Opinion
No. SC01-2455.
December 6, 2001.
Pursuant to the procedures approved by this Court in Amendments to the Florida Family Law Rules of Procedure and Family Law Forms, 810 So.2d 1 (Fla. 2000), this Court has reviewed the Family Law Forms and determined that some of the forms request a social security number where the social security number is not necessary. We have jurisdiction. See art. V, § 2(a), Fla. Const.
Input on this issue was sought and received from the Advisory Workgroup on the Florida Supreme Court Approved Family Law Forms. Additionally, the Florida Family Law Rules Committee has filed a separate petition with this Court wherein the Committee agrees that the request for social security numbers should be removed from all Family Law Forms where no legitimate purpose is served.
The Committee's petition, No. SC01-2344, is pending with the Court and contains additional requests that will be addressed separately.
We hereby adopt the amendments to forms 12.902(c), 12.902(d), 12.981(b) and 12.941(e) deleting the request for a social security number. The amended forms are set forth in the appendix to this opinion, fully engrossed, and effective for immediate use. By approval of these forms, we express no opinion as to their correctness or applicability.
The request for a social security number will remain on forms 12.902(j), Notice of Social Security Number, and 12.912(a), Memo for Certificate of Military Service.
This opinion and the forms discussed herein may be accessed and downloaded from this Court's website at www. flcourts.org.
It is so ordered.
WELLS, C.J., and SHAW, HARDING, ANSTEAD, PARIENTE, LEWIS, and QUINCE, JJ., concur.
APPENDIX
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULE OF PROCEDURE FORM 12.902(c), FAMILY LAW FINANCIAL AFFIDAVIT
When should this form be used?
This form should be used when you are involved in a family law case which requires a financial affidavit and your individual gross income is $50,000 OR MORE per year.
This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public . You should then file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records.
What should I do next?
A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served on him or her with your initial papers. This must be accomplished within 45 days of service of the petition.
Where can I look for more information?
Before proceeding, you should read "General Information for Self Represented Litigants" found at the beginning of these forms. The words that are in " bold underline " in these instructions are defined there. For further information, see rule 12.285, Florida Family Law Rules of Procedure.
Special notes . . .
If this is a domestic violence case and you want to keep your address confidential for safety reasons, do not enter the address, telephone, and fax information at the bottom of this form. Instead, file Petitioner's Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(i).
The affidavit must be completed using monthly income and expense amounts. If you are paid or your bills are due on a schedule which is not monthly, you must convert those amounts. Hints are provided below for making these conversions.
Hourly Monthly Amount Daily Monthly Amount Weekly Monthly Amount Bi-weekly Monthly Amount Bi-monthly Monthly Amount
— If you are paid by the hour, you may convert your income to monthly as follows: Hourly amount x Hours worked per week = Weekly amount Weekly amount x 52 Weeks per year = Yearly amount Yearly amount ÷ 12 Months per year = — If you are paid by the day, you may convert your income to monthly as follows: Daily amount x Days worked per week = Weekly amount Weekly amount x 52 Weeks per year = Yearly amount Yearly amount ÷ 12 Months per year = — If you are paid by the week, you may convert your income to monthly as follows: Weekly amount x 52 Weeks per year = Yearly amount Yearly amount ÷ 12 Months per year = — If you are paid every two weeks, you may convert your income to monthly as follows: Bi-weekly amount x 26 = Yearly amount Yearly amount ÷ 12 Months per year = — If you are paid twice per month, you may convert your income to monthly as follows: Bi-monthly amount x 2 = Expenses may be converted in the same manner.Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
FORM 12.902(c), FAMILY LAW FINANCIAL AFFIDAVIT FAMILY LAW FINANCIAL AFFIDAVIT full legal name SECTION I. INCOME
IN THE CIRCUIT COURT OF THE ____________ JUDICIAL CIRCUIT, IN AND FOR ______ COUNTY, FLORIDA Case No.: __________________________ Division: ___________________________ _________________________________, Petitioner, and _________________________________, Respondent. $50,000 or more Individual Gross Annual Income) I, {} __________________________________________________, being sworn, certify that the following information is true: _______________________________________________________________________________________ _______________________________________________________________________________________all LAST YEAR'S GROSS INCOME: if known PRESENT MONTHLY GROSS INCOME: All amounts must be MONTHLY.
