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Family law forms dealing with child custody

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Family law forms dealing with child custody


The Florida Supreme Court, on its own motion and with input from the Advisory Workgroup on the Florida Supreme Court Approved Family Law Forms, has adopted new Florida Supreme Court Approved Family Law Forms pertaining to temporary and concurrent child custody. These new forms are adopted to conform to the changes in statutory language accomplished by chapter 2010-30, Laws of Florida. The Court invites all interested persons to comment on the amended forms, which are reproduced in full below and can be viewed online at www.floridasupremecourt.org/decisions/proposed.shtml . An original and nine paper copies of all comments must be filed with the Court on or before June 6, 2011, 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. Electronic copies of all comments also must be filed in accordance with the Court’s administrative order In re Mandatory Submission of Electronic Copies of Documents, Fla. Admin. Order No. AOSC04-84 (Sept. 13, 2004).

IN THE SUPREME COURT OF FLORIDA

IN RE: AMENDMENTS TO THE FLORIDA SUPREME COURT APPROVED FAMILY LAW FORMS, CASE NO. SC10-2344

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.970(a), PETITION FOR TEMPORARY CUSTODY BY EXTENDED FAMILY (04/11)

When should this form be used?

This form should be used by an extended family member to obtain temporary custody of a child or children pursuant to Chapter 751, Florida Statutes. This form should not be used if you are a parent seeking to establish parental responsibility or time-sharing with a child or children.

An Extended Family Member is:

A relative of a minor child within the third degree by blood or marriage to the parent;

OR

The stepparent of a minor child if the stepparent is currently married to the parent of the child and is not a party in a pending dissolution, separate maintenance, domestic violence, or other civil or criminal proceeding in any court of competent jurisdiction involving one or both of the child(ren)’s parents as an adverse party.

You may file a Petition for Temporary Custody if:

You have the signed, notarized consents of the child(ren)’s legal parents;

OR

You are an extended family member who is caring full time for the child(ren) in the role of a substitute parent and with whom the child(ren) is (are) presently living.

If one of the minor child(ren)’s parents objects to the Petition, the court shall grant the Petition only upon a finding, by clear and convincing evidence, that the child(ren)’s parent or parents are unfit to provide for the care and control of the child(ren). In determining that a parent is unfit, the court must find that the parent has abused, abandoned, or neglected the child(ren), as defined in Chapter 39, Florida Statutes. If you do not have the parents’ consents you should consult a family law attorney before you file your papers.

If you do not meet the qualifications above, you should talk to an attorney about other options. You may also report any suspected abuse, abandonment, or neglect to the appropriate authorities.

This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in the county where you live and keep a copy for your records.

What should I do next?

IF YOU HAVE SIGNED AND NOTARIZED WAIVERS OF SERVICE OF PROCESS AND CONSENTS from the child(ren)’s mother and father, and the case is uncontested, you may call the clerk, family law intake staff, or judicial assistant, to set a final hearing. You must notify the child(ren)’s parents of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.

If one of the parents is deceased, you must file a certified copy of the proof of death.

IF YOU DO NOT HAVE SIGNED AND NOTARIZED WAIVERS OF SERVICE OF PROCESS AND CONSENTS from the child(ren)’s parents, you must properly notify the parents of the petition. If you know where he or she lives, you should use personal service . If you absolutely do not know where he or she lives after conducting a diligent search, you may use constructive service . You must complete all of the searches listed in the Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b), and file the form with the clerk. You should seek legal advice on constructive service as this is a complicated area of the law. If the identity of one parent is unknown, you will need to seek legal advice to determine the proper way to serve an unknown parent. For more information, see Chapter 49, Florida Statutes.

If personal service is used, the parents have 20 days to answer after being served with your petition. Your case will generally proceed in one of the following ways:

DEFAULT .. . If after 20 days, no answer has been filed, you may file a Motion for Default, Florida Supreme Court Approved Family Law Form 12.922(a), with the clerk of court. You must file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant, to set a final hearing. You must notify the child(ren)’s parents of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.

CONTESTED .. . If either parent files an answer which disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you must file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, to request a final hearing. Some circuits may require the completion of mediation before a final hearing may be set. You should contact the clerk, family law intake staff,
or judicial assistant for instructions on how to set your case for trial (final hearing).

At any time, either or both of the child(ren)’s parents may petition the court to modify or terminate the order granting temporary custody. The court shall terminate the order upon a finding that the parent is a fit parent, or by the consent of the parties. The court may modify an order granting temporary custody if the parties consent or if the modification is in the best interest of the child(ren).

Where can I look for more information?

Before proceeding, you should read General Information for Self-Represented Litigants found at the beginning of these forms. The words that are in bold underline in these instructions are defined there. For further information, see Chapter 751 and Chapter 39, Florida Statutes.

Special Notes.. .

If you do not have the money to pay the filing fee, you may obtain an application for Determination of Civil Indigent Status, fill it out, and the clerk will determine whether you are eligible to have filing fees deferred.

With this petition, you must file the following and provide a copy to the other party:

    Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d).
    Notice of Related Cases, Florida Family Law Rules of Procedure Form 12.900(h).
    Family Court Cover Sheet, Florida Family Law Rules of Procedure Form 12.928.
    Non-Military Affidavit, Florida Supreme Court Approved Family Law Form 12.912(b). (Required only for obtaining a default on petitions that have been personally or constructively served. Not required if both parents have signed a waiver and consent)


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


IN THE CIRCUIT COURT OF THE _______________ JUDICIAL CIRCUIT,

IN AND FOR _______________________________ COUNTY, FLORIDA

Case No: _______________________

Division: _______________________

__________________________________,

Petitioner,

and

__________________________________,

Respondent/Mother,

__________________________________,

Respondent/Father.

PETITION FOR TEMPORARY CUSTODY BY EXTENDED FAMILY

Petitioner, { full legal name} _________________________________, being sworn, certifies that the following information is true:

    This is an action for temporary custody pursuant to Chapter 751, Florida Statutes.
    Petitioner requests temporary custody of the following minor child(ren):

      Name Date of Birth Current Address

      __________________________________________________________________________

      __________________________________________________________________________

      __________________________________________________________________________

      __________________________________________________________________________

    Petitioner completed a Uniform Child Custody Jurisdiction and Enforcement Act Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), which was filed with this Petition. The affidavit includes the names and current addresses of the persons with whom the child(ren) has(have) lived during the past 5 years, the places where the child(ren) has(have) lived during the past 5 years, and information concerning any custody proceeding in this or any other state with respect to the child(ren). If the Affidavit is not completely filled out, signed under oath, and filed with the Petition, the case may be dismissed without hearing.

