- In Re: Amendments To The Florida Supreme Court Approved Family Law Forms
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Supreme Court of Florida
____________
No. SC11-945
____________
IN RE: AMENDMENTS TO THE FLORIDA SUPREME COURT
APPROVED FAMILY LAW FORMS.
[July 3, 2013]
PER CURIAM.
Previously in this case, the Court adopted revisions to twenty-six Florida
Supreme Court Approved Family Law Forms in response to legislation amending
chapter 61, Florida Statutes. In re Amendments to the Florida Supreme Court
Approved Family Law Forms, 96 So. 3d 217 (Fla. 2012) (amending forms in
response to legislative amendments made by chapter 2011-92, §§ 79-80, Laws of
Fla. and chapter 2010-199, Laws of Fla.). 1 The legislation affected alimony, child
support, retroactive child support, child support guidelines, and income deduction
1. We have jurisdiction. See art. V, § 2(a), Fla. Const.
orders. Other minor revisions were also made. Interested parties were given an
opportunity to file comments. Id. at 218.
One comment was filed by the Florida Department of Revenue (DOR).
Upon consideration of DOR’s comment, and with input from the Advisory
Workgroup on the Florida Supreme Court Family Law Forms, we adopt additional
amendments to the forms, as reflected in the appendix to this opinion. The
amended forms are fully engrossed and ready for use. The forms may also be
accessed and downloaded from the Florida State Courts’ website at
www.flcourts.org/gen_public/family/forms_rules/index.shtml. By adoption of the
amended forms, we express no opinion as to their correctness or applicability. The
forms shall become effective immediately upon release of this opinion.
It is so ordered.
POLSTON, C.J., and PARIENTE, LEWIS, QUINCE, CANADY, LABARGA,
and PERRY, JJ., concur.
THE FILING OF A MOTION FOR REHEARING SHALL NOT ALTER THE
EFFECTIVE DATE OF THESE AMENDMENTS.
Original Proceedings – Family Law Rules Committee
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APPENDIX
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.901(b)(1),
PETITION FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR
MINOR CHILD (REN) (07/13)
When should this form be used?
This form should be used when a husband or wife is filing for a dissolution of marriage and you and your
spouse have a dependent or minor child(ren) together or the wife is pregnant. You and/or your spouse
must have lived in Florida for at least 6 months before filing for a dissolution in Florida. You must file
this form if the following is true:
•
You and your spouse have a dependent or minor child(ren) together or the wife is pregnant.
This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in
the county where you live and keep a copy for your records. Because you are filing the petition in this
proceeding, you may also be referred to as the petitioner and your spouse as the respondent.
What should I do next?
For your case to proceed, you must properly notify your spouse of the petition. If you know where he
or she lives, you should use personal service. If you absolutely do not know where he or she lives, you
may use constructive service. You may also be able to use constructive service if your spouse resides in
another state or country. However, if constructive service is used, other than granting a divorce, the
court may only grant limited relief, which cannot include either spousal support (alimony) or child
support. For more information on constructive service, see Notice of Action for Family Cases with
Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.913(a)(2), and Affidavit of
Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b). If your spouse is in
the military service of the United States, additional steps for service may be required. See, for example,
Memorandum for Certificate of Military Service, Florida Supreme Court Approved Family Law Form
12.912(a) and Affidavit of Military Service, Florida Supreme Court Approved Family Law Form
12.912(b). In sum, the law regarding constructive service and service on an individual in the military
service is very complex and you may wish to consult an attorney regarding these issues.
If personal service is used, your spouse has 20 days to answer after being served with your petition.
Your case will then generally proceed in one of the following three ways:
DEFAULT. If after 20 days, your spouse has not filed an answer, you may file a Motion for Default,
Florida Supreme Court Approved Family Law Form 12.922(a), with the clerk of court. Then, if you have
filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
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a final hearing. You must notify your spouse of the hearing by using a Notice of Hearing (General),
Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
UNCONTESTED.
If your spouse files an answer that agrees with everything in your petition or an
answer and waiver, and you have complied with mandatory disclosure and filed all of the required
papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You
must notify your spouse of the hearing by using a Notice of Hearing (General), Florida Supreme Court
Approved Family Law Form 12.923, or other appropriate notice of hearing form.
CONTESTED... If your spouse files an answer or an answer and counterpetition, which disagrees with or
denies anything in your petition, and you are unable to settle the disputed issues, you should file a
Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with
mandatory disclosure and filed all of the required papers. Some circuits may require the completion of
mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or
judicial assistant for instructions on how to set your case for trial (final hearing). If your spouse files an
answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to
Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).
Where can I look for more information?
Before proceeding, you should read “General Information for Self-Represented Litigants” found at the
beginning of these forms. The words that are in bold underline in these instructions are defined there.
For further information, see chapter 61, Florida Statutes.
Special notes...
If you do not have the money to pay the filing fee, you may obtain an Application for Determination of
Civil Indigent Status from the clerk, fill it out, and the clerk will determine whether you are eligible to
have filing fees deferred.
If you want to keep your address confidential because you are the victim of sexual battery, aggravated
child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence, do not enter the
address, telephone, and fax information at the bottom of this form. Instead, file a Request for
Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h).
With this form, you must also file the following:
•
•
•
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme
Court Approved Family Law Form 12.902(d).
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), if
you are asking that child support be ordered in the final judgment. (If you do not know your
spouse’s income, you may file this worksheet after his or her financial affidavit has been served
on you.)
Affidavit of Corroborating Witness, Florida Supreme Court Approved Family Law Form 12.902(i)
OR photocopy of current Florida driver’s license, Florida identification card, or voter’s
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
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•
•
•
•
•
registration card (issue date of copied document must be at least six months before date case is
actually filed with the clerk of the circuit court).
Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor
Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1), if you and your
spouse have reached an agreement on any or all of the issues.
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c).
(This must be filed with the petition if the petitioner seeks to establish child support.
Otherwise, it must be filed within 45 days of service of the petition on the respondent.)
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure
Form 12.932. (This must be filed within 45 days of service of the petition on the respondent, if
not filed at the time of the petition, unless you and your spouse have agreed not to exchange
these documents.)
Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a), (b), or (c). If the
parents have reached an agreement, a signed and notarized Parenting Plan should be attached.
If the parents have not reached an agreement, a proposed Parenting Plan may be filed.
Parenting Plan and Time-Sharing... If you and your spouse are unable to agree on parenting
arrangements and a time-sharing schedule, a judge will decide for you as part of establishing a Parenting
Plan. The judge will decide the parenting arrangements and time-sharing based on the child(ren)’s best
interests. Regardless of whether there is an agreement, the court reserves jurisdiction to modify issues
relating to the minor child(ren).