1. Date of Birth: _______________________________ 2. My occupation is: _________________________________________________________________ 3. I am currently [ that apply] ___ a. Unemployed Describe your efforts to find employment, how soon you expect to be employed, and the pay you expect to receive: _______________________________________________ __________________________________________________________________________________ ___ b. Employed by: _________________________________________________________________ Address: _________________________________________________________________________ City, State, Zip Code: ___________________________________________________________ Telephone Number: ________________________________________________________________ Pay rate: $______ ( ) every week ( ) every other week ( ) twice a month ( ) monthly ( ) other: ______________________________________________________________ If you are expecting to become unemployed or change jobs soon, describe the change yon expect and why and how it will affect your income: ___________________________ __________________________________________________________________________________ · Check here if you currently have more than one job. List the information above for the second job(s) on a separate sheet and attach it to this affidavit. ___ c. Retired. Date of retirement: ______________________________ Employer from whom retired: __________________________________________________ Address: _____________________________________________________________________ City, State, Zip code: ________________________ Telephone Number: __________ Your Income Other Party's Income () YEAR ______ $__________ $___________________ See the instructions with this form to figure out money amounts for anything that is NOT paid monthly. Attach more paper, if needed. Items included under "other" should be listed separately with separate dollar amounts. 1. Monthly gross salary or wages 1. $_____ 2. Monthly bonuses, commissions, allowances, overtime, tips, and similar payments 2. ______ 3. Monthly business income from sources such as self-employment, partnerships, close corporations, and/or independent contracts (Gross receipts minus ordinary and necessary expenses required to produce income.) (· Attach sheet itemizing such income and expenses.) 3. ______ 4. Monthly disability benefits/SSI 4. ______ 5. Monthly Workers' Compensation 5. ______ 6. Monthly Unemployment Compensation 6. ______ 7. Monthly pension, retirement, or annuity payments 7. ______ 8. Monthly Social Security benefits 8. ______ 9. Monthly alimony actually received 9a. From this case: $_____ 9b. From other case(s): _____ Add 9a and 9b 9. ______ 10. Monthly interest and dividends 10. ______ 11. Monthly rental income (gross receipts minus ordinary and necessary expenses required to produce income) (· Attach sheet itemizing such income and expense items.) 11. ______ 12. Monthly income from royalties, trusts, or estates 12. ______17. PRESENT MONTHLY GROSS INCOME TOTAL: 17. PRESENT MONTHLY DEDUCTIONS: All amounts must be MONTHLY. 26. TOTAL DEDUCTIONS ALLOWABLE UNDER SECTION 61.30, TOTAL: 26. FLORIDA STATUTES 27. PRESENT NET MONTHLY INCOME 27. SECTION II. AVERAGE MONTHLY EXPENSES Proposed/Estimated Expenses. and HOUSEHOLD:
13. Monthly reimbursed expenses and in-kind payments to the extent that they reduce personal living expenses (· Attach sheet itemizing each item and amount.) 13. ______ 14. Monthly gains derived from dealing in property (not including nonrecurring gains) 14. ______ Any other income of a recurring nature (identify source) 15. ____________________________________________________________________ 15. ______ 16. ____________________________________________________________________ 16. ______ (Add lines 1-16) $_____ See the instructions with this form to figure out money amounts for anything that is NOT paid monthly. 18. Monthly federal, state, and local income tax (corrected for filing status and allowable dependents and income tax liabilities) a. Filing Status ____ b. Number of dependents claimed ______ 18. $________ 19. Monthly FICA or self-employment taxes 19. _________ 20. Monthly Medicare payments 20. _________ 21. Monthly mandatory union dues 21. _________ 22. Monthly mandatory retirement payments 22. _________ 23. Monthly health insurance payments (including dental insurance), excluding portion paid for any minor children of this relationship 23. _________ 24. Monthly court-ordered child support actually paid for children from another relationship 24. _________ 25. Monthly court-ordered alimony actually paid 25a. from this case: $______ 25b. from other case(s): ______ Add 25a and 25b 25. _________ $________ (Add lines 18 through 25) (Subtract line 26 from line 17) $________ _______________________________________________________________________________________ _______________________________________________________________________________________ If this is a dissolution of marriage case your expenses as listed below do not reflect what you actually pay currently, you should write "estimate" next to each amount that is estimated. 1. Monthly mortgage or rent payments 1. $_____ 2. Monthly property taxes (if not included in mortgage) 2. ______ 3. Monthly insurance on residence (if not included in mortgage) 3. ______ 4. Monthly condominium maintenance fees and homeowner's association fees 4. ______ 5. Monthly electricity 5. ______ 6. Monthly water, garbage, and sewer 6. ______ 7. Monthly telephone 7. ______ 8. Monthly fuel oil or natural gas 8. ______ 9. Monthly repairs and maintenance 9. ______ 10. Monthly lawn care 10. ______ 11. Monthly pool maintenance 11. ______ 12. Monthly pest control 12. ______ 13. Monthly misc. household 13. ______25. SUBTOTAL 25. AUTOMOBILE: 35. (add lines 26 through 34) 35. MONTHLY EXPENSES FOR CHILDREN COMMON TO BOTH PARTIES: 58. (add lines 36 through 57) 58. MONTHLY EXPENSES FOR CHILD(REN) FROM ANOTHER RELATIONSHIP:
