I have practiced this profession:
Dates (to/from) Place and address
/
/
/
/
/
(___ Please indicate here if you are continuing these facts on an attached page.)

11. Education
I have graduated from the following school(s):
Degree Date of
Received Graduation School

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

12. Criminal History
[Indicate all that apply]
____I have never been arrested for or charged with, pled guilty or nolo contendere to, or been
found to have committed a criminal offense, regardless of adjudication.

____I have a criminal history. In the past I have been arrested for or charged with, pled guilty or
nolo contendere to, or been found to have committed a criminal offense, regardless of
adjudication. The details of my criminal history are:

Date City/State Event (arrest, charge, plea, or adjudication)

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

I _____ have ____have not ever been required to register as a sexual predator under section
775.21, Florida Statutes.
Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name
(Family) (02/18)
- 319 -
 I _____ have ______have not ever been required to register as a sexual offender under section
943.0435, Florida Statutes.

13. Bankruptcy
[Choose one only]
____I have never been adjudicated bankrupt.

____I was adjudicated bankrupt on {date} , in {city} ,
{county} , {state} .
(___ Please indicate here if you have had additional bankruptcies, and explain on an attached
page.)

14. Creditor’s Judgments
[Choose one only]
____I have never had a money judgment entered against me by a creditor.

____The following creditor(s)’ money judgment(s) have been entered against me:

Date Amount Creditor Court entering judgment and case number {date} if
Paid
___
___
___
___
(____ Please indicate here if these facts are continued on an attached page.)

15. Unless I am seeking to restore a former name, a copy of my fingerprints has been taken in a
manner approved by the Department of Law Enforcement and submitted for a state and
national criminal history records check. I understand that I cannot request a hearing on my
Petition until the Clerk of Court receives the results of the criminal history records check.

16. I have no ulterior or illegal purpose for filing this petition, and granting it will not in any manner
invade the property rights of others, whether partnership, patent, good will, privacy, trademark,
or otherwise.

17. My civil rights have never been suspended, or, if my civil rights have been suspended, they
have been fully restored.

Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name
(Family) (02/18)
- 320 -
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
petition and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated: ________________________ _____________________________________________
Signature of Petitioner
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-Mail Address(es):____________________
_____________________________________________

STATE OF FLORIDA
COUNTY OF

Sworn to or affirmed and signed before me on by

NOTARY PUBLIC or DEPUTY CLERK

[Print, type, or stamp commissioned name of notary or
clerk.]
Personally known
Produced identification
Type of identification produced

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the Petitioner(s).
This form was completed with the assistance of:
{name of individual} _________________________________________________________________,
{name of business}_____________________________________________________________________,
{address} _______________________________________________________________,
{city} ____________________ ,{state} ____, {zip code}______, {telephone number} .

Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name
(Family) (02/18)
- 321 -
 CHILD SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME (FAMILY)

Case No.:

THE FOLLOWING INFORMATION IS TRUE ABOUT MINOR CHILD # :

1. The minor child’s complete present name is:

I/We request that minor child’s name be changed to:

2. The minor child lives in County, Florida, at {street address}
.

3. The minor child was born on , in {city, county, state, country}
.

4. The minor child’s parents’ full legal names are:
a. ______________________________________ and

b. ______________________________________

c. {If applicable} The minor child’s parents’ maiden name(s) is/are:_________
_______________and _____________________________.

5. The minor child has lived in the following places since birth:
Dates (to/from) Address
/
/
/
/
/
/
/
(____ Please indicate here if continuing these facts on an attached page.)

6. [Choose one only]
____The minor child is not married

____The minor child is married to: {full legal name} .

[Choose one only]
____The minor child has no children.

____The minor child is the parent of the following child(ren):

Name {last, first, middle initial} Date of Birth
_______________________________________________________________________

Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change
of Name (Family) (02/18)
- 322 -
 ______________________________________________________________________
____________________________________________________________________

(______Please indicate here if you are continuing these facts on an attached page.)

7. Former Names
[Indicate all that apply]
____The minor child’s name has never been changed by court order.

____The minor child’s name previously was changed by court order from __________
to on {date} __________________ {court, city,
and state} .
A copy of the court order is attached.

____ The minor child’s name previously was changed by marriage from ______________
to on {date} __________,
in {city, county, and state} .
A copy of the marriage certificate is attached.

____The minor child has never been known or called by any other name.

____ The minor child has been known or called by the following other name(s): {list
name(s) and explain where child was known or called by such name(s)} _________
____________________________________________________________________
____________________________________________________________________.

8. The minor child is not employed in an occupation or profession, does not own and
operate a business, and has received no educational degrees. If the minor child has
a job, explain: _________________________________________________________
________________________________________________________________________

9. Criminal History
[Indicate all that apply]
____ The minor child has never been arrested for or charged with, pled guilty or nolo
contendere to, or been found to have committed a criminal offense, regardless of
adjudication.

____ The minor child has a criminal history. In the past, the minor child was arrested for
or charged with, pled guilty or nolo contendere to, or been found to have committed
a criminal offense, regardless of adjudication. The details of the criminal history are:

Date City/State Event (arrest, charge, plea, or adjudication)

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

Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change
of Name (Family) (02/18)
- 323 -
 _____ The minor child _____ has _____has not ever been required to register as a sexual
predator under section 775.21, Florida Statutes.

_____ The minor child _____has _____has not ever been required to register as a sexual
offender under section 943.0435, Florida Statutes.

10. Money Judgments
[Choose one only]
____ The minor child has never been adjudicated bankrupt, and no money judgment has
ever been entered against him or her.

____ The following money judgment(s) has been entered against him or her:

Date Amount Creditor Court entering judgment and case number {date} if Paid
____________________________________________________________________
_____________________________________________________________________
______________________________________________________________________
______________________________________________________________________
____________________________________________________________________
(_____ Please indicate here if you are continuing these facts on an attached page.)

Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change
of Name (Family) (02/18)
- 324 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
IN RE: THE NAME CHANGE OF

_ ,
Petitioner

,
Petitioner

FINAL JUDGMENT OF CHANGE OF NAME (FAMILY)

This cause came before the Court on {date} , for a hearing on Petition for Change of
Name under section 68.07, Florida Statutes, and it appearing to the Court that:

1. Petitioners are bona fide residents of County, Florida;

2. a. _____Petitioners are the parents of the minor child(ren) named in the petition;

b. _____Petitioner is the parent of the minor child(ren) named in the petition, and the other
parent has been properly notified and has either consented or failed to respond;
c. ____ Other: ;

3. Petitioner’s request is not for any ulterior or illegal purpose; and

4. Granting this petition will not in any manner invade the property rights of others, whether
partnership, patent, good will, privacy, trademark, or otherwise; it is

ORDERED that the:
present name(s) be changed to
(1) ____________________________________ (1) _____________________________
(2) ____________________________________ (2) ____________________________
(3) ____________________________________ (3) ____________________________
(4) ____________________________________ (4) ____________________________
(5) ____________________________________ (5) ___________________________
(6) ____________________________________ (6) ___________________________
by which they shall hereafter be known.

DONE AND ORDERED on ___________________in _________________________, Florida.

____________________________________________
CIRCUIT JUDGE
Florida Supreme Court Approved Family Law Form 12.982(g), Final Judgment of Change of Name (Family) (02/18)
- 325 -
I certify that a copy of the {name of document(s)} __________________________________
was ( ) mailed ( ) faxed and mailed ( ) e-mailed ( ) hand-delivered to the parties and any other
persons or entities listed below on {date} ________________________.

_______________________________________
By: Clerk of Court, Designee, or Judicial Assistant

Petitioner(s) (or his/her/their attorneys)
Other:__________________________

Florida Supreme Court Approved Family Law Form 12.982(g), Final Judgment of Change of Name (Family) (02/18)
- 326 -
 IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
IN RE: The Marriage of:

,
Petitioner,

and

,
Respondent.

FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH MINOR
CHILD(REN) (UNCONTESTED)
This cause came before this Court for a hearing on a Petition for Dissolution of Marriage. The Court,
having reviewed the file and heard the testimony, makes these findings of fact and reaches these
conclusions of law:

FINDINGS:

1. The Court has jurisdiction over the subject matter and the parties.

2. At least one party has been a resident of the State of Florida for more than 6 months
immediately before filing the Petition for Dissolution of Marriage.

3. The marriage between the parties is irretrievably broken.

4. The names of the parties’ children are as follows: ______________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

5. The parties have voluntarily entered into a Marital Settlement Agreement and Parenting Plan,
and each party has filed the required Family Law Financial Affidavit. The Parenting Plan is in the
best interests of the children.

6. The Court finds that the parties have the present ability to pay support as agreed to in the
marital settlement agreement.

7. {If applicable} _____ Petitioner _____Respondent requests that his/her former name of

Florida Supreme Court Approved Family Law Form 12.990(b)(1), Final Judgment of Dissolution of Marriage with
Minor Child(ren) (Uncontested) (02/18)
- 327 -
 {full legal name} ____________________________________________________be restored.

ORDERED AND ADJUDGED:

A. The marriage between the parties is dissolved and the parties are restored to the status of being
single.

B. The Marital Settlement Agreement, attached as Exhibit A, is approved by the court and
incorporated herein, but not merged. The parties shall obey all of its provisions.

C. The Parenting Plan, attached as Exhibit B, is approved by the court and incorporated herein. The
parties shall obey all of its provisions.

D. _____ Petitioner’s _____Respondent’s former name of
{full legal name} ___________________________________________________ is restored.

E. The court reserves jurisdiction to modify and enforce this final judgment.

DONE AND ORDERED in ___________________________, Florida, on .

CIRCUIT JUDGE

I certify that a copy of this Final Judgment of Dissolution of Marriage was _____ mailed _____faxed and
mailed ______ e-mailed _____ hand-delivered to the parties and any entities listed below on
{date} ________________________________.

by__________________________________
{Clerk of court or designee}

Petitioner (or his or her attorney)
Respondent (or his or her attorney)
Other:

Florida Supreme Court Approved Family Law Form 12.990(b)(1), Final Judgment of Dissolution of Marriage with
Minor Child(ren) (Uncontested) (02/18)
- 328 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
IN RE: The Marriage of:

,
Petitioner,

and

,
Respondent.

FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH
PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN)
(UNCONTESTED)

This cause came before this Court for a hearing on a Petition for Dissolution of Marriage. The Court,
having reviewed the file and heard the testimony, makes these findings of fact and reaches these
conclusions of law:

FINDINGS:

1. The Court has jurisdiction over the subject matter and the parties.
2. At least one party has been a resident of the State of Florida for more than 6 months
immediately before filing the Petition for Dissolution of Marriage.
3. The parties have no minor or dependent children in common, no children born to either spouse
during the marriage remain minor or dependent and neither spouse is pregnant.
4. The marriage between the parties is irretrievably broken. .
5. The parties have voluntarily entered into a Marital Settlement Agreement, and each has filed
the required Family Law Financial Affidavit.
6. {If applicable} _____ Petitioner _____ Respondent requests that his/her former name of {full
legal name} _______________________ be restored.

ORDERED AND ADJUDGED:

A. The marriage between the parties is dissolved and the parties are restored to the status of being

Florida Supreme Court Approved Family Law Form 12.990(b)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (Uncontested) (02/18)
- 329 -
 single.

B. The Marital Settlement Agreement, attached as Exhibit A, is approved by the court and
incorporated herein, but not merged. The parties shall obey all of its provisions.

C. _____Petitioner’s _____ Respondent’s former name of
{full legal name}__________________________________________________is restored.

D. The court reserves jurisdiction to modify and enforce this final judgment.

DONE AND ORDERED in ____________________________, Florida on __.

CIRCUIT JUDGE

I certify that a copy of this Final Judgment of Dissolution of Marriage was _____ mailed _____ faxed and
mailed _____ e-mailed _____ hand-delivered to the parties listed below on {date} _________________.

by__________________________________
{Clerk of court or designee}

Petitioner (or his or her attorney)
Respondent (or his or her attorney)
Other:

Florida Supreme Court Approved Family Law Form 12.990(b)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (Uncontested) (02/18)
- 330 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:

IN RE: The Marriage of:

,
Petitioner,

and

,
Respondent.

FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH
NO PROPERTY OR DEPENDENT OR MINOR CHILD(REN) (UNCONTESTED)

This cause came before this Court for a hearing on a Petition for Dissolution of Marriage. The Court,
having reviewed the file and heard the testimony, makes these findings of fact and reaches these
conclusions of law:

FINDINGS:

1. The Court has jurisdiction over the subject matter and the parties.
2. At least one party has been a resident of the State of Florida for more than 6 months
immediately before filing the Petition for Dissolution of Marriage.
3. The parties have no minor or dependent children in common, no children born to either spouse
during the marriage remain minor or dependent, and neither spouse is pregnant.
4. The marriage between the parties is irretrievably broken.
5. There are no marital assets or marital liabilities for the court to divide.
6. {If applicable} _____Petitioner _____ Respondent requests that his/her former name of
{full legal name} _______________________________________________be restored.

ORDERED AND ADJUDGED:

A. The marriage between the parties is dissolved and the parties are restored to the status of being
single.

Florida Supreme Court Approved Family Law Form 12.990(b)(3), Final Judgment of Dissolution of Marriage with No
Property or Minor Child(ren) (Uncontested) (02/18)
- 331 -
 B. _____Petitioner’s _____Respondent’s former name of
{full legal name} ____________________________________________________ is restored.

C. The court reserves jurisdiction to modify and enforce this final judgment.

DONE AND ORDERED in_______________________, Florida, on .

CIRCUIT JUDGE

I certify that a copy of this Final Judgment of Dissolution of Marriage was _____ mailed _____ faxed and
mailed _____ e-mailed _____ hand-delivered to the parties listed below on {date} _________________.

by__________________________________
{Clerk of court or designee}

Petitioner (or his or her attorney)
Respondent (or his or her attorney)
Other:

Florida Supreme Court Approved Family Law Form 12.990(b)(3), Final Judgment of Dissolution of Marriage with No
Property or Minor Child(ren) (Uncontested) (02/18)
- 332 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT
IN AND FOR COUNTY, FLORIDA

Case No.:______________________________
Division: ______________________________

In Re: The Marriage of:

,
Petitioner,

and

,
Respondent.

FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE
WITH DEPENDENT OR MINOR CHILD(REN)
This cause came before this Court for a trial on a Petition for Dissolution of Marriage. The Court, having
reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of
law:

FINDINGS:

1. The Court has jurisdiction over the subject matter and the parties.

2. At least one party has been a resident of the State of Florida for more than 6 months
immediately before filing the Petition for Dissolution of Marriage.

3. The marriage between the parties is irretrievably broken.

ORDERED AND ADJUDGED:

SECTION I: DISSOLUTION AND RESTORATION

A. The marriage between the parties is dissolved and the parties are restored to the status of being
single.

Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
- 333 -
 B. Former Name. {If applicable}______Petitioner’s _______ Respondent’s former name of
{full legal name} ______________________________________ is restored.

SECTION II. MARITAL ASSETS AND LIABILITIES
A. Date of Valuation of Property. The assets and liabilities listed below are divided as indicated.
The date of valuation of these assets and liabilities is, unless otherwise indicated:
1. _____ date of filing petition for dissolution of marriage.
2. _____ date of separation.
3. _____ date of final hearing .
4. _____ other: {specify date}_____________________________________________

B. Division of Assets.
1. The assets listed below are non-marital assets. Each party shall keep, as his or her
own, the assets found to be non-marital, and the other party shall have no further rights
or responsibilities regarding these assets.

ASSETS: DESCRIPTION OF ITEM(S) Current Fair Petitioner’s Respondent’s
Please describe each item as clearly as possible. Market Non-marital Non-marital
You do not need to list account numbers. Value Property Property
$ $ $

Total Non-marital Assets $ $ $

2. The assets listed below are marital assets. Each party shall keep, as his or her own, the
assets awarded in this section, and the other party shall have no further rights or
responsibilities regarding these assets. Any personal item(s) not listed below are
awarded to the party currently in possession or control of the item(s).

ASSETS: DESCRIPTION OF ITEM(S) Current Fair
Please describe each item as clearly as possible. Market Petitioner Respondent
You do not need to list account numbers. Value Shall Receive Shall Receive
Cash (on hand or in banks/credit unions) $ $ $

Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
- 334 -
 ASSETS: DESCRIPTION OF ITEM(S) Current Fair
Please describe each item as clearly as possible. Market Petitioner Respondent
You do not need to list account numbers. Value Shall Receive Shall Receive
Stocks/bonds ____________ _____________ _____________

Notes
Business interests

Real estate: (Home)

Automobiles

Boats
Furniture & furnishings

Jewelry

Life Insurance (cash surrender value)
Retirement Plans (Profit sharing, Pension, IRA, 401(k)(s),
etc)

Other assets

Total Marital Assets $ $ $

Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
- 335 -
 C. Division of Liabilities/Debts.
1. The liabilities listed below are nonmarital liabilities and, therefore, are owed as
indicated. Each party shall owe, as his or her own, the liabilities found to be nonmarital,
and the other party shall have no responsibilities regarding these debts.

Petitioner’s Respondent’s
LIABILITIES: DESCRIPTION OF DEBT(S) Current Non- Non-
Please describe each item as clearly as possible. Amount marital marital
You do not need to list account numbers) Owed Liability Liability
$ $ $

Total Non-marital Liabilities $ $ $

2. The liabilities listed below are marital liabilities and are divided as indicated. Each party shall
hold the other party harmless and pay, as his or her own, the marital liabilities awarded below.

LIABILITIES: DESCRIPTION OF DEBTS
Please describe each item as clearly as possible. Current Petitioner Respondent
You do not need to list account numbers. Amount Owed Shall Pay Shall Pay
Mortgages on real estate: (Home) $ $ $
(Other)
Charge/Credit card accounts
-------------------- ----------------- -----------------

Auto loan
Auto loan
Bank, Credit Union loans

Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
- 336 -
 LIABILITIES: DESCRIPTION OF DEBTS
Please describe each item as clearly as possible. Current Petitioner Respondent
You do not need to list account numbers. Amount Owed Shall Pay Shall Pay
Other

Total Marital Liabilities
$ $ $

D. Contingent assets and liabilities will be divided as follows: _______________________________
________________________________________________________________________________
________________________________________________________________________________.

E. The distribution of assets and liabilities in this final judgment is equitable; if each party does not
receive approximately one-half, the distribution is based on the following facts and reasoning:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

F. Beneficiary Designation (By completing this section, the beneficiary designations continue
after Entry of Final Judgment of Dissolution of Marriage.)

The designation providing for the payment or transfer at death of an interest in the assets
described below to or for the benefit of the deceased party’s former spouse is NOT VOID as of
the date of entry of the Final Judgment of Dissolution of Marriage.

The Final Judgment of Dissolution of Marriage shall provide that the designations set forth
below remain in full force and effect.

_____1. The _____Petitioner _____ Respondent shall acquire or maintain the following assets for
the benefit of the other spouse or child(ren), to be paid upon his/her death outright or in trust.
This provision only applies if other assets fulfilling such requirement for the benefit of the other
spouse or child(ren) do not exist upon his/her death and unless precluded by statute. {Describe the
assets with specificity}: ___________________________________________________________
________________________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
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 ______________________________________________________________________________
______________________________________________________________________________.

_____2. The _____ Petitioner _____ Respondent shall not unilaterally terminate or modify the
ownership of the following assets, or their disposition upon his/her death. {Describe the assets with
specificity}: _________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________.