The judge may request a parenting plan recommendation or appoint a guardian ad litem in your case.
This means that a neutral person will review your situation and report to the judge concerning parenting
issues. The purpose of such intervention is to be sure that the best interests of the child(ren) is (are)
being served. For more information, you may consult section 61.13, Florida Statutes.
A parenting course must be completed prior to entry of the final judgment. You should contact the
clerk, family law intake staff, or judicial assistant about requirements for parenting courses where you
live.
Listed below are some terms with which you should become familiar before completing your petition. If
you do not fully understand any of the terms below or their implications, you should speak with an
attorney before going any further.
•
•
•
•
•
•
•
Shared Parental Responsibility
Sole Parental Responsibility
Supervised Time-Sharing
No contact
Parenting Plan
Parenting Plan Recommendation
Time-Sharing Schedule
Child Support… The court may order one parent to pay child support to assist the other parent in
meeting the child(ren)’s material needs. Both parents are required to provide financial support, but
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
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one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent.
Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines
are based on the combined income of both parents and take into account the financial contributions of
both parents. You must file a Family Law Financial Affidavit, Florida Family Law Rules of Procedure
Form 12.902(b) or (c), and your spouse will be required to do the same. From your financial affidavits,
you should be able to calculate the amount of child support that should be paid using the Child Support
Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). Because the child
support guidelines take several factors into consideration, change over time, and vary from state to
state, your child support obligation may be more or less than that of other people in seemingly similar
situations.
Alimony… Alimony may be awarded to a spouse if the judge finds that he or she has an actual need for
it and also finds that the other spouse has the ability to pay. If you want alimony, you must request it
in writing in the original petition or counterpetition. If you do not request alimony in writing before
the final hearing, it is waived (you may not request it later). You may request permanent alimony,
bridge-the-gap alimony, durational alimony, lump sum alimony, or rehabilitative alimony.
Marital/Nonmarital Assets and Liabilities… Florida law requires an equitable distribution of marital
assets and marital liabilities. “Equitable” does not necessarily mean “equal.” Many factors, including
child support, time-sharing, and alimony awards, may lead the court to make an unequal (but still
equitable) distribution of assets and liabilities. Nonmarital assets and nonmarital liabilities are those
assets and liabilities which the parties agree or the court determines belong to, or are the responsibility
of, only one of the parties. If the parties agree or the court finds an asset or liability to be nonmarital,
the judge will not consider it when distributing marital assets and liabilities.
Temporary Relief… If you need temporary relief regarding temporary use of assets, temporary
responsibility for liabilities, parental responsibility and time-sharing with child(ren), temporary child
support, or temporary alimony, you may file a Motion for Temporary Support and Time-Sharing with
Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(a). For
more information, see the instructions for that form.
Marital Settlement Agreement… If you and your spouse are able to reach an agreement on any or all
of the issues, you should file a Marital Settlement Agreement for Dissolution of Marriage with
Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1). Both of
you must sign this agreement before a notary public or deputy clerk. Any issues on which you are
unable to agree will be considered contested and settled by the judge at the final hearing.
Parenting Plan… In all cases involving minor or dependent child(ren), a Parenting Plan shall be
approved or established by the court. If you and your spouse have reached an agreement, you should
file one of the following: Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a),
Safety-Focused Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(b), or
Relocation/Long-Distance Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(c),
which addresses the time-sharing schedule for the child(ren). If you have not reached an agreement, a
proposed Parenting Plan may be filed. If the parties are unable to agree, a Parenting Plan will be
established by the court.
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
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Final Judgment Form… These family law forms contain a Final Judgment of Dissolution of Marriage
with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.990(c)(1),
which the judge may use if your case is contested. If you and your spouse reach an agreement on all of
the issues, the judge may use a Final Judgment of Dissolution of Marriage with Dependent or Minor
Child(ren) (Uncontested), Florida Supreme Court Approved Family Law Form 12.990(b)(1). You should
check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final
judgment with you to the hearing. If so, you should type or print the heading, including the circuit,
county, case number, division, and the parties’ names, and leave the rest blank for the judge to
complete at your hearing or trial.
Nonlawyer… Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps
you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida
Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill
out these forms also must put his or her name, address, and telephone number on the bottom of the
last page of every form he or she helps you complete.
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
-7-
IN THE CIRCUIT COURT OF THE
IN AND FOR
JUDICIAL CIRCUIT,
COUNTY, FLORIDA
Case No.: _________________
Division: _________________
In re: The Marriage of:
______________________________,
Husband,
and
_______________________________,
Wife.
PETITION FOR DISSOLUTION OF MARRIAGE WITH
DEPENDENT OR MINOR CHILD(REN)
I, {full legal name}
[Choose only one]
( ) Husband ( ) Wife, being sworn, certify that the following statements are true:
, the
1. JURISDICTION/RESIDENCE
( ) Husband ( ) Wife ( ) Both has (have) lived in Florida for at least 6 months before the filing of this
Petition for Dissolution of Marriage.
2. The husband [Choose only one] ( ) is ( ) is not a member of the military service.
The wife [Choose only one]
( ) is ( ) is not a member of the military service.
3. MARRIAGE HISTORY
Date of marriage: {month, day, year} ___________________
Date of separation: {month, day, year}__________________ (___Please indicate if approximate)
4. DEPENDENT OR MINOR CHILD(REN)
[Choose all that apply]
a. ____ The wife is pregnant. Baby is due on: {date}
b. ____ The minor (under 18) child(ren) common to both parties are:
Name
Birth date
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (07/13)
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_____________________________________________________________________________________
___________________________________________
c.____The minor child(ren) born or conceived during the marriage who are not common to both
parties are:
Name
Birth date
_____________________________________________________________________________________
_______________________________________________________________________
The birth father(s) of the above minor child(ren) is (are) {name and address} ________________
______________________________________________________________________________
d.____ The child(ren) common to both parties who are 18 or older but who are dependent
upon the parties due to a mental or physical disability are:
Name
Birth date
_____________________________________________________________________________________
_______________________________________________________________________
5. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form
12.902(b) or (c) [choose only one] ( ) is filed with this petition or ( ) will be timely filed.
6. A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida
Supreme Court Approved Family Law Form 12.902(d), is filed with this petition. (You must
complete and attach this form in a dissolution of marriage with minor child(ren)).
7. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law
Form 12.902(j), is filed with this petition.
8. This petition for dissolution of marriage should be granted because:
[Choose only one]
a. ____ The marriage is irretrievably broken.
b. ____ One of the parties has been adjudged mentally incapacitated for a period of 3 years
prior to the filing of this petition. A copy of the Judgment of Incapacity is attached.
SECTION I. MARITAL ASSETS AND LIABILITIES
[Choose only one]
1. ____ There are no marital assets or liabilities.