14. Monthly food and home supplies 14. ______ 15. Monthly meals outside home 15. ______ 16. Monthly cable t.v. 16. ______ 17. Monthly alarm service contract 17. ______ 18. Monthly service contracts on appliances 18. ______ 19. Monthly maid service 19. ______ Other: 20. _____________________________________________________________________ 20. ______ 21. _____________________________________________________________________ 21. ______ 22. _____________________________________________________________________ 22. ______ 23. _____________________________________________________________________ 23. ______ 24. _____________________________________________________________________ 24. ______ (add lines 1 through $_____ 26. Monthly gasoline and oil 26. $_____ 27. Monthly repairs 27. ______ 28. Monthly auto tags and emission testing 28. ______ 29. Monthly insurance 29. ______ 30. Monthly payments (lease or financing) 30. ______ 31. Monthly rental/replacements 31. ______ 32. Monthly alternative transportation (bus, rail, car pool, etc.) 32. ______ 33. Monthly tolls and parking 33. ______ 34. Other: ______________________________________________________________ 34. ______ SUBTOTAL $_____ 36. Monthly nursery, babysitting, or day care 36. $_____ 37. Monthly school tuition 37. ______ 38. Monthly school supplies, books, and fees 38. ______ 39. Monthly after school activities 39. ______ 40. Monthly lunch money 40. ______ 41. Monthly private lessons or tutoring 41. ______ 42. Monthly allowances 42. ______ 43. Monthly clothing and uniforms 43. ______ 44. Monthly entertainment (movies, parties, etc.) 44. ______ 45. Monthly health insurance 45. ______ 46. Monthly medical, dental, prescriptions (nonreimbursed only) 46. ______ 47. Monthly psychiatric/psychological/counselor 47. ______ 48. Monthly orthodontic 48. ______ 49. Monthly vitamins 49. ______ 50. Monthly beauty parlor/barber shop 50. ______ 51. Monthly nonprescription medication 51. ______ 52. Monthly cosmetics, toiletries, and sundries 52. ______ 53. Monthly gifts from child(ren) to others (other children, relatives, teachers, etc.) 53. ______ 54. Monthly camp or summer activities 54. ______ 55. Monthly clubs (Boy/Girl Scouts, etc.) 55. ______ 56. Monthly access expenses (for nonresidential parent) 56. ______ 57. Monthly miscellaneous 57. ______ SUBTOTAL $_____ (other than court-ordered child support) 59. ______________________________________________________________________ 59. $_____63. SUBTOTAL 63. MONTHLY INSURANCE: 69. SUBTOTAL 69. OTHER MONTHLY EXPENSES NOT LISTED ABOVE: 90. SUBTOTAL 90. MONTHLY PAYMENTS TO CREDITORS:
60. ______________________________________________________________________ 60. ______ 61. ______________________________________________________________________ 61. ______ 62. ______________________________________________________________________ 62. ______ (add lines 59 through 62) $_____ 64. Health insurance, excluding portion paid for any minor child(ren) of this relationship 64. $_____ 65. Life insurance 65. ______ 66. Dental insurance 66. ______ Other: 67. ______________________________________________________________________ 67. ______ 68. ______________________________________________________________________ 68. ______ (add lines 64 through68) $_____ 70. Monthly dry cleaning and laundry 70. $_____ 71. Monthly clothing 71. ______ 72. Monthly medical, dental, and prescription (unreimbursed only) 72. ______ 73. Monthly psychiatric, psychological, or counselor (unreimbursed only) 73. ______ 74. Monthly non-prescription medications, cosmetics, toiletries, and sundries 74. ______ 75. Monthly grooming 75. ______ 76. Monthly gifts 76. ______ 77. Monthly pet expenses 77. ______ 78. Monthly club dues and membership 78. ______ 79. Monthly sports and hobbies 79. ______ 80. Monthly entertainment 80. ______ 81. Monthly periodicals/books/tapes/CD's 80. ______ 82. Monthly vacations 82. ______ 83. Monthly religious organizations 83. ______ 84. Monthly bank charges/credit card fees 84. ______ 85. Monthly education expenses 85. ______ Other: (include any usual and customary expenses not otherwise mentioned in the items listed above) 86. ______________________________________________________________________ 86. ______ 87. ______________________________________________________________________ 87. ______ 88. ______________________________________________________________________ 88. ______ 89. ______________________________________________________________________ 89. ______ (add lines 70 through 89) $_____ (only when payments are currently made by you on outstanding balances) NAME OF CREDITOR(s): 91. ______________________________________________________________________ 91. $_____ 92. ______________________________________________________________________ 92. ______ 93. ______________________________________________________________________ 93. ______ 94. ______________________________________________________________________ 94. ______ 95. ______________________________________________________________________ 95. ______ 96. ______________________________________________________________________ 96. ______ 97. ______________________________________________________________________ 97. ______ 98. ______________________________________________________________________ 98. ______ 99. ______________________________________________________________________ 99. ______ 100. ______________________________________________________________________ 100. ______ 101. ______________________________________________________________________ 101. ______ 102. ______________________________________________________________________ 102. ______104. SUBTOTAL 104. 