SECTION III. EXCLUSIVE USE AND POSSESSION OF HOME
{Indicate all that apply}
A. The_____ Petitioner _____ Respondent, as a condition of support, shall have exclusive use and
possession of the dwelling located at the following
address:________________________________________________________________________
_______________________________________________________________________________
until: {date or event} ______________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________.

B. The_____ Petitioner _____ Respondent may make visits to the premises described in the
paragraph above for the purpose of obtaining any items awarded in this Final Judgment. These visits
shall occur after notice to the person granted exclusive use and possession of the dwelling and at
the earliest convenience of both parties or as ordered in paragraph 4 below.

C. _____Upon the termination of the right of exclusive use and possession, the dwelling shall be sold
and the net proceeds divided __% to Petitioner and __% to Respondent, with the following
credits and/or setoffs being allowed:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________.

D. _____Other: __________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________.

Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
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SECTION IV. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING WITH
DEPENDENT OR MINOR CHILD(REN)
A. Jurisdiction. The Court has jurisdiction to determine parental responsibility, to establish or
adopt a Parenting Plan, and a time-sharing schedule with regard to the minor child(ren) listed
in paragraph 2 below.

B. The parties’ dependent or minor child(ren) is (are):
Name Birth date
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

C. Parenting Plan. The parties shall comply with the Parenting Plan which is attached and
incorporated herein as Exhibit _______.

SECTION V. ALIMONY
A. ______ The Court denies the request(s) for alimony;

OR
B. ______ The Court finds that _____ Petitioner _____ Respondent, (hereinafter Obligee), has an
actual need for, and that _____ Petitioner _____ Respondent, (hereinafter Obligor), has the present
ability to pay, alimony as follows: {Indicate all that apply}

1. _____Permanent Periodic.

a. The Court finds that no other form of alimony is fair and reasonable under the
circumstances of the parties.

b. As a marriage of: {Choose only one}

_______ Long Duration (17 years or greater) alimony is appropriate upon consideration
of all relevant factors;

_______Moderate Duration (greater than 7 years but less than 17) alimony is
appropriate based upon clear and convincing evidence after consideration of all relevant
factors; or

_______Short Duration (less than 7 years) alimony is appropriate based upon the
following exceptional circumstances: _________________________________________

Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
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 ________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________.

c. Obligor shall pay permanent 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, or _____ other {explain}
_____________________________________________________________________
______________________________________________________________________
beginning {date} ___________________. This alimony shall continue until modified by
court order, death of either party, or remarriage of Obligee, whichever occurs first. The
alimony may be modified or terminated based upon either a substantial change in
circumstances, or the existence of a supportive relationship in accordance with section
61.14, Florida Statutes.

2. _____ Bridge-the-Gap. Obligor shall pay bridge-the-gap 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, or _____ other {explain}
________________ beginning {date}_____________________and continuing until:
{date}______________________{a period not to exceed two (2) years}; death of either
party; or remarriage of the Obligee, whichever occurs first.

3. ______Rehabilitative. Obligor shall pay 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, or _____ other {explain}
______________________beginning {date}___________________. This rehabilitative
alimony shall continue until: modified by court order; the death of either party; or until
{date/event} _____________________________________________________________,
whichever occurs first. The rehabilitative plan presented demonstrated the following:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

4. _____Durational. Obligor shall pay durational 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, or _____ other {explain}
_________________beginning {date}_____________________and terminating on
{date}______________________, the death of either party, remarriage of the Obligee, or
until modified by court order in accordance with section 61.08(7), Florida Statutes,
whichever occurs first.

5. _____Lump Sum. Obligor shall pay lump sum alimony to Obligee in the amount of
$______________, which shall be paid as follows: ______________________________
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
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 beginning {date}____________________and terminating on {date}_________________,
the death of either party, remarriage of the Obligee, or until modified by court order,
whichever occurs first.

6._____Retroactive. Obligor shall pay retroactive alimony in the amount of
$ ___ for the period of {date}_______________, through {date}
__________________, which shall be paid pursuant to paragraph D. below.

C. Reasons for _____ Awarding _____ Denying Alimony. The Court has considered all of the
following in awarding/denying alimony:
1. The standard of living established during the marriage;
2. The duration of the marriage;
3. The age and the physical and emotional condition of each party;
4. The financial resources of each party, including the nonmarital and marital assets and
liabilities distributed to each;
5. The earning capacities, educational levels, vocational skills, and employability of the
parties and, when applicable, the time necessary for either party to acquire sufficient
education or training to enable such party to find appropriate employment;
6. The contribution of each party to the marriage, including, but not limited to, services
rendered in homemaking, child care, education, and career building of the other party;
7. The responsibilities each party will have with regard to any minor or dependent children
they have in common;
8. The tax treatment and consequences to both parties of any alimony award, including
the designation of all or a portion of the payment as a nontaxable, nondeductible
payment;
9. All sources of income available to either party, including income available to either party
through investments of any asset held by that party and
10. Any other factor necessary to do equity and justice between the parties: {explain}
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______ Please indicate here if additional pages are attached.

D. Retroactive Alimony and/or Arrearages.

1. ____There is no alimony arrearage at the time of this Final Judgment.

OR
2. _____The _____ Petitioner _____ Respondent shall pay to the other spouse the sum of:
$ ___ for retroactive alimony, as of {date}_______________________;
$ ___ for previously ordered unpaid alimony, as of {date} ________________.
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
- 341 -
 The total of $ ____________ 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, or _____ other {explain} _________________________________________beginning
{date}____________________________, until paid in full including statutory interest.

E. ____ Life Insurance (to secure payment of support). To secure the alimony obligations set forth
in this judgment, Obligor shall maintain life insurance on his/her life naming Obligee as the sole
irrevocable beneficiary, so long as reasonably available. This insurance shall be in the amount of at
least $___________ and shall remain in effect until the obligation for alimony terminates.

F. ____Other provisions relating to alimony, including any tax treatment and consequences:

1. The award of alimony _____ does not _____ does leave the Obligor with significantly
less net income than the net income of the recipient/Obligee. If the award does leave the
Obligor with significantly less net income than that of the Obligee, the Court finds the
following exceptional circumstances: _______________________________
_________________________________________________________________
_________________________________________________________________
__________________________________________________________________.

2. Other_____________________________________________________________
__________________________________________________________________
__________________________________________________________________.

SECTION VI. CHILD SUPPORT

A. _____The Court finds that there is a need for child support and that the _____ Petitioner
_____ Respondent (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 _____ Petitioner _____ Respondent are correct;

OR
_____The Court makes the following findings:
Petitioner’s net monthly income is $ , (Child Support Guidelines ____%).
Respondent’s net monthly income is $ , (Child Support Guidelines ____%).
Monthly child care costs are $ .
Monthly health/dental insurance costs are $ .

B. Amount.
Child support established at the rate of $_________per month for the _______children {total
number of parties’ minor or dependent children} shall be paid commencing ____________________
{month, day, year} and terminating ________________________________ {month, day, year}. Child
support shall be paid in the amount of $________ per _______________ {week, month, other}
consistent with the Obligor’s current payroll cycle.
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
- 342 -
 Upon the termination of the obligation of child support for one of the parties’ children, child support
in the amount of $__________for the remaining __________children {total number of remaining
children} shall be paid commencing _______________________________ {month, day, year} and
terminating_____________________________ {month, day, year}. This child support shall be paid
in the amount of $________per __________ {week, month, other} consistent with the Obligor’s
current payroll cycle.

{Insert schedule for the child support obligation, including the amount, and commencement and
termination dates, for the remaining minor or dependent children, which shall be payable as the
obligation for each child ceases. Please indicate whether the schedule _____appears below or
_____ is attached as part of this form.}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

The Obligor shall pay child support until all of the minor or dependent children: reach the age of 18;
become emancipated, marry, join the armed services, die, or become self-supporting; or until
further order of the court or agreement of the parties. The child support obligation shall continue
beyond the age of 18 and until high school graduation for any child who is dependent in fact,
between the ages of 18 and 19, and is still in high school, performing in good faith with a reasonable
expectation of graduation before the age of 19.

If the child support ordered deviates from the guidelines by more than 5%, the factual findings
which support that deviation are: ______________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.

C. Retroactive Child Support and/or Arrearages.
1. _______There is no retroactive child support or child support arrearage at the time of this
Final Judgment.

OR

2. ____There is either retroactive child support or child support arrearage.

______ Petitioner ____ Respondent shall pay to the other spouse child support in the amount
of:
$ for retroactive child support, as of {date} ______________;
$ for previously ordered unpaid child support, as of {date} ______.

Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
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 The total of $ _____________ in child support 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 a month, or _____ other {explain} ____________________________________
beginning {date}_________________________, until paid in full including statutory interest.

D. Insurance.

1. _____Health/Dental Insurance. _____ Petitioner _____ Respondent shall be required to
maintain _____health and/or _____ dental insurance for the parties’ minor child(ren), so long as
reasonable in cost and accessible to the child(ren). The party providing insurance shall be
required to convey insurance cards demonstrating said coverage to the other party;
OR

_____ health and/or _____ dental insurance is not reasonable in cost or accessible to the
child(ren) at this time.

2. _____Reasonable and necessary uninsured medical/dental/prescription drug costs for the
minor child(ren) shall be assessed as follows:
_____ Shared equally by both spouses.
_____ Prorated according to the child support guideline percentages.
_____ 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.

E.______Life Insurance (to secure payment of support). To secure the child support obligations in
this judgment, _____ Petitioner _____Respondent _____ Each party shall maintain life insurance, in
an amount of at least $______________, on his/her life her life naming minor child(ren) as the
beneficiary(ies) OR naming _____ Petitioner _____Respondent, or _____other {name}
____________________________________ as Trustee for the minor child(ren), so long as
reasonably available. The obligation to maintain the life insurance shall continue until the youngest
child turns 18, becomes emancipated, marries, joins the armed services, dies, or becomes self-
supporting.

F. IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall be
as follows: ________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.
Each party shall execute any and all IRS forms necessary to effectuate the provisions of this
paragraph.

G. Other provisions relating to child support: ___________________________________________
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
- 344 -
 __________________________________________________________________________________
_________________________________________________________________________________.

SECTION VII. METHOD OF PAYMENT

Obligor shall pay court-ordered alimony and child support, including any retroactive support or
arrearages as follows:

A. Place of Payment.

1. ____Obligor shall pay court-ordered support directly to either the State Disbursement Unit or
the central depository, as required by statute, along with any fee required by statute.

2. _____Both parties have requested and the court finds that it is in the best interests of the
child(ren) that support payments need not be directed through either the State Disbursement
Unit or the central depository at this time; however, either party may subsequently apply,
pursuant to section 61.13(1)(d)3, Florida Statutes, to require payment through either the State
Disbursement Unit or the central depository.

B. Income Deduction.

1. _____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 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.

2. ______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 Title IV-D agency, the clerk of court, and the Obligee of any change in Payor
and/or health insurance

OR

Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
- 345 -
 _____there is a signed written agreement providing an alternative arrangement between the
Obligor and the Obligee and, at the option of the IV-D agency, by the IV-D agency in IV-D cases in
which there is an assignment of support rights to the state, reviewed and entered in the record by
the court.

C. 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.

D. Other provisions relating to method of payment.
________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.

SECTION VIII. ATTORNEY’S FEES, COSTS, AND SUIT MONEY
A. _____ Petitioner’s _____Respondent’s request(s) for attorney’s fees, costs, and suit money is
(are) denied because: ____________________________________________________________
________________________________________________________________________________.

OR

B. _____The Court finds there is a need for and an ability to pay attorney’s fees, costs, and suit
money. _______ Petitioner _______ Respondent is hereby ordered to pay to the other spouse
$______________ in attorney’s fees, and $ ___________ in costs. The Court further finds that the
attorney’s fees awarded are based on the reasonable rate of $ __________ per hour and _________
reasonable hours. Other provisions relating to attorney’s fees, costs, and suit money are as follows:
________________________________________________________________________________
_________________________________________________________________________________.

SECTION IX. OTHER PROVISIONS
Other Provisions.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
The Court reserves jurisdiction to modify and enforce this Final Judgment.

DONE AND ORDERED in ______, Florida, on ___________________________.

_______________________________________
CIRCUIT JUDGE

Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
- 346 -
I certify that a copy of this Final Judgment of Dissolution was _____ mailed _____ faxed and mailed
_____e-mailed _____ hand delivered to the parties listed below on {date} _____________________.

by___________________________________
{Clerk of court or designee}

_______ Petitioner (or his/her attorney)
_______ Respondent (or his/her attorney)
_______ Central Depository
_______ State Disbursement Unit
_______ Other __________________________________

Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (02/18)
- 347 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
In Re: The Marriage of:

____________________________
Petitioner,

and

,
Respondent.

FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH
PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN)
This cause came before this Court for a trial on a Petition for Dissolution of Marriage. The Court, having
reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of
law:

FINDINGS:

1. The Court has jurisdiction over the subject matter and the parties.

2. At least one party has been a resident of the State of Florida for more than 6 months immediately
before filing the Petition for Dissolution of Marriage.

3. The parties have no minor or dependent children in common, no children born to either spouse
during the marriage remain minor or dependent, and neither spouse is pregnant.

4. The marriage between the parties is irretrievably broken.

ORDERED AND ADJUDGED:

SECTION I. DISSOLUTION AND RESTORATION

A. The marriage between the parties is dissolved and the parties are restored to the status of being
single.

Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (02/18)
- 348 -
 B. Former Name. {If applicable} _____ Petitioner’s ______ Respondent’s former name of
{full legal name} _____________________________________________is restored.

SECTION II. MARITAL ASSETS AND LIABILITIES
A. Date of Valuation of Property. The assets and liabilities listed below are divided as
indicated. The date of valuation of these assets and liabilities is, unless otherwise indicated:
1._____ date of filing petition for dissolution of marriage .
2._____ date of separation .
3. _____ date of final hearing .
4. _____ other: {specify date}____________________________________________.

B. Division of Assets.
1. The assets listed below are nonmarital assets. Each party shall keep, as his or her own, the
assets found to be nonmarital, and the other party shall have no further rights or responsibilities
regarding these assets.

ASSETS: DESCRIPTION OF ITEM(S) Current Fair Petitioner’s Respondent’s
Please describe each item as clearly as possible. Market Non-marital Non-marital
You do not need to list account numbers. Value Property Property
$ $ $

Total Nonmarital Assets $ $ $

2. The assets listed below are marital assets. Each party shall keep, as his or her own, the assets
awarded in this section, and the other party shall have no further rights or responsibilities
regarding these assets. Any personal item(s) not listed below are awarded to the party currently
in possession or control of the item(s).

Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (02/18)
- 349 -
 ASSETS: DESCRIPTION OF ITEM(S) Current Petitioner Respondent
Please describe each item as clearly as possible. Fair Market Shall Shall
You do not need to list account numbers. Value Receive Receive
Cash (on hand or in banks/credit unions) $ $ $

Stocks/bonds _____________ ___________ __________

Notes
Business interests

Real estate: (Home)

Automobiles

Boats
Furniture & furnishings

Jewelry

Life insurance (cash surrender value)
Retirement Plans (Profit sharing, Pension, IRA, 401(k)s,
etc.)

Other assets

Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (02/18)
- 350 -
 Total Marital Assets $ $ $

C. Division of Liabilities/Debts.
1. The liabilities listed below are nonmarital liabilities and, therefore, are owed as indicated.
Each party shall owe, as his or her own, the liabilities found to be nonmarital, and the other party
shall have no responsibilities regarding these debts.

Petitioner’s Respondent’s
LIABILITIES: DESCRIPTION OF DEBT(S) Current Non- Non-
Please describe each item as clearly as possible. Amount marital marital
You do not need to list account numbers) Owed Liability Liability
$ $ $

Total Nonmarital Liabilities $ $ $

2. The liabilities listed below are marital liabilities and are divided as indicated. Each party shall
hold the other party harmless and pay, as his or her own, the marital liabilities awarded below.

Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (02/18)
- 351 -
 LIABILITIES: DESCRIPTION OF DEBT(S) Current
Please describe each item as clearly as possible. Amount Petitioner Respondent
You do not need to list account numbers. Owed Shall Pay Shall Pay
Mortgages on real estate: (Home) $ $ $
(Other)
_____________ __________ ___________
Charge/credit card accounts

Auto loan
Auto loan
Bank/Credit Union loans

Other

Total Marital Liabilities $ $ $

D. Contingent assets and liabilities will be divided as follows:________________________________
__________________________________________________________________________________

E. The distribution of assets and liabilities in this final judgment is equitable; if each party does not
receive approximately one-half, the distribution is based on the following facts and reasoning:

.

Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (02/18)
- 352 -
 F. Beneficiary Designation (By completing this section, the beneficiary designations continue after
Entry of Final Judgment of Dissolution of Marriage.)

The designation providing for the payment or transfer at death of an interest in the assets described
below to or for the benefit of the deceased party’s former spouse is NOT VOID as of the date of
entry of the Final Judgment of Dissolution of Marriage.

The Final Judgment of Dissolution of Marriage shall provide that the designations set forth below
remain in full force and effect.

_____ 1. The _____ Petitioner _____Respondent shall acquire or maintain the following assets for
the benefit of the other spouse or child(ren) to be paid upon his/her death outright or in trust. This
provision only applies if other assets fulfilling such requirement for the benefit of the other spouse
or child(ren) do not exist upon his/her death and unless precluded by statute. {Describe the assets
with specificity}__________________________________________________________________
_________________________________________________________________________________
________________________________________________________________________________.

_____2. The _____ Petitioner _____ Respondent shall not unilaterally terminate or modify the
ownership of the following assets, or their disposition upon his/her death. {Describe the assets
with specificity} _________________________________________________________________
_______________________________________________________________________________
________________________________________________________________________________.

SECTION III. EXCLUSIVE USE AND POSSESSION OF HOME
{Indicate all that apply}
A. _____ The _____ Petitioner _____ Respondent, as a condition of support, shall have exclusive use
and possession of the dwelling located at the following address:
__________________________________________________________________________
until {date or event}____________________________________________________________
______________________________________________________________________________.

B. _____The_____ Petitioner ______Respondent may make visits to the premises described in the
paragraph above for the purpose of obtaining any items awarded in this Final Judgment. These
visits shall occur after notice to the person granted exclusive use and possession of the dwelling
and at the earliest convenience of both parties or as ordered in paragraph 4 below.

C. _____Upon the termination of the right of exclusive use and possession, the dwelling shall be
sold and the net proceeds divided % to Petitioner and % to Respondent, with the following
credits and/or setoffs being allowed:_______________________________________________

Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (02/18)
- 353 -
 ______________________________________________________________________________
______________________________________________________________________________.

D. _____Other: __________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

SECTION IV. ALIMONY
A. _____ The Court denies the request(s) for alimony
OR
B. _____ The Court finds that _____Petitioner _____Respondent, (hereinafter Obligee), has an actual
need for, and that _____ Petitioner _____ Respondent (hereinafter Obligor) has the present ability to
pay, alimony as follows:
{Indicate all that apply}

1. _____ Permanent Periodic.
a. The Court finds that no other form of alimony is fair and reasonable under the
circumstances of the parties.

b. As a marriage of: {Choose only one}

1. _____Long Duration (17 years or greater) alimony is appropriate upon
consideration of all relevant factors;

2. _____Moderate Duration (greater than 7 years but less than 17) alimony is
appropriate based upon clear and convincing evidence after consideration
of all relevant factors; or

3. _____Short Duration (less than 7 years) alimony is appropriate based
upon the following exceptional circumstances:
____________________________________________________________
____________________________________________________________.

c. Obligor shall pay permanent 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, or ___ other {explain}:_________________
beginning {date} ___________. This alimony shall continue until
modified by court order, the death of either party, or remarriage of Obligee,
whichever occurs first. The alimony may be modified or terminated based upon either a
substantial change in circumstances or the existence of a supportive relationship in
accordance with section 61.14, Florida Statutes.

Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (02/18)
- 354 -
 2. _____Bridge-the-Gap. Obligor shall pay bridge-the-gap 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 or _____ other {explain} _________________
beginning {date}__________________and continuing until {date}______________________
{a period not to exceed two years}, the death of either party, or remarriage of the Obligee,
whichever occurs first.

3. ______Rehabilitative. Obligor shall pay 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, or _____other {explain} ________________________
beginning {date} ______________. This rehabilitative alimony shall continue until modified
by court order, the death of either party or until {date/event} _______________________,
whichever occurs first. The rehabilitative plan presented demonstrated the following:
___________________________________________________________________________
___________________________________________________________________________.

4. _____Durational. Obligor shall pay durational 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 or _____ {explain}_______________________________
beginning {date}____________ and terminating on {date}______________________, the
death of either party, remarriage of Obligee, or until modified by court order in accordance
with section 61.08(7), Florida Statutes, whichever occurs first.

5. _____ Lump Sum. Obligor shall pay lump sum alimony to Obligee in the amount of
$_____________, which shall be paid as follows:______________________________
____________________________________________________________________.

6. _____Retroactive. Obligor shall pay retroactive alimony in the amount of $ ____________
for the period of {date}___________________, through {date} ,
which shall be paid pursuant to paragraph 4 below.

C. Reasons for _____ Awarding _____ Denying Alimony. The Court has considered all of the
following in awarding/denying alimony:
1. The standard of living established during the marriage;
2. The duration of the marriage;
3. The age and the physical and emotional condition of each party;
4. The financial resources of each party, including, the nonmarital and the marital assets and
liabilities distributed to each;
5. The earning capacities, educational levels, vocational skills, and employability of the parties
and, when applicable, the time necessary for either party to acquire sufficient education or
training to enable such party to find appropriate employment;
6. The contribution of each party to the marriage, including, but not limited to, services rendered
in homemaking, child care, education, and career building of the other party;

Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (02/18)
- 355 -
 7. The tax treatment and consequences to both parties of any alimony award, including the
designation of all or a portion of the payment as a nontaxable, nondeductible payment;
8. All sources of income available to either party, including income available to either party
through investments of any asset held by the party; and
9. Any other factor necessary to do equity and justice between the parties: {explain} ________

(______ Please indicate here if additional pages are attached.)

D. Retroactive Alimony and/or Arrearages.

1. ____ There is no alimony arrearage at the time of this Final Judgment.

OR
2. ____ The ____ Petitioner ____ Respondent shall pay to the other party the sum of:
$ for retroactive alimony, as of {date} ;
$ for previously ordered unpaid alimony, as of {date} _____.
The total of $ 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 or _____ other explain} ___________________________________
________________________________________________________________________
beginning {date} _________, until paid in full including statutory interest.

E. _____Life Insurance (to secure payment of support). To secure the alimony obligations set forth
in this judgment, Obligor shall maintain life insurance coverage on his/her life naming Obligee as the
sole irrevocable beneficiary, so long as reasonably available. This insurance shall be in the amount of
at least $ ________ and shall remain in effect until the obligation for alimony terminates.

F. _____Other provisions relating to alimony, including any tax treatment and consequences:

1. The award of alimony _____does not _____does leave the Obligor with significantly less net
income than the net income of the recipient/Obligee. If yes, the court finds the
following exceptional circumstances:_______________________________________
______________________________________________________________________
______________________________________________________________________.

2. Other:__________________________________________________________________
____________________________________________________________________.

Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (02/18)
- 356 -
SECTION V. METHOD OF PAYMENT
Obligor shall pay court-ordered alimony, including any arrearages, as follows:

A. Place of Payment.

1._____ Obligor shall pay court-ordered support directly to either the State Disbursement Unit
or the central depository, as required by statute, along with any fee required by statute.

2. _____ Both parties have requested and the court finds that support payments need not be
directed through either the State Disbursement Unit or the central depository at this time at this
time; however, either party may subsequently apply, pursuant to section 61.13(1)(d)3, Florida
Statutes, to require payments through either the State Disbursement Unit or the central
depository.

B. Income Deduction.

1. _____ 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 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.

2. _____ 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 or dependent 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 Title IV-D agency, the clerk of court,
and the Obligee of any change in Payor and/or health insurance OR _____ there is a signed
written agreement providing an alternative arrangement between the Obligor and the
Obligee and, at the option of the IV-D agency, by the IV-D agency in IV-D cases in which there
is an assignment of support rights to the state, reviewed and entered in the record by the
court.

C. 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.

Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (02/18)
- 357 -
 D. Other provisions relating to method of payment.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

SECTION VI. ATTORNEY’S FEES, COSTS, AND SUIT MONEY

A.____ Petitioner’s ____ Respondent’s request(s) for attorney’s fees, costs, and suit money is (are)
denied because ____________________________________________________________________
______________________________________________________________________________ .

OR

B._____ The Court finds there is a need for and an ability to pay attorney’s fees, costs, and suit money.
_____ Petitioner _____ Respondent is hereby ordered to pay to the other spouse $____________in
attorney’s fees, and $ in costs. The Court further finds that the attorney’s fees awarded
are based on the reasonable rate of $ per hour and ______ reasonable hours. Other
provisions relating to attorney’s fees, costs, and suit money are as follows: ____________________
___________________________________________________________________________.

SECTION VII. OTHER PROVISONS
Other Provisions.
________________________________________________________________________

.

The Court reserves jurisdiction to modify and enforce this Final Judgment.

DONE AND ORDERED in __________________________, Florida on ______________________.

CIRCUIT JUDGE

Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (02/18)
- 358 -
I certify that a copy of this Final Judgment of Dissolution was _____ mailed _____ faxed and mailed
_____e-mailed _____ hand-delivered to the parties or entities listed below on
{date} ______________________________.

by ___________________________________
{Clerk of court or designee}

_____Petitioner (or his/her attorney)
_____Respondent (or his/her attorney)
_____Central depository
_____State Disbursement Unit
_____Other:

Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (02/18)
- 359 -
 IN THE CIRCUIT COURT OF THE ________________________JUDICIAL CIRCUIT
IN AND FOR COUNTY, _______________________FLORIDA

Case No.:
Division:
____________________________ _____,
Petitioner,

and

_____________________________ ____,
Respondent.

SUPPLEMENTAL FINAL JUDGMENT MODIFYING PARENTAL
RESPONSIBILITY, VISITATION, OR PARENTING
PLAN/TIME-SHARING SCHEDULE AND OTHER RELIEF
This cause came before this Court on a Supplemental Petition to Modify Parental Responsibility, Visitation,
or Parenting Plan/Time-Sharing Schedule and Other Relief. The Court, having reviewed the file, having
heard the testimony, and being otherwise fully advised, makes these findings of fact and reaches these
conclusions of law:

SECTION I. FINDINGS

1. The Court has jurisdiction over the subject matter and the parties.

2. The last order establishing or modifying parental responsibility, visitation, a Parenting Plan, or time-
sharing was entered on {date} ________________________.

3. There has been a substantial change in circumstances of the parties since the entry of the last order,
specifically: ________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.

4. It is in the best interests of the minor child(ren) that the current parental responsibility, visitation,
time-sharing schedule or Parenting Plan be changed because:________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_____________________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental
Responsibility, Visitation, or Parenting Plan/Time-Sharing Schedule and Other Relief (02/18)
- 360 -
SECTION II. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING WITH
DEPENDENT OR MINOR CHILD(REN)

1. Jurisdiction. The Court has jurisdiction to determine parental responsibility, to establish or approve
a Parenting Plan, and time-sharing with regard to the parties’ minor child(ren) listed in paragraph 2
below.

2. The parties’ dependent or minor child(ren) is (are):
Name Birth date
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

3. Parenting Plan. The parties shall comply with the Parenting Plan which is attached and
incorporated herein as Exhibit ______.

SECTION III. CHILD SUPPORT

1. Modification of Child Support.
{Choose one only}

a. ______The modification of parental responsibility or time-sharing entered above does not
necessitate a modification of child support. The previous order or final judgment establishing or
modifying child support shall remain in effect.

OR

b. ______The Court finds that there is a need for modification of child support and that the
______ Petitioner ______ Respondent, (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 ______ Petitioner ______ Respondent are correct OR
the Court makes the following findings:

Petitioner’s net monthly income is $_____________, (Child Support Guidelines _____%).
Respondent’s net monthly income is $_____________, (Child Support Guidelines _____%).
Monthly child care costs are $_______________.
Monthly health/dental insurance costs are $_____________.

Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental
Responsibility, Visitation, or Parenting Plan/Time-Sharing Schedule and Other Relief (02/18)
- 361 -
2. Amount.
Child support established at the rate of $_____________ per month for the _______children {total
number of parties’ minor or dependent children} shall be paid commencing ____________________
{month, day, year} and terminating _________________________________ {month, day, year}.
Child support shall be paid in the amount of $___________per ____________ {week, month, other}
which is consistent with the Obligor’s current payroll cycle.

Upon the termination of the obligation of child support for one of the parties’ children, child support
in the amount of $_____________for the remaining _______ children {total number of remaining
children} shall be paid commencing___________________________________ {month, day, year}
and terminating_________________________________ {month, day, year}. This child support shall
be paid in the amount of $____________ per ____________ {week, month, other} consistent with
the Obligor’s current payroll cycle.

{Insert schedule for the child support obligation, including the amount, and commencement and
termination dates, for the remaining minor or dependent children, which shall be payable as the
obligation for each child ceases. Please indicate whether the schedule ______appears below or
_____ is attached as part of this form.}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

The Obligor shall pay child support until all of the minor or dependent child(ren): reach the age of
18; become emancipated, marry, join the armed services, die, or become self-supporting; or until
further order of the court or agreement of the parties. The child support obligation shall continue
beyond the age of 18 and until high school graduation for any child who is dependent in fact,
between the ages of 18 and 19, and is still in high school, performing in good faith with a reasonable
expectation of graduation before the age of 19.

If the child support ordered deviates from the guidelines by more than 5%, the factual findings
which support that deviation are: ______________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

3. Retroactive Child Support and/or Arrearages.
{Choose one only}

a. _____There is no child support arrearage at the time of this Supplemental Final Judgment.
OR
b. _____The _____ Petitioner _____ Respondent shall pay to the other party child support in the
amount of:

Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental
Responsibility, Visitation, or Parenting Plan/Time-Sharing Schedule and Other Relief (02/18)
- 362 -
 $_____________ for retroactive child support, as of {date}_________________________________.
$_____________ for previously ordered unpaid child support, as of {date}_____________________.
The total of $_______________ in retroactive child support and arrearages 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.
[Indicate all that apply]

a. ______ Health/Dental Insurance. _____ Petitioner _____ Respondent shall be required to
maintain _____ health and/or _____ dental insurance for the parties’ minor child(ren), so long
as reasonable in cost and accessible to the child(ren). The party providing insurance shall be
required to convey insurance cards demonstrating said coverage to the other party;
OR
______ health and/or ______ dental insurance is not reasonable in cost or accessible to the
child(ren) at this time.

b. _____Reasonable and necessary uninsured medical/dental/prescription drug costs for the
minor child(ren) shall be assessed as follows:
_____ Shared equally by both parents.
_____ Prorated according to the child support guideline percentages.
_____ Other {explain}: ___________________________________________________________
___________________________________________________________________________
As to these uninsured medical/dental/prescription drug expenses, the party who incurs the
expense shall submit a request for reimbursement to the 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 child support obligations in this
judgment, ______ Petitioner ______ Respondent ______Each parent shall maintain life insurance, in
an amount of at least $ ________, on his/her life naming the _____ minor child(ren) as the
beneficiary(ies) OR naming _____ Petitioner _____ Respondent or _____ other {name}
_________________________ as Trustee for the minor child(ren), so long as reasonably available.
The obligation to maintain the life insurance shall continue until the youngest child turns 18,
becomes emancipated, marries, joins the armed services, dies, or becomes self-supporting.

6. ______IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall
be as follows: ______________________________________________________________________
_________________________________________________________________________________.
Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of this
paragraph.

7. Other provisions relating to child support: ______________________________________________
__________________________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental
Responsibility, Visitation, or Parenting Plan/Time-Sharing Schedule and Other Relief (02/18)
- 363 -
 _________________________________________________________________________________.

SECTION IV. METHOD OF PAYMENT

Obligor shall pay court-ordered child support and arrears, if any, as follows:

1. Place of Payment.

a. _____Obligor shall pay court-ordered support directly to either the State Disbursement Unit or
the central depository, as required by statute, along with any fee required by statute.

b. _____Both parties have requested and the court finds that it is in the best interests of the
child(ren) that support payments need not be directed through either the State Disbursement
Unit or the central depository at this time; however, either party may subsequently apply,
pursuant to section 61.13(1)(d)3, Florida Statutes, to require payments through either the State
Disbursement Unit or the central depository.

2. Income Deduction.

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 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: Income deduction is not in the best interests of the child(ren) because: {explain}
______________________________________________________________________________
______________________________________________________________________________,

AND
There is proof of timely payment of a previously ordered obligation without an income
deduction order,
AND
_____ There is an agreement by the Obligor to advise the Title IV-D agency, the clerk of court,
and the Obligee of any change in Payor and/or health insurance OR
_____ there is a signed written agreement providing an alternative arrangement between
the Obligor and the Obligee and, at the option of the IV-D agency, by the IV-D agency in IV-D
cases in which there is an assignment of support rights to the state, reviewed and entered in the
record by the court.

3. Bonus/one-time payments. _____All _________% _____No income paid in the form of a bonus or
Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental
Responsibility, Visitation, or Parenting Plan/Time-Sharing Schedule and Other Relief (02/18)
- 364 -
 other similar one-time payment, up to the amount of any arrearage or the remaining balance
thereof owed pursuant to this order, shall be forwarded to the Obligee pursuant to the payment
method prescribed above.
4. Other provisions relating to method of payment. ________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.

SECTION V. ATTORNEY’S FEES, COSTS, AND SUIT MONEY

1. _____ Petitioner’s _____ Respondent’s request(s) for attorney’s fees, costs, and suit money is (are)
denied because
________________________________________________________________________________
_________________________________________________________________________________.

OR

2. _____The Court finds there is a need for and an ability to pay attorney’s fees, costs, and suit money.
_____ Petitioner _____ Respondent is hereby ordered to pay to the other party $______________
in attorney’s fees, and $_______________ in costs. The Court further finds that the attorney’s fees
awarded are based on the reasonable rate of $____________ per hour and ____________
reasonable hours. Other provisions relating to attorney’s fees, costs, and suit money are as follows:
_________________________________________________________________________________
_________________________________________________________________________________.

SECTION VI. OTHER

1. Other Provisions. ___________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.

2. The Court reserves jurisdiction to modify and enforce this Supplemental Final Judgment.

3. Unless specifically modified by this Supplemental Final Judgment, the provisions of all final
judgments or orders in effect remain the same.

DONE AND ORDERED at __________________________, Florida, on _____________________.

_____________________________________________
CIRCUIT JUDGE

Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental
Responsibility, Visitation, or Parenting Plan/Time-Sharing Schedule and Other Relief (02/18)
- 365 -
I certify that a copy of this Supplemental Final Judgment Modifying Parental Responsibility, Visitation, or
Parenting Plan/Time-Sharing Schedule was: _____ mailed _____ faxed and mailed _____ e-mailed _____
hand-delivered to the parties and any entities listed below on {date}____________________________.

by____________________________________
{Clerk of court or designee}

_____Petitioner (or his or her attorney)
_____Respondent (or his or her attorney)
_____Central Depository
_____State Disbursement Unit
Other: ________________________

Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental
Responsibility, Visitation, or Parenting Plan/Time-Sharing Schedule and Other Relief (02/18)
- 366 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
,
Petitioner,

and

,
Respondent.

SUPPLEMENTAL FINAL JUDGMENT MODIFYING CHILD SUPPORT
This cause came before this Court on a Supplemental Petition for Modification of Child Support. The Court,
having heard the testimony and reviewed the file and financial affidavits of the parties and being
otherwise fully advised, makes these findings of fact and reaches these conclusions of law:

SECTION I. FINDINGS

1. The Court has jurisdiction over the subject matter and the parties.

2. The parties’ dependent or minor child(ren) is (are):
Name Birth date

3. The last order awarding or modifying child support was entered on {date} __________________

4. There has been a substantial change in circumstances of the parties since the entry of the last
order, specifically: _________________________________________________________________

.

5. It is in the best interests of the minor child(ren) that the current child support order be changed
because:
Florida Supreme Court Approved Family Law Form 12.993(b), Supplemental Final Judgment Modifying Child
Support (02/18)
- 367 -
 ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________.

SECTION II. CHILD SUPPORT

1. The Court finds that there is a need for modification of child support and that the
_____ Petitioner _____ Respondent, (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 _____ Petitioner _____ Respondent are correct OR the
Court makes the following findings:

Petitioner’s net monthly income is $ ___ , (Child Support Guidelines____ %).
Respondent’s net monthly income is $ ____, (Child Support Guidelines ______%).
Monthly child care costs are $ ________.
Monthly health/dental insurance costs are $ .

2. Amount.
Child support established at the rate of $__________ per month for the _______children {total
number of parties’ minor or dependent children} shall be paid commencing________________
{month, day, year} and terminating_____________________________ {month, day, year}. Child
support shall be paid in the amount of $______________ per ______________ {week, month,
other} consistent with the Obligor’s current payroll cycle.
Upon the termination of the obligation of child support for one of the parties’ children, child
support in the amount of $_____________for the remaining ______ children {total number of
remaining children} shall be paid commencing______________________ {month, day, year} and
terminating _________________month, day, year}. This child support shall be paid in the amount
of $____________ per ____________ {week, month, other} consistent with the Obligor’s current
payroll cycle.
{Insert schedule for the child support obligation, including the amount, and commencement and
termination dates, for the remaining minor or dependent children, which shall be payable as
the obligation for each child ceases. Please indicate whether the schedule ______ appears
below or _____ is attached as part of this form.}
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________.

Florida Supreme Court Approved Family Law Form 12.993(b), Supplemental Final Judgment Modifying Child
Support (02/18)
- 368 -
 The Obligor shall pay child support until all of the minor or dependent children: reach the age of
18; become emancipated, marry, join the armed services, die, or become self-supporting; or until
further order of the court or agreement of the parties. The child support obligation shall continue
beyond the age of 18 and until high school graduation for any child who is dependent in fact,
between the ages of 18 and 19, and is still in high school, performing in good faith with a
reasonable expectation of graduation before the age of 19.
If the child support ordered deviates from the guidelines by more than 5%, the factual findings
which support that deviation are:

.