2. ____ There are marital assets or liabilities. All marital and nonmarital assets and liabilities are
(or will be) listed in the financial affidavits, Florida Family Law Rules of Procedure Form
12.902(b) or (c), filed in this case.
[Choose all that apply]
a.
____ All marital assets and liabilities have been divided by a written agreement
between the parties, which is attached, to be incorporated into the final judgment of
dissolution of marriage. (The parties may use Marital Settlement Agreement for Dissolution
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (07/13)
-9-
of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family
Law Form 12.902(f)(1).
b.
____ The Court should determine how the assets and liabilities of this marriage
are to be distributed, under section 61.075, Florida Statutes.
c.
____ Husband ____Wife should be awarded an interest in the other spouse’s
property because:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
SECTION II. SPOUSAL SUPPORT (ALIMONY)
1. ____ Husband ____Wife forever gives up his/her right to spousal support (alimony) from the
other spouse .
OR
2. ____ Husband _____Wife requests that the Court order the other spouse to pay the following
spousal support (alimony) and claims that he or she has an actual need for the support that he
or she is requesting and that the other spouse has the ability to pay that support. Spousal
support (alimony) is requested in the amount of $_________ every ( ) week ( ) other week
( ) month, beginning {date} __________ and continuing until {date or event} _____________
_____________________________________________________________________________.
Explain why the Court should order ____Husband ____Wife to pay, and any specific request(s) for type
of alimony (temporary, permanent, bridge-the-gap, durational, rehabilitative, and/or lump sum):
3. ____Other provisions relating to alimony, including any tax treatment and consequences:
_____________________________________________________________________________________
_____________________________________________________________________________________
________________________________________________________________
4. ____ Husband ____ Wife requests life insurance on the other spouse’s life, provided by that
spouse, to secure such support.
SECTION III. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING
1.
2.
The minor child(ren) currently reside(s) with ( ) Mother ( ) Father ( ) Other: {explain}
Parental Responsibility. It is in the child(ren)’s best interests that parental
responsibility be:
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (07/13)
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[Choose only one]
a. ____ shared by both Father and Mother.
b. ____ awarded solely to ( ) Father ( ) Mother. Shared parental responsibility would be
detrimental to the child(ren) because:____________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
3.
Parenting Plan and Time-Sharing. It is in the best interests of the child(ren) that the
family be ordered to comply with a Parenting Plan that ( ) includes ( ) does not include
parental time-sharing with the child(ren). The Petitioner states that it is in the best interests of
the child (ren) that:
[Choose only one]
a.
___ The attached proposed Parenting Plan should be adopted by the court. The parties
[choose only one] ( ) have ( ) have not agreed to the Parenting Plan.
b.
____ The court should establish a Parenting Plan with the following provisions:
____ No time-sharing for the ____ Father____ Mother.
____ Limited time-sharing with the ____Father____Mother.
____ Supervised Time-Sharing for the ____ Father____ Mother.
____ Supervised or third-party exchange of the child(ren).
____ Time-Sharing Schedule as follows:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
4.
Explain why this request is in the best interests of the child(ren):
__________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
SECTION IV. CHILD SUPPORT
[Choose all that apply]
1. ____ Husband ____Wife requests that the Court award child support as determined by Florida’s
child support guidelines, section 61.30, Florida Statutes. A completed Child Support Guidelines
Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), ( ) is, or ( ) will be filed.
Such support should be ordered retroactive to:
a. ____ the date of separation {date} ____________________.
b. ____ the date of the filing of this petition.
c. ____ other {date} _______ {explain}
___________________________________.
2. ____ Husband ____Wife requests that the Court award child support to be paid beyond the age
of 18 years because:
a.
____ the following child(ren) {name(s)}
is (are) dependent because of a mental or physical incapacity which began before the age of 18.
{explain}
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (07/13)
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b. ____ the following child(ren) {name(s)}________________________is (are) dependent in
fact, is (are) in high school, and are between the ages of 18 and 19; said child(ren) is (are)
performing in good faith with reasonable expectation of graduation before the age of 19.
3. ____Husband ____ Wife requests that the Court award a child support amount that is more
than or less than Florida’s child support guidelines and understands that a Motion to Deviate
from Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, must
be filed before the Court will consider this request.
4. ____Husband ____Wife requests that medical/dental insurance for the minor child(ren) be
provided by:
[Choose only one]
a. ____ Husband.
b. ____ Wife.
5. ____Husband ____ Wife requests that uninsured medical/dental expenses for the child(ren) be
paid:
[Choose only one]
a. ____by Husband.
b. ____by Wife .
c. ____by Husband and Wife equally [each pay one-half].
d. ____according to the percentages in the Child Support Guidelines Worksheet, Florida Family
Law Rules of Procedure Form 12.902(e).
e. ____Other {explain}: __________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
6. _____Husband ____Wife requests that life insurance to secure child support be provided by the
other spouse.
SECTION V. OTHER
1. ____ Wife requests to be known by her former name, which was {full legal name}:
_____________________________________________________________________.
2. Other relief {specify}:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
SECTION VI. REQUEST (This section summarizes what you are asking the Court to include in the final
judgment of dissolution of marriage.)
[Choose only one] ____Husband ____Wife requests that the Court enter an order dissolving the
marriage and:
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (07/13)
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[Choose all that apply]
1. ____distributing marital assets and liabilities as requested in Section I of this petition;
2. ____awarding spousal support (alimony) as requested in Section II of this petition;
3. ____ adopting or establishing a Parenting Plan containing provisions for parental responsibility
and time-sharing for the dependent or minor child(ren) common to both parties, as requested in
Section III of this petition;
4. ____establishing child support for the dependent or minor child(ren) common to both parties,
as requested in Section IV of this petition;
5. ____restoring Wife’s former name as requested in Section V of this petition;
6. ____awarding other relief as requested in Section V of this petition; and any other terms the
Court deems necessary.
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (07/13)
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I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
petition and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.
Dated_________________________
_____________________________________________
Signature of ( ) HUSBAND ( ) WIFE
Printed Name:
Address: ______________________________________
City, State, Zip: _________________________________
Telephone Number: _____________________________
Fax Number: __________________________________________
E-mail Address: _____________________________
STATE OF FLORIDA
COUNTY OF ____________________
Sworn to or affirmed and signed before me on __________ by _________________________________.
_____________________________________________
NOTARY PUBLIC or DEPUTY CLERK
_______________________________________
[Print, type, or stamp commissioned name of notary or deputy clerk.]
____
____
Personally known
Produced identification
Type of identification produced ________________________________
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the: {choose only one} ( ) Husband ( ) Wife
This form was completed with the assistance of:
{name of individual}_______________________________________________________________,
{name of business} ________________________________________________________________,
{address} ________________________________________________________________________,
{city}______________________________{state}______, {telephone number} _________________.