    Petitioner is an extended family member who is: [Choose one only]

      _____ Related to the minor child(ren) within the third degree by blood or marriage to a parent; OR

      _____ The stepparent of the minor child(ren), is married to the ( )Mother ( )Father and is not a party in a pending dissolution, separate maintenance, domestic violence, or other civil or criminal proceeding in any court of competent jurisdiction involving one or both of the child(ren)’s parents as an adverse party.
    Petitioner’s relationship to the minor child(ren) is: ____________________________________.
    The residence and post office address of the Petitioner is: ______________________________

      ____________________________________________________________________________.

    Petitioner is a proper person to be awarded temporary custody because: [Choose one only]

      ____ Petitioner has the signed, notarized consent from both of the child(ren)’s legal parents; OR

      ____ Petitioner is caring full time for the child(ren) in the role of a substitute parent and the child(ren) currently live with the Petitioner.
      If Petitioner does not have the signed consents from both parents or is not caring for the child(ren) full time as a substitute parent, Petitioner cannot obtain temporary custody under Chapter 751, Florida Statutes. Petitioner should consult an attorney about other options.

    The legal mother of the child(ren) is ____________________________________, whose current address is: _____________________________________________________________________.
    The legal father of the child(ren) is ______________________________________, whose current address is: ___________________________________________________________.
    The Consents of ______Father and/or _________ Mother is/are attached to the Petition.

      OR
      { If Applicable} The Consent of the _________________ is not attached because that parent is deceased. A certified copy of the proof of death is attached.

      OR

      Consent has NOT been obtained from the parents. The specific acts or omissions of the parents which demonstrate that the parents have abused, abandoned, or neglected the child(ren) as defined in Chapter 39, Florida Statutes are: (attach additional sheets if necessary) ________________________________________________________________________

      _____________________________________________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________.

    Petitioner requests temporary custody be granted for the following period of time:___________

      ________________________________________________________­­­___________________. The reasons that support this request are: ___________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________.

    It is in the best interests of the child(ren) that the Petitioner have temporary custody of the child(ren) for the following reasons: _______________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________.

    ORDER OF PROTECTION

      ___ Petitioner IS NOT aware of any temporary or permanent order for protection entered on behalf of or against either parent, the Petitioner, or the child(ren) in Florida or any other jurisdiction.

      OR

      ___ Petitioner IS aware of the following temporary or permanent orders for protection entered on behalf of or against either parent, the Petitioner, or the child(ren) in Florida or any other jurisdiction. The court entering the order and the case number is: _______

          ________________________________________________________________________

          ________________________________________________________________________

          _______________________________________________________________________.

    TEMPORARY OR PERMANENT CHILD SUPPORT ORDERS

      ___ Petitioner IS NOT aware of any temporary or permanent orders for child support for the minor child(ren).

      OR

      ___ Petitioner IS aware of the following temporary or permanent order for child support for the minor child(ren). The court entering the order and the case number is:_________

      _______________________________________________________________________

      ________________________________________________________________________

      _______________________________________________________________________.

    CHILD SUPPORT [Choose one only]

      (You must have proof or waiver of service of process upon the parent(s) or a Waiver of Service of Process and Consent for the court to consider an award for child support)

      ___ Petitioner requests the court to order the parents to pay child support.

      ___ Petitioner requests the court to redirect all or part of Mother’s and/or Father’s existing child support obligation to the Petitioner.

      ___ Petitioner requests the court to redirect all or part of Mother’s and/or Father’s existing child support obligation to the Petitioner, and to award the Petitioner child support arrearages.

    Petitioner ____ requests _____ does not request that the court establish reasonable visitation or a time-sharing schedule with the parents.
    Other _____________________________________________________________________________

      _____________________________________________________________________________

      _____________________________________________________________________________

      _____________________________________________________________________________.

WHEREFORE, Petitioner requests that this Court grant the Petitioner temporary custody of the child(ren) subject to this proceeding; award the Petitioner other relief as requested; and award any other relief that the Court deems necessary.

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

Dated: _____________________________ ______________________________________

Signature of Petitioner

Printed Name: __________________________

Address: __________________________________

City, State, Zip Code: ________________________

Telephone Number: _________________________

Fax Number: _______________________________

STATE OF FLORIDA

COUNTY OF __________________________________

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

_______________________________________

NOTARY PUBLIC OR DEPUTY CLERK

________________________________________

                          Print, type, or stamp commissioned name of notary or deputy clerk.

____ Personally known

____ Produced identification

Type of identification produced _________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks]

I, { full legal name and trade name of nonlawyer} ___________________________________________

a nonlawyer, whose address is { street} ________________________________________________,
{ city} _______________________, { state} ___________, { phone }
________________________, helped { name} ______________________________________________ who is the Petitioner, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.970(b), PETITION FOR CONCURRENT CUSTODY BY EXTENDED FAMILY (04/11)
When should this form be used?

This form should be used by an extended family member to obtain concurrent custody of a child or children pursuant to Chapter 751, Florida Statutes. This form should not be used if you are a parent seeking to establish parental responsibility or time-sharing with a child or children. “Concurrent custody” means that an eligible extended family member is awarded custodial rights to care for a child or children concurrently with the child(ren)’s parent or parents.

An Extended Family Member is:

A relative of a minor child within the third degree by blood or marriage to the parent;

OR

The stepparent of a minor child if the stepparent is currently married to the parent of the child and is not a party in a pending dissolution, separate maintenance, domestic violence, or other civil or criminal proceeding in any court of competent jurisdiction involving one or both of the child(ren)’s parents as an adverse party.

You may file a Petition for Concurrent Custody if:

You have the signed, notarized consents of the child(ren)’s legal parents;

OR

You are an extended family member who is caring full time for the child(ren) in the role of a substitute parent and with whom the child(ren) is (are) presently living.

In addition, you must currently have physical custody of the child(ren) and have had physical custody of the child(ren) for at least 10 days in any 30-day period within the last 12 months; and not have signed, written documentation from a parent which is sufficient to enable you to do all the things necessary to care for the child(ren).

If you do not meet the qualifications above, you should talk to an attorney about other options. You may also report any suspected abuse, abandonment, or neglect to the appropriate authorities.