3. Retroactive Child Support and/or Arrearages.

a. ____There is no child support arrearage at the time of this Supplemental Final Judgment.
OR
b. ____ Petitioner ____ Respondent shall pay to the other party child support in the amount of:
$ __ for retroactive child support, as of {date} ___________.
$ __ for previously ordered unpaid child support, as of {date} ___________________.
The total of $ _ in retroactive child support and arrearages shall be paid in the
amount of $ ________, per month payable _____ in accordance with his or her employer’s
payroll cycle, and in any event at least once a month, or _____ other {explain} ______________
beginning {date} ________, until paid in full including statutory interest.

4. Insurance.
{Indicate all that apply}

a. ______Health/Dental Insurance. _____ Petitioner _____ Respondent shall be required to
maintain ______ health _____dental insurance for the parties’ minor child(ren), so long as it
is reasonable in cost and accessible to the child(ren). The party providing insurance shall be
required to convey insurance cards demonstrating said coverage to the other party

OR

_____ Health _____ Dental insurance is not reasonable in cost or accessible to the child(ren)
at this time.

b. _____ Reasonable and necessary uninsured medical/dental/prescription costs for the minor
child(ren) shall be assessed as follows:
______ Shared equally by both parents.
______ Prorated according to the child support guideline percentages.
______ Other {explain}: _______________________________________________________
.

Florida Supreme Court Approved Family Law Form 12.993(b), Supplemental Final Judgment Modifying Child
Support (02/18)
- 369 -
 As to these uninsured medical/dental/prescription expenses, the party who incurs the
expense shall submit a 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 child support obligations
in this judgment, _____ Petitioner _____ Respondent _____ Each party shall maintain life
insurance coverage, in an amount of at least $ __________, on his/her life
naming the _____ minor child(ren) as the beneficiary(ies) OR naming _____Petitioner
_____ Respondent _____ 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 youngest child turns 18, becomes emancipated,
marries, joins the armed services, dies or otherwise becomes self-supporting.

6. IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall
be as follows: ________________________________________________________________
.
Further, each party shall execute any and all IRS forms necessary to effectuate the
provisions of this paragraph.

7. Other provisions relating to child support: ________________________________________

___________________________________________________________________________.

SECTION III. METHOD OF PAYMENT

1. Place of Payment.

a. _____Obligor shall pay court-ordered support directly to either the State Disbursement Unit
or the central depository, as required by statute, along with any fee required by statute.

b. _____Both parties have requested and the court finds that it is in the best interests of the
child(ren) that support payments need not be directed through either the State
Disbursement Unit or the central depository at this time; however, either party may
subsequently apply, pursuant to section 61.13(1)(d)3, Florida Statutes, to require payments
through either the State Disbursement Unit or the central depository.

2. Income Deduction.

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 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
Florida Supreme Court Approved Family Law Form 12.993(b), Supplemental Final Judgment Modifying Child
Support (02/18)
- 370 -
 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:

Income deduction is not in the best interests of the child(ren) because: {explain} _____

,
AND
There is proof of timely payment of a previously ordered obligation without an Income
Deduction Order,
AND
_____ There is an agreement by the Obligor to advise the Title IV-D agency, the clerk of
court, and the Obligee of any change in Payor and/or health insurance
OR
_____ there is a signed written agreement providing an alternative arrangement between
the Obligor and the Obligee and, at the option of the IV-D agency, by the IV-D agency in IV-D
cases in which there is an assignment of support rights to the state, reviewed and entered in
the record by the court.

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 the Obligee pursuant to the payment
method prescribed above.

4. Other provisions relating to method of payment ______________________________________
.

SECTION IV. ATTORNEY’S FEES, COSTS, AND SUIT MONEY

1. _____ Petitioner’s _____ Respondent’s request(s) for attorney’s fees, costs, and suit money is
(are) denied because
______________________________________________________________________________
.

OR

2. _____The Court finds there is a need for and an ability to pay attorney’s fees, costs, and suit
money. _____ Petitioner _____ Respondent is hereby ordered to pay to the other party $
______ in attorney’s fees, and $ ______ in costs. The Court further finds that the
attorney’s fees awarded are based on the reasonable rate of $ __ per hour and
_________reasonable hours. Other provisions relating to attorney’s fees, costs, and suit money
are as follows:
Florida Supreme Court Approved Family Law Form 12.993(b), Supplemental Final Judgment Modifying Child
Support (02/18)
- 371 -
 .

SECTION V. OTHER

1. Other Provisions.

.

2. The Court reserves jurisdiction to modify and enforce this Supplemental Final Judgment.

3. Unless specifically modified by this Supplemental Final Judgment, the provisions of all final
judgments or orders in effect remain the same.

DONE AND ORDERED at ____________________________, Florida, on .

CIRCUIT JUDGE

I certify that a copy of this Supplemental Final Judgment Modifying Child Support was _____ mailed
_____ faxed and mailed ______ e-mailed _____ hand-delivered to the parties and any entities listed
below on {date}_____________________.

by _____________________________________
{Clerk of court or designee}

______Petitioner (or his or her attorney)
______Respondent (or his or her attorney)
______Central Depository
______State Disbursement Unit
______Other: _______________________

Florida Supreme Court Approved Family Law Form 12.993(b), Supplemental Final Judgment Modifying Child
Support (02/18)
- 372 -
 IN THE CIRCUIT COURT OF THE _____________________JUDICIAL CIRCUIT,
IN AND FOR ________________________COUNTY, FLORIDA

Case No:____________________
Division: ______________________

In Re: The Marriage of:

__________________________________,
Petitioner,
and
____________________________________,
Respondent.

SUPPLEMENTAL FINAL JUDGMENT MODIFYING ALIMONY
This cause came before this Court on a Supplemental Petition for Modification of Alimony. The Court,
having heard the testimony and reviewed the file and the financial affidavits of the parties and being
otherwise fully advised, makes these findings of fact and reaches these conclusions of law:

SECTION I. FINDINGS

1. The Court has jurisdiction over the subject matter and the parties.

2. The last order awarding or modifying alimony was entered on {date}______________________.

3. There has been a substantial change in circumstances of the parties since entry of the last order,
specifically: ____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

SECTION II. ALIMONY

1. _____The Court denies the request(s) for modification of alimony
OR
2. _____ The Court finds that there is a need to modify alimony and that _____ Petitioner
_____ Respondent (hereinafter Obligor) has/had the present ability to pay alimony as follows:

{Indicate all that apply}
a. ______ Permanent Periodic. The permanent periodic alimony is _____ modified
_____ terminated based upon either _____ a substantial change in circumstances, OR _____ the
existence of a supportive relationship in accordance with Section 61.14, Florida Statutes.
Obligor shall pay modified permanent periodic alimony to Obligee in the amount of $_________

Florida Supreme Court Approved Family Law Form 12.993(c), Supplemental Final Judgment Modifying Alimony
(02/18)
- 373 -
 per month, payable _____ in accordance with Obligor’s employer’s payroll cycle, and in any
event, at least once a month, or _____ other : {explain} ________________________________
_____________________________________________________________________________
beginning {date} _______________________. This alimony shall continue until further modified
by court order, the death of either party, or remarriage of Obligee, whichever occurs first

b. _____ Durational. The durational alimony is _____ modified _____terminated based upon a
substantial change in circumstances in accordance with section 61.08(7), Florida Statutes. If the
length of the durational alimony is modified, the court finds that the following exceptional
circumstances exist:__________________________________________________________
__________________________________________________________________________
Obligor shall pay modified durational 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} ___________________, and terminating on {date}_________________, the death of
either party, remarriage of the Obligee, or until further modified by court order, whichever
occurs first.

c. ______Rehabilitative. The rehabilitative alimony is _____ modified _____ terminated based
upon: _____ a substantial change in circumstances, _____ noncompliance with the rehabilitative
plan, or _____ completion of the rehabilitative plan. Obligor shall pay modified 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, or _____ other
{explain} ___________________________ beginning {date} __________________________.
This modified rehabilitative alimony shall continue until modified further by court order, the
death of either party or until {date/event} __________________________________________,
whichever occurs first. The 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 4 below.

3. Reasons for _____ Awarding _____Denying Modification of Alimony. The Court has considered all
of the following in awarding/denying the modification of alimony request:
a. The standard of living established during the marriage;
b. The duration of the marriage;
c. The age and the physical and emotional condition of each party;
d. The financial resources of each party, including, the nonmarital and the marital assets and
liabilities distributed to each;
e. The earning capacities, educational levels, vocational skills, and employability of the parties and
when applicable, the time necessary for either party to acquire sufficient education or training
to enable such party to find appropriate employment;

Florida Supreme Court Approved Family Law Form 12.993(c), Supplemental Final Judgment Modifying Alimony
(02/18)
- 374 -
 f. The contribution of each party to the marriage, including, but not limited to, services rendered
in homemaking, child care, education, and career building of the other party;
g. The tax treatment and consequences to both parties of any alimony award, including the
designation of all or a portion of the payment as nontaxable, nondeductible payment;
h. All sources of income available to either party, including income available to either party
through investments of any assets held by that party, and
i. _____Any other factor necessary to do equity and justice between the parties {Explain}
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
____ Please indicate here if additional pages are attached.

4. Retroactive Alimony and/or Arrearages.

a. _____There is no alimony arrearage at the time of this Supplemental Final Judgment.
OR
b. _____The _____ Petitioner _____ Respondent shall pay to the other party alimony in the
amount of:
$______________for retroactive alimony, as of {date} ______________________________;
$______________for previously ordered unpaid alimony, as of {date} __________________.
The total of $____________________ in retroactive alimony and arrearages 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, or _____ other {explain}
__________________________________________________________________________
beginning {date} ________________________, until paid in full including statutory interest.

5. _____Life Insurance (to secure payment of support).
To secure the alimony obligations set forth in this judgment, Obligor shall maintain life insurance
coverage on his/her life naming Obligee as the sole irrevocable beneficiary, so long as
reasonably available. This insurance shall be in the amount of at least $___________________
and shall remain in effect until the obligation for alimony terminates.

6. _____Other provisions relating to modification of alimony, including any tax treatment and
consequences: ________________________________________________________
____________________________________________________________________________
_____________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

SECTION III. METHOD OF PAYMENT

1. Place of Payment

a. _____Obligor shall pay court-ordered support directly to either the State Disbursement Unit or
the central depository, as required by statute, along with any fee required by statute.

Florida Supreme Court Approved Family Law Form 12.993(c), Supplemental Final Judgment Modifying Alimony
(02/18)
- 375 -
 b. _____Both parties have requested that support payments not be directed through either the
State Disbursement Unit or the central depository at this time; however, either party may
subsequently apply to the depository pursuant to section 61.08, Florida Statutes, to require
payments through either the State Disbursement Unit or the central depository.

2. Income Deduction.

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 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 is (are) no minor or dependent child(ren) common to the parties,
AND
There is proof of timely payment of a previously ordered obligation without an Income
Deduction Order,
AND
_____ There is an agreement by the Obligor to advise the Title IV-D agency, the clerk of court,
and the Obligee of any change in Payor and/or health insurance
OR
_____ there is a signed written agreement providing an alternative arrangement between the
Obligor and the Obligee and, at the option of the IV-D agency, by the IV-D agency in IV-D cases
in which there is an assignment of support rights to the state, reviewed and entered in the
record by the court.

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 of the remaining balance
thereof owed pursuant to this order, shall be forwarded to the Obligee pursuant to the payment
method prescribed above.

4. Other provisions relating to method of payment. _____________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

SECTION IV. ATTORNEY’S FEES, COSTS, AND SUIT MONEY

1. _____ Petitioner’s _____ Respondent’s request(s) for attorney’s fees, costs, and suit money is (are)
denied because ___________________________________________________________________

Florida Supreme Court Approved Family Law Form 12.993(c), Supplemental Final Judgment Modifying Alimony
(02/18)
- 376 -
 ________________________________________________________________________________
________________________________________________________________________________.

OR

2. _____ The Court finds there is a need for and an ability to pay attorney’s fees, costs, and suit money.
_____ Petitioner _____ Respondent is hereby ordered to pay to the other party $_______________
in attorney’s fees, and $_________________ in costs. The Court further finds that the attorney’s
fees awarded are based on the reasonable rate of $__________ per hour and ______________
reasonable hours. Other provisions relating to attorney’s fees, costs, and suit money are as follows:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________.

SECTION V. OTHER
1. Other Provisions: _______________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

2. The Court reserves jurisdiction to modify and enforce this Supplemental Final Judgment.

3. Unless specifically modified by this Supplemental Final Judgment, the provisions of all final
judgments or orders in effect remain the same.

DONE AND ORDERED on __________________ in __________________________, Florida.

_________________________________
CIRCUIT JUDGE

I certify that a copy of this Supplemental Judgment Modifying Alimony was _____mailed _____ faxed
and mailed _____ e-mailed _____ hand-delivered to the parties and any entities listed below on {date}
_______________________.

by__________________________________
{Clerk of court or designee}

____Petitioner (or his or her attorney)
____Respondent (or his or her attorney)
____Central Depository
____State Disbursement Unit
____Other:_________________________

Florida Supreme Court Approved Family Law Form 12.993(c), Supplemental Final Judgment Modifying Alimony
(02/18)
- 377 -
 IN THE CIRCUIT COURT OF THE___________________________JUDICIAL CIRCUIT,
IN AND FOR _______________________COUNTY, FLORIDA

Case No.: _______________________________
Division: ________________________________
________________________________,
Petitioner,

and

________________________________,
Respondent.

SUPPLEMENTAL TEMPORARY JUDGMENT MODIFYING PARENTING
ISSUES FOR CHILD(REN) OF A PARENT ACTIVATIED, DEPLOYED,
OR TEMPORARILY ASSIGNED TO MILITARY SERVICE
This cause came before this Court on a Supplemental Petition for Temporary Modification of Custody or
Parenting Plan/Time-Sharing Schedule for Child(ren) of a Parent Activated, Deployed, or Temporarily
Assigned to Military Service. The Court, having reviewed the file, heard the testimony, and being
otherwise fully advised, makes these findings of fact and reaches these conclusions of law:

SECTION I. FINDINGS

1. The Court has jurisdiction over the subject matter and the parties.

2. The last order establishing or modifying parental responsibility, visitation, or time-sharing was
entered on {date} _______________________.

3. There is clear and convincing evidence that it is in the best interests of the minor child(ren) that the
current order establishing parental responsibility, visitation, and time-sharing be temporarily
modified as the _____ Petitioner _____ Respondent is activated, deployed, or temporarily assigned
to military service. Specifically:
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.

SECTION II. TEMPORARY PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-
SHARING WITH DEPENDENT OR MINOR CHILD(REN)

1. Jurisdiction. The Court has jurisdiction to determine parental responsibility, to establish or approve
a Parenting Plan, and time-sharing with regards to the parties’ minor child(ren) listed in paragraph 2
below.
Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment Modifying
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service (02/18)
- 378 -
2. The parties’ dependent or minor child(ren) is (are):
Name Birth date
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

3. Parenting Plan. The parties shall comply with the temporary Parenting Plan which is attached and
incorporated herein as Exhibit _____.

SECTION III. CHILD SUPPORT

1. Temporary Modification of Child Support.
{Choose one only}

a. _____The _____ Petitioner’s _____ Respondent’s current obligation to pay child support is:

_____ Abated
_____ Suspended
_____ Modified to $______________ per ________________.

b. _____The Court finds that there is a need for temporary modification of child support and that
the service member _____ Petitioner _____ Respondent, (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 _____ Petitioner _____ Respondent are
correct OR the Court makes the following findings:

Petitioner’s net monthly income is $____________, (Child Support Guidelines ____ %).
Respondent’s net monthly income is $_____________, (Child Support Guidelines____ %).
Monthly child care costs are $________________.
Monthly health/dental insurance costs are $__________________.

2. Amount.
Child support established at the rate of $____________per month for the _______children
{total number of parties’ minor or dependent children} shall be paid commencing
___________________ {month, day, year} and terminating _______________________ {month,
day, year}. Child support shall be paid in the amount of $_____________ per ____________
{week, month, other} which is consistent with the Obligor’s current payroll cycle.

Upon the termination of the obligation of child support for one of the parties’ children, child
support in the amount of $___________for the remaining _______children {total number of
remaining children} shall be paid commencing _______________________________ {month,
day, year} and terminating ___________________________ {month, day, year}. This child
Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment Modifying
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service (02/18)
- 379 -
 support shall be paid in the amount of $_________ per ______________ {week, month, other}
consistent with the Obligor’s current payroll cycle.

{Insert schedule for the child support obligation, including the amount, and commencement
and termination dates, for the remaining minor or dependent children, which shall be payable
as the obligation for each child ceases. Please indicate whether the schedule _____ appears
below or _____ is attached as part of this form.}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

The Obligor shall pay child support until all of the minor or dependent children: reach the age of
18; become emancipated, marry, join the armed services, die, or become self-supporting; or
until further order of the court or agreement of the parties. The child support obligation shall
continue beyond the age of 18 and until high school graduation for any child who is dependent
in fact, between the ages of 18 and 19, and is still in high school, performing in good faith with a
reasonable expectation of graduation before the age of 19.

If the child support ordered deviates from the guidelines by more than 5%, the factual findings
which support that deviation are: _________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________.

3. Retroactive Child Support and/or Arrearages.
{Choose one only}

a. _____There is no child support arrearage at the time of this Supplemental Temporary Judgment.

OR

b. _____The _____ Petitioner _____ Respondent shall pay to the other party child support in the
amount of:
$___________ for retroactive child support, as of {date} __________________.
$___________ for previously ordered unpaid child support, as of {date} _________________. The
total of $___________ in retroactive child support and arrearages 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, or _____other {explain} _______________
beginning {date} ___________________________, until paid in full including statutory interest.

4. Insurance.

a. _____Health/Dental Insurance.
Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment Modifying
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service (02/18)
- 380 -
 {Choose one only}
_____ The service member _____ Petitioner _____ Respondent shall enroll the child(ren) as a
military dependent(s) with DEERs, TriCare, or other similar benefits available to military
dependents as provided by the service member’s branch or service and federal regulations;
OR
______The _____ Petitioner _____ Respondent shall maintain _____ health and/or _____ dental
insurance for the parties’ minor child(ren), so long as it is reasonable in cost and accessible to the
child(ren). The party providing insurance shall be required to convey insurance cards
demonstrating said insurance to the other party;
OR
______ Health _____Dental insurance is not reasonable in cost or accessible to the
child(ren) at this time.

b. _____Reasonable and necessary uninsured medical/dental/prescription drug costs for the minor
child(ren) shall be assessed as follows:
_____ Shared equally by both parents.
_____ Prorated according to the child support guideline percentages.
_____ Other {explain}: ____________________________________________________________
______________________________________________________________________________
As to these uninsured medical/dental/prescription drug expenses, the party who incurs the
expense shall submit a request for reimbursement to the 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 child support obligations in this
judgment, _____ Petitioner _____ Respondent _____Each party shall maintain life insurance, in an
amount of at least $____________, on his/her life naming the _____ minor child(ren) as the
beneficiary(ies) OR naming the _____ Petitioner _____ Respondent _____ 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
youngest child turns 18, becomes emancipated, marries, joins the armed services, dies, or otherwise
becomes self-supporting.

6. _____IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall
be as follows: ____________________________________________________________________
________________________________________________________________________________.
Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of this
paragraph.

7. Other provisions relating to child support: _____________________________________________
_________________________________________________________________________________
________________________________________________________________________________.

