In RE: AMENDMENTS TO the FLORIDA SUPREME COURT APPROVED FAMILY LAW FORMS-12.913(A)(3).

Supreme Court of Florida
____________

No. SC18-696
____________

IN RE: AMENDMENTS TO THE FLORIDA SUPREME COURT
APPROVED FAMILY LAW FORMS—12.913(a)(3).

[June 21, 2018]

PER CURIAM.

Pursuant to the procedures approved 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 decided that amendments to the existing forms are needed, as

well as development of a new form. Input was received from the Advisory

Workgroup on the Florida Supreme Court Approved Family Law Forms, which

provided valuable assistance. We have jurisdiction,1 and create new form

12.913(a)(3) (Notice of Action for Termination of Parental Rights and Stepparent

Adoption) and amend the existing forms as follows.

1. See art. V, § 2(a), Fla. Const.
 First, forms 12.902(j) (Notice of Social Security Number) and 12.913(a)(2)

(Notice of Action for Family Cases with Minor Child(ren)) are amended to add the

phrase “or dependent” after “minor” as needed to more accurately represent the

proper use for each form; the title of form 12.913(a)(2) is similarly amended to

read “Notice of Action for Family Cases with Minor or Dependent Child(ren).”

Additionally, the instructions to forms 12.902(j) and 12.980(h) (Request for

Confidential Filing of Address) are amended to clarify procedures to make certain

information required by those forms confidential, pursuant to Florida Rule of

Judicial Administration 2.420. The instructions to forms 12.913(a)(2) and 12.921

(Notice of Hearing (Child Support Enforcement Hearing Officer)) are also

amended to clarify when each form should be used and eliminate confusion as to

when similarly numbered forms should be used. Form 12.921 is further amended

to add language advising litigants whether a hearing will be electronically recorded

or if a court reporter will be provided by the court to transcribe the hearing.

Next, form 12.915 (Designation of Current Mailing and E-Mail Address) is

amended to add language allowing a litigant to indicate whether he or she is

designating an e-mail or mailing address. Form 12.924 (Notice for Trial) is also

amended to add language indicating the estimated length of the trial, as required by

Florida Family Law Rule of Procedure 12.440(b) (Setting Action for Trial; Notice

for Trial).

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 Last, we create new form 12.913(a)(3) (Notice of Action for Termination of

Parental Rights and Stepparent Adoption). This form should be used to obtain

constructive service, as required by section 63.088(6), Florida Statutes (2017), in

conjunction with form 12.981(b)(1) (Joint Petition for Adoption by Stepparent).

The amended forms and new form 12.913(a)(3) 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 Courts’ website at

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

courts/family-law-forms.stml. By adoption of the new and amended forms, we

express no opinion as to their correctness or applicability. We also direct that the

amended and new 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 August 20, 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 Florida Courts E-Filing Portal (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 nonlawyer or a lawyer not licensed to practice in Florida, the comment
may be, but is not required to be, filed via the Portal. Comments filed via the
Portal must be submitted in Microsoft Word 97 or higher. See In re Electronic
Filing in the Florida Supreme Court, Fla. Admin. Order No. AOSC17-27 (May 9,
2017). 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

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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

Clerk, 500 South Duval Street, Tallahassee, Florida 32399-1927; no additional
copies are required or will be accepted.

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 APPENDIX

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.902(j),
NOTICE OF SOCIAL SECURITY NUMBER
(06/18)

When should this form be used?

This form must be completed and filed by each party in all paternity, child support, and dissolution of
marriage cases, regardless of whether the case involves a minor child(ren) and/or property.

This form should be typed or printed in black ink. After completing this form, you should file the original
with the clerk of the circuit court in the county where your case was filed and keep a copy for your records.

CONFIDENTIAL INFORMATION

Under Rule 2.420 of the Florida Rules of Judicial Administration, Social Security Numbers are confidential;
however, this information is required by the Florida Statutes. A Notice of Confidential Information within
Court Filing must be filed with the Notice of Social Security Number. This Notice is an appendix to rule
2.420.

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

Instructions for Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security Number
(06/18)
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.

Special notes...