This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in the county where you live and keep a copy for your records.

What should I do next?

IF YOU HAVE SIGNED AND NOTARIZED WAIVERS OF SERVICE OF PROCESS AND CONSENTS from the child(ren)’s mother and father, you may call the clerk, family law intake staff, or judicial assistant, to set a final hearing. You must notify the child(ren)’s parents of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.

If one of the parents is deceased, you must file a certified copy of the proof of death.

If one of the minor child(ren)’s parents objects to the Petition for Concurrent Custody in writing, the court may not grant the petition even if the other parent consents, in writing, to the entry of the order. If a parent objects, you have the option of converting the Petition to a Petition for Temporary Custody by Extended Family, Florida Supreme Court Approved Family Law Form 12.970(a) . If the Petition is not converted into a Petition for Temporary Custody by Extended Family, it shall be dismissed without prejudice.

At any time, the Petitioner or either or both of the child(ren)’s parents may move the court to terminate the order granting concurrent custody. The court shall terminate the order upon a finding that either or both of the child(ren)’s parents objects to the order. The fact that the order for concurrent custody has been terminated does not preclude any person who is otherwise eligible to petition for temporary custody from filing such petition.

Where can I look for more information?

Before proceeding, you should read General Information for Self-Represented Litigants found at the beginning of these forms. The words that are in bold underline in these instructions are defined there. For further information, see Chapter 751 and Chapter 39, Florida Statutes.

Special Notes.. .

If you do not have the money to pay the filing fee, you may obtain an application for Determination of Civil Indigent Status, fill it out, and the clerk will determine whether you are eligible to have filing fees deferred.

With this petition, you must file the following and provide a copy to the other party:

    Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d).
    Notice of Related Cases, Florida Family Law Rules of Procedure Form 12.900(h).
    Family Court Cover Sheet, Florida Family Law Rules of Procedure Form 12.928.
    Non-Military Affidavit, Florida Supreme Court Approved Family Law Form 12.912(b). (Required only for obtaining a default on petitions that have been personally or constructively served. Not required if both parents have signed a waiver and consent.)


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

(04/11)

IN THE CIRCUIT COURT OF THE _______________ JUDICIAL CIRCUIT,

IN AND FOR _______________________________ COUNTY, FLORIDA

Case No: _______________________

Division: _______________________

__________________________________,

Petitioner,

and

__________________________________,

Respondent/Mother,

__________________________________,

Respondent/Father.

PETITION FOR CONCURRENT CUSTODY BY EXTENDED FAMILY

Petitioner, { full legal name} _________________________________, being sworn, certifies that the following information is true:

    This is an action for concurrent custody pursuant to Chapter 751, Florida Statutes.
    Petitioner requests concurrent custody of the following minor child(ren):

      Name Date of Birth Current Address

      __________________________________________________________________________

      __________________________________________________________________________

      __________________________________________________________________________

      __________________________________________________________________________

    Petitioner completed a Uniform Child Custody Jurisdiction and Enforcement Act Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), which was filed with this Petition. The affidavit includes the names and current addresses of the persons with whom the child(ren) has (have) lived during the past 5 years, the places where the child(ren) has(have) lived during the past 5 years, and information concerning any custody proceeding in this or any other state with respect to the child(ren). If the Affidavit is not completely filled out, signed under oath, and filed with the Petition, the case may be dismissed without a hearing.

    Petitioner is an extended family member who is: [Choose one only]

      _____ Related to the minor child(ren) within the third degree by blood or marriage to a parent; OR

      _____ The stepparent of the minor child(ren), is married to the ( )Mother ( )Father and is not a party in a pending dissolution, separate maintenance, domestic violence, or other civil or criminal proceeding in any court of competent jurisdiction involving one or both of the child(ren)’s parents as an adverse party.
    Petitioner’s relationship to the minor child(ren) is: ____________________________________.
    The residence and post office address of the Petitioner is: ______________________________

      ______________________________________________________________________________.
    The legal mother of the child(ren) is _____________________________________, whose current address is:__________________________________________________________.
    The legal father of the child(ren) is ______________________________________, whose current address is: ______________________________________________________________.
    Petitioner currently has physical custody of the child(ren) and has had physical custody of the child(ren) for at least 10 days in any 30-day period within the last 12 months. Detail the time periods during the past 12 months when the child(ren) have resided with the Petitioner: ______________________________________________________________________________

      _____________________________________________________________________________

      ______________________________________________________________________________.

    Petitioner does not have signed, written documentation from a parent which is sufficient to enable the Petitioner to do all of the things necessary to care for the child(ren). { If applicable} Describe the type of documents, if any, provided by the parent or parents which enables the Petitioner to act on behalf of the child(ren): ________________________________

      ______________________________________________________________________________.

      These documents are attached to this Petition as Exhibit ________.

    Petitioner is unable to obtain or undertake the following services or actions without an order of custody:

      ______________________________________________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________.

    The Consents of ______Father and/or _________ Mother is/are attached to the Petition.

      OR

      [If applicable] The Consent of the _________________ is not attached because that parent is deceased. A certified copy of the proof of death is attached.

    Petitioner requests concurrent custody be granted for the following period of time:________________________________________________________________________.

      The reasons that support this request are: ___________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________.

    It is in the best interests of the child(ren) that the Petitioner have concurrent custody of the child(ren) for the following reasons: ________________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________

      _____________________________________________________________________________.

    ORDER OF PROTECTION

      ___ Petitioner IS NOT aware of any temporary or permanent order for protection entered on behalf of or against either parent, the Petitioner, or the child(ren) in Florida or any other jurisdiction.

      OR

      ___ Petitioner IS aware of the following temporary or permanent orders for protection entered on behalf of or against either parent, the Petitioner, or the child(ren) in Florida or any other jurisdiction. The court entering the order and the case number is: _______

          ________________________________________________________________________

          ________________________________________________________________________

          _______________________________________________________________________.

    TEMPORARY OR PERMANENT CHILD SUPPORT ORDERS

      ___ Petitioner IS NOT aware of any temporary or permanent orders for child support for the minor child(ren).

      OR

      ___ Petitioner IS aware of the following temporary or permanent order for child support for the minor child(ren). The court entering the order and the case number is:__________

      _______________________________________________________________________

      _______________________________________________________________________

      _______________________________________________________________________.

    CHILD SUPPORT (If Petitioner is seeking child support) [Choose one only]

      (You must have proof of service upon or waiver of process by the parent(s) or a Waiver of Service of Process and Consent for the court to consider an award for child support)

      ___ Petitioner requests the court to order the parents to pay child support.

      ___ Petitioner requests the court to redirect all or part of Mother’s and/or Father’s existing child support obligation to the Petitioner.