SECTION IV. METHOD OF PAYMENT

Obligor shall pay court-ordered child support and arrears, if any, as follows:
Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment Modifying
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service (02/18)
- 381 -
1. Place of Payment.

a. _____Obligor shall pay court-ordered support directly to either the State Disbursement Unit or
the central depository, as required by statute, along with any fee required by statute.

b. _____Both parties have requested and the court finds that it is in the best interests of the
child(ren) that support payments need not be directed through either the State Disbursement
Unit or the central depository at this time; however, either party may subsequently apply,
pursuant to section 61.13(1)(d)3, Florida Statutes, to require payments through the State
Disbursement Unit or the central depository.

2. Income Deduction.

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 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:
Income deduction is not in the best interests of the child(ren) because: {explain}
_____________________________________________________________________________
______________________________________________________________________________
AND
_____ There is proof of timely payment of a previously ordered obligation without an Income
Deduction Order,
AND
_____ There is an agreement by the Obligor to advise the Title IV-D agency, clerk of court and
Obligee of any change in Payor and/or health insurance OR _____there is a signed written
agreement providing an alternative arrangement between the Obligor and the Obligee and, at
the option of the IV-D agency, by the IV-D agency in IV-D cases in which there is an assignment of
support rights to the state, reviewed and entered in the record by the court.

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 the Obligee pursuant to the payment
method prescribed above.

4. Other provisions relating to method of payment. _________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.

Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment Modifying
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service (02/18)
- 382 -
SECTION V. ATTORNEY’S FEES, COSTS, AND SUIT MONEY

1. _____ Petitioner’s _____ Respondent’s request(s) for attorney’s fees, costs, and suit money is (are)
denied because ____________________________________________________________________
_________________________________________________________________________________.

OR

2. ______ The Court finds there is a need for and an ability to pay attorney’s fees, costs, and suit
money. _____Petitioner _____ Respondent is hereby ordered to pay to the other party
$ ____________ in attorney’s fees, and $ ____ in costs. The Court further finds that the
attorney’s fees awarded are based on the reasonable rate of $ ____ per hour
and reasonable hours. Other provisions relating to attorney’s fees, costs, and suit money
are as follows: ____________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.

SECTION VI. OTHER

1. Other Provisions. ___________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

2. The Court reserves jurisdiction to modify and enforce this Supplemental Temporary Judgment.

3. Unless specifically modified by this supplemental temporary judgment, the provisions of all final
judgments or orders in effect remain the same.

DONE AND ORDERED at _________________________, Florida, on ___________________.

_____________________________________________
CIRCUIT JUDGE

I certify that a copy of this Supplemental Temporary Judgment Modifying Parenting Issues for Child(ren)
of a Parent Activated, Deployed, or Temporarily Assigned to Military Service was _____ mailed _____
faxed and mailed _____ e-mailed
_____hand-delivered to the parties and any entities listed below on {date}____________________.

Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment Modifying
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service (02/18)
- 383 -
 ______________________________________
by {clerk of court or designee}

_____Petitioner (or his or her attorney)
_____Respondent (or his or her attorney)
_____Central Depository
_____State Disbursement Unit
_____Other: _______________________

Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment Modifying
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service (02/18)
- 384 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:

In Re: the Marriage of:

,
Petitioner,

and

,
Respondent.

FINAL JUDGMENT FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF
MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN)

This cause came before this Court on a Petition for Support Unconnected with Dissolution of Marriage
under section 61.09, Florida Statutes. The Court, having reviewed the file and heard the testimony,
makes these findings of fact and reaches these conclusions of law:

1. The Court has jurisdiction over the subject matter and the parties.

2. The following child(ren) are common to the parties:

Name Birth date

SECTION I. ALIMONY

A. _____ The Court denies the request for alimony;
OR

Florida Supreme Court Approved Family Law Form 12.994(a)(1), Final Judgment for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)
- 385 -
 B. _____The Court finds that that there is a need for alimony and that the ____ Petitioner
____Respondent has/had the ability to support his/her spouse and has failed to do so.
____ Petitioner ____ Respondent (hereinafter Obligor) has the present ability to pay alimony as
follows: {Indicate all that apply}

1. ______ Permanent Periodic.

a. The court finds that no other form of alimony is fair and reasonable
under the circumstances of the parties.

b. As a marriage of {choose only one}:

______Long Duration (17 years or greater) alimony is appropriate upon
consideration of all relevant factors;

______Moderate Duration ( greater than 7 years but less than 17) alimony is
appropriate based upon clear and convincing evidence after consideration of all
relevant factors; or

______Short Duration (less than 7 years) alimony is appropriate based upon the
following exceptional circumstances:_________________________________
_______________________________________________________________
_______________________________________________________________.

c. Obligor shall pay permanent 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, or _____ other:
{explain}_________________ beginning {date} _________________. This
alimony shall continue until modified by court order, the death
of either party, or remarriage of Obligee, whichever occurs
first. The alimony may be modified or terminated based
upon either a substantial change in circumstances or the
existence of a supportive relationship in accordance with section 61.14,
Florida Statutes.

2. _______Bridge-the-Gap. Obligor shall pay bridge-the-gap 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, or _____ other:
{explain}____________________beginning {date}____________________ and continuing
until {date}______________________ {a period not to exceed two (2) years}, death of either
party or remarriage of Obligee.

Florida Supreme Court Approved Family Law Form 12.994(a)(1), Final Judgment for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)
- 386 -
 3. _____Rehabilitative. Obligor shall pay 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, or _____ other {explain} _________________
beginning {date} ____. This rehabilitative alimony shall continue until modified
by court order, the death of either party or until {date/event}
__________________________________________, whichever occurs first. The
rehabilitative plan presented demonstrated the following: _____________________
______________________________________________________________________.

4. _____Durational. Obligor shall pay durational 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, or _____ other:
{explain}____________________ beginning
{date}_______________________ and terminating on
{date}____________________, the death of either party, remarriage of
Obligee, or until modified by court order in accordance with section 61.08(7), Florida
Statutes; whichever occurs first.

5._____ Lump Sum. Obligor shall pay lump sum alimony to Obligee in the amount of
$_________ which shall be paid as follows: _______________________________.

6. _____ Retroactive. Obligor shall pay retroactive alimony in the amount of $___________
for the period of {date} , through {date} ,
which shall be paid pursuant to paragraph D. below.

C. Reasons for _____ Awarding _____ Denying Alimony. The Court has considered all of the
following in awarding/denying alimony:
1. The standard of living established during the marriage;
2. The duration of the marriage;
3. The age and the physical and emotional condition of each party;
4. The financial resources of each party, including the nonmarital and marital assets and
liabilities distributed to each;
5. The earning capacities, educational levels, vocational skills, and employability of the
parties, and, when applicable, the time necessary for either party to acquire sufficient
education or training to enable such party to find appropriate employment;
6. The contribution of each party to the marriage, including, but not limited to, services
rendered in homemaking, child care, education, and career building of the other party;
7. The responsibilities each party will have with regard to any minor or dependent children
they have in common;
8. The tax treatment and consequences to both parties of any alimony award, including the
designation of all or a portion of the payment as a nontaxable, nondeductible payment;
9. All sources of income available to either party, including income available to either party
through investments of any asset held by that party and

Florida Supreme Court Approved Family Law Form 12.994(a)(1), Final Judgment for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)
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 10. Any other factor necessary to do equity and justice between the parties: {explain}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
_______ Please indicate here if additional pages are attached.

D. Retroactive Alimony and/or Arrearages.

1. _____There is no alimony arrearage at the time of this Final Judgment.

OR

2. _____Petitioner _____ Respondent shall pay to the other party alimony in the amount
of:
$ for retroactive alimony, as of {date} ____ .
$ for previously ordered unpaid alimony, as of {date} .

The total of $ ___ in retroactive alimony and arrearages 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 or _____ other {explain} ___________
beginning {date __________, until paid in full including statutory interest.

E. _____Life Insurance (to secure payment of support). To secure the alimony obligations set forth
in this judgment, Obligor shall maintain life insurance on his/her life naming Obligee as the sole
irrevocable beneficiary, so long as reasonably available. This insurance shall be in the amount of
at least $___________ and shall remain in effect until the obligation for alimony
terminates.

F. _____ Other provisions relating to alimony including any tax treatment and consequences:

1. The award of alimony _____ does not _____ does leave the Obligor with significantly less
net income than the net income of the recipient/Obligee. If the award does leave the
Obligor with significantly less net income than that of the Obligee, the Court finds the
following exceptional circumstances: _______________________________________
____________________________________________________________________
_____________________________________________________________________
______________________________________________________________________.

2. Other:__________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________.

Florida Supreme Court Approved Family Law Form 12.994(a)(1), Final Judgment for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)
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SECTION II. CHILD SUPPORT
A.______ The Court finds that there is a need for child support and that the _____ Petitioner
_____ Respondent (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 _____ Petitioner _____Respondent are correct

OR

_____the Court makes the following findings:

Petitioner’s net monthly income is $ ___________, (Child Support Guidelines _ %).
Respondent’s net monthly income is $ __________, (Child Support Guidelines _____%).
Monthly child care costs are $ _.
Monthly health/dental insurance costs are $ __________.

B. Amount.
Child support established at the rate of $____________ per month for the ______children {total
number of parties’ minor or dependent children} shall be paid commencing _______________
{month, day, year} and terminating ___________________ {month, day, year}. Child support
shall be paid in the amount of $________ per ______________ {week, month, other} which is
consistent with the Obligor’s current payroll cycle.

Upon the termination of the obligation of child support for one of the parties’ children, child
support in the amount of $__________for the remaining _________children {total number of
remaining children} shall be paid commencing ____________________________{month, day,
year} and terminating________________________________{month, day, year}. This child
support shall be paid in the amount of $_______ _per_______________ {week, month, other}
consistent with the Obligor’s current payroll cycle.

{Insert schedule for the child support obligation, including the amount, and commencement
and termination dates, for the remaining minor or dependent children, which shall be payable
as the obligation for each child ceases. Please indicate whether the schedule _____appears
below or _____ is attached as part of this form.}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

The Obligor shall pay child support until all of the minor or dependent children: reach the age of
18; become emancipated, marry, join the armed services, die, or become self-supporting; or
until further order of the court or agreement of the parties. The child support obligation shall

Florida Supreme Court Approved Family Law Form 12.994(a)(1), Final Judgment for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)
- 389 -
 continue beyond the age of 18 and until high school graduation for any child who is dependent
in fact, between the ages of 18 and 19, and is still in high school, performing in good faith with a
reasonable expectation of graduation before the age of 19.

If the child support ordered deviates from the guidelines by more than 5%, the factual findings
which support that deviation are:

.

C. Retroactive Child Support and/or Arrearages.

1. _____ There is no retroactive child support or child support arrearage at the time of this
Final Judgment.

OR

2. _____ The _____ Petitioner _____ Respondent shall pay to the other party child support
in the amount of:
$____________for retroactive child support, as of {date}_________________________;
$ ___________ for previously ordered unpaid child support, as of {date} _______________

The total of $ __________ of retroactive child support and arrearages 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 or _____ other {explain}
___________beginning {date} _________, until paid in full including
statutory interest.

D. Insurance.
{Indicate all that apply}

1. Health/Dental Insurance. _____ Petitioner _____ Respondent shall be required to
maintain _____ health and/or _____dental insurance for the parties’ minor child(ren), so
long as it is reasonable in cost and accessible to the child(ren). The party providing insurance
shall be required to convey insurance cards demonstrating said insurance to the other party.
OR
_____ Health _____ Dental insurance is either not reasonable in cost or accessible to the
children at this time.

2. _____ Reasonable and necessary uninsured medical/dental/prescription drug costs for
the minor child(ren) shall be assessed as follows:
_____ Shared equally by both parents.
_____ Prorated according to the child support guideline percentages.
_____ Other {explain}:

Florida Supreme Court Approved Family Law Form 12.994(a)(1), Final Judgment for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)
- 390 -
 As to these uninsured medical/dental/prescription drug expenses, the party who incurs the
expense shall submit a 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.

E. _____Life Insurance (to secure payment of support). To secure the child support obligations in
this judgment, _____ Petitioner _____Respondent ______ Each party shall maintain life
insurance 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 _____ Petitioner _____
Respondent _____ other {name}_______________________as Trustee for the minor
child(ren). The obligation to maintain the life insurance coverage shall continue until the
youngest child turns 18, becomes emancipated, marries, joins the armed services, dies, or
becomes self-supporting.

F. IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall
be as follows:
______________________________________________________________________________
.
Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of
this paragraph.

G. Other provisions relating to child support:
______________________________________________________________________________

SECTION III. METHOD OF PAYMENT
Obligor shall pay court-ordered child support/alimony and arrears, if any, as follows:

A. Place of Payment.

1._____ Obligor shall pay court-ordered support directly to either the State Disbursement
Unit or the central depository, as required by statute, along with any fee required by
statute.

2._____ Both parties have requested and the court finds that it is in the best interests of the
child(ren) that support payments need not be directed through either the State
Disbursement Unit or the central depository at this time; however, either party may
subsequently apply ,pursuant to section 61.08 or 61.13, Florida Statutes, to require
payments through either the State Disbursement Unit or the central depository.

B. Income Deduction.

Florida Supreme Court Approved Family Law Form 12.994(a)(1), Final Judgment for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)
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 1._____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 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.

2._____ 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 Title IV-D agency, clerk of court,
and Obligee of any change in Payor and/or health insurance
OR
_____there is a signed written agreement providing an alternative arrangement between
the Obligor and the Obligee and, at the option of the IV-D agency, by the IV-D agency in IV-D
cases in which there is an assignment of support rights to the state, reviewed and entered in
the record by the court.

C. 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 the Obligee pursuant to
the payment method prescribed above.

D. Other provisions relating to method of payment.
______________________________________________________________________________

.

SECTION IV. ATTORNEY’S FEES, COSTS, AND SUIT MONEY
A._____ Petitioner’s _____ Respondent’s request(s) for attorney’s fees, costs, and suit money is
(are) denied because: _________________________________________________________
.

OR

B. _____ The Court finds there is a need for and an ability to pay attorney’s fees, costs, and suit
money. _____Petitioner _____ Respondent is hereby ordered to pay to the other party $
_____ in attorney’s fees, and $ _____ in costs. The Court further finds that the

Florida Supreme Court Approved Family Law Form 12.994(a)(1), Final Judgment for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)
- 392 -
 attorney’s fees awarded are based on the reasonable rate of $____________per hour and
___ reasonable hours. Other provisions relating to attorney’s fees, costs, and suit money
are as follows:
___________________________________________________________________________

.

SECTION V. OTHER PROVISIONS
A. Other Provisions: _______________________________________________________________

.

B. The Court reserves jurisdiction to modify and enforce this Final Judgment.

DONE AND ORDERED at _____, Florida, on _______________________ .

CIRCUIT JUDGE

I certify that a copy of this Final Judgment for Support Unconnected with Dissolution of Marriage with
Dependent or Minor Child(ren) was _____ mailed _____ faxed and mailed _____ e-mailed _____ hand-
delivered to the parties and any entities listed below on {date}_______________________.

by ______________________________________
{Clerk of court or designee}

_____Petitioner (or his attorney)
_____Respondent (or her attorney)
_____Central Depository
_____State Disbursement Unit
_____Other:

Florida Supreme Court Approved Family Law Form 12.994(a)(1), Final Judgment for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)
- 393 -
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:

In Re: the Marriage of:

,
Petitioner,

and

,
Respondent.

FINAL JUDGMENT FOR SUPPORT AND PARENTING PLAN
UNCONNECTED WITH DISSOLUTION OF MARRIAGE
WITH DEPENDENT OR MINOR CHILD(REN)

This cause came before this Court on a Petition for Support and Parenting Plan Unconnected with
Dissolution of Marriage under section 61.09, Florida Statutes. The Court, having reviewed the file and
heard the testimony, makes these findings of fact and reaches these conclusions of law:

1. The Court has jurisdiction over the subject matter and the parties.

2. The following child(ren) are common to the parties:

Name Birth date

SECTION I. ALIMONY

A. _____ The Court denies the request for alimony;

Florida Supreme Court Approved Family Law Form 12.994(a)(2), Final Judgment for Support and Parenting Plan
Unconnected with Dissolution of Marriage (02/18)
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 OR

B. _____The Court finds that that there is a need for alimony and that the _____ Petitioner
_____Respondent has/had the ability to support his/her spouse and has failed to do so.
_____Petitioner _____ Respondent (hereinafter Obligor) has the present ability to pay alimony
as follows: {Indicate all that apply}

1. ______ Permanent Periodic.

a. The court finds that no other form of alimony is fair and reasonable under the
circumstances of the parties.

b. As a marriage of {choose only one}:

______Long Duration (17 years or greater) alimony is appropriate upon
consideration of all relevant factors;

______Moderate Duration ( greater than 7 years but less than 17) alimony is
appropriate based upon clear and convincing evidence after consideration of all
relevant factors; or

______Short Duration (less than 7 years) alimony is appropriate based upon the
following exceptional circumstances:_________________________________
_______________________________________________________________
_______________________________________________________________.

c. Obligor shall pay permanent 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 or _____ other:
{explain}___________________beginning {date} __________________________.
This alimony shall continue until modified by court order, the death of either party,
or remarriage of Obligee, whichever occurs first. The alimony may be modified or
terminated based upon either a substantial change in circumstances or the existence
of a supportive relationship in accordance with section 61.14, Florida Statutes.

2. _______Bridge-the-Gap. Obligor shall pay bridge-the-gap 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, or _____ other:
{explain}____________________beginning {date}___________ _________ and continuing
until {date}_________________________{a period not to exceed two (2) years}, death of
either party or remarriage of Obligee.

3. _____Rehabilitative. Obligor shall pay rehabilitative alimony to Obligee in the amount of
Florida Supreme Court Approved Family Law Form 12.994(a)(2), Final Judgment for Support and Parenting Plan
Unconnected with Dissolution of Marriage (02/18)
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 $ per month, payable _____ in accordance with Obligor’s employer’s payroll
cycle, and in any event, at least once a month, or _____ other {explain} _________________
beginning {date} ____. This rehabilitative alimony shall continue until modified
by court order, the death of either party or until {date/event}
_________________________, whichever occurs first. The rehabilitative plan presented
demonstrated the following: __________________________________________
__________________________________________________________________________
__________________________________________________________________________
___________________________________________________________________________.

4. __ ___Durational. Obligor shall pay durational 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, or _____ other:
{explain}____________________ beginning {date}_______________________ and
terminating on {date}____________________, the death of either party, remarriage of
Obligee, or until modified by court order in accordance with section 61.08(7),Florida
Statutes; whichever occurs first.

5. _____ Lump Sum. Obligor shall pay lump sum alimony to Obligee in the amount of
$_________ which shall be paid as
follows:____________________________________________.

6. _____ Retroactive. Obligor shall pay retroactive alimony in the amount of
$ _____________ for the period of {date} , through {date} , which
shall be paid pursuant to paragraph D. below.