If this is a domestic violence case and you want to keep your address confidential for safety reasons,
do not enter the address, telephone, fax, or e-mail 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(i).

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(j), Notice of Social Security Number
(06/18)
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:

Petitioner,

and

Respondent.

NOTICE OF SOCIAL SECURITY NUMBER
I, {full legal name} ___________________________________________________________, certify that
my social security number is ___________________________, as required by the applicable section of
the Florida Statutes. My date of birth is ______________________________.

[Choose one only]
__ 1. This notice is being filed in a dissolution of marriage case in which the parties have no minor
or dependent child(ren) in common.

__ 2. This notice is being filed in a paternity or child support case, or in a dissolution of marriage
in which the parties have minor or dependent children in common. The minor or dependent
child(ren)'s name(s), date(s) of birth, and social security number(s) is/are:

Name Birth date Social Security Number
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
{Attach additional pages if necessary.}

Instructions for Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security Number
(06/18)
Disclosure of social security numbers shall be limited to the purpose of administration of the Title IV-D
program for child support enforcement.

Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security Number (06/18)
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
notice 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 .

Date:__________________________ _____________________________________________
NOTARY PUBLIC or DEPUTY CLERK

___________________
[Print, type, or stamp commissioned name of notary or
clerk]

Personally known
Produced identification
Type of identification produced

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

Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security Number (06/18)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY
LAW FORM 12.913(a)(2)
NOTICE OF ACTION FOR FAMILY CASES
WITH MINOR OR DEPENDENT CHILD(REN)
(06/18)

When should this form be used?

This form may be used to obtain constructive service (also called service by publication) in an
action involving a parenting plan for minor or dependent child(ren) under chapter 61, Florida
Statutes; an action to determine temporary custody by extended family under chapter 751,
Florida Statutes; and termination of a legal father’s parental rights when another man is alleged
to be the biological father. "Parenting plan" means a document created to govern the
relationship between the parents relating to decisions that must be made regarding the minor
or dependent child and must contain a time-sharing schedule for the parents and child. Section
61.046(14), Florida Statutes.

You may use constructive service if you do not know where the other party lives or if the other
party lives outside Florida and you are unable to obtain personal service. Constructive notice
will allow the court to grant the relief requested, but personal service is required before a court
can order payment or termination of child support, spousal support (alimony), or costs. If you
are asking the court to decide how real or personal property located in Florida should be
divided, the Notice of Action must include a specific description of the property. If you use
constructive service, the court can grant only limited relief because its jurisdiction is limited.
This is a complicated area of the law and you should consult an attorney before using
constructive service.

You should complete this form by typing or printing the appropriate information in black ink.
You must insert the other party’s name and last known address and then file this form with the
clerk of the circuit court in the county where your petition was filed. You must also complete
and file an Affidavit of Diligent Search and Inquiry. Use Florida Family Law Rules of Procedure
Form 12.913(b) unless you are serving the legal father in a paternity case where another man is
alleged to be the biological father, or the case involves parental responsibility, custody, or time-
sharing, in which case, you must use Form 12.913(c). You should keep a copy for your records.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and
documents be filed electronically except in certain circumstances. Self-represented litigants may
file petitions or other pleadings or documents electronically; however, they are not required to
do so. If you choose to file your pleadings or other documents electronically, you must do so in
accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures
of the judicial circuit in which you file. The rules and procedures should be carefully read and
followed.
Instructions for Florida Supreme Court Approved Family Law Form 12.913(a)(2), Notice of Action For Family
Cases With Minor or Dependent Child(ren) (06/18)
 What should I do next?

After the Affidavit of Diligent Search and Inquiry, Family Law Rules of Procedure Form 12.913(c),
is filed, the clerk will sign this form. You will need to publish notice once each week for four
consecutive weeks in a “qualified” newspaper in the county where the case is pending. When in
doubt, ask the clerk which newspapers are “qualified.” The newspaper will charge you for this
service. If you cannot afford to pay the cost of publishing this notice, you may ask the clerk to
post the notice at a place designated for such postings. You will need to file an Application for
Determination of Civil Indigent Status, which you can obtain from the clerk. If the clerk
determines that you cannot afford these costs, the clerk will post the notice of action. If your case
involves termination of a legal father's parental rights when another man is alleged to be the
biological father, you need to publish the notice only in the county where the legal father was last
known to have resided. You are responsible for locating a “qualified” newspaper in the county
where the other party last resided and paying the cost of publication.