105. TOTAL MONTHLY EXPENSES: 105. SUMMARY 106. TOTAL PRESENT MONTHLY NET INCOME 106. 107. TOTAL MONTHLY EXPENSES 107. 108. SURPLUS 108. 109. (DEFICIT) 109. SECTION III. ASSETS AND LIABILITIES A. ASSETS (This is where you list what you OWN.) INSTRUCTIONS: STEP 1 : In column A STEP 2 : in Column A STEP 3 : In column B STEP 4 : Use column C only if this is a petition for dissolution of marriage and you believe an item is "nonmarital," meaning it belongs to only one of you and should not be divided. "General Information for Self-Represented Litigants" 61.075 A B C Current Fair Nonmarital ASSETS: DESCRIPTION OF ITEM(S) Market Value ( correct column) the box next to any asset(s) which you are requesting the judge award to you. husband wife
103. ______________________________________________________________________ 103. ______ (add lines 91 through 103) $_____ (add lines 25, 35, 58, 63, 69, 90, and 104 of Section II, Expenses) $_____ (from line 27 of SECTION I. INCOME) $_____ (from line 105 above) $_____ (If line 106 is more than line 107, subtract line 107 from line 106. This is the amount of your surplus. Enter that amount here.) $_____ (If line 107 is more than line 106, subtract line 106 from line 107. This is the amount of your deficit. Enter that amount here.) ($____) _______________________________________________________________________________________ _______________________________________________________________________________________ , list a description of each separate item owned by you (and/or your spouse, if this is a petition for dissolution of marriage). Blank spaces are provided if you need to list more than one of an item. If this is a petition for dissolution of marriage, check the box next to any item that you are requesting the judge award to you. , write what you believe to be the current fair market value of all items listed. You should indicate to whom you believe the item belongs. (Typically, you will only use Column C if property was owned by one spouse before the marriage. See the found at the beginning of these forms and section (1), Florida Statutes, for definitions of "marital" and "nonmarital" assets and liabilities.) ________________________________________________________________________________________ ____ ________________________________________________________________________________________ · Cash (on hand) $ ________________________________________________________________________________________ · Cash (in banks or credit unions) ________________________________________________________________________________________ · ________________________________________________________________________________________ · Stocks/Bonds ________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ · Notes (money owed to you in writing) ________________________________________________________________________________________ ·Total Assets B. LIABILITIES/DEBTS (This is where you list what you OWE.) INSTRUCTIONS: STEP 1 : In column A STEP 2 : in Column A STEP 3 : In column B STEP 4 : Use column C only if this is a petition for dissolution of marriage and you believe an item is "nonmarital," meaning the debt belongs to only one of you and should not be divided. "General Information for Self-Represented 61.075 A B C Current Nonmarital LIABILITIES: DESCRIPTION OF ITEM(S) Amount Owed ( correct column) the box next to any debt(s) for which you believe you should be responsible. husband wife
________________________________________________________________________________________ · ________________________________________________________________________________________ · 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 ________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ (add column B) $_________ ________________________________________________________________________________________ , list a description of each separate debt owed by you (and/or your spouse, if this is a petition for dissolution of marriage). Blank spaces are provided if you need to list more than one of an item. If this is a petition for dissolution of marriage, check the box next to any debt(s) for which you believe you should be responsible. , write what you believe to be the current amount owed for all items listed. You should indicate to whom you believe the debt belongs. (Typically, you will only use Column C if the debt was owed by one spouse before the marriage. See the Litigants" found at the beginning of these forms and section (1), Florida Statutes, for definitions of "marital" and "nonmarital" assets and liabilities.) ________________________________________________________________________________________ ____ ________________________________________________________________________________________ · Mortgages on real estate: (Home) $ ________________________________________________________________________________________ · (Other) ________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ · Charge/credit card accounts ________________________________________________________________________________________Total Debts C. NET WORTH (excluding contingent