C. Reasons for _____ Awarding _____ Denying Alimony. The Court has considered all of the
following in awarding/denying alimony:
1. The standard of living established during the marriage;
2. The duration of the marriage;
3. The age and the physical and emotional condition of each party;
4. The financial resources of each party, including the nonmarital and marital assets and
liabilities distributed to each;
5. The earning capacities, educational levels, vocational skills, and employability of the
parties and, when applicable, the time necessary for either party to acquire sufficient
education or training to enable such party to find appropriate employment;
6. The contribution of each party to the marriage, including, but not limited to, services
rendered in homemaking, child care, education, and career building of the other party;
7. The responsibilities each party will have with regard to any minor or dependent children
they have in common;
8. The tax treatment and consequences to both parties of any alimony award, including the
designation of all or a portion of the payment as a nontaxable, nondeductible payment;
9. All sources of income available to either party, including income available to either party
through investments of any asset held by that party and

Florida Supreme Court Approved Family Law Form 12.994(a)(2), Final Judgment for Support and Parenting Plan
Unconnected with Dissolution of Marriage (02/18)
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 10. Any other factor necessary to do equity and justice between the parties: {explain}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
_______ Please indicate here if additional pages are attached.

D. Retroactive Alimony and/or Arrearages.

1. _____There is no alimony arrearage at the time of this Final Judgment.

OR

2. _____Petitioner _____ Respondent shall pay to the other party alimony in the
amount of:

$ for retroactive alimony, as of {date} ____ .
$ for previously ordered unpaid alimony, as of {date} .

The total of $ ___ in retroactive alimony and arrearages 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 or _____ other {explain} ___________
beginning {date __________, until paid in full including statutory interest.

E. ._____Life Insurance (to secure payment of support). To secure the alimony obligations set forth
in this judgment, Obligor shall maintain life insurance on his/her life naming Obligee as the sole
irrevocable beneficiary, so long as reasonably available. This insurance shall be in the amount of
at least $___________ and shall remain in effect until the obligation for alimony
terminates.

F. _____ Other provisions relating to alimony including any tax treatment and consequences:

1. The award of alimony _____ does not _____ does leave the Obligor with significantly less
net income than the net income of the recipient/Obligee. If the award does leave the
Obligor with significantly less net income than that of the Obligee, the Court finds the
following exceptional circumstances: _______________________________________
____________________________________________________________________
_____________________________________________________________________
______________________________________________________________________.

2. Other:__________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Florida Supreme Court Approved Family Law Form 12.994(a)(2), Final Judgment for Support and Parenting Plan
Unconnected with Dissolution of Marriage (02/18)
- 397 -
 _______________________________________________________________________.

SECTION II. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING WITH
DEPENDENT OR MINOR CHILD(REN)
A. Jurisdiction. The Court has jurisdiction to determine parental responsibility, to establish or adopt
a Parenting Plan, and a time-sharing schedule with regard to the minor child(ren) listed in paragraph
2 below.

B. The parties’ dependent or minor child(ren) is (are):
Name Birth date
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

C. Parenting Plan. The parties shall comply with the Parenting Plan which is attached and
incorporated herein as Exhibit _______.

SECTION III. CHILD SUPPORT
A.______The Court finds that there is a need for child support and that the _____ Petitioner _____
Respondent (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 _____ Petitioner _____Respondent are correct

OR

_____the Court makes the following findings:

Petitioner’s net monthly income is $ ___________, (Child Support Guidelines _ %).
Respondent’s net monthly income is $ ____, (Child Support Guidelines ____%).
Monthly child care costs are $ _.
Monthly health/dental insurance costs are $ ____________.

B. Amount.
Child support established at the rate of $____________ per month for the ______children
{total number of parties’ minor or dependent children} shall be paid commencing
_______________ {month, day, year} and terminating ___________________ {month, day,
year}. Child support shall be paid in the amount of $________ per ______________ {week,
month, other} which is consistent with the Obligor’s current payroll cycle.

Upon the termination of the obligation of child support for one of the parties’ children, child
Florida Supreme Court Approved Family Law Form 12.994(a)(2), Final Judgment for Support and Parenting Plan
Unconnected with Dissolution of Marriage (02/18)
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 support in the amount of $__________for the remaining _________children {total number of
remaining children} shall be paid commencing ____________________________{month, day,
year} and terminating________________________________{month, day, year}. This child
support shall be paid in the amount of $_______ _per_______________ {week, month, other}
consistent with the Obligor’s current payroll cycle.

{Insert schedule for the child support obligation, including the amount, and commencement
and termination dates, for the remaining minor or dependent children, which shall be payable
as the obligation for each child ceases. Please indicate whether the schedule _____appears
below or _____ is attached as part of this form.}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

The Obligor shall pay child support until all of the minor or dependent children: reach the age of
18; become emancipated, marry, join the armed services, die, or become self-supporting; or
until further order of the court or agreement of the parties. The child support obligation shall
continue beyond the age of 18 and until high school graduation for any child who is dependent
in fact, between the ages of 18 and 19, and is still in high school, performing in good faith with a
reasonable expectation of graduation before the age of 19.

If the child support ordered deviates from the guidelines by more than 5%, the factual findings
which support that deviation are:

.

C. Retroactive Child Support and/or Arrearages.

1. _____ There is no retroactive child support or child support arrearage at the time of this
Final Judgment.

OR

2. _____ The _____ Petitioner _____ Respondent shall pay to the other party child
support in the amount of:

$_____________for retroactive child support, as of {date}_______________________;
$ ___________ _ for previously ordered unpaid child support, as of {date} ______________

The total of $ __________ of retroactive child support and arrearages shall be paid in
the amount of $ ____ per month, payable _____ in accordance with Obligor’s
Florida Supreme Court Approved Family Law Form 12.994(a)(2), Final Judgment for Support and Parenting Plan
Unconnected with Dissolution of Marriage (02/18)
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 employer’s payroll cycle, and in any event, at least once a month or _____ other {explain}
_______________beginning {date} _________, until paid in full including
statutory interest.

D. Insurance.
{Indicate all that apply}

1. Health/Dental Insurance. _____ Petitioner _____ Respondent shall be required to
maintain _____ health and/or _____dental insurance for the parties’ minor child(ren), so
long as it is reasonable in cost and accessible to the child(ren). The party providing insurance
shall be required to convey insurance cards demonstrating said
insurance to the other party.

OR

_____ Health _____ Dental insurance is either not reasonable in cost or accessible to the
children at this time.

2. _____ Reasonable and necessary uninsured medical/dental/prescription drug costs for
the minor child(ren) shall be assessed as follows:

_____ Shared equally by both parents.

_____ Prorated according to the child support guideline percentages.

_____ Other {explain}:

As to these uninsured medical/dental/prescription drug expenses, the party who incurs the
expense shall submit a request for reimbursement to the 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.

E. _____Life Insurance (to secure payment of support). To secure the child support obligations in
this judgment, _____ Petitioner _____Respondent ______ Each party shall maintain life insurance
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 _____ Petitioner _____ Respondent
_____ other {name}_______________________as Trustee for the minor child(ren). The obligation
to maintain the life insurance coverage shall continue until the youngest child turns 18, becomes
emancipated, marries, joins the armed services, dies, or becomes self-supporting.

F. IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall be
as follows:
_________________________________________________________________________________
.

Florida Supreme Court Approved Family Law Form 12.994(a)(2), Final Judgment for Support and Parenting Plan
Unconnected with Dissolution of Marriage (02/18)
- 400 -
 Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of this
paragraph.

G. Other provisions relating to child support:
______________________________________________________________________________

SECTION IV. METHOD OF PAYMENT
Obligor shall pay court-ordered child support/alimony and arrears, if any, as follows:

A. Place of Payment.

1_____ Obligor shall pay court-ordered support directly to either the State Disbursement
Unit or the central depository, as required by statute, along with any fee required by
statute.

2._____ Both parties have requested and the court finds that it is in the best interests of the
child(ren) that support payments need not be directed through either the State
Disbursement Unit or the central depository at this time; however, either party may
subsequently apply, pursuant to section 61.08 or 61.13, Florida Statutes, to require
payments through either the State Disbursement Unit or the central depository.

B. Income Deduction.

1._____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 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.

2._____ 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 Title IV-D agency, clerk of court,
and Obligee of any change in Payor and/or health insurance
OR
_____there is a signed written agreement providing an alternative arrangement between
the Obligor and the Obligee and, at the option of the IV-D agency, by the IV-D agency in IV-D
cases in which there is an assignment of support rights to the state, reviewed and entered in
Florida Supreme Court Approved Family Law Form 12.994(a)(2), Final Judgment for Support and Parenting Plan
Unconnected with Dissolution of Marriage (02/18)
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 the record by the court.

C. 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 the Obligee pursuant to the payment
method prescribed above.

D. Other provisions relating to method of payment.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

SECTION V. ATTORNEY’S FEES, COSTS, AND SUIT MONEY
A._____ Petitioner’s _____ Respondent’s request(s) for attorney’s fees, costs, and suit money is
(are) denied because:
_____________________________________________________________________________
.

OR

B. _____ The Court finds there is a need for and an ability to pay attorney’s fees, costs, and suit money.
_____Petitioner _____ Respondent is hereby ordered to pay to the other party
$ _____ in attorney’s fees, and $ _____ in costs. The Court further finds that the
attorney’s fees awarded are based on the reasonable rate of $____________per hour and ___
reasonable hours. Other provisions relating to attorney’s fees, costs, and suit money are as follows:
______________________________________________________________________________

.

SECTION VI. OTHER PROVISIONS
A. Other Provisions: _______________________________________________________________

B. The Court reserves jurisdiction to modify and enforce this Final Judgment.

DONE AND ORDERED in _____, Florida, on _______________________ .

CIRCUIT JUDGE

Florida Supreme Court Approved Family Law Form 12.994(a)(2), Final Judgment for Support and Parenting Plan
Unconnected with Dissolution of Marriage (02/18)
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I certify that a copy of this Final Judgment for Support and Parenting Plan Unconnected with Dissolution
of Marriage with Dependent or Minor Child(ren) was _____ mailed _____ faxed and mailed
_____e-mailed _____ hand-delivered to the parties and any entities listed below on
{date}_______________________.

by ______________________________________
{Clerk of court or designee}

_____Petitioner (or his/her attorney)
_____Respondent (or his/her attorney)
_____Central Depository
_____State Disbursement Unit
_____Other:

Florida Supreme Court Approved Family Law Form 12.994(a)(2), Final Judgment for Support and Parenting Plan
Unconnected with Dissolution of Marriage (02/18)
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 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT
IN AND _________ COUNTY, FLORIDA

In Re: the Marriage of:

Case No.:
Division:
______________,
Petitioner,

and

____________,
Respondent.

FINAL JUDGMENT FOR SUPPORT
UNCONNECTED WITH DISSOLUTION OF MARRIAGE
WITH NO DEPENDENT OR MINOR CHILD(REN)

This cause came before this Court on a Petition for Support Unconnected with Dissolution of Marriage
under section 61.09, Florida Statutes. The Court, having reviewed the file and heard the testimony, makes
these findings of fact and reaches these conclusions of law:
1. The Court has jurisdiction over the subject matter and the parties.

2. The parties have no minor or dependent children in common, no child born to either
spouse during the marriage remains minor or dependent, and neither spouse is pregnant.

SECTION I. ALIMONY

A. _____The Court denies the request(s) for alimony.
OR
B. _____The Court finds that _____Petitioner _____Respondent has an actual need for alimony and
that _____Petitioner _____Respondent has/had the ability to support his/her spouse and has failed
to do so. _____Petitioner _____Respondent (hereinafter Obligor) has the present ability to pay
alimony as follows:
{Indicate all that apply}

Florida Supreme Court Approved Family Law Form 12.994(b), Final Judgment for Support Unconnected with
Dissolution of Marriage with No Dependent or Minor Child(ren) (02/18)
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 1. ______ Permanent Periodic.

a. The court finds that no other form of alimony is fair and reasonable under the
circumstances of the parties.

b. As a marriage of (choose one only):

_____Long Duration (17 years or greater) alimony is appropriate upon consideration of
all relevant factors;

_____Moderate Duration (greater than 7 years but less than 17) alimony is appropriate
based upon clear and convincing evidence after consideration of all relevant
factors; or

_____ Short Duration (less than 7 years) alimony is appropriate based upon the
following exceptional circumstances:________________________________
_____________________________________________________________
_______________________________________________________________
____________________________________________________________.

c. Obligor shall pay permanent 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, or _____ other: {explain}_______________________________
beginning {date} _________. This alimony shall continue until modified by court
order, the death of either party, or remarriage of Obligee, whichever occurs first. The alimony
may be modified or terminated based upon either a substantial change in circumstances, or
a supportive relationship in accordance with section 61.14, Florida Statutes.

2. _____Bridge-the-Gap. Obligor shall pay bridge-the-gap alimony to Obligee in the amount of
$______per month, payable_____ in accordance with Obligor’s employer’s payroll cycle,
beginning {date}________________and continuing until {date}___________________ {a period
not to exceed two years}, remarriage of Obligee, or death of either party, whichever occurs first.

3. _____Rehabilitative. Obligor shall pay 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 rehabilitative alimony shall continue until modified by
court order, the death of either party or until {date/event} _____________________________
_____________________________________________________________________________.
whichever occurs first. The rehabilitative plan presented demonstrated the following: ________
_____________________________________________________________________________.

4. ______Durational. Obligor shall pay durational alimony to Obligee in the amount of

Florida Supreme Court Approved Family Law Form 12.994(b), Final Judgment for Support Unconnected with
Dissolution of Marriage with No Dependent or Minor Child(ren) (02/18)
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 $____________per month payable _____ in accordance with Obligor’s employer’s payroll
cycle, and in any event, at least once a month, or _____ other {explain}______________________
beginning {date}________________and terminating on {date }___________________________,
remarriage of the Obligee, death of either party, or until modified by court order in
accordance with section 61.08(7), Florida Statutes; whichever occurs first.

5. _____Lump Sum. Obligor shall pay lump sum alimony to Obligee in the amount of
$_________which shall be paid as follows:___________________________________________
.

6.______Retroactive. Obligor shall pay retroactive alimony in the amount of $ ____ for
the period of {date} __________, through {date} ____________, which
shall be paid pursuant to paragraph 4 below.

C. Reasons for _____ Awarding _____ Denying Alimony. The Court has considered all of the
following in awarding/denying alimony:
1. The standard of living established during the marriage;
2. The duration of the marriage;
3. The age and the physical and emotional condition of each party;
4. The financial resources of each party, including the nonmarital and the marital assets and
liabilities distributed to each;
5. The earning capacities, educational levels, vocational skills, and employability of the parties
and, when applicable, the time necessary for either party to acquire sufficient education or
training to enable such party to find appropriate employment;
6. The contribution of each party to the marriage, including, but not limited to, services rendered
in homemaking, child care, education, and career building of the other party;
7. The tax treatment and consequences to both parties of any alimony award, including the
designation of all or a portion of the payment as nontaxable, nondeductible payment;
8. All sources of income available to either party, including income available to either party
through investments of any asset held by the party; and
9. Any other factor necessary to do equity and justice between the parties {Explain}

.
______ Please indicate here if additional pages are attached.

D. Retroactive Alimony and/or Arrearages.

1. _____There is no alimony arrearage at the time of this Final Judgment.
OR
2. _____Petitioner _____Respondent shall pay to the other party alimony in the amount of:

Florida Supreme Court Approved Family Law Form 12.994(b), Final Judgment for Support Unconnected with
Dissolution of Marriage with No Dependent or Minor Child(ren) (02/18)
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 $ for retroactive alimony, as of {date} _____________________.
$ for previously ordered unpaid alimony, as of {date} ________.
The total of $ _ in retroactive alimony and arrearages 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, _____ or other: {explain}________________________
beginning {date} _______________, until paid in full including statutory interest.

E. ______Life Insurance (to secure payment of support). To secure the alimony obligations set forth
in this judgment, Obligor shall maintain life insurance coverage on his/her life naming Obligee as the
sole irrevocable beneficiary, so long as reasonably available. This insurance shall be in the amount of
at least $ ________ and shall remain in effect until the obligation for alimony terminates.

F. ______Other provisions relating to alimony including any tax treatment and consequences:

a. The award of alimony _____ does not _____ does leave the Obligor with significantly less net
income than the net income of the recipient/Obligee. If yes, the court finds the following
exceptional circumstances:________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

b. Other _______________________________________________________________________
______________________________________________________________________________
.

SECTION II. METHOD OF PAYMENT
Obligor shall pay court-ordered alimony and arrears, if any, as follows:

A. Place of Payment

a._____ Obligor shall pay court-ordered support directly to either the State Disbursement Unit or
the central depository, as required by statute, along with any fee required by statute.

b._____ Both parties have requested and the court finds that support payments need not be
directed through either the State Disbursement Unit or the central depository at this time;
however, either party may subsequently apply, pursuant to section 61.13(1)(d)3, Florida Statutes,
to require payments through either the State Disbursement Unit or the central depository.

B. Income Deduction.

1. _____Immediate. Obligor shall pay through income deduction, pursuant to a separate Income
Deduction Order which shall be effective immediately. Obligor is individually responsible for

Florida Supreme Court Approved Family Law Form 12.994(b), Final Judgment for Support Unconnected with
Dissolution of Marriage with No Dependent or Minor Child(ren) (02/18)
- 407 -
 paying this 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.

2._____ 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 Title IV-D agency, clerk of court, and
Obligee of any change in Payor and/or health insurance
OR
_____ there is a signed written agreement providing an alternative arrangement between the
Obligor and the Obligee and, at the option of the IV-D agency, by the IV-D agency in IV-D cases in
which there is an assignment of support rights to the state, reviewed and entered in the record
by the court.

C. 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 the Obligee pursuant to the payment
method prescribed above.

D. Other provisions relating to method of payment:

.

SECTION III. ATTORNEY’S FEES, COSTS, AND SUIT MONEY
A. _____ Petitioner’s _____ Respondent’s request(s) for attorney’s fees, costs, and suit money is
(are) denied because________________________________________________________________
.

OR

B. The Court finds there is a need for and an ability to pay attorney’s fees, costs, and suit money.
_____Petitioner _____Respondent is hereby ordered to pay to the other party $ ___ in
attorney’s fees, and $ __ in costs. The Court further finds that the attorney’s fees awarded
are based on the reasonable rate of $ _______ per hour and ___ reasonable hours. Other
provisions relating to attorney’s fees, costs, and suit money are as follows: ______________________

Florida Supreme Court Approved Family Law Form 12.994(b), Final Judgment for Support Unconnected with
Dissolution of Marriage with No Dependent or Minor Child(ren) (02/18)
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 .

SECTION IV. OTHER PROVISIONS
A. Other Provisions:

.

B. The Court reserves jurisdiction to modify and enforce this Final Judgment.

DONE AND ORDERED on _____________________ in ___________________________, Florida.

CIRCUIT JUDGE

I certify that a copy of this Final Judgment for Support Unconnected with Dissolution of Marriage with
no Dependent or Minor Child(ren) was _____ mailed _____ faxed and mailed _____ e-mailed _____
hand-delivered to the parties and any entities listed below on {date}__________________________.

by__________________________________
{Clerk of court or designee}

______Petitioner (or his/her attorney)
______Respondent (or his/her attorney)
______Central Depository
______State Disbursement Unit
____Other:

Florida Supreme Court Approved Family Law Form 12.994(b), Final Judgment for Support Unconnected with
Dissolution of Marriage with No Dependent or Minor Child(ren) (02/18)
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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.995(a),
PARENTING PLAN
(02/18)

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 Supervised/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. The parents must identify a name or designation to be used
throughout this Parenting Plan.

This form should be typed or printed in black ink. Please either delete or strike-through terms or
paragraphs that are inappropriate or inapplicable 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.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

Instructions for Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (02/18)
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After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving pleadings
by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of
Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of
Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the
A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

Where can I look for more information?