      ___ Petitioner requests the court to redirect all or part of Mother’s and/or Father’s existing child support obligation to the Petitioner, and to award the Petitioner child support arrearages.

    Petitioner ____ requests _____ does not request that the court establish reasonable visitation or a time-sharing schedule with the parents.
    Other _______________________________________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________

      _____________________________________________________________________________

WHEREFORE, Petitioner requests that this Court grant the Petitioner concurrent custody of the child(ren) subject to this proceeding; award the Petitioner other relief as requested; and award any other relief that the Court deems necessary.

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

Dated: _____________________________ _________________________________________

Signature of Petitioner

Printed Name: _____________________________

Address: __________________________________

City, State, Zip Code: ________________________

Telephone Number: _________________________

Fax Number: _______________________________

STATE OF FLORIDA

COUNTY OF __________________________________

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

_______________________________________

NOTARY PUBLIC OR DEPUTY CLERK

________________________________________

                          Print, type, or stamp commissioned name of notary or deputy clerk.

____ Personally known

____ Produced identification

Type of identification produced _________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks]

I, { full legal name and trade name of nonlawyer} ________________________________________

a nonlawyer, whose address is { street} ________________________________________________,
{ city} _______________________, { state} ___________, { phone }
_______________________, helped { name} ______________________________________________ who is the Petitioner, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM, 12.970(c), WAIVER OF SERVICE OF PROCESS AND CONSENT FOR TEMPORARY CUSTODY BY EXTENDED FAMILY (04/11)

This form is to be completed and signed by a parent who agrees to grant temporary custody of a minor child or child(ren) to an extended family member and agrees to waive service of process. Service of process occurs when a summons and a copy of the petition (or other pleading) that has been filed with the court are delivered by a deputy or private process server.

An Extended Family Member is:

A relative of a minor child within the third degree by blood or marriage to the parent;

OR

The stepparent of a minor child if the stepparent is currently married to the parent of the child and is not a party in a pending dissolution, separate maintenance, domestic violence, or other civil or criminal proceeding in any court of competent jurisdiction involving one or both of the child(ren)’s parents as an adverse party.


This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in the county where the Petition for Temporary Custody by Extended Family, Florida Supreme Court Approved Family Law Form 12.970(a) is filed and keep a copy for your records.

Special notes.. .


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

IN THE CIRCUIT COURT OF THE _______________ JUDICIAL CIRCUIT,

IN AND FOR _______________________________ COUNTY, FLORIDA

Case No: _______________________

Division: _______________________

__________________________________,

Petitioner,

and

__________________________________,

Respondent/Mother,

__________________________________,

Respondent/Father.

WAIVER OF SERVICE OF PROCESS AND CONSENT FOR TEMPORARY CUSTODY BY EXTENDED FAMILY

I, _____________________________________________, the legal _____ Mother ____ Father of
{ child(ren)’s name)s)} _____________________________________________, having received a copy of the Petition for Temporary Custody by Extended Family filed herein and waived service of process, freely and voluntarily consent to the Petition filed by: { Petitioner’s Name} __________________________.

I realize that by signing this document, I am consenting to the Petitioner having temporary legal custody of the minor child(ren) and that such temporary custody is in the best interest of the child(ren). Upon entry of an Order, the Petitioner shall be able to:

    Consent to all necessary and reasonable medical and dental care for the child(ren), including nonemergency surgery and psychiatric care;

    Secure copies of the child(ren)’s records, held by third parties, that are necessary for the care of the child(ren), including, but not limited to:

      Medical, dental, and psychiatric records;

      Birth Certificates and other records, and

      Educational records.

    Enroll the child(ren) in school and grant or withhold consent for the child(ren) to be tested or placed in special school programs, including exceptional education; and

    Do all other things necessary for the care of the child(ren).

I realize that the custody of my child(ren) by the Petitioner is temporary and that I may, at any time, petition the court to return legal custody to me.
Dated: __________________

_________________________________________

Signature of Parent

Printed Name: _____________________________

Address: __________________________________

City, State, Zip Code: ________________________

Telephone Number: _________________________

Fax Number: _______________________________

STATE OF FLORIDA

COUNTY OF __________________________________

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

_______________________________________

NOTARY PUBLIC OR DEPUTY CLERK

________________________________________

                          Print, type, or stamp commissioned name of notary or deputy clerk.

____ Personally known

____ Produced identification

Type of identification produced _________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks]

I, { full legal name and trade name of nonlawyer} ________________________________________

a nonlawyer, whose address is { street} ________________________________________________,
{ city} ______________________________, { state} ___________, { phone }
___________________,

helped { name} ______________________________________who is a Respondent, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM, 12.970(d), WAIVER OF SERVICE OF PROCESS AND CONSENT FOR CONCURRENT CUSTODY BY EXTENDED FAMILY (04/11)

This form is to be completed and signed by a parent who agrees to grant concurrent custody of a minor child or child(ren) to an extended family member and who agrees to waive service of process. Service of process occurs when a summons and a copy of the petition (or other pleading) that has been filed with the court are delivered by a deputy or private process server. “Concurrent custody” means that an eligible extended family member is awarded custodial rights to care for a child or children concurrently with the child(ren)’s parent or parents.

An Extended Family Member is:

A relative of a minor child within the third degree by blood or marriage to the parent;

OR

The stepparent of a minor child if the stepparent is currently married to the parent of the child and is not a party in a pending dissolution, separate maintenance, domestic violence, or other civil or criminal proceeding in any court of competent jurisdiction involving one or both of the child(ren)’s parents as an adverse party.


This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in the county where the Petition for Concurrent Custody by Extended Family, Florida Supreme Court Approved Family Law Form 12.970(b) is filed and keep a copy for your records.

Special notes.. .

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

IN THE CIRCUIT COURT OF THE _______________ JUDICIAL CIRCUIT,

IN AND FOR _______________________________ COUNTY, FLORIDA

Case No: _______________________

Division: _______________________

__________________________________,

Petitioner,

and

__________________________________,

Respondent/Mother,

__________________________________,

Respondent/Father.