assets and liabilities) Total Assets Total Liabilities TOTAL NET WORTH (Total Assets minus Total Liabilities) D. CONTINGENT ASSETS AND LIABILITIES POSSIBLE assets POSSIBLE liabilities A B C Nonmarital Contingent Assets Possible Value ( correct column) the box next to any contingent asset(s) which you are requesting the judge award to you. husband wife
· ________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ · _______________________________________________________________________________________ · ________________________________________________________________________________________ · Auto loan ________________________________________________________________________________________ · Auto loan ________________________________________________________________________________________ · Bank/Credit Union loans ________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ · Money you owe (not evidenced by a note) ________________________________________________________________________________________ · ________________________________________________________________________________________ · Judgments ________________________________________________________________________________________ · ________________________________________________________________________________________ · Other ________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ (add column B) $_________ ________________________________________________________________________________________ (enter total of Column B in Asset Table; Section A) $_____ (enter total of Column B in Liabilities Table; Section B) $_____ $_____ (excluding contingent assets and liabilities) _____ INSTRUCTIONS: If you have any (income potential, accrued vacation or sick leave, bonus, inheritance, etc.) or (possible lawsuits, future unpaid taxes, contingent tax liabilities, debts assumed by another), you must list them here. ________________________________________________________________________________________ ____ ________________________________________________________________________________________ · $ ________________________________________________________________________________________ · ________________________________________________________________________________________ ·Total Contingent Assets A B C Possible Nonmarital Contingent Liabilities Amount Owed ( correct column) the box next to any contingent debt(s) for which you believe you should be responsible. husband wife Total Contingent Liabilities E. F. CHILD SUPPORT GUIDELINES WORKSHEET. one A Child Support Guidelines Worksheet IS or WILL BE filed in this case. A Child Support Guidelines Worksheet IS NOT being filed in this case. I certify that a copy of this financial affidavit was: ( ) mailed, ( ) faxed and mailed, or ( ) hand delivered to the person(s) listed below on { date } Other party or his/her attorney: 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.
________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ $_____ ________________________________________________________________________________________ ________________________________________________________________________________________ ____ ________________________________________________________________________________________ · $ ________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ · ________________________________________________________________________________________ $_____ ________________________________________________________________________________________ Has there been any agreement between you and the other party that one of you will take responsibility for a debt and will hold the other party harmless from that debt? ( ) yes ( ) no If yes, explain: _______________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet, MUST be filed with the court at or prior to a hearing to establish or modify child support. This requirement cannot be waived by the parties. [ only] ___ This case involves the establishment or modification of child support. ___ The establishment or modification of child support is not an issue in this case. ________________________ Name: __________________________________ Address: _______________________________ City, State, Zip: ______________________ Fax Number: ____________________________ Dated: _________________________________IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: all full legal name, and trade name of nonlawyer street city state phone name one or
____________________________________________ Signature of Party Printed Name: ______________________________ Address: ___________________________________ City, State, Zip: __________________________ Telephone Number: __________________________ Fax Number: ________________________________ STATE OF FLORIDA COUNTY OF ______________________________ Sworn to or affirmed and signed before me on ____________ by ____________________________ _______________________________________ NOTARY PUBLIC or DEPUTY CLERK ________________________________________ [Print, type, or stamp commissioned name of notary or deputy clerk.] ___ Personally known ___ Produced identification Type of identification produced ______________ [fill in blanks] I, {] ______________________________________, a nonlawyer, located at. {} _____________________________, {} _______________, {} ______, {} __________, helped {} ______________________________________, who is the [ only] ________ petitioner ______ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.902(d), UNIFORM CHILD CUSTODY JURISDICTION ACT (UCCJA) AFFIDAVITWhen should this form be used?