Where can I look for more information?

Before proceeding, you should read “General Information for Self-Represented Litigants” found
at the beginning of these forms. For further information, see rule 12.070, Florida Family Law
Rules of Procedure, rule 1.070, Florida Rules of Civil Procedure, sections 61.501–61.542, Florida
Statutes and chapter 49, 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-
Instructions for Florida Supreme Court Approved Family Law Form 12.913(a)(2), Notice of Action For Family
Cases With Minor or Dependent Child(ren) (06/18)
mail Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of
Judicial Administration 2.516.

Special notes...

If the other party fails to respond to your petition within the time limit stated in the notice of
action that is published or posted, you are entitled to request a default. (See Motion for
Default, Florida Supreme Court Approved Family Law Form 12.922(a), and Default, Florida
Supreme Court Approved Family Law Form 12.922(b).)

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 12.913(a)(2), Notice of Action For Family
Cases With Minor or Dependent Child(ren) (06/18)
 IN THE CIRCUIT COURT OF THE _______________ JUDICIAL CIRCUIT,
IN AND FOR _______________________ COUNTY, FLORIDA

Case No.: _______________________________
Division: ________________________________
__________________________________ ,
Petitioner

and

_________________________________ ,
Respondent.

NOTICE OF ACTION FOR

{Specify action} _____________________________________________________________________

TO: {name of Respondent} _______________________________________________________________
{Respondent’s last known address} ________________________________________________________

YOU ARE NOTIFIED that an action for {identify the type of case} _________________________________
has been filed against you and that you are required to serve a copy of your written defenses, if any, to
it on {name of Petitioner} ___________________________________________________, whose address
is __________________________________________________________________________________,
on or before {date}_______________, and file the original with the clerk of this Court at {clerk’s address}
____________________________________________________________________________________,
before service on Petitioner or immediately thereafter. If you fail to do so, a default may be entered
against you for the relief demanded in the petition.

{If applicable, insert the legal description of real property, a specific description of personal property, and
the name of the county in Florida where the property is located} _________________________________
____________________________________________________________________________________.

Copies of all court documents in this case, including orders, are available at the Clerk of the Circuit
Court’s office. You may review these documents upon request.

You must keep the Clerk of the Circuit Court’s office notified of your current address. (You may file
Designation of Current Mailing and E-Mail Address, Florida Supreme Court Approved Family Law Form
12.915.) Future papers in this lawsuit will be mailed or e-mailed to the addresses on record at the clerk’s
office.

Florida Supreme Court Approved Family Law Form 12.913(a)(2), Notice of Action For Family Cases With Minor or
Dependent Child(ren) (06/18)
WARNING: Rule 12.285, Florida Family Law Rules of Procedure, requires certain automatic disclosure
of documents and information. Failure to comply can result in sanctions, including dismissal or striking
of pleadings.

Dated: __________________. CLERK OF THE CIRCUIT COURT

By: ___________________________________
{Deputy Clerk}

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 12.913(a)(2), Notice of Action For Family Cases With Minor or
Dependent Child(ren) (06/18)
 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY
LAW FORM 12.913(a)(3)
NOTICE OF ACTION FOR TERMINATION OF PARENTAL RIGHTS AND
STEPPARENT ADOPTION
(06/18)

When should this form be used?