WAIVER OF SERVICE OF PROCESS AND CONSENT FOR CONCURRENT CUSTODY BY EXTENDED FAMILY

I, ____________________________________________, the legal _____ Mother ____ Father of
{ child(ren)’s name(s)} _____________________________________, having received a copy of the Petition for Concurrent Custody by Extended Family filed herein and waived service of process, freely and voluntarily consent to the Petition filed by { Petitioner’s Name} ______________________________.

I realize that by signing this document, I am consenting to the Petitioner having temporary concurrent custody of the minor child(ren) and that such concurrent custody is in the best interest of the child(ren). Upon entry of an Order, the Petitioner shall be able to:

    Consent to all necessary and reasonable medical and dental care for the child(ren), including nonemergency surgery and psychiatric care;

    Secure copies of the child(ren)’s records, held by third parties, that are necessary for the care of the child(ren), including, but not limited to:

      Medical, dental, and psychiatric records;

      Birth Certificates and other records, and

      Educational records.

    Enroll the child(ren) in school and grant or withhold consent for the child(ren) to be tested or placed in special school programs, including exceptional education; and

    Do all other things necessary for the care of the child(ren).


I realize that the concurrent custody of my child(ren) by the Petitioner is temporary and that I may, at any time, petition the court to return legal custody to me.
Dated: _____________________________

_________________________________________

Signature of Parent

Printed Name: _____________________________

Address: __________________________________

City, State, Zip Code: ________________________

Telephone Number: _________________________

Fax Number: _______________________________

STATE OF FLORIDA

COUNTY OF __________________________

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

_________________________________________

NOTARY PUBLIC OR DEPUTY CLERK

_________________________________________

                          Print, type, or stamp commissioned name of notary or deputy clerk.

____ Personally known

____ Produced identification

Type of identification produced _________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks]

I, { full legal name and trade name of nonlawyer} _________________________________________

a nonlawyer, whose address is { street} ________________________________________________,
{ city} _______________________, { state} ___________, { phone }
____________________________, helped { name} __________________________________ who is a Respondent, fill out this form.

IN THE CIRCUIT COURT OF THE _________________________ JUDICIAL CIRCUIT

IN AND FOR __________________________ COUNTY, FLORIDA

Case No: ______________________

Division: ______________________

__________________________________,

Petitioner,

and

__________________________________,

Respondent/Mother

__________________________________,

Respondent/Father.

ORDER GRANTING PETITION FOR
TEMPORARY CUSTODY BY EXTENDED FAMILY

This case came before this Court for a hearing on a Petition for Temporary Custody by Extended Family. The Court, having reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of law:

SECTION I. FINDINGS:

    The Court has jurisdiction over the subject matter and the parties.
    The minor child(ren) at issue in this matter are:

      Name Date of Birth

      ___________________________________________________________________

      ___________________________________________________________________

      ___________________________________________________________________

      ___________________________________________________________________

    The Petitioner, { full legal name} _____________________________________ is the { extended family relationship} ___________________________________________ of the child(ren).
    The Mother { full legal name} _________________________________ of the child(ren):

      (Choose one only)

      ___ Filed a Waiver and Consent

      ___ Was served with the petition and failed to file an Answer

      ___ Is deceased as evidenced by: __________________________________________

      ___ Objected to the petition. Based upon clear and convincing evidence, the Court finds that the Mother is unfit to provide for the care and control of the child(ren). Specifically, the Mother has abused, abandoned, or neglected the child(ren) as defined in Chapter 39, Florida Statutes. It is in the best interest of the child(ren) that the Petitioner have temporary custody because: { facts in support of finding }
      __________________________________________________

      __________________________________________________________________

      __________________________________________________________________

      __________________________________________________________________

      _________________________________________________________________.

    The Father { full legal name} _________________________________ of the child(ren):

      (Choose one only)

      ___ Filed a Waiver and Consent

      ___ Was served with the petition and failed to file an Answer

      ___ Is deceased as evidenced by: __________________________________________

      ___ Objected to the petition. Based upon clear and convincing evidence, the Court finds that the Father is unfit to provide for the care and control of the child(ren). Specifically, the Father has abused, abandoned, or neglected the child(ren) as defined in Chapter 39, Florida Statutes. It is in the best interest of the child(ren) that the Petitioner have temporary custody because: { facts in support of finding }
      _________________________________________________________________

      _________________________________________________________________

      _________________________________________________________________

      _________________________________________________________________

      _________________________________________________________________.

    It is in the best interest of the child(ren) for the Petitioner to have temporary custody.

SECTION II: TEMPORARY CUSTODY

    The Petitioner, ___________________________________, is granted temporary custody of the minor child(ren).
    The Petitioner shall have all the rights and responsibilities of a legal parent.
    The Petitioner is authorized to make all reasonable and necessary decisions for the minor child(ren), including but not limited to:

      Consent to all necessary and reasonable medical and dental care for the child(ren), including nonemergency surgery and psychiatric care;

      Secure copies of the child(ren)’s records, held by third parties, that are necessary for the care of the child(ren), including, but not limited to:

            Medical, Dental, and psychiatric records;

            Birth certificates and other records; and

            Educational records.
    Enroll the child(ren) in school and grant or withhold consent for the child(ren) to be tested or placed in special school programs, including exceptional education; and
    Do all other things necessary for the care of the child(ren).

SECTION III. TEMPORARY TIME-SHARING WITH MINOR CHILD(REN)

The parent(s) shall have: (Choose one only)

    ___ reasonable time-sharing with the minor child(ren) as agreed to by the parties, subject to the following limitations: __________________________________________

      _______________________________________________________________________.

    ___ the following specified time-sharing schedule : { specify days and times} _______

      ______________________________________________________________________.
      Mother’s Temporary Time-Sharing Schedule.

      ________________________________________________________________________

      ________________________________________________________________________

      _______________________________________________________________________.
      Father’s Temporary Time-Sharing Schedule.

      _______________________________________________________________________

      _______________________________________________________________________

      _______________________________________________________________________.

    ___ Time-Sharing in accordance with the temporary Parenting Plan attached as

      Exhibit ___.


    ___ ( ) Mother ( ) Father shall have No Contact with the minor child(ren) until further order of the Court, due to existing conditions that are detrimental to the welfare of the minor child(ren): { explain} _________________________________________________

      _______________________________________________________________________

      _______________________________________________________________________.

SECTION IV. CHILD SUPPORT

    The Petitioner ____ did ____ did not request the establishment of child support.