This form should be used in any case involving custody of or visitation with any minor child(ren). This affidavit is required even if the custody and visitation of the minor child(ren) are 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 the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records.
What should I do next?
A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served on him or her with your initial papers.
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 61.1302— 61.1354, Florida Statutes.
Special notes . . .
If you are the petitioner in an injunction for protection against domestic violence case and you have filed Petitioner's Request for Confidential Filing of Address,
Florida Supreme Court Approved Family Law Form 12.980(i), 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.
FORM 12.902(d), UNIFORM CHILD CUSTODY JURISDICTION ACT (UCCJA) AFFIDAVIT UNIFORM CHILD CUSTODY JURISDICTION ACT (UCCJA) AFFIDAVIT full legal name within the past five (5) years; THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # 1 : Child's Residence for the past 5 years:
If you are the petitioner in an injunction for protection against domestic violence case and you have filed Petitioner's Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(i), 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 Residence for the past 5 years: THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD #_________: Child's Residence for the past 5 years: Participation in custody proceeding(s): one Information about custody proceeding(s): one Persons not a party to this proceeding: one
Child's Full Legal Name: ____________________________________________ Place of Birth: ______________________ Date of Birth: _______________ Sex: __________________ _____________________________________________________________________________________________ Dates Address (including city and Name and present address of Relationship From/To) state) where child lived person child lived with to child _____________________________________________________________________________________________ _______/present _____________________________________________________________________________________________ _______/_______ _____________________________________________________________________________________________ _______/_______ _____________________________________________________________________________________________ _______/_______ _____________________________________________________________________________________________ _______/_______ _____________________________________________________________________________________________ _______/_______ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Dates Address (including city and Name and present address of Relationship (From/To) state) where child lived person child lived with to child _____________________________________________________________________________________________ _______/present _____________________________________________________________________________________________ _______/_______ _____________________________________________________________________________________________ _______/_______ _____________________________________________________________________________________________ _______/_______ _____________________________________________________________________________________________ _______/_______ _____________________________________________________________________________________________ _______/_______ _____________________________________________________________________________________________ 2. [ only] __ 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, concerning custody of 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, concerning custody of 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. [ only] __ I HAVE NO INFORMATION of any custody proceeding pending in a court of this or any other state concerning a child subject to this proceeding. __ I HAVE THE FOLLOWING INFORMATION concerning a custody 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: _________________________________________________________________ b. Type of proceeding: _________________________________________________________________ c. Court and state: ____________________________________________________________________ d. Date of court order or judgment (if any): ___________________________________________ 4. [ only]Knowledge of prior child support proceedings: one are I acknowledge that I have a continuing duty to advise this Court of any custody, 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. one date Other party or his/her attorney: 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.