Before proceeding, you should read “General Information for Self-Represented Litigants” found at the
beginning of these forms. 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

Instructions for Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (02/18)
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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 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;
 The demonstrated capacity and disposition of each parent to participate and be involved in the
child(ren)’s school and extracurricular activities;

Instructions for Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (02/18)
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 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.

Instructions for Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (02/18)
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 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
Petitioner, hereinafter referred to in this Parenting Plan as Parent
{name or designation} ___________________________________________.
Name:__________________________________________________________________
Address: ________________________________________________________________
Telephone Number: __________________E-Mail: _______________________________
_____ Address Unknown: {Please indicate here if Petitioner’s address is unknown}
_____ Address Confidential: {Please indicate here if Petitioner’s address and phone numbers are
confidential pursuant to either a _____ Final Judgment for Protection Against Domestic Violence,
or _____ other court order ______________________________________}.

Respondent, hereinafter referred to in this Parenting Plan as Parent
{name or designation} ____________________________________________.
Name:__________________________________________________________________
Address: ________________________________________________________________
Telephone Number: _________________ E-Mail: ________________________________
_____ Address Unknown: {Please indicate here if Respondent’s address is unknown}

Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (02/18)
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 _____ Address Confidential: {Please indicate here if Respondent’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
{Insert the name or designation of the appropriate parent in the space provided.}

1. Parental Responsibility {Choose only one}

a._____ 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. Either parent may consent to mental health
treatment for the child(ren).

OR

b._____Shared Parental Responsibility with Decision Making Authority

Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (02/18)
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 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:

Education/Academic decisions Parent ________________________
Non-emergency health care Parent ________________________
Other: {Specify}______________ Parent ________________________
___________________________ Parent ________________________
___________________________ Parent ________________________

OR

c._____ Sole Parental Responsibility:
It is in the best interests of the child(ren) that _____Parent {name or designation}
____________________ 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 while the child is with that parent. Regardless of the
allocation of decision making in the 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 {Indicate all that apply}
{Insert the name or designation of the appropriate parent in the space provided.

a._____Either parent may register the child(ren) and allow them to participate in the
activity of the child(ren)’s choice.

b._____The parents must mutually agree to all extra-curricular activities.

c._____ 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.

d._____ The costs of the extra-curricular activities shall be paid by:
Parent __________________ ______%
Parent __________________ _______ %

e._____ The uniforms and equipment required for the extra-curricular activities shall be
paid by:
Parent __________________ _______ %

Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (02/18)
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 Parent __________________ ________%

f._____ Other: {Specify}_________________________________________________
_______________________________________________________________.

V. INFORMATION SHARING. Unless otherwise indicated or ordered by the Court:

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: {Indicate all that apply}
a._____the oldest child

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 b._____the youngest child
c.______________________ County
d.______________________ 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 end on the first day of
regularly scheduled classes after the holiday or break.

3. Schedule Changes {Indicate all that apply}

a._____ 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.

b._____ A parent requesting a change of schedule shall be responsible for any additional
child care, or transportation costs caused by the change.

c._____ Other {Specify}____________________________________________________.

VII. TIME-SHARING SCHEDULE
{Insert the name or designation of the appropriate parent in the space provided.}
{A time-sharing schedule must be provided for both parents.}

1. Weekday and Weekend Schedule
The following schedule shall apply beginning on ________________________ with
Parent {name or designation}______________________ and continue as follows:

The child(ren) shall spend time with Parent _______________ on the following dates
and times:
WEEKENDS: _____ Every _____ Every Other _____ Other {specify} _____________
From____________________________ to _________________________________
WEEKDAYS: {Specify days} ______________________________________________
From _____________________________ to _______________________________
OTHER: {Specify} _____________________________________________________
___________________________________________________________________
___________________________________________________________________.

The child(ren) shall spend time with the Parent _______________ on the following
dates and times:
WEEKENDS: _____ Every _____ Every Other _____ Other {specify}______________
From____________________________ to _________________________________
WEEKDAYS: {Specify days} ______________________________________________

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 From _____________________________ to _______________________________
OTHER: {Specify} _____________________________________________________
___________________________________________________________________
___________________________________________________________________.

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.

_____ 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}

a. _____No holiday time sharing shall apply. The regular time-sharing schedule set forth
above shall apply.

b. _____Holiday time-sharing shall be as the parties agree.

c. _____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 the name or designation of the appropriate parent 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 __________ _________ __________ _____________
M. L. King Day __________ _________ __________ _____________
Easter __________ _________ __________ _____________
Passover __________ _________ __________ _____________
Memorial Day Wkd _______ __________ __________ _____________
4th of July __________ _________ __________ _____________
Labor Day Wkd __________ _________ __________ _____________
Columbus Day Wkd _______ _________ __________ _____________
Halloween __________ _________ __________ _____________
Thanksgiving __________ _________ __________ _____________
Veteran’s Day __________ _________ __________ _____________
Hanukkah __________ _________ __________ _____________

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 Yom Kippur __________ _________ __________ _____________
Rosh Hashanah __________ _________ __________ _____________
Child(ren)’s
Birthdays: __________ _________ __________ _____________
__________ __________ _________ __________ _____________
__________ __________ _________ __________ _____________

This holiday schedule may affect the regular Time-Sharing Schedule. Parents may wish to
specify either or both of the following options:

d._____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.

e._____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 {Choose only one}
{Insert the name or designation of the appropriate parent in the space provided.}

a. _____Parent ___________________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.

b._____ Parent ________________ shall have the child(ren) for the entire Winter Break
during _____ odd-numbered years _____ even-numbered years _____ every year.

c._____Other: ___________________________________________________________
_______________________________________________________________________
_______________________________________________________________________.

d. _____Specific Winter Holidays
If not addressed above, the specific Winter Holidays such as Christmas, New Year’s Eve,
Hanukkah, Kwanzaa, etc. shall be shared as follows:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________.

4. Spring Break {Choose only one}

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 {Insert the name or designation of the appropriate parent in the space provided.}
a._____The parents shall follow the regular schedule.

b._____The parents shall alternate the entire Spring Break with Parent
________________having the child(ren) during the _____odd-numbered years
and Parent ____________________ during _____the even numbered years.

c._____Parent _______________ shall have the child(ren) for the entire Spring Break
every year.

d._____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.

e._____Other: {Specify}_______________________________________.

5. Summer Break {Choose only one}
{Insert the name or designation of the appropriate parent in the space provided.}

a._____The parents shall follow the regular schedule through the summer.

b._____ Parent _________________ shall have the entire Summer Break from
__________after school is out until _______________ before school starts.

c._____The parents shall equally divide the Summer Break as follows: During _____
odd-numbered years_____ even numbered years, _____Parent _______ _______
_____ Parent ______________ 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) _____________________________________________
_______________________________________________________________________.

d._____Other: {Specify}____________________________________________________
_______________________________________________________________________.

6. Number of Overnights:
{Insert the name or designation of the appropriate parent in the space provided.}

Based upon the time-sharing schedule, Parent ____________________ has a total of
_____ overnights per year and Parent _________________ has a total of _____ overnights
per year. Note: The two numbers must equal 365.

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 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)
{Insert the name or designation of the appropriate parent in the space provided.}

1. Transportation {Choose only one}

a.____ Parent ______________ shall provide all transportation.

b. _____The parent beginning their time-sharing shall provide transportation for the
child(ren).

c._____The parent ending their time-sharing shall provide transportation for the
child(ren).

d._____Other: {Specify}___________________________________________________
_____________________________________________________________________.

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}:

a._____Exchanges shall be at the parents’ homes unless both parents agree to a
different meeting place.

b._____Exchanges shall occur at __________________________________________
____________________________________________________________ unless both
parties agree in advance to a different meeting place.

c._____Other: _______________________________________________________.

3. Transportation Costs {Choose only one}
{Insert the name or designation of the appropriate parent in the space provided.}

a._____Transportation costs are included in the Child Support Worksheets and/or the
Order for Child Support and should not be included here.

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 b._____Parent _____________ shall pay ______% and Parent __________________
shall pay ______ % of the transportation costs.

c._____Other: ___________________________________________________________.

4. Foreign and Out-Of-State Travel {Indicate all that apply}

a._____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.

b._____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.

c._____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
_____________________________________________________________________
_____________________________________________________________________.

d._____Other _________________________________________________________.

IX. EDUCATION

1. School designation.
For purposes of school boundary determination and registration, the address of
Parent {name or designation} _______________________ shall be used .

2. _____ {If Applicable} The following provisions are made regarding private or home
schooling: _______________________________________________________
_____________________________________________________________________
_____________________________________________________________________.

3. Other. ________________________________________________________________
____________________________________________________________________
____________________________________________________________________.

X. DESIGNATION FOR OTHER LEGAL PURPOSES

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 {Insert the name or designation of the appropriate parent in the space provided.}

The child(ren) named in this Parenting Plan are scheduled to reside the majority of the time with
Parent _______________ . 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: {Indicate all that apply}

_____in person
_____by telephone
_____by letter
_____by e-mail
_____Other: {Specify}_________________________________________.

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
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}
a._____Anytime
b._____Every day during the hours of ______________ to ______________________.
c._____On the following days_____________________________________________
during the hours of __________________________ to _________________________.
d._____Other: _________________________________________________________.

3. Costs of Electronic Communication shall be addressed as follows:
_____________________________________________________________________
_____________________________________________________________________

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 _____________________________________________________________________.

XII. CHILD CARE {Choose only one}

a._____Each parent may select appropriate child care providers
b._____All child care providers must be agreed upon by both parents.
c._____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.
d._____Other : {Specify}__________________________________________________.

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
and assistance, such as Parenting Coordinators and Parenting Counselors, before filing a court
action.

XVI. OTHER PROVISIONS
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________.

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 SIGNATURES 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 Petitioner/Parent _____________
Printed Name: ___________________________
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es):____________
____________________________________
STATE OF FLORIDA

COUNTY OF _________________________

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

{Print, type, or stamp commissioned name of
notary or clerk.}

__ Personally known
__ Produced identification
Type of identification produced _____________________________

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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 Respondent/Parent ____________
Printed Name: ___________________________
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es):______________
_______________________________________

STATE OF FLORIDA
COUNTY OF _________________________

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

{Print, type, or stamp commissioned name of
notary or clerk.}
__ Personally known
__Produced identification
Type of identification produced ____________________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the: {choose only one} _____ Petitioner _____ Respondent
This form was completed with the assistance of:
{name of individual} ________________________________________________________________,
{name of business} _________________________________________________________________,
{address} _________________________________________________________________________,
{city} _________________, {state} ______, {zip code} _________, {telephone number} ______________.

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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.995(b),
SUPERVISED/SAFETY-FOCUSED PARENTING PLAN
(02/18)

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 parents must identify a name or designation to be used throughout this Parenting Plan.

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.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain

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circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving pleadings
by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of
Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of
Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the
A-Z Topical Index.
SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

Where can I look for more information?

Before proceeding, you should read “General Information for Self-Represented Litigants” found at the
beginning of these forms. 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
 The methods and technologies that the parents will use to communicate with the child(ren).

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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 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;

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  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.

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 IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT
IN AND FOR ________________________ COUNTY, FLORIDA

Case No: _____________________
Division: _____________________
_______________________________
Petitioner,
and

______________________________
Respondent.

SUPERVISED/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
Petitioner, hereafter referred to in this Parenting Plan as Parent
{name or designation} _______________________________________________________
Name:_____________________________________________________________________
Address:___________________________________________________________________
Telephone Number:___________________E-Mail:_________________________________
_____ Address Unknown: {Please indicate if Petitioner’s address is unknown}
_____ Address Confidential: {Please indicate if Petitioner’s address and phone numbers are
confidential pursuant to either a _____ Final Judgment for Protection Against Domestic Violence or
_____ other court order _____________________________________________.}

Respondent, hereafter referred to in this Parenting Plan as Parent
{name or designation} ________________________________________________________
Name:______________________________________________________________________
Address:_____________________________________________________________________
Telephone Number: _________________ E-Mail: _____________________________________
_____ Address Unknown: (Please indicate if Respondent’s address is unknown}
_____ Address Confidential: (Please indicate if Respondentr’s address and telephone

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 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}
{Insert the name or designation of the appropriate parent in the space provided.}

1. _____Sole Parental Responsibility
It is in the best interests of the child(ren) that Parent {name or designation}
______________ 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.

OR

2. _____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:

Education/Academic decisions Parent ______________
Non-emergency health care Parent ______________
________________________ Parent ______________
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 ________________________ Parent ______________
_________________________ Parent ______________

_____Other: {Specify}___________________________________________.

V. TIME-SHARING SCHEDULE {Choose only one}
{Insert the name or designation of the appropriate parent in the space provided}

1.______No Time-Sharing: Parent ________________ shall have no contact with the child(ren)
until further order of the court. All parenting decisions shall be made by the other parent.

2. _____Supervised Time-Sharing: Whenever the child(ren) are with _____Parent
_____________ ______Parent _________________, the supervisor shall be present.
_____Parent ___________________ _____Parent ________________ 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}
a. _____ hours per week. The place(s), and time(s) shall be set by ______Parent
________________ _____ Parent ______________________________.

b. _____From ___ m. to ____ m, on the following day(s) ____________________
_______________________________________________________________________.

3. _____ Restricted Time-Sharing: ____Parent ________________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:_____________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.

4. ______ hours per week. The place(s), and time(s) shall be set by Parent _________________ .

5.______Other: ___________________________________________________________.

VI. SUPERVISOR AND SUPERVISION {Choose only one}
{Insert the name or designation of the appropriate parent in the space provided.}

1. Supervisor. The person supervising the time-sharing shall be selected by: {Choose only one}
_____both parents
_____Parent {name or designation} _______________________, subject to the other
parent’s approval.

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 _____ Be selected by Parent {name or designation} ___________________ , 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 Parent _____________

_____Other: ______________________________________________________.

VII. LOCATION: {Choose only one}
{Insert the name or designation of the appropriate parent in the space provided.}

_____Parent____________________ ______Parent _________________ shall spend his/her
time-sharing with the child(ren) at the following location(s):

1. _____Supervised visitation center (name and address of facility) ________________________
_______________________________________________________________________.

2._____ _______________________________________ {location} or other location designated
by Parent ______________

3._____Any location designated by Parent ____________________ with the approval of the
supervisor.

4._____Other: _____________________________________________________ .

VIII. DESIGNATION FOR OTHER LEGAL PURPOSES
{Insert the name or designation of the appropriate parent in the space provided.}

1. The child(ren) named in this Safety-Focused Parenting Plan are scheduled to reside the majority
of the time with Parent {name or designation} ______________________________. 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 address of Parent {name
or designation} _________________________________shall be used .

IX. TRANSPORTATION AND EXCHANGE OF CHILD(REN)
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 {Insert the name or designation of the appropriate parent in the space provided.}

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.

Parent ____________ Parent ______________ 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}

a. _____ Parent ________________ with the supervisor present.

b. _____ The supervisor alone.

c. ____ Other: _______________________________________________.

2. Exchange
{Insert the name or designation of the appropriate parent in the space provided.}

The exchange of the child(ren) shall occur at: {Indicate all that apply}

a._____ The site of the supervised visit.

b._____ A monitored exchange location {specify name and address of facility}________
_______________________________________________________________________.

c._____ Other: ____________________________________________________________.

d. Parent(s) {name(s) or designation(s)}_____________________________ and {if applicable}
_____________________________ is prohibited from coming to the exchange point.

X. 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: {Indicate all that apply}
_____in person
_____by telephone
_____by letter
_____by e-mail
_____Other: {Specify] ___________________________________________.

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 _____ 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)
{Insert the name or designation of the appropriate parent in the space provided.}

Parent {name or designation} __________________ {Indicate all that apply}

a._____Shall not telephone, write, or e-mail the child(ren) unless the contact is agreed to
in advance by the other parent.

b._____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.

c._____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.

d._____ 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.

e._____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
{Insert the name or designation of the appropriate parent in the space provided.}

_____Parent {name or designation} ______________________ {Choose only one}

1._____Shall not attend the child(ren)’s activities and events, including but not limited to,
school, athletic, and extra-curricular activities and events.
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 2._____May attend the child(ren)’s school, athletic, and extra-curricular activities and
events.

3._____ Must stay ______ feet from the other parent and ______ feet from the child.

4._____ Other _______________________________________________.

XII. CHILD(REN)’S SAFETY
{Insert the name or designation of the appropriate parent in the space provided.}

_____ Parent ______________________ shall follow the safety rules checked below. (Indicate
all that apply)

1._____There shall be no firearms in the home, car, or in the child(ren)’s presence during
time-sharing.

2. _____No alcoholic beverages shall be consumed from twenty-four (24) hours before
the child(ren) arrive until they are returned to the other parent.

3._____The child(ren) shall not be disciplined by corporal punishment.

4._____The following person(s) present a danger to the child(ren) and shall not be present
during time-sharing: ________________________________________________
_______________________________________________________________________.

5._____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
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________.

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 SIGNATURES 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 Petitioner/Parent ______________
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es):___________________
__________________________________________
STATE OF FLORIDA
COUNTY OF ___________________________

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

{Print, type, or stamp commissioned name of notary or
clerk}
__ Personally known
__ Produced identification
Type of identification produced _________________________________

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l 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 Respondent/Parent __________________
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es):___________________
__________________________________________

STATE OF FLORIDA
COUNTY OF ________________________

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

{Print, type, or stamp commissioned name of notary or
clerk.}
__ Personally known
__ Produced identification
Type of identification produced __________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the: {choose only one} _____ Petitioner _____ Respondent
.This form was completed with the assistance of:
{name of individual} __________________________________________________________________,
{name of business} ____________________________________________________________________,
{address} ____________________________________________________________________________,
{city} ___ ,{state} , {zip code}____________,{telephone number} .

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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.995(c)
RELOCATION/LONG DISTANCE PARENTING PLAN
(02/18)

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 every
other person entitled to access or time-sharing with the child(ren) and approved by the court. “Other
Person” means an individual who is not the parent, but with whom the child resides pursuant to court
order, or who has the right of access to, time-sharing with or visitation with the child(ren). 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. The parents or Other Person must identify a name or designation to be used
throughout this Parenting Plan.

This form or a similar form should be used in the development of a Parenting Plan when you are
planning to relocate your or the child(ren)’s principal residence more than 50 miles from the principal
place of residence:

 at the time of the last order either establishing or modifying time-sharing, or
 at the time of filing the pending action to either establish or modify time-sharing

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 an agreed Parenting Plan is not filed by the parties, the Court shall establish a
Plan.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.

Instructions for Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting
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 IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving pleadings
by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of
Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of
Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the
A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.

Where can I look for more information?

Before proceeding, you should read “General Information for Self-Represented Litigants” found at the
beginning of these forms. 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 Relocation/Long Distance 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 that specifies the time that the minor child(ren) will spend with each
parent and every other person entitled to access or time-sharing,
 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,
 The methods and technologies that the parties will use to communicate with the child(ren), and

Instructions for Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting
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  Any transportation arrangements related to access or time-sharing.
The best interests of the child(ren) is the primary consideration in the Parenting Plan. In creating the
Parenting Plan, all circumstances between the parties, including the parties’ 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 the family as listed in section 61.13(3), Florida
Statutes, including, but not limited to:
 The demonstrated capacity and disposition of each party 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 party 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 party with a child(ren);
 The moral fitness of the parties;
 The mental and physical health of the parties;
 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 party 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 party 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 party to communicate with and keep the other
part(y)ies informed of issues and activities regarding the minor child(ren), and the
willingness of each party 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 any party 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;

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  The particular parenting tasks customarily performed by each party 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 party to participate and be involved
in the child(ren)’s school and extracurricular activities;
 The demonstrated capacity and disposition of each party to maintain an environment
for the child(ren) which is free from substance abuse;
 The capacity and disposition of each party 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 any other party to the child)ren); and
 The developmental stages and needs of the child(ren) and the demonstrated capacity
and disposition of each party 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.