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (07/13)
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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.902(f)(1), MARITAL SETTLEMENT AGREEMENT FOR
DISSOLUTION OF MARRIAGE
WITH DEPENDENT OR MINOR CHILD(REN) (07/13)
When should this form be used?
This form should be used when a Petition for Dissolution of Marriage with Dependent or Minor
Child(ren), Florida Supreme Court Approved Family Law Form 12.901(b)(1), has been filed and the
parties have reached an agreement on some or all of the issues at hand.
This form should be typed or printed in black ink. Both parties must sign the agreement and have their
signatures witnessed by a notary public or deputy clerk. After completing this form, you should file the
original with the clerk of the circuit court in the county where the petition was filed and keep a copy for
your records. You should then refer to the instructions for your petition, answer, or answer and
counterpetition concerning the procedures for setting a hearing or trial (final hearing).
Where can I look for more information?
Before proceeding, you should read General Information for Self-Represented Litigants found at the
beginning of these forms. The words that are in bold underline in these instructions are defined there.
For further information, see chapter 61, Florida Statutes, and the instructions for the petition and/or
answer that were filed in this case.
Special notes...
With this form you must also file a Child Support Guidelines Worksheet, Florida Family Law Rules of
Procedure Form 12.902(e), if not already filed.
This form does not act to transfer title to the property. Such transfer must be done by deed or
supplemental final judgment.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms
also must put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.
Instructions for Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for
Dissolution of Marriage with Dependent or Minor Child(ren) (07/13)
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IN THE CIRCUIT COURT OF THE
IN AND FOR
JUDICIAL CIRCUIT,
COUNTY, FLORIDA
Case No.: _______________
Division: _______________
In re: the Marriage of:
,
Husband,
and
,
Wife.
MARITAL SETTLEMENT AGREEMENT FOR DISSOLUTION OF MARRIAGE
WITH DEPENDENT OR MINOR CHILD(REN)
We, {Husband’s full legal name}_______________________________________________, and
{Wife’s full legal name},_________________________________ being sworn, certify that the following
statements are true:
1. We were married to each other on {date}
.
2. Because of irreconcilable differences in our marriage (no chance of staying together), we have
made this agreement to settle once and for all what we owe to each other and what we can
expect to receive from each other. Each of us states that nothing has been held back, that we
have honestly included everything we could think of in listing our assets (everything we own and
that is owed to us) and our debts (everything we owe), and that we believe the other has been
open and honest in writing this agreement.
3. We have both filed a Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form
12.902(b) or (c). Because we have voluntarily made full and fair disclosure to each other of all
our assets and debts, we waive any further disclosure under rule 12.285, Florida Family Law
Rules of Procedure.
4. Each of us agrees to execute and exchange any papers that might be needed to complete this
agreement, including deeds, title certificates, etc.
SECTION I. MARITAL ASSETS AND LIABILITIES
A. Division of Assets. We divide our assets (everything we own and that is owed to us) as follows: Any
personal item(s) not listed below is the property of the party currently in possession of the item(s).
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
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1. Wife shall receive as her own and Husband shall have no further rights or responsibilities
regarding these assets:
ASSETS: DESCRIPTION OF ITEM(S) WIFE SHALL RECEIVE
Current Fair
Market Value
( Please describe each item as clearly as possible. You do not need to list account
numbers. Where applicable, include whether the name on any title/deed/account
described below is wife’s, husband’s, or both.)
Cash (on hand)
$
Cash (in banks/credit unions)
Stocks/Bonds
Notes (money owed to you in writing)
Money owed to you (not evidenced by a note)
Real estate: (Home)
(Other)
Business interests
Automobiles
Boats
Other vehicles
Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.)
Furniture & furnishings in home
Furniture & furnishings elsewhere
Collectibles
Jewelry
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
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ASSETS: DESCRIPTION OF ITEM(S) WIFE SHALL RECEIVE
( Please describe each item as clearly as possible. You do not need to list account
numbers. Where applicable, include whether the name on any title/deed/account
described below is wife’s, husband’s, or both.)
Current Fair
Market Value
Life insurance (cash surrender value)
Sporting and entertainment (T.V., stereo, etc.) equipment
Other assets
Total Assets to Wife
$
2. Husband shall receive as his own and Wife shall have no further rights or responsibilities
regarding these assets:
ASSETS: DESCRIPTION OF ITEM(S) HUSBAND SHALL RECEIVE
(Please describe each item as clearly as possible. You do not need to list account
numbers. Where applicable, include whether the name on any title/deed/account
described below is wife’s, husband’s or both.)
Current Fair
Market Value
Cash (on hand)
Cash (in banks/credit unions)
$
Stocks/Bonds
Notes (money owed to you in writing)
Money owed to you (not evidenced by a note)
Real estate: (Home)
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
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ASSETS: DESCRIPTION OF ITEM(S) HUSBAND SHALL RECEIVE
(Please describe each item as clearly as possible. You do not need to list account
numbers. Where applicable, include whether the name on any title/deed/account
described below is wife’s, husband’s or both.)
Current Fair
Market Value
(Other)
Business interests
Automobiles
Boats
Other vehicles
Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.)
Furniture & furnishings in home
Furniture & furnishings elsewhere
Collectibles
Jewelry
Life insurance (cash surrender value)
Sporting and entertainment (T.V., stereo, etc.) equipment
Other assets
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
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ASSETS: DESCRIPTION OF ITEM(S) HUSBAND SHALL RECEIVE
(Please describe each item as clearly as possible. You do not need to list account
numbers. Where applicable, include whether the name on any title/deed/account
described below is wife’s, husband’s or both.)
Current Fair
Market Value
Total Assets to Husband
$
B. Division of Liabilities/Debts. We divide our liabilities (everything we owe) as follows:
1. Wife shall pay as her own the following and will not at any time ask Husband to pay these
debts/bills:
LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY WIFE
(Please describe each item as clearly as possible. You do not need to list
account numbers. Where applicable, include whether the name on any
mortgage, note, or account described below is wife’s, husband’s, or both.)
Mortgages on real estate: (Home)
Current
Amount
Owed
Monthly
Payment
$
$
(Other)
Charge/credit card accounts
Auto loan
Auto loan
Bank/credit union loans
Money you owe (not evidenced by a note)
Judgments
Other
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
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LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY WIFE
(Please describe each item as clearly as possible. You do not need to list
account numbers. Where applicable, include whether the name on any
mortgage, note, or account described below is wife’s, husband’s, or both.)