___ I DO NOT KNOW OF ANY PERSON not a party to this proceeding who has physical custody or claims to have custody or visitation rights 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 custody or visitation rights with respect to any child subject to this proceeding: a. Name and address of person: _________________________________________________________ ________________________________________________________________________________________ ( ) has physical custody ( ) claims custody rights ( ) claims visitation rights. Name of each child: ____________________________________________________________________ b. Name and address of person: _________________________________________________________ ( ) has physical custody ( ) claims custody rights ( ) claims visitation rights. Name of each child: ____________________________________________________________________ c. Name and address of person: _________________________________________________________ ( ) has physical custody ( ) claims custody rights ( ) claims visitation rights. Name of each child: ____________________________________________________________________ 5. [ only] ___ The child(ren) described in this affidavit are NOT subject to existing child support order(s) in this or any state or territory. ___ The child(ren) described in this affidavit 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 paid and by whom: ___________________________________________ 6. I certify that a copy of this document was [ only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {} _________________. Name: ____________________________________ Address: _________________________________ City, State, Zip: ________________________ Fax Number: ______________________________ Dated:_________________________________ _______________________________________________ Signature of Party Printed Name: _________________________________ Address: ______________________________________ City, State, Zip: _____________________________ Telephone Number: _____________________________IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: all full legal name and trade name of nonlawyer street city state phone name one or
Fax Number: ___________________________________ STATE OF FLORIDA COUNTY OF _____________________ Sworn to or affirmed and signed before me on _______________ by ____________________________ _______________________________________________________ NOTARY PUBLIC or DEPUTY CLERK _______________________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification Type of identification produced _____________ [fill in blanks] I, {} _____________________________________, a nonlawyer, located at {} ______________________, {} ______________________, {} __________, {} ______________, helped {} ____________________________, who is the [ only] _____ petitioner ______ respondent, fill out this form. FORM 12.941(e). ORDER TO PICK-UP MINOR CHILD(REN) IN THE CIRCUIT COURT OF THE ________________ JUDICIAL CIRCUIT, IN AND FOR ________________ COUNTY, FLORIDA Case No.: ___________________________________ Division: ___________________________________ __________________________________, Petitioner, and __________________________________,ORDER TO PICK-UP MINOR CHILD(REN) JURISDICTION all 28 U.S.C. § 1738A 742.031 744.301 NOTICE OF HEARING name date name room name/number, location, address, city name address telephone are
Respondent. An Emergency Verified Motion for Child Pick-Up Order has been filed by ( ) Petitioner ( ) Respondent, alleging facts which under existing law are determined to be sufficient to authorize taking into custody the minor child(ren) named below. Based on this motion, this Court makes the following findings, notices, and conclusions: This Court has jurisdiction over issues surrounding the minor child(ren) listed below based on the following: [ that apply] ___ a. This Court exercised and continues to exercise original jurisdiction over the minor children listed below under the Uniform Child Custody Jurisdiction Act (UCCJA), specifically, section 61.1308, Florida Statutes. ___ b. A certified out-of-state custody decree has been presented to this Court with a request for full faith and credit recognition and enforcement under the Parental Kidnaping Prevention Act, . This Court has jurisdiction to enforce this decree under the UCCJA, specifically section 61.1328, Florida Statutes. ___ c. By operation of Florida law governing the primary custody rights of children born out of wedlock, this Court has jurisdiction over the child(ren) listed below because this (these) child(ren) was (were) born in the State of Florida and no prior court action involving the minor child(ren) has addressed a putative father's rights to custody or other parental rights. See sections and , Florida Statutes. ___ d. Pursuant to the UCCJA, specifically section 61.133, Florida Statutes, this Court has jurisdiction to modify a custody decree of another state and has consulted with the Court which took initial jurisdiction over the minor child(ren) to determine this authority. ___ e. Other: ___________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Because this Order to Pick-Up Minor Child(ren) has been issued without prior notice to the non-movant {} ____________________________, all parties involved in this matter are informed that they are scheduled to appear and testify at a hearing regarding this matter on {} _______, at _______.m., at which time the Court will consider whether the Court should issue a further order in this case, and whether other things should be ordered, including who should pay the filing fees and costs. The hearing will be before The Honorable {} ___________________________________ at {} __________________________________________, Florida. If a party does not appear, this order may be continued in force, extended, or dismissed, and/or additional orders may be issued, including the imposition of court costs. 