This form may be used to obtain constructive service (also called service by publication or posting) in an
action involving a Joint Petition for Adoption by Stepparent. You may use constructive service for any person
whose consent is required under the Florida Statutes and who has NOT executed a consent to the
adoption. This includes:
 The mother of the minor child(ren);

 The father of the minor child(ren), if:
 The minor child(ren) were conceived or born while the father was married to the
mother;
 The minor child(ren) is/are his children by adoption;
 The minor child(ren) have been adjudicated by the court to be his child(ren)
before the date a petition for termination of parental rights is filed;
 He has filed an affidavit of paternity or was listed on the minor child’s birth
certificate before the date the petition for termination of parental rights was
filed; or
 In the case of an unmarried biological father, he has acknowledged in writing,
signed in the present of a competent witness, that he is the father of the minor,
has filed such acknowledgment with the Office of Vital Statistics for the
Department of Health within the required timeframes, and has complied with the
requirements of section 63.062(2), Florida Statutes; and

 Any person lawfully entitled to custody of the minor child if required by the court.

The location of the person must be unknown. You must complete and file a Stepparent Adoption: Affidavit
of Diligent Search, Florida Supreme Court Approved Family Law Form 12.981(a)(4). This is a complicated
area of the law and you should consult an attorney before using constructive service.

You should complete this form by typing or printing the appropriate information in black ink. You must
insert the other party’s name; last known address; physical description, including but not limited to age,
race, hair and eye color, and approximate height and weight of the person; the minor child(ren)’s date of
birth; and the minor child(ren)’s place of birth. File this form with the clerk of the circuit court in the
county where your petition was filed. You should 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
Instructions for Florida Supreme Court Approved Family Form 12.913(a)(3), Notice of Action for Termination of
Parental Rights and Stepparent Adoption (06/18)
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.

After the Stepparent Adoption: Affidavit of Diligent Search, Florida Supreme Court Approved Family Law Form
12.981(a)(4) is filed, the clerk will sign this form. You will need to publish notice once each week for four
consecutive weeks in a “qualified” newspaper in the county where the person was last known to have
resided. When in doubt, ask the clerk which newspapers are “qualified.” The newspaper will charge you
for this service. If you cannot afford to pay the cost of publishing this notice, you may ask the clerk to post
the notice at a place designated for such postings. You will need to file an Application for Determination
of Civil Indigent Status, which you can obtain from the clerk. If the clerk determines that you cannot
afford these costs, the clerk will post the notice of action. You are responsible for locating a “qualified”
newspaper in the county where the other party last resided and paying the cost of publication.

Where can I look for more information?

Before proceeding, you should read “General Information for Self-Represented Litigants” found at the
beginning of these forms. For further information, see rule 12.070, Florida Family Law Rules of Procedure,
rule 1.070, Florida Rules of Civil Procedure, sections 61.501–61.542, Florida Statutes and chapter 49,
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 Form 12.913(a)(3), Notice of Action for Termination of
Parental Rights and Stepparent Adoption (06/18)
If the other party fails to respond to your petition within the time limit stated in the notice of action that
is published or posted, you are entitled to request a default. (See Motion for Default, Florida Supreme
Court Approved Family Law Form 12.922(a), and Default, Florida Supreme Court Approved Family Law
Form 12.922(b).) 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 Form 12.913(a)(3), Notice of Action for Termination of
Parental Rights and Stepparent Adoption (06/18)
 IN THE CIRCUIT COURT OF THE _______________________ JUDICIAL CIRCUIT,
IN AND FOR ________________________ COUNTY, FLORIDA

Case No.: ___________________________ ___
Division: __________________________________________________________________________________ ________
IN RE: THE ADOPTION OF:

_______________________________________
[Name to be given child(ren) Adoptees(s).

NOTICE OF ACTION FOR TERMINATION OF PARENTAL RIGHTS AND
STEPPARENT ADOPTION
TO: {name of Respondent} _______________________________________________________________
{Respondent’s last known address} ________________________________________________________

YOU ARE NOTIFIED that a Joint Petition for Adoption by Stepparent has been filed against you and that
you are required to serve a copy of your written defenses, if any, to it on
{name of Petitioner} __________________________________________________________________,
whose address is ______________________________________________________________________,
on or before {date} _________________, and file the original with the clerk of this Court at {clerk’s
address} _____________________________________________________________________________,
before service on Petitioner or immediately thereafter. If you fail to do so, a default may be entered
against you for the relief demanded in the petition.