Total Debts to Be Paid by Wife
Current
Amount
Owed
Monthly
Payment
$
$
2. Husband shall pay as his own the following and will not at any time ask Wife to pay these
debts/bills:
LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY HUSBAND
(Please describe each item as clearly as possible. You do not need to list
account numbers. Where applicable, include whether the name on any
mortgage, note or account described below is wife’s, husband’s, or both.)
Mortgages on real estate: (Home)
Current
Amount
Owed
Monthly
Payment
$
$
(Other)
Charge/credit card accounts
Auto loan
Auto loan
Bank/credit union loans
Money you owe (not evidenced by a note)
Judgments
Other
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
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LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY HUSBAND
(Please describe each item as clearly as possible. You do not need to list
account numbers. Where applicable, include whether the name on any
mortgage, note or account described below is wife’s, husband’s, or both.)
Total Debts to Be Paid by Husband
C.
Current
Amount
Owed
Monthly
Payment
$
$
Contingent Assets and Liabilities (listed in Section III of our Family Law Financial Affidavits) will be
divided as follows:
SECTION II. SPOUSAL SUPPORT (ALIMONY) (If you have not agreed on this matter, write n/a on the
lines provided.)
1. ____Each of us forever gives up any right to spousal support (alimony) that we may have.
OR
2. ____ HUSBAND ____ WIFE (hereinafter “Obligor”) agrees to pay spousal support (alimony) in
_____every ( ) week ( ) other week ( ) month, beginning {date}
the amount of $
____________and continuing until {date or event}
_______________________
________________________________________________________________________.
Explain type of alimony (such as, permanent, bridge-the-gap, durational, rehabilitative, and/or
lump sum) and any other specifics: _____________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_________________________________________________________________________.
3. _____ Other provisions relating to alimony, including any tax treatment and consequences:
___________________________________________________________________________
________________________________________________________________________
4. ____ Husband _____Wife will provide life insurance in the amount of $__________ to secure
the above support.
SECTION III. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
- 22 -
1. The parties’ minor child(ren) are:
Name
Birth date
2. The parties shall have time-sharing and parental responsibility in accordance with the Parenting
Plan attached as Exhibit _____.
SECTION IV. CHILD SUPPORT
1. ____ Wife ____ Husband (hereinafter “Obligor”) will pay child support, under Florida’s child
support guidelines, section 61.30, Florida Statutes, to the other parent. The Child Support
Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), is completed and
attached.
Child support established at the rate of $_________ per month for the ______children {total
number of parties’ minor or dependent children} shall be paid commencing ______________
{month, day, year} and terminating __________________ {month, day, year}. Child support
shall be paid in the amount of $_________ per ___________ {week, month, other} which is
consistent with the Obligor’s current payroll cycle.
Upon the termination of the obligation of child support for one of the parties’ children, child
support in the amount of $____________ for the remaining ____ children {total number of
remaining children} shall be paid commencing____________________ {month, day, year} and
terminating _________________ {month, day, year}. This child support shall be paid in the
amount of $________per ______ _____{week, month, other} consistent with Obligor’s current
payroll cycle.
{Insert schedule for the child support obligation, including the amount, and commencement
and termination dates, for the remaining minor or dependent children, which shall be payable
as the obligation for each child ceases. Please indicate whether the schedule ____appears
below or ____is attached as part of this form}
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
- 23 -
The Obligor shall pay child support until all the minor or dependent child(ren): reach the age of
18; become emancipated, marry, join the armed services, die, or become self-supporting; or
until further order of the court or agreement of the parties. The child support obligation shall
continue beyond the age of 18 and until high school graduation for any child who is: dependent
in fact; between the ages of 18 and 19; and is still in high school, performing in good faith with a
reasonable expectation of graduation before the age of 19.
If the child support amount above deviates from the guidelines by 5% or more, explain the
reason(s) here:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
2. Child Support Arrearage. There currently is a child support arrearage of $
__________
for retroactive child support and/or $
for previously ordered unpaid child support.
The total of $
in child support arrearage shall be repaid at the rate of $
___ every
( ) week ( ) other week ( ) month, beginning {date}
_______, until paid in full
including statutory interest.
3. Health Insurance. ____ Wife ____ Husband ( ) will maintain health insurance for the parties’
minor child(ren). The party providing coverage will provide insurance cards to the other party
showing coverage. OR
(
) Health insurance is either not reasonable in cost or accessible to the child(ren) at this time.
Any uninsured/ unreimbursed medical costs for the minor child(ren) shall be assessed as
follows:
a. ____Shared equally by husband and wife.
b. ____Prorated according to the child support guideline percentages.
c. ____Other {explain}:
________________________________________________
As to these uninsured/unreimbursed medical expenses, the party who incurs the expense shall
submit a request for reimbursement to the other party within 30 days, and the other party,
within 30 days of receipt, shall submit the applicable reimbursement for that expense, according
to the schedule of reimbursement set out in this paragraph.
4. Dental Insurance. ____ Wife ____ Husband ( ) will maintain dental insurance for the parties’
minor child(ren). The party providing coverage will provide insurance cards to the other party
showing coverage. OR
(
) dental insurance is either not reasonable in cost or accessible to the child(ren) at this time.
Any uninsured/ unreimbursed dental costs for the minor child(ren) shall be assessed as follows:
a. ____Shared equally by husband and wife.
b. ____Prorated according to the child support guideline percentages.
c. ____Other {explain}: ____________________________________________________
As to these uninsured/unreimbursed dental expenses, the party who incurs the expense shall
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
- 24 -
submit a request for reimbursement to the other party within 30 days, and the other party,
within 30 days of receipt, shall submit the applicable reimbursement for that expense, according
to the schedule of reimbursement set out in this paragraph.
5. Life Insurance. ____ Wife ____ Husband will maintain life insurance for the benefit of the
parties’ minor child(ren) in the amount of $
_____until the youngest child turns 18,
becomes emancipated, marries, joins the armed services, or dies.
6. IRS Income Tax Deduction(s). The assignment of any tax deductions for the child(ren) shall be
as follows: {explain} __________________________________________________________
_________________________________________________________________________
The other parent will convey any applicable IRS form regarding the income tax deduction.
7. Other provisions relating to child support (e.g., uninsured medical/dental expenses, health or
dental insurance, life insurance to secure child support, orthodontic payments, college fund,
etc.): ____________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________.
SECTION V. OTHER
SECTION VI. We have not agreed on the following issues:
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
- 25 -
I certify that I have been open and honest in entering into this settlement agreement. I am satisfied
with this agreement and intend to be bound by it.
Dated:
__________________________________________
Signature of Husband
Printed Name: _______________________________
Address: ___________________________________
City, State, Zip: _______________________________
Telephone Number: ____________________________
Fax Number: ________________________________
E-mail Address: ____________________________
STATE OF FLORIDA
COUNTY OF ________________________
Sworn to or affirmed and signed before me on
by
.