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 {} _______________________________________________________, {} _______________________________________________________________________________, {} _____________, within 2 working days of your receipt of this order. If you hearing or voice impaired, call TDD 1-800-955-8771.ORDER ORDERS AND DIRECTS Place the minor child(ren) in the physical custody of name ______, who ( ) may ( ) may not remove the minor child(ren) from the jurisdiction of this Court. OR Accompany the minor child(ren) to the undersigned judge, if the minor child(ren) is (are) picked up during court hours, for immediate hearing on the issue of custody. OR Place the minor child(ren) in the physical custody of agency ______, who shall contact the undersigned judge for an expedited hearing. NEITHER PARTY OR ANYONE AT THEIR DIRECTION, EXCEPT PURSUANT TO THIS ORDER, MAY REMOVE THE CHILD(REN) FROM THE JURISDICTION OF THIS COURT PENDING FURTHER HEARING. SHOULD THE NONMOVING PARTY IN ANY WAY VIOLATE THE MANDATES OF THIS ORDER IN THE PRESENCE OF THE LAW ENFORCEMENT OFFICER, THIS OFFICER IS TO IMMEDIATELY ARREST AND INCARCERATE THE OFFENDING PARTY UNTIL SUCH TIME AS THE OFFENDING PARTY MAY BE BROUGHT BEFORE THIS COURT FOR FURTHER PROCEEDINGS. Name Sex Birth date Race Physical Description
This Court any and all sheriffs of the State of Florida (or any other authorized law enforcement officer in this state or in any other state) to immediately take into custody the minor child(ren) identified below from anyone who has possession and: ___ 1. {} ___ 2. It is the intention of this Court that the nonmoving party, minor child(ren), and movant appear immediately upon service of this order before the undersigned judge, if available, or duty judge to conduct a hearing as to which party is entitled to lawful custody of the minor child(ren) at issue. It is not the intention of the court to turn over the child(ren) to the movant on an ex parte basis. Neither party should be permitted to remove the child(ren) from the jurisdiction of this Court pending a hearing. If unable to accomplish the above, the sheriff/officer shall take the child(ren) into custody and place them with the Department of Children and Family Services of the State of Florida pending an expedited hearing herein. ___ 3. {} The sheriff/officer shall not delay the execution of this court order for any reason or permit the situation to arise where the nonmoving party is allowed to remove the child(ren) from the jurisdiction of this court. 4. All sheriffs of the State for Florida are authorized and ORDERED to serve (and/or execute) and enforce this order in the daytime or in the nighttime and any day of the week, except as limited by this order above. Except as limited by the above, if necessary, the sheriff/officer is authorized to take all reasonable, necessary, and appropriate measures to effectuate this order. The sheriff/officer shall not delay the execution of this order for any reason or permit the situation to arise where the child(ren) is (are) removed from the jurisdiction of this Court before execution of this order. The minor child(ren) is (are) identified as follows: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________date time
Current location/address of minor child(ren) or of party believed to have possession of the minor child(ren): ___________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ORDERED on {} _________________, at {} ________________________________. ________________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.981(b), STEPPARENT ADOPTION: CONSENT OF ADOPTEEWhen should this form be used?
This form must be completed and signed by the person being adopted, the adoptee, if he or she is over 12 years of age. It must be signed in the presence of a notary public or deputy clerk and two witnesses other than the notary public or deputy clerk.
This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where the adoption petition is filed and keep a copy for your records.
What should I do next?
A copy of this form must be mailed or hand delivered to the people identified in the instructions for Joint Petition for Stepparent Adoption, Florida Family Law Form 12.981(a).
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.
FORM 12.981(b), STEPPARENT ADOPTION: CONSENT OF ADOPTEE use name to be given to child(ren)
IN THE CIRCUIT COURT OF THE _____________ JUDICIAL CIRCUIT, IN AND FOR ___________ COUNTY, FLORIDA Case No.: ___________________________________ Division: ___________________________________ IN RE: THE ADOPTION OF ____________________________________________, {} Adoptee(s).STEPPARENT ADOPTION: CONSENT OF ADOPTEE full legal name name specify 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. IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: all full legal name and trade name of nonlawyer street city state phone name
1. I, {} ____________________, being over the age of 12, consent to my adoption by {} ____________________, to be his/her legal child and heir at law. 2. I consent to my name being legally changed to {}____________________. Dated: _______________________________ _______________________________________ Signature of Adoptee Printed Name: _________________________ Address: ______________________________ City, State, Zip: _____________________ Telephone Number: _____________________ Fax Number: ___________________________ ________________________________________________________________________________ Signature of Witness Printed Name: __________________________________________________________________ Business Address: ______________________________________________________________ Home Address: __________________________________________________________________ ________________________________________________________________________________ Signature of Witness Printed Name: __________________________________________________________________ Business Address: ______________________________________________________________ Home Address: __________________________________________________________________ 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 _____________ [fill in blanks] I, {} _______________________________, a nonlawyer, located at {} ____________________, {} __________________, {} _____________, {} ______________, helped {} ___________________, who is the adoptee, fill out this form.