The minor child(ren) are identified as follows:
Date of Birth Place of Birth
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Physical Description of Respondent:
Age: _____________
Race:____________________
Hair Color: _______________
Eye Color: _______________
Approximate Height: _______
Approximate Weight: ______

Copies of all court documents in this case, including orders, are available at the Clerk of the Circuit
Court’s office. You may review these documents upon request.

You must keep the Clerk of the Circuit Court’s office notified of your current address. (You may file
Designation of Current Mailing and E-Mail Address, Florida Supreme Court Approved Family Law Form
12.915.) Future papers in this lawsuit will be mailed or e-mailed to the addresses on record at the clerk’s

Florida Supreme Court Approved Family Law Form, 12.913(a)(3) Notice of Action for Termination of Parental Rights
and Stepparent Adoption (06/18)
office.

Dated: _______________ CLERK OF THE CIRCUIT COURT

By: ___________________________________________
{Deputy Clerk}

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, 12.913(a)(3) Notice of Action for Termination of Parental Rights
and Stepparent Adoption (06/18)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.915
DESIGNATION OF CURRENT MAILING AND E-MAIL ADDRESS
(06/18)
When should this form be used?

This form should be used to inform the clerk and the other party of your current mailing and e-mail
address(es) or any change of address. It is very important that the court and the other party in your case
have your correct address.

A party not represented by an attorney may choose to designate e-mail address(es) for service. A primary
and up to two secondary e-mail addresses can be designated. If you do so and the other party is
represented by an attorney or has also designated e-mail address(es) for service, e-mail will be the
exclusive means of service.

If there is any change in your mailing or e-mail address(es), you must complete a new form, file it with the
clerk, and serve a copy on any other party or parties in your case.

What should I do next?

This form should be typed or printed in black ink. After completing this form, you should file the original
with the clerk of the circuit court in the county where your case is filed and keep a copy for your records.
A copy of this form must be served on any other party in your case. Service must be in accordance with
Florida Rule of Judicial Administration 2.516.

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

Instructions for Florida Supreme Court Approved Family Law Form 12.915, Designation of Current Mailing and
E-mail Address (06/18)
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.

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 12.915, Designation of Current Mailing and
E-mail Address (06/18)
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
,
Petitioner,

and

,
Respondent.

DESIGNATION OF CURRENT MAILING AND E-MAIL ADDRESS

I, {full legal name}, _________________________________________, being sworn, certify that:

MAILING ADDRESS:

My current mailing address is:
{Street or Post Office Box} _________________________________________________________,
{City}, ___________________________________, {State}, _____________, {Zip}_____________.
{Telephone No.} _____________ {Fax No.} ______________________.

E-MAIL ADDRESS:
{Do not provide an e-mail address unless you choose to serve and receive all documents in the future
only by e-mail. If you are a self-represented litigant (appearing without an attorney), you are not
required to serve or receive documents by electronic mail (e-mail); however, once you designate an e-
mail address, that address will be the exclusive means of serving and receiving documents. Once you
choose to serve and receive documents by e-mail, you cannot change your decision.}
I wish to designate the following e-mail address(es) for the purposes of serving and receiving documents:
___________________________________________________________________________________

Florida Supreme Court Approved Family Law Form 12.915, Designation of Current Mailing and E-mail Address
(06/18)
I understand that I must keep the clerk’s office and the opposing party or parties notified of my current
mailing and e-mail address(es) and that all future papers in this lawsuit will be served at the address(es)
on record at the clerk’s office.
I certify that a copy of this document was _____ e-mailed _____ 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): ___________
__________________________________

_____________________________________________
Signature of Party

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} _______________________________________________________________,
{street} ______________________________________________,
{city} ,{state} __, {zip code}______,{telephone number}__________________.

Florida Supreme Court Approved Family Law Form 12.915, Designation of Current Mailing and E-mail Address
(06/18)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.921,
NOTICE OF HEARING
(CHILD SUPPORT ENFORCEMENT HEARING OFFICER)
(06/18)

When should this form be used?

A child support enforcement hearing officer is an attorney who has been appointed by administrative
order of the court to take testimony and recommend decisions in cases involving the establishment,
enforcement, and/or modification of child support. If your case only involves issues pertaining to child
support, you cannot object to the referral of your case to a hearing officer.