_____________________________________________
NOTARY PUBLIC or DEPUTY CLERK
______________________________________________
[Print, type, or stamp commissioned name of notary or clerk.]
_
_
Personally known
Produced identification
Type of identification produced: ________________________
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in
all blanks] This form was prepared for the: {choose only one} ( ) Husband ( ) Wife
This form was completed with the assistance of:
{name of individual} ____________________________________________________________,
{name of business} _____________________________________________________________,
{address}
_____________________________________________________,
{city} _______________________, {state}
__, {telephone number}
_____.
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
- 26 -
I certify that I have been open and honest in entering into this settlement agreement. I am satisfied
with this agreement and intend to be bound by it.
Dated:
Signature of Wife
Printed Name: _______________________________
Address: ___________________________________
City, State, Zip: _______________________________
Telephone Number: ____________________________
Fax Number: ________________________________
E-mail Address: ____________________________
STATE OF FLORIDA
COUNTY OF ___________________________
Sworn to or affirmed and signed before me on
by
____________________________________________
NOTARY PUBLIC or DEPUTY CLERK
_____________________________________________
[Print, type, or stamp commissioned name of notary or
clerk.]
_
_
Personally known
Produced identification
Type of identification produced ____________________________
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the: {choose only one} ( ) Husband ( ) Wife
This form was completed with the assistance of:
{name of individual}_______________________________________________________,
{name of business} ________________________________________________________,
{address}
_____________________________________________________,
{city}
____, {state}
___, {telephone number} ________________.
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
- 27 -
.
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.904(a),
PETITION FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF
MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN)
(07/13)
When should this form be used?
This form may be used to ask the court to enter a support order if your spouse has the ability to
contribute to you and your minor child(ren), but has failed to do so. You can only use this form if a
dissolution of marriage has not been filed and based upon the time-sharing schedule, you are entitled
to support. If a petition for dissolution of marriage has been filed, you should file a Motion for
Temporary Support and Time-Sharing with Dependent or Minor Child(ren), Florida Supreme Court
Approved Family Law Form 12.947(a), instead of using this petition. Also, if you are requesting that an
order be entered for you to pay support to your spouse, you should not file this form.
This petition cannot address the issues of property, debts, or parental responsibility and time-sharing
with child(ren). It only deals with alimony and child support.
This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in
the county where you live and keep a copy for your records. Because you are filing this petition, you are
also referred to as the petitioner and your spouse as the respondent.
What should I do next?
For your case to proceed, you must properly notify your spouse of the petition. Because this petition
concerns child support and alimony, you should use personal service. If your spouse is in the military
service of the United States, additional steps for service may be required. See, for example,
Memorandum for Certificate of Military Service, Florida Supreme Court Approved Family Law Form
12.912(a) and Affidavit of Military Service, Florida Supreme Court Approved Family Law Form
12.912(b). Service on a spouse who is in the military can be complicated; therefore, you may wish to
consult an attorney regarding this issue.
Your spouse has 20 days to answer after being served with your petition. Your case will then generally
proceed in one of the following three ways:
DEFAULT. If after 20 days, no answer has been filed, you may file a Motion for Default, Florida Supreme
Court Approved Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all of the
required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final
hearing. You must notify your spouse of the hearing by using a Notice of Hearing (General), Florida
Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
Instructions for Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected
with Dissolution of Marriage with Dependent or Minor Child(ren) (07/13)
- 28 -
UNCONTESTED. If your spouse files an answer that agrees with everything in your petition or an
answer and waiver, and you have complied with mandatory disclosure and filed all of the required
papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You
must notify your spouse of the hearing by using a Notice of Hearing (General), Florida Supreme Court
Approved Family Law Form 12.923, or other appropriate notice of hearing form.
CONTESTED. If your spouse files an answer or an answer and counterpetition, which disagrees with or
denies anything in your petition, and you are unable to settle the disputed issues, you should file a
Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with
mandatory disclosure and filed all of the required papers. Some circuits may require the completion of
mediation before a final hearing may be set. Then you should contact the clerk, family law intake staff,
or judicial assistant for instructions on how to set your case for trial (final hearing). If your spouse files
an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer
to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).
Where can I look for more information?
Before proceeding, you should read “General Information for Self-Represented Litigants” found at the
beginning of these forms. The words that are in bold underline in these instructions are defined there.
For further information, see section 61.09, Florida Statutes.
Special notes...
If you do not have the money to pay the filing fee, you may obtain an Application for Determination of
Civil Indigent Status from the clerk, fill it out, and the clerk will determine whether you are eligible to
have filing fees deferred.
With this form you must also file the following:
•
•
•
•
•
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme
Court Approved Family Law Form 12.902(d), if the case involves minor or dependent child(ren).
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c).
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure
Form 12.932. (This must be filed within 45 days of service of the petition on the respondent, if
not filed at the time of the petition, unless you and the other party have agreed not to exchange
these documents.)
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), if
you are asking that child support be ordered in the final judgment. (If you do not know the
other party’s income, you may file this worksheet after his or her financial affidavit has been
served on you.)
Alimony. Alimony may be awarded to a spouse if the judge finds that he or she has an actual need for it
and that the other spouse has the ability to pay. If you want alimony, you must request it in writing in
the original petition. If you do not request alimony in writing before the final hearing, it is waived (you
Instructions for Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected
with Dissolution of Marriage with Dependent or Minor Child(ren) (07/13)
- 29 -
may not request it later). You may request permanent alimony, bridge-the-gap alimony, durational
alimony, lump sum alimony, or rehabilitative alimony.
Child Support. The court may order one parent to pay child support to assist the other parent in
meeting the child(ren)’s material needs. Both parents are required to provide financial support, but
one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent.
Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines
are based on the combined income of both parents and take into account the financial contributions of
both parents and the number of overnights the child(ren) spend with each parent. You must file a
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), and your
spouse will be required to do the same. From your financial affidavits, you should be able to calculate
the amount of child support that should be paid using the Child Support Guidelines Worksheet, Florida
Family Law Rules of Procedure Form 12.902(e). Because the child support guidelines take several
factors into consideration, change over time, and vary from state to state, your child support obligation
may be more or less than that of other people in seemingly similar situations.
Temporary Relief. If you need temporary relief regarding child support or temporary alimony, you may
file a Motion for Temporary Support and Time-Sharing with Dependent or Minor Child(ren), Florida
Supreme Court Approved Family Law Form 12.947(a). For more information, see the instructions for
that form.
Final Judgment Forms. These family law forms contain a Final Judgment of Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family
Law Form 12.994(a), which the judge may use if your case is contested. You should check with the clerk,
family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the
hearing. If so, you should type or print the heading, including the circuit, county, case number, division,
and the parties’ names, and leave the rest blank for the judge to complete at your hearing or trial.