    ___ If child support is requested, the parents have received personal or substituted service of process, the petition requests an order for support of the child(ren), and there is evidence of the parents’ ability to pay the support ordered. The( ) Mother ( ) Father has the present ability to pay child support.

      (Choose one only)

      ___ The amounts in the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e) filed by the ( ) Mother ( ) Father are correct;
      OR

      ___ The Court makes the following findings: The Mother’s net monthly income is $_______________, (Child Support Guidelines ___%). The Father’s net monthly income is $____________________, (Child Support Guidelines ____%) Monthly child care costs are $_________________. Monthly health/dental insurance costs are $_____________.
      OR

    ___ The ( ) Mother ( ) Father is currently ordered to pay child support to the other parent in the amount of $_____________ per ________________ as established in the case of { style of case and number} ___________________________________________
    _______________________________________________________________________.

    ( ) All of the child support or ( ) a portion of the child support in the amount of $_________ shall be redirected to the Petitioner.

    Amount

      Father’s Obligation

      The Father shall be obligated to pay child support in the amount of $___________ for the______ children { total number of parties’ minor or dependent children} commencing ____________________ { month, day, year} and terminating ______________________ {month, day, year}.

      Upon the termination of the obligation of child support for one of the parties’ children, child support in the amount of $__________ for the remaining_______ children { total number of remaining children} shall be paid commencing ________________ { month, day, year} and terminating _______________________ {month, day, year}.

      { Insert paragraph for the child support obligation, including the amount, commencement, and termination dates, for the remaining minor or dependent children, which shall be payable as the obligation for each child ceases.}

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

      If the child support ordered deviates from the guidelines more than 5%, the factual findings which support that deviation are: __________________________________

      _____________________________________________________________________

      ____________________________________________________________________.

      Child support shall be payable ( ) at least once a month and in accordance with Father’s employer’s payroll cycle, or ( ) other {explain}_______________________

      _____________________________________________________________________.
      Mother’s Obligation

        The Mother shall be obligated to pay child support in the amount of $____________ for the ______ children { total number of parties’ minor or dependent children} commencing __________________________ {month, day, year} and terminating ______________________ { month, day, year}.

        Upon the termination of the obligation of child support for one of the parties’ children, child support in the amount of $___________ for the remaining ______ children { total number of remaining children} shall be paid commencing _______________ {month, day, year} and terminating ________________________ { month, day, year}.

        { Insert paragraph for the child support obligation, including the amount, commencement, and termination dates, for the remaining minor or dependent children which shall be payable as the obligation for each child ceases.}

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

        If the child support ordered deviates from the guidelines more than 5%, the factual findings which support that deviation are: __________________________________

        _____________________________________________________________________

        ____________________________________________________________________.

        Child support shall be payable ( ) at least once a month and in accordance with the Mother’s employer’s payroll cycle, or ( ) other { explain} ______________________

        ____________________________________________________________________.

    Arrearages/Retroactive Child Support

      The ( ) Mother ( ) Father owes child support arrearages in the amount of $_________ as of { date} ________________ to the other parent. The child support arrearages shall be repaid in the amount of $_______ per month, payable ( ) in accordance with the employer’s payroll cycle, and in any event at least once per month ( ) other { explain} _______________________________________________ commencing { date} _____________________, until paid in full including statutory interest.

      The ( ) Mother ( ) Father owes retroactive child support in the amount of $_________ as of { date} ________________ to the Petitioner. The retroactive child support shall be repaid in the amount of $_______ per month, payable ( ) in accordance with the employer’s payroll cycle, and in any event at least once per month ( )other { explain} ________________________________________________

        _____________________________________________________________________

        commencing { date} ______________________, until paid in full including statutory interest.

    Insurance
    (Choose all that apply)

      ( ) Mother ( ) Father shall be required to maintain ( ) health and/or ( ) dental insurance for the parties’ minor child(ren), so long as reasonable in cost and accessible to the child(ren). The party providing insurance shall be required to convey insurance cards demonstrating said coverage to the Petitioner and other parent.

        OR

        ( ) health and/or ( ) dental insurance is either not reasonable in cost or accessible to the child(ren) at this time.

      ___ Reasonable and necessary uninsured medical/dental/prescription drug costs for the minor child(ren) shall be assessed as follows:

        ( ) Shared equally by both parents.

        ( ) Prorated according to the child support guidelines percentages.

        ( ) Other { explain } ______________________________________________

        As to these uninsured medical/dental/prescription drug expenses, the party who incurs the expense shall submit a request for reimbursement to the parent or parents within 30 days, and the parent or parents, within 30 days of receipt, shall submit the applicable reimbursement for that expense.

SECTION V. METHOD OF PAYMENT

The parent(s) shall pay court-ordered child support and arrearages, if any, as follows:

    State Disbursement Unit

      (Choose if applies)

      ___Parent(s) shall pay court-ordered support directly to the State Disbursement Unit along with the deposit service charge.

      ___ The Petitioner and the Parent(s) have requested and the Court finds that it is in the best interest of the child(ren) that support payments need not be directed through the State Disbursement Unit at this time; however, any party may subsequently apply, pursuant to section 61.13(1)(d)(3), Florida Statutes, to require payment through the State Disbursement Unit.

    Income Deduction

      (If applicable)

      ___ Immediate. ( ) Mother ( ) Father shall pay through income deduction, pursuant to a separate Income Deduction Order which shall be effective immediately. Payor is individually responsible for paying this support obligation until all of said support is deducted from his/her income. Until support payments are deducted, the Payor is responsible for making timely payments directly to the State Disbursement Unit or the Petitioner as previously set forth in this Order.

      ­­­___ Deferred. Income deduction is ordered this day, but it shall not be effective until a delinquency of $_____________, or, if not specified, an amount equal to one month’s obligation occurs. Income deduction is not being implemented immediately based on the following findings: Income deduction is not in the best interests of the child(ren) because: { explain} ________________________________

        _____________________________________________________________________

        ____________________________________________________________________.
        AND

        There is proof of timely payment of a previously ordered obligation without an Income Deduction Order,
        AND

        ( ) there is an agreement by the Payor(s) to advise the State Disbursement Unit of any change in Payor(s) or health insurance OR ( ) there is a signed, written agreement providing an alternative arrangement between the Petitioner and Payor(s).