Use this form anytime you have set a hearing before a child support enforcement hearing officer and
have been instructed to send notice of the hearing to the other party. Before you fill out this form, you
should coordinate a hearing time and date with the hearing officer and the other party. If the
Department of Revenue is a party to the case, you may need to schedule your hearing time with the
attorney for the Department of Revenue. If your case involves a Motion for Civil Contempt in Support
Matters pursuant to Florida Family Rule of Procedure 12.615, you should use form 12.961—Notice of
Hearing on Motion for Civil Contempt/Enforcement Matters (Rule 12.615).

This form should be typed or printed in black ink. After completing this form, you should file the original
with the clerk of the circuit court in the county where your case is filed and keep a copy for your
records.

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. 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.

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.

Instructions for Florida Supreme Court Approved Family Law Form 12.921, Notice of Hearing (Child Support
Enforcement Hearing Officer) (06/18)
 IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

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

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

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

Where can I look for more information?

Before proceeding, you should read General Information for Self Represented Litigants found at the
beginning of these forms. For further information, See Rule 12.941, Florida Family Law Rules of
Procedure.

Special notes...

An attorney who has been appointed by the court to serve as a child support enforcement hearing
officer can also be appointed to serve as a general magistrate. If your case involves only child support
issues, your case may properly be referred to a general magistrate acting as a child support enforcement
hearing officer.

Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms
also must put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.

Instructions for Florida Supreme Court Approved Family Law Form 12.921, Notice of Hearing (Child Support
Enforcement Hearing Officer) (06/18)
 IN THE CIRCUIT COURT OF THE ____________________ JUDICIAL CIRCUIT,
IN AND FOR ____________________ COUNTY, FLORIDA

Case No.: __________________________
Division: ___________________________

______________________________________,
Petitioner,

and

_____________________________________,
Respondent.

NOTICE OF HEARING
(CHILD SUPPORT ENFORCEMENT HEARING OFFICER)
TO: {name of other party}: _______________________________________________________________
There will be a hearing before Child Support Enforcement Hearing Officer {name} __________________,
on {date} ________________, at {time} _____ m., in Room ______ of the _________________________
County Courthouse, on the following issues:
_____________________________________________________________________________________
____________________________________________________________________________________.
_____ hour(s)/_____ minutes have been reserved for this hearing.
If the matter before the Child Support Enforcement Hearing Officer is a Motion for Civil
Contempt/Enforcement, FAILURE TO APPEAR AT THE HEARING MAY RESULT IN THE COURT ISSUING A
WRIT OF BODILY ATTACHMENT FOR YOUR ARREST. IF YOU ARE ARRESTED, YOU MAY BE HELD IN JAIL
UP TO 48 HOURS BEFORE A HEARING IS HELD.

This part to be filled out by the court or filled in with information you have obtained from the court:

If you are a person with a disability who needs any accommodation in order to
participate in this proceeding, you are entitled, at no cost to you, to the
provision of certain assistance. Please contact:
__________________________________________________________________
{identify applicable court personnel by name, address, and telephone number} at
least 7 days before your scheduled court appearance, or immediately upon
receiving this notification if the time before the scheduled appearance is less
than 7 days; if you are hearing or voice impaired, call 711.

Florida Supreme Court Approved Family Law Form 12.921, Notice of Hearing (Child Support Enforcement Hearing
Officer) (06/18)
 YOU ARE ADVISED THAT FOR THIS HEARING

a. _____ Electronic recording is provided by the court. A party may provide a court
reporter at that party’s expense.

b. _____ A court reporter is provided by the court.

If you are represented by an attorney or plan to retain an attorney for this matter, you should notify the
attorney of this hearing.

If this matter is resolved, the moving party shall contact the hearing officer’s office to cancel this hearing.

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

Other party or his/her attorney:
Name: ________________________________________
Address: ______________________________________
City, State, Zip: _________________________________
Fax Number: ___________________________________
Designated E-mail Address(es):_____________________
______________________________________________

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

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the: {choose only one} ( ) Petitioner ( ) Respondent
This form was completed with the assistance of:
{name of individual } __________________________________________________________________,
{name of business} ____________________________________________________________________,
{address} ____________________________________________________________________________,
{city} ________________, {state} ____, {zip code}__________,{telephone number} ________________.