Nonlawyer. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps
you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida
Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill
out these forms also must put his or her name, address, and telephone number on the bottom of the
last page of every form he or she helps you complete.
Instructions for Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected
with Dissolution of Marriage with Dependent or Minor Child(ren) (07/13)
- 30 -
IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA
In re: the Marriage of:
Case No: ________________________
Division: ________________________
_________________________________,
Husband,
and
_________________________________,
Wife.
PETITION FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF
MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN)
I, {full legal name}
, the
( ) Husband ( ) Wife, the Petitioner, being sworn, certify that the following statements are true:
1. JURISDICTION
( ) Husband ( ) Wife ( ) Both live in Florida at the filing of this Petition for Support Unconnected with
Dissolution of Marriage, which is filed pursuant to section 61.09, Florida Statutes.
2. Husband [Choose only one] ( ) is ( ) is not a member of the military service.
Wife [Choose only one] ( ) is ( ) is not a member of the military service.
3. MARRIAGE HISTORY
a.
ate of marriage: {month, day, year} _____________________.
b.
ate of separation: {month, day, year} __________ (___Please indicate if approximate)
4. MINOR CHILD(REN)
[Choose all that apply]
a. ____The wife is pregnant. The baby is due on: {date}
______________.
b. ____The minor (under 18) child(ren) common to both parties are:
Name
Birth Date
________________________________________________________________________
_________________________________________________________________________
__________________________________________________________________________
_________________________________________________________________________
c.
The minor child(ren) born or conceived during the marriage who are not common to
both parties are:
Name
Birth Date
Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected with Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
- 31 -
D
D
______________
__________________________________________________________________________
_________________________________________________________________________
The birth father(s) of the above minor child(ren) is (are) {name and address}
______________________________________________________________________________
______________________________________________________________________________
d. The child(ren) common to both parties who are 18 or older but who are dependent upon the
parties due to a mental or physical incapacity are:
Name
Birth Date
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law
Form 12.902(j), is filed with this petition.
6. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form
12.902(b) or (c), ( ) is, or ( ) will be filed.
7. A completed Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form
12.902(e), is, or will be, filed.
8. A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida
Supreme Court Approved Family Law Form 12.902(d), is filed with this petition.
SECTION I. SPOUSAL SUPPORT (ALIMONY)
1. ____Husband ____ Wife does not request spousal support (alimony) from the other spouse at
this time.
OR
2. ___ Husband ____Wife has the ability to contribute to the maintenance of the other spouse
and has failed to do so. ____ Husband ____Wife requests that the Court order the other spouse
to pay the following spousal support (alimony) and claims that he or she has a need for the
support that he or she is requesting. Spousal support (alimony) is requested in the amount of
$___________ every ( ) week ( ) other week ( ) month, beginning {date} _______________,
and continuing until {date or event}______________________________.
Explain why the Court should order ____ Husband ____ Wife to pay and any specific request(s) for type
of alimony (temporary, permanent, rehabilitative, bridge-the-gap, durational, and/or lump sum)
Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected with Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
- 32 -
3. ____Other provisions relating to alimony including any tax treatment and consequences:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
4. _____Husband ____ Wife requests life insurance on the other spouse’s life, provided by that
spouse, to secure such support.
SECTION II. CHILD SUPPORT
1. ____ Husband ____Wife has the ability to contribute to the maintenance of his or her minor
child(ren) and has failed to do so. Based upon the time-sharing schedule, the ____Husband
_____Wife is entitled to child support.
[Choose all that apply]
2. ____Husband ____Wife requests that the Court award child support as determined by Florida’s
child support guidelines, section 61.30, Florida Statutes.
3. ____ Husband _____ Wife requests that the Court award child support to be paid beyond the
age of 18 years by ____Husband ____Wife because:
a.
____the following child(ren), {name(s)}
,
is (are) dependent because of a mental or physical incapacity which began prior to the age of 18
{explain}:
_______________________________________________________________________
_______________________________________________________________________
b.
____the following child(ren), {name(s)}
,
is (are) dependent in fact, is (are) in high school and is (are) between the ages of 18 and 19; said
child(ren) is (are) performing in good faith with a reasonable expectation of graduation before the age
of 19.
4. ____ Husband ____ Wife requests that medical/dental insurance for the minor child(ren) be
provided by: [Choose only one]
a. ____ Husband
b. ____ Wife
5. ____ Husband ____ Wife requests that uninsured medical/dental expenses for the
child(ren) be paid:
[Choose only one]
a. ____ by Husband
b. ____ by Wife
c. ____ by Husband and Wife each paying one-half.
d.
__according to the percentages in the Child Support Guidelines Worksheet, Florida
Family Law Rules of Procedure Form 12.902(e).
e.
_ Other {explain}: ___________________________________________________
_______________________________________________________________________
6.
_ Husband ____ Wife requests that life insurance to secure child support be provided by
____ Husband
____ Wife
____ Both
Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected with Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
- 33 -
SECTION III. OTHER RELIEF
SECTION IV. REQUEST
(This section summarizes what you are asking the Court to include in the order for support.)
____ Husband ____ Wife requests that the Court enter an order establishing support and:
[Choose all that apply]
a. ____ awarding spousal support (alimony) as requested in Section I of this petition;
b. ____ establishing child support for the minor child(ren) common to both parties, as requested in
Section II of this petition;
c. ____ awarding other relief as requested in Section III of this petition; and any other items the
Court deems necessary.
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 (
Printed Name:
Address:
_________________________
City, State, Zip: ______________________
_
Telephone Number:
___________________
Fax Number:
_____________
E-mail Address: _________________________
) Husband (
) Wife
STATE OF FLORIDA
COUNTY OF
Sworn to or affirmed and signed before me on
by
.
_____________________________________________
NOTARY PUBLIC or DEPUTY CLERK
[Print, type, or stamp commissioned name of notary or deputy clerk.]
_ Personally known
__ Produced identification
Type of identification produced ___________________
Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected with Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
- 34 -
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the: {choose only one} ( ) Husband ( ) Wife
This form was completed with the assistance of:
{name of individual}_______________________________________________________________,
{name of business} _________________________________________________________________,
{address} ________________________________________________________________________,
{city} ________________________, {state} ______, {telephone number} ______________________.
Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected with Dissolution of
Marriage with Dependent or Minor Child(ren) (07/13)
- 35 -
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.904(b), PETITION FOR SUPPORT UNCONNECTED WITH
DISSOLUTION OF MARRIAGE WITH NO DEPENDENT OR MINOR
CHILD(REN)(07/13)
When should this form be used?
This form may be used if a dissolution of marriage has not been filed, and you are requesting alimony.