    Bonus/one-time payments.

      [Choose one only]

      ( ) All ( ) __________% ( ) No income paid in the form of a bonus or other similar one-time payment, up to the amount of any arrearage or the remaining balance thereof owed pursuant to this order, shall be forwarded to the Petitioner pursuant to the payment method prescribed above.

    Other provisions relating to method of payment : _______________________________

      _______________________________________________________________________.

SECTION VI. ATTORNEY FEES, COSTS, AND SUIT MONEY

(Choose one only)

    ___ ( ) Petitioner’s ( )Respondents’ request(s) for attorney fees, costs, and suit money is (are) denied because ____________________________________________________

      _______________________________________________________________________.

    ­­­
    ___ The Court finds there is a need for and ability to pay attorney fees, costs, and suit money. ( ) Petitioner ( ) Respondent(s) is (are) ordered to pay the other party $________ in attorney fees, and $ ______ in costs. The Court further finds that the attorney fees are awarded based on the reasonable rate of $________________ per hour and ________________ reasonable hours. Other provisions relating to attorney fees, costs, and suit money are as follows: _____________________________________

      _______________________________________________________________________.

SECTION VII. OTHER PROVISIONS

    Other Provisions ________________________________________________________

      ________________________________________________________________________

      ________________________________________________________________________

      _______________________________________________________________________.

    The Court reserves jurisdiction to modify and enforce this Order for Temporary Custody.

DONE AND ORDERED in ______________________, Florida on { date} __________________

                              _____________________________

      CIRCUIT JUDGE

A copy of this Order for Temporary Custody was: [Choose one only]

( ) mailed ( ) faxed and mailed ( ) hand delivered to the parties listed below on
{ date} _______________ by ________________________________ { clerk of court or designee}.

Petitioner (or his or her attorney)

Respondents (or his or her attorney)

State Disbursement Unit

Other _________________________________


IN THE CIRCUIT COURT OF THE _________________________ JUDICIAL CIRCUIT

IN AND FOR __________________________ COUNTY, FLORIDA

Case No: ______________________

Division: ______________________

__________________________________,

                  Petitioner,

and

__________________________________,

Respondent/Father

__________________________________,

Respondent/Mother.

ORDER GRANTING PETITION FOR
CONCURRENT CUSTODY BY EXTENDED FAMILY

This case came before this Court for a hearing on a Petition for Concurrent Custody by Extended Family. The Court, having reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of law:

SECTION I. FINDINGS:

    The Court has jurisdiction over the subject matter and the parties.
    The minor child(ren) at issue in this matter are:

      Name Date of Birth

      ___________________________________________________________________

      ___________________________________________________________________

      ___________________________________________________________________

      ___________________________________________________________________

    The Petitioner, { full legal name} _____________________________________ is the { extended family relationship} ___________________________________________ of the child(ren).
    The Petitioner currently has physical custody of the child(ren) and has had physical custody of the child(ren) for at least 10 days in any 30-day period within the last 12 months.
    The Petitioner does not have signed, written documentation from the parent(s) which is sufficient to enable the custodian to do all the things necessary to care for the child(ren) which are available to custodians who have an order for temporary custody by extended family.
    The Mother { full legal name} _________________________________ of the child(ren):

      (choose one only)

      ___ Filed a Waiver and Consent

      ___ Was served with the petition and failed to file an Answer

___ Is deceased as evidenced by: _______________________________________

    The Father { full legal name} _________________________________ of the child(ren):

      (choose one only)

      ___ Filed a Waiver and Consent

      ___ Was served with the petition and failed to file an Answer

      ___ Is deceased as evidenced by: _______________________________________

    It is in the best interest of the child(ren) for the Petitioner to have concurrent custody.

SECTION II: CONCURRENT CUSTODY

    The Petitioner,___________________________________________________, is granted concurrent custody of the minor child(ren).
    The Petitioner shall have all the concurrent rights and responsibilities of a legal parent.
    The Petitioner is authorized to make all reasonable and necessary decisions for the minor child(ren), including but not limited to:

        Consent to all necessary and reasonable medical and dental care for the child(ren), including nonemergency surgery and psychiatric care;

        Secure copies of the child(ren)’s records, held by third parties, that are necessary for the care of the child(ren), including, but not limited to:

            Medical, Dental, and psychiatric records;

            Birth certificates and other records; and

            Educational records.
    Enroll the child(ren) in school and grant or withhold consent for the child(ren) to be tested or placed in special school programs, including exceptional education; and
    Do all other things necessary for the care of the child(ren).

SECTION III. CHILD SUPPORT

    1. The Petitioner ____ did ____ did not request the establishment of child support.

    2. ___ If child support is requested, the parents have received personal or substituted service of process, the petition requests an order for support of the child(ren), and there is evidence of the parents’ ability to pay the support ordered. The ( )Mother ( ) Father has the present ability to pay child support

      (Choose one only)

      ___ The amounts in the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e) filed by the ( )Mother ( ) Father are correct;
      OR

      ___ The Court makes the following findings: The Mother’s net monthly income is $_______________, (Child Support Guidelines ___%). The Father’s net monthly income is $____________________, (Child Support Guidelines ____%) Monthly child care costs are $_________________. Monthly health/dental insurance costs are $_____________.
      OR

    ___ The ( ) Mother ( ) Father is currently ordered to pay child support to the other parent in the amount of $_____________ per ________________ as established in the case of (style of case and number} _________________________________________
    _____________________________________________________________________.

    ( ) All of the child support or ( ) a portion of the child support in the amount of $_________ shall be redirected to the Petitioner.

    3. Amount
    a) Father’s Obligation
    The Father shall be obligated to pay child support in the amount of $__________ for the _______children { total number of parties’ minor or dependent children} commencing _________________ { month, day, year} and terminating ________________________ { month, day, year}.

    Upon the termination of child support for one of the parties’ children, child support in the amount of $_____________ for the remaining _________ children { total number of remaining children} shall be paid commencing __________________ { month, day, year} and terminating _________________________ { month, day, year}.

    { Insert paragraph for the child support obligation, including the amount, commencement, and termination dates, for the remaining minor or dependent children, which shall be payable as the obligation for each child ceases.}

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

    If the child support ordered deviates from the guidelines more than 5%, the factual findings which support that deviation are: ____________________________________

    _______________________________________________________________________

    _______________________________________________________________________.

    Child support shall be payable ( ) at least once a month and in accordance with the Father’s employer’s payroll cycle, or ( ) other { explain} ___________________________

    ________________________________________________________________________

b) Mother’s Obligation

      The Mother shall be obligated to pay child support in the amount of $____________ for the ________children { total number of parties’ minor or dependent children} commencing { month, day, year} and terminating __________________ { month, day, year}.