Florida Supreme Court Approved Family Law Form 12.921, Notice of Hearing (Child Support Enforcement Hearing
Officer) (06/18)
 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED
FAMILY LAW FORM 12.924
NOTICE FOR TRIAL
(06/18)

When should this form be used?

Generally, the court will have trials (or final hearings) in contested cases. This form is to be used to
notify the court that your case is ready to be set for trial. Before setting your case for 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 case and the
procedures in your particular circuit. In some circuits you must complete mediation or a parenting
course before you can set a final hearing by using a Notice of Hearing (General), Florida Supreme Court
Approved Family Law Form 12.923, or other appropriate notice of hearing form. Other circuits may
require that you set the trial using an Order Setting Trial. Contact the clerk of the circuit court, family
law intake staff, or judicial assistant to determine how the judge assigned to your case sets trials. For
further information, you should refer to the instructions for the type of form you are filing.

This form should be typed or printed in black ink. After completing this form, you should file the original
with the clerk of the circuit court in the county where your case is filed and keep a copy for your records.

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.

Where can I look for more information?

Before proceeding, you should read General Information for Self-Represented Litigants found at the
beginning of these forms. For further information, see rule 12.440, Florida Family Law Rules of
Procedure.

Instructions for Florida Supreme Court Approved Family Law Form 12.924, Notice for Trial (06/18)
 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...

These family law forms contain orders and final judgments, which the judge may use. You should ask
the clerk of court, family law intake staff, or judicial assistant 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.

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 12.924, Notice for Trial (06/18)
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
,
Petitioner,

and

_,
Respondent.

NOTICE FOR TRIAL

Pursuant to Rule 12.440, Florida Family Law Rules of Procedure, the party signing below states that the
case is ready to be set for trial.

The estimated time required for the parties to present their cases is: {hours} or
{days} __________________.

The trial is on ______the original action or ______ a subsequent proceeding.

There are issues to be tried by jury. _____ Yes or _____ No.

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): ______________________

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

Florida Supreme Court Approved Family Law Form 12.924, Notice for Trial (06/18)
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 12.924, Notice for Trial (06/18)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.980(h)
REQUEST FOR CONFIDENTIAL FILING OF ADDRESS
(06/18)
When should this form be used?

If you fear that disclosing your address would put you in danger because you are the victim of sexual
battery, aggravated child abuse, stalking, aggravated stalking, harassment, aggravated battery, or
domestic violence, you should complete this form and file it with the clerk of the circuit court.

This form should be typed or printed in black ink. After completing this form, you should file the original
with the clerk of the circuit court in the county where your 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.

Instructions for Florida Supreme Court Approved Family Law Form 12.980(h), Request for Confidential Filing of
Address (06/18)
 IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

Case No.:
Division:
___________________,
Petitioner,

and

___________________,
Respondent.

REQUEST FOR CONFIDENTIAL FILING OF ADDRESS

I, {full legal name} , request that the Court
maintain and hold as confidential, the following address:

Address

City State Zip
Telephone (area code and number)

This request is being made for the purpose of keeping the location of my residence unknown for safety
reasons pursuant to section 119.071(2)(j)1, section 741.30(3)(b)(a), section 784.046(4)(b)1, and section
784.0485(3)(b)1, Florida Statutes, or other statutory provision providing for the separate confidential
filing for safety reasons.

Dated: __________________________________________
Signature

CLERK’S CERTIFICATE AS TO REQUEST FOR
CONFIDENTIAL FILING OF ADDRESS

I, , as Clerk of the Circuit Court, do hereby certify that I
received and filed the above and will keep the above address confidential, subsequent to further order
of the Court relative to such confidentiality.

CLERK OF THE CIRCUIT COURT
(SEAL)
By:
{Deputy Clerk}

Florida Supreme Court Approved Family Law Form 12.980(h), Request for Confidential Filing of Address
(06/18)