Family law forms dealing with child custody
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 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)
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.
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).
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.
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.
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.
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.
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.
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 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.
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.
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 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.
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 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 AND FOR __________________________ COUNTY, FLORIDA
Case No: ______________________
Division: ______________________
__________________________________,
Petitioner,
and
__________________________________,
Respondent/Mother
__________________________________,
Respondent/Father.
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.
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 _________________________________