      Upon the termination of the obligation of child support for one of the parties’ children, child support in the amount of $__________ for the remaining ______ children { total number of remaining children} shall be paid commencing _____________________ { month, day, year} and terminating ________________________ month, day, year}.

      { Insert paragraph for the child support obligation, including the amount, commencement, and termination dates, for the remaining minor or dependent children, which shall be payable as the obligation for each child ceases.}

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

      If the child support ordered deviates from the guidelines more than 5%, the factual findings which support that deviation are:______________________________________

      ________________________________________________________________________

      _______________________________________________________________________.

      Child support shall be payable ( ) at least once a month and in accordance with the Mother’s employer’s payroll cycle, or ( ) other { explain} __________________________

      _______________________________________________________________________.

    4. Arrearages/Retroactive Child Support

        The ( )Mother ( ) Father owes child support arrearages in the amount of $_________ as of { date} ________________ to the other parent. The child support arrearages shall be repaid in the amount of $_______ per month, payable ( ) in accordance with the employer’s payroll cycle, and in any event at least once per month ( )other { explain} ________________________________

      __________________________________________________________________

          commencing { date} ______________________, until paid in full including statutory interest.

        The ( ) Mother ( ) Father owes retroactive child support in the amount of $_________ as of { date} ________________ to the Petitioner. The retroactive child support shall be repaid in the amount of $_______ per month, payable ( ) in accordance with the employer’s payroll cycle, and in any event at least once per month ( )other { explain} __________________________________________

      __________________________________________________________________

          commencing { date} ______________________, until paid in full including statutory interest.

    5. Insurance
    (Choose all that apply)

        ( ) Mother ( ) Father shall be required to maintain ( ) health and/or ( ) dental insurance for the parties’ minor child(ren), so long as reasonable in cost and accessible to the child(ren). The party providing insurance shall be required to convey insurance cards demonstrating said coverage to the Petitioner and other parent.

          OR

          ( ) health and/or ( ) dental insurance is either not reasonable in cost or accessible to the child(ren) at this time.

        ___ Reasonable and necessary uninsured medical/dental/prescription drug costs for the minor child(ren) shall be assessed as follows:

          ( ) Shared equally by both parents.

          ( ) Prorated according to the child support guidelines percentages.

          ( ) Other { explain } ______________________________________________

          As to these uninsured medical/dental/prescription drug expenses, the party who incurs the expense shall submit a request for reimbursement to the parent or parents within 30 days, and the parent or parents, within 30 days of receipt, shall submit the applicable reimbursement for that expense.

SECTION IV. METHOD OF PAYMENT

The parent(s) shall pay court-ordered child support and arrearages, if any, as follows:

    State Disbursement Unit

      (Choose if applies)

        ___Parent(s) shall pay court-ordered support directly to the State Disbursement Unit along with the deposit service charge.
        ___ The Petitioner and the Parents have requested and the court finds that it is in the best interest of the child(ren) that support payments need not be directed through the State Disbursement Unit at this time; however, any party may subsequently apply, pursuant to section 61.13(1)(d)(3), Florida Statutes, to require payment through the State Disbursement Unit.

    Income Deduction

      (If applies)

        ___ Immediate. ( ) Mother ( ) Father shall pay through income deduction, pursuant to a separate Income Deduction Order which shall be effective immediately. Payor is individually responsible for paying this support obligation until all of said support is deducted from his/her income. Until support payments are deducted, the Payor is responsible for making timely payments directly to the State Disbursement Unit or the Petitioner as previously set forth in this Order.

        ­­­___ Deferred. Income deduction is ordered this day, but it shall not be effective until a delinquency of $_____________, or, if not specified, an amount equal to one month’s obligation occurs. Income deduction is not being implemented immediately based on the following findings: Income deduction is not in the best interests of the child(ren) because: { explain} _________________________

          _______________________________________________________________

          _______________________________________________________________.

AND

          There is proof of timely payment of a previously ordered obligation without an Income Deduction Order,
          AND

          ( ) there is an agreement by the Payor(s) to advise the State Disbursement Unit of any change in Payor(s) or health insurance OR ( ) there is a signed, written agreement providing an alternative arrangement between the Petitioner and Payor(s).
    Bonus/one-time payments.

      [Choose one only]

      ( ) All ( ) __________% ( ) No income paid in the form of a bonus or other similar one-time payment, up to the amount of any arrearage or the remaining balance thereof owed pursuant to this order, shall be forwarded to the Petitioner pursuant to the payment method prescribed above.

    Other provisions relating to method of payment : _______________________________

      ________________________________________________________________________

SECTION V. ATTORNEY FEES, COSTS, AND SUIT MONEY

(Choose one only)

    ___ ( ) Petitioner’s ( ) Respondents’ request(s) for attorney fees, costs, and suit money is (are) denied because ____________________________________________________

      _____________________________________________________________________.

    ­­­
    ___ The Court finds there is a need for and ability to pay attorney fees, costs, and suit money. ( ) Petitioner ( ) Respondent(s) is (are) ordered to pay the other party $________ in attorney fees, and $ ______ in costs. The Court further finds that the attorney fees are awarded based on the reasonable rate of $________________ per hour and ________________ reasonable hours. Other provisions relating to attorney fees, costs, and suit money are as follows: _____________________________________

      _______________________________________________________________________.

SECTION VI. OTHER PROVISIONS

    Other Provisions _________________________________________________________

      ________________________________________________________________________

      ________________________________________________________________________

      ________________________________________________________________________
    The Court reserves jurisdiction to modify and enforce this Order for Concurrent Custody.
    The granting of concurrent custody does not affect the ability of the child(ren)’s parent or parents to obtain physical custody of the child(ren) at any time.

DONE AND ORDERED in _____________________, Florida on { date} ____________________

                                  _____________________________

      CIRCUIT JUDGE

A copy of this Order for Concurrent Custody was:

[Choose one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the parties listed below on { date} ___________ by____________________________. { Clerk of court or designee}

Petitioner (or his or her attorney)

Respondents (or his or her attorney)

State Disbursement Unit

Other _________________________________

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