Instructions for Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting
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 IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT
IN AND FOR ______________________________ COUNTY, FLORIDA

Case No: __________________
Division: __________________

_________________________________,
Petitioner,

And

_________________________________,
Respondent.

RELOCATION/LONG-DISTANCE 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:
{Name of Parent or Other Person}__________________________________.
_____ 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. PARTIES
Petitioner, hereinafter referred to as Parent
{name or designation} ___________________________________________________
Name:__________________________________________________________________
Address: ________________________________________________________________
Telephone Number: ___________________ E-Mail: ____________________________

Respondent, hereinafter referred to as Parent
{name or designation} ____________________________________________________
Name:__________________________________________________________________
Address: ________________________________________________________________
Telephone Number: ___________________ E-Mail: ____________________________

Other Person {If Applicable}, hereinafter referred to as
{name or designation}_____________________________________________________
Name:___________________________________________________________________
Address:_________________________________________________________________
Telephone Number___________________ E-mail:________________________________
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II. CHILDREN: This parenting plan is for the following child(ren):
{Add additional lines as needed}
Name(s) Birth Date(s)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

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
{Insert the name or designation of the appropriate parent or other person in the space provided}

1. Parental Responsibility {Choose only one}

a. ______ Shared Parental Responsibility.
It is in the best interests of the child(ren) that the parties 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. Either parent may consent to mental health
treatment for the child(ren)

OR

b. _____ Shared Parental Responsibility with Decision Making Authority
It is in the best interests of the child(ren) that the parties confer and attempt to agree on
the major decisions involving the child(ren). If the parties are unable to agree, the authority
for making major decisions regarding the child(ren) shall be as follows:

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 Education/Academic
decisions Parent_________ Parent__________ Other
Person________
Non-emergency Other
health care Parent__________ Parent___________ Person________
Parent__________ Parent___________ Other
Person
________________ _________
Other
________________ Parent__________ Parent___________ Person________

c. _____ Sole Parental Responsibility:
It is in the best interests of the child(ren) that _____Parent ____________________ or
_____ Other Person ________________shall have sole authority to make major decisions
for the child(ren). It is detrimental to the child(ren) for the parties to share decision-making.

2. Day-to-Day Decisions
Unless otherwise specified in this plan, each party 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 party. Regardless of the allocation of decision making in the Parenting Plan, any party
may make emergency decisions affecting the health or safety of the child(ren) when the child
is residing with that party. A party who makes an emergency decision shall share the decision
with the other party as soon as reasonably possible.

3. Extracurricular Activities (Indicate all that apply)
{Insert the name or designation of parent or other person in the space provided.}

a. _____Any party may register the child(ren) and allow them to participate in the activity of
the child(ren)’s choice.

b. _____The parties must mutually agree to all extracurricular activities.

c. _____The party 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 party’s possession.

d. _____The costs of the extracurricular activities shall be paid by:
Parent _______________________ _______%
Parent _______________________ _______ %
Other Person __________________ _______%

e. _____The uniforms and equipment required for the extracurricular activities shall be paid
by:
Parent ________________________ ______ %
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 Parent _________________________ _______%
Other Person ______________________ _____%

f. _____Other: _____________________________________________________ .

V. INFORMATION SHARING. Unless Otherwise Indicated or Ordered by the Court:

1. Unless otherwise prohibited by law, the parties 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 parties 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 all parties have access
to said records.

2. Each party shall be responsible for obtaining records and reports directly from the school and
health care providers.

3. The parties have equal rights to inspect and receive governmental agency and law
enforcement records concerning the child(ren).

4. The parties 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.

5. The parties shall be listed as “emergency contacts” for the child(ren).

6. Each party has a continuing responsibility to provide a residential and mailing address, and
contact telephone number (s) to the other parties. Each party shall notify the other parties in
writing within 24 hours of any changes. Each party shall notify the court in writing within seven
(7) days of any changes.

7. Other: _________________________________________________________________
__________________________________________________________________
__________________________________________________________________.

VI. SCHEDULING

1. School Calendar
a. _____ If necessary, on or before ______________ of each year, the parties should obtain
a copy of the school calendar for the next school year. The parties shall discuss the calendars
and the time-sharing schedule so that any differences or questions can be resolved.

b. _____The parties shall follow the school calendar of: {Indicate all that apply}
_____ the oldest child
_____ the youngest child

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 _____ _________________ County
_____ _________________ 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 end on the first day of regularly scheduled
classes after the holiday or break.

3. Schedule Changes {Indicate all that apply}

a. _____ A party 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.

b. _____ A party requesting a change of schedule shall be responsible for any additional
child care, or transportation costs caused by the change.

b. _____ Other ______________________________________________________.

VII. TIME-SHARING SCHEDULE
{Insert the name or designation of the appropriate parent in the space provided. A time-sharing
scheduled must be indicated for both parents, or the Other Person}

1. Weekday and Weekend Schedule
The following schedule shall apply beginning on __________________ with
Parent _______________, or _____ {If Applicable} Other Person _____________________ and
continue as follows:

The child(ren) shall spend time with Parent ____________ on the following dates and times:
WEEKENDS: _____ Every _____ Every Other _____ Other {Specify}: _____________________
From ___________________________ to ___________________________
WEEKDAYS: {Specify days} _______________________________________
From _____________________________ to _________________________
OTHER: {Specify} _______________________________________________
______________________________________________________________
______________________________________________________________

The child(ren) shall spend time with Parent ______________ on the following dates and times:
WEEKENDS: _____ Every _____ Every Other _____ Other {Specify}: ______________________
From____________________________ to ___________________________
WEEKDAYS: {Specify days} ________________________________________
From _____________________________ to __________________________
OTHER: {Specify} _________________________________________________
_______________________________________________________________

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 _______________________________________________________________

{If Applicable} The child(ren) shall spend time with the Other Person ___________________
on the following dates and times:
WEEKENDS: _____ Every _____ Every Other _____ Other {Specify}: ____________________
From _____________________________to __________________________
WEEKDAYS: {Specify Days}________________________________________
From _____________________________to __________________________
OTHER: {Specify} ________________________________________________
______________________________________________________________
______________________________________________________________

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.

_____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}
{Insert the name or designation of the appropriate parent or Other Person in the space
provided.}

a. _____No holiday time sharing shall apply. The regular time-sharing schedule set forth
above shall apply.

b. _____Holiday time-sharing shall be as the parties agree.

c. _____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 the name of either the appropriate parent or {If
Applicable} Other Person 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 party, then the child(ren) will remain with the other party in accordance with the
regular schedule
Holidays Even Years Odd Years Every Year Begin/End Time
{name} {name} {name} {from/to}
New Year’s Day
Martin Luther King Wknd
President’s Day Wknd
Easter
Passover
Mother’s Day
Memorial Day Wknd
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 Father’s Day
4th of July
Labor Day Weekend
Rosh Hashanah
Yom Kippur
Columbus Day Wknd
Veteran’s Day
Thanksgiving
Hanukkah
Christmas
Other _______________
Children’s Birthday’s

This holiday schedule may affect the regular time-sharing schedule. Parties may
wish to specify one or more of the following options:

d. _____ When the parties are using an alternating weekend plan and the holiday schedule
would result in one party having the child(ren) for three weekends in a row, the parties will
exchange the following weekend, so that each has two weekends in a row before the
regular alternating weekend pattern resumes.

e. _____ If a party 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 {choose only one}

a. _____Parent _______________or _____{If Applicable} Other Person {name or
designation} _______________________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 party will have the child(ren) for
the second portion of the Winter Break. The parties shall alternate the arrangement each
year.

b. _____Parent _________________ or _____ {If Applicable} Other Person {name or
designation} _____________________shall have the child(ren) for the entire Winter Break
during _____ odd-numbered years _____ even-numbered years _____ every year

c. _____Other:_________________________________________________________
______________________________________________________________
______________________________________________________________

4. Specific Winter Holidays
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 If not addressed above, the specific Winter Holidays such as Christmas, New Year’s Eve,
Hanukkah, Kwanzaa, etc. shall be shared as follows:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________.

5. Spring Break {Choose only one}

a. _____The parties shall follow the regular schedule.

b. _____The parties shall alternate the entire Spring Break with Parent _________________,
or ______ {If Applicable} Other Person {name or designation} _________________ having
the child(ren) during the _____ odd-numbered years______ even-numbered years
____every year

c. _____Parent __________________, or _____ {If Applicable} Other Person {name or
designation} _______________________shall have the child(ren) for the entire Spring Break
every year.

d. _____The Spring Break will be evenly divided. The first half of the Spring Break will go to
the party whose regularly scheduled weekend falls on the first half and the second half
going to the party whose weekend falls during the second half.

e. _____Other: __________________________________________________________.

6. Summer Break {Choose only one}

a. _____The parents shall follow the regular schedule through the summer.

b. _____Parent _______________________, or _____ {If Applicable} Other Person {name or
designation} ______________________shall have the entire Summer Break from
_____________________________after school is out until ____________________ before
school starts.

c. _____The parties shall equally divide the Summer Break as follows:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________.

d. _____Other: ______________________________________________________________
_________________________________________________________________.

7. Number of Overnights:

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 Based upon the time-sharing schedule, Parent {name or designation}___________________r
has a total of _____ overnights per year, Parent {name or designation} ________________
has a total of _____ overnights per year and ______{If Applicable} the Other Person {name or
designation} ____________________________ has a total of ______ overnights per year.
Note: The total of these numbers must equal 365.

8. Attached Time-Sharing Schedule:

_____If not set forth above, the parties shall have time-sharing in accordance with the schedule
which is attached as Attachment ______and incorporated herein.

VIII. TRANSPORTATION AND EXCHANGE OF CHILD(REN)
{Insert the name or designation of the appropriate parent or Other Person in the space
provided.}

1. The parties shall have the child(ren) ready on time with sufficient clothing packed and ready
at the agreed upon time of exchange. All necessary information and medicines will accompany
the child(ren).

2. The parties shall exchange travel information and finalize travel plans at least ______days in
advance of the date of travel. Except in cases of emergency, any party requesting a change of
travel plans after the date of finalization shall be solely responsible for any additional costs.

3. Automobile Transportation and Exchange {Choose only one}
If a party is more than _____minutes late without contacting the other party to make other
arrangements, the party with the child(ren) may proceed with other plans and activities.

a. _____Parent {name or designation} ___________________, or ____ {If Applicable} Other
Person {name or designation} ______________________shall provide all transportation.

b. _____Parent {name or designation} ________________, or _____ {If Applicable} Other
Person {name or designation} _______________________shall pick up the child(ren) at the
beginning of the visit and the other party shall pick up the child(ren) at the end of the visit.
The exchange shall take place:
_____At the parties’ homes unless otherwise agreed;

_____At the following location unless the parties agree in advance to a different location:
{specify}_______________________________________;

_____ At the following central location {specify}________________________________;

c. _____Other:___________________________________________________________.

4. Airplane and Other Public Transportation and Exchange

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 Airline regulations govern the age at which a child may fly unescorted. An older child or
children may fly under such regulations as each airline may establish.

a. _____Until a child reaches the age of ______, the parties agree that the child(ren) shall
take a direct flight and/or fly accompanied by: __________________________________.

b._____ Once a child reaches the age of _____, the child shall be permitted to fly
accompanied by an airline employee.

c._____ Once a child reaches the age of _____, the child shall be permitted to fly
unescorted.

d._____ Other: _______________________________________________________.

Airline reservations should be made well in advance and preferably, non-stop or direct.

All flight information shall be sent to the other party(ies) at least _____days in advance of
the flight by the party purchasing the tickets.

If the child(ren) are flying accompanied by a party, the party picking up the child(ren) shall
exchange the child(ren) with the other party at__________________ and the party
returning the child(ren) shall exchange the children at _________________________.

If the exchange is to be made at the airport, the party flying in to pick up or drop off the
child(ren) from/to the airport must notify the other party of any flight delays.

Unless otherwise agreed in advance, the party taking the child(ren) to the airport must call
the other party(ies) immediately upon departure to notify the other party(ies) that the
child(ren) is/are arriving, and the party who meets the child(ren) must immediately notify
the other party(ies) upon the child(ren)’s arrival.

5. Costs of Airline and Other Public Transportation {Indicate all that apply}
{Insert the name or designation of the appropriate parent in the space provided.}

a. _____Ticket Purchase {If Applicable}:
The parties shall work together to purchase the most convenient and least expensive
tickets.

After consultation among the parties, it shall be the responsibility of ___________________
to purchase the tickets by {date} _______________.

All parties entitled to access to, or time-sharing with the child(ren) shall be notified of the
purchase by {date}_____________________.

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (02/18)
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 Proof of the purchase and a copy of the itinerary (choose only one) _____ shall be provided
to all parties by ____________________ {date} ______shall not be provided.

Unless otherwise agreed or in the case of an unavoidable emergency, any costs incurred by
a missed travel connection shall be the sole responsibility of the party who failed to timely
deliver the child(ren) to the missed connection.

b. _____Transportation costs are included in the Child Support Worksheets and/or the
Order for Child Support and should not be included here.

c. _____Parent ___________ shall pay _____% Parent ________________ shall pay _____%
of the transportation costs.

d. _____Parent _____________ shall pay _____% Parent ___________ shall pay _____% of
the transportation costs for an adult to accompany the child(ren) during travel.

e. _____If the parties are sharing travel costs, the non-purchasing party shall reimburse the
other party within ______days of receipt of documentation establishing the travel costs.

f. _____Other:____________________________________________________.

6. Foreign and Out-Of-State Travel {Indicate all that apply}

a. _____The parties may travel within the United States with the child(ren) during his/her
time-sharing. The party traveling with the child(ren) shall give the other party(ies) at least
____ days written notice before traveling out of state unless there is an emergency, and
shall provide the other party(ies) with a detailed itinerary, including locations and telephone
numbers where the child(ren) and party can be reached at least ____ days in advance of the
date of travel.

b. _____A party may travel out of the country with the child(ren) during his/her time-
sharing. At least ____ days in advance of the date of travel, the party shall provide a
detailed itinerary, including locations, and telephone numbers where the child(ren) and
party may be reached during the trip. Each party agrees to provide whatever
documentation is necessary for the other party(ies) to take the child(ren) out of the country.

c. _____If a party wishes to travel out of the country with the child(ren), he/she shall
provide the following security for the return of the child _______________________
_____________________________________________________________________.

d. _____Other___________________________________________________________.

7. Other Travel and Exchange Arrangements: ___________________________________
_______________________________________________________________________

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (02/18)
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 _______________________________________________________________________

IX. EDUCATION

1. School designation. For purposes of school boundary determination and registration, the
address of Parent {name or designation}_______________________, or _____ {If Applicable}
Other Person’s {name or designation} __________________________ address shall be used.

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
Parent {name or designation} ______________________or _____ {If Applicable} Other Person
{name or designation}_____________________________. This majority designation is SOLELY for
purposes of all other state and federal laws which require such a designation. This designation does
not affect the rights or responsibilities of any party under this Parenting Plan.

XI. COMMUNICATION

1. Between Parties
All communications regarding the child(ren) shall be between the parties. The parties shall not
use the child(ren) as messengers to convey information, ask questions, or set up schedule
changes.

The parties shall communicate with each other by: {Indicate all that apply}
_____ in person
_____ by telephone
_____ by letter
_____ by e-mail
_____ Other:___________________________________________________.

2. Between Parties and Child(ren)

The parties shall keep contact information current. Telephone or other electronic
communication between the child(ren) and another party shall not be monitored by or
interrupted by the other party. “Electronic communication” includes telephones, electronic

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 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 child(ren) may have _____ telephone _____ e-mail _____ other electronic communication
in the form of ________________________________ with the other party: {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:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

X. CHILD CARE {Choose only one}

1. _____Each party may select appropriate child care providers

2. _____All child care providers must be agreed upon by the parties.

3. _____Each party must offer the other party the opportunity to care for the child(ren)
before using a child care provider for any period exceeding __________ hours.

4. _____Other ________________________________________________________.

XI. CHANGES TO OR MODIFICATIONS OF THE PARENTING PLAN

Temporary changes may be made informally without a written document. When the parties do not
agree, this Parenting Plan remains 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.

XII. RELOCATION

Any relocation of the child(ren) is subject to and must be sought in compliance with Section
61.13001, Florida Statutes.

XIII. DISPUTES OR CONFLICT RESOLUTION

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 The parties shall attempt to cooperatively resolve any disputes which may arise over the terms of
the Parenting Plan. The parties may wish to use mediation or other dispute resolution methods and
assistance, such as Parenting Coordinators and Parenting Counselors, before filing a court action.

XIV. OTHER PROVISIONS
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________.

SIGNATURES OF PARTIES

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 Petitioner/ Parent _____________
Printed Name: ___________________________
Address: _______________________________
City, State, Zip: __________________________
Telephone Number: ______________________
Fax Number: ___________________________
Designated E-mail Address(es):______________
_______________________________________

STATE OF FLORIDA
COUNTY OF ____________________

Sworn to or affirmed and signed before me on __________ by ___________________________.

_______________________________________
NOTARY PUBLIC or DEPUTY CLERK

_______________________________________
[Print, type, or stamp commissioned name of notary or
deputy clerk.]
____ Personally known
____ Produced identification
____ Type of identification produced ________________________________

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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 Respondent/Parent ____________
Printed Name: ___________________________
Address: _______________________________
City, State, Zip: __________________________
Telephone Number: ______________________
Fax Number: ___________________________
Designated E-mail Address(es):______________
_______________________________________

STATE OF FLORIDA
COUNTY OF ____________________

Sworn to or affirmed and signed before me on __________ by ___________________________.

_______________________________________
NOTARY PUBLIC or DEPUTY CLERK

_______________________________________
[Print, type, or stamp commissioned name of notary or
deputy clerk.]

____ Personally known
____ Produced identification
____ Type of identification produced ________________________________

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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 Other Person__________________
Printed Name: ___________________________
Address: _______________________________
City, State, Zip: __________________________
Telephone Number: ______________________
Fax Number: ___________________________
Designated E-mail Address(es):______________
________________________________________

STATE OF FLORIDA
COUNTY OF ____________________
Sworn to or affirmed and signed before me on __________ by ___________________________.

_______________________________________
NOTARY PUBLIC or DEPUTY CLERK

_______________________________________
[Print, type, or stamp commissioned name of notary or
deputy clerk.]

____ Personally known
____ Produced identification
____ Type of identification produced ________________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in
all blanks] This form was prepared for the: {choose only one} _____ Petitioner _____ Respondent _____
______Other Person.
This form was completed with the assistance of:
{name of individual} ___________________________________________________________________,
{name of business}_____________________________________________________________________,
{address} ____________________________________________________________________________,
{city} ________________, {state} _____,{zip code}__________,{telephone number} _________________.

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