If a petition for dissolution has been filed, you should file a Motion for Temporary Support with No
Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(c), instead of
using this petition. Also, if you are requesting that an order be entered for you to pay support to your
spouse, you should not file this form.
This petition does not address the issues of property or debts. It only deals with alimony.
This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in
the county where you live and keep a copy for your records. Because you are filing the petition in this
proceeding, you are also referred to as the petitioner and your spouse as the respondent.
What should I do next?
For your case to proceed, you must properly notify your spouse of the petition. Because this petition
concerns alimony, you should use personal service. If your spouse is in the military service of the
United States, additional steps for service may be required. See, for example, Memorandum for
Certificate of Military Service, Florida Supreme Court Approved Family Law Form 12.912(a) and
Affidavit of Military Service, Florida Supreme Court Approved Family Law Form 12.912(b). Service on a
spouse who is in the military can be complicated; therefore, you may wish to consult an attorney
regarding this issue.
Your spouse has 20 days to answer after being served with your petition. Your case will then generally
proceed in one of the following three ways:
DEFAULT... If after 20 days, no answer has been filed, you may file a Motion for Default, Florida
Supreme Court Approved Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all
of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final
hearing. You must notify your spouse of the hearing by using a Notice of Hearing (General), Florida
Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
UNCONTESTED... If your spouse files an answer that agrees with everything in your petition or an
answer and waiver, and you have complied with mandatory disclosure and filed all of the required
papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You
must notify your spouse of the hearing by using a Notice of Hearing (General), Florida Supreme Court
Approved Family Law Form 12.923, or other appropriate notice of hearing form.
Instructions for Florida Supreme Court Approved Family Law Form 12.904(b), Petition for Support Unconnected
with Dissolution of Marriage with No Dependent or Minor Child(ren) (07/13)
- 36 -
CONTESTED... If your spouse files an answer or an answer and counterpetition, which disagrees with or
denies anything in your petition, and you are unable to settle the disputed issues, you should file a
Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with
mandatory disclosure and filed all of the required papers. Some circuits may require the completion of
mediation before a final hearing may be set. Then you should contact the clerk, family law intake staff,
or judicial assistant for instructions on how to set your case for trial (final hearing). If your spouse files
an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer
to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).
Where can I look for more information?
Before proceeding, you should read General Information for Self-Represented Litigants found at the
beginning of these forms. The words that are in bold underline in these instructions are defined there.
For further information, see section 61.09, Florida Statutes.
Special notes...
If you do not have the money to pay the filing fee, you may obtain an Application for Determination of
Civil Indigent Status from the clerk, fill it out, and the clerk will determine whether you are eligible to
have filing fees deferred.
With this form you must also file the following:
•
•
•
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This
must be filed within 45 days of service of the petition on the respondent, if not filed at the time of
the petition.)
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form
12.932. (This must be filed within 45 days of service of the petition on the respondent, if not filed at
the time of the petition, unless you and the other party have agreed not to exchange these
documents.)
Alimony... Alimony may be awarded to a spouse if the judge finds that he or she has an actual need for
it and that the other spouse has the ability to pay. If you want alimony, you must request it in writing
in the original petition. If you do not request alimony in writing before the final hearing, it is waived
(you may not request it later). You may request permanent alimony, bridge-the-gap alimony,
durational alimony, lump sum alimony, or rehabilitative alimony.
Temporary Relief... If you need temporary relief regarding alimony, you may file a Motion for
Temporary Support with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family
Law Form 12.947(c). For more information, see the instructions for that form.
Final Judgment Forms... These family law forms contain a Final Judgment of Support Unconnected
with Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Supreme Court Approved
Family Law Form 12.994(b), which the judge may use if your case is contested. You should check with
the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with
Instructions for Florida Supreme Court Approved Family Law Form 12.904(b), Petition for Support Unconnected
with Dissolution of Marriage with No Dependent or Minor Child(ren) (07/13)
- 37 -
you to the hearing. If so, you should type or print the heading, including the circuit, county, case
number, division, and the parties’ names, and leave the rest blank for the judge to complete at your
hearing or trial.
Nonlawyer... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps
you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida
Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill
out these forms also must put his or her name, address, and telephone number on the bottom of the
last page of every form he or she helps you complete.
Instructions for Florida Supreme Court Approved Family Law Form 12.904(b), Petition for Support Unconnected
with Dissolution of Marriage with No Dependent or Minor Child(ren) (07/13)
- 38 -
IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA
In re: the Marriage of:
Case No: ________________________
Division: ________________________
_________________________________,
Husband,
and
_________________________________,
Wife.
PETITION FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF
MARRIAGE WITH NO DEPENDENT OR MINOR CHILD(REN)
I, {full legal name} ______________________________________________________, the
[Choose only one] ( ) Husband ( ) Wife, being sworn, certify that the following statements are true:
1. JURISDICTION
( ) Husband ( ) Wife ( ) Both live in Florida at the filing of this Petition for Support Unconnected with
Dissolution of Marriage, which is filed pursuant to section 61.09, Florida Statutes.
2. Husband [Choose only one] ( ) is ( ) is not a member of the military service.
Wife [Choose only one] ( ) is ( ) is not a member of the military service.
3. MARRIAGE HISTORY
Date of marriage: {month, day, year} ______________
Date of separation: {month, day, year} (___Indicate if approximate) ______________________)
4. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or
(c), is, or will be, filed.
5. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form
12.902(j), is, or will be filed.
SECTION I. SPOUSAL SUPPORT (ALIMONY)
1. ____ Husband ____Wife has the ability to contribute to the maintenance of the other spouse and
has failed to do so. _____Husband ____Wife requests that the Court order the other spouse to pay
the following spousal support (alimony) and claims that he or she has a need for the support that
he and that or she is requesting and that the other spouse has the ability to pay. Spousal support
(alimony) is requested in the amount of $__________every ( ) week ( ) other week ( ) month,
beginning {date} ______________, and continuing until {date or event}_______________________
________________________________________________________________________________.
Florida Supreme Court Approved Family Law Form 12.904(b), Petition for Support Unconnected with Dissolution of
Marriage with No Dependent or Minor Child(ren) (07/13)
- 39 -
Explain why the Court should order ____ Husband ____Wife to pay and any specific request(s) for type
of alimony (temporary, permanent, bridge-the-gap, durational, rehabilitative, and/or lump sum):
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
2. ____ Other provisions relating to alimony including any tax treatment and consequences:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
3. ____ Husband ____ Wife requests life insurance on the other spouse’s life, provided by that
spouse, to secure such support.
SECTION II. OTHER RELIEF
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
SECTION III. REQUEST (This section summarizes what you are asking the Court to include in the order
for support.)
____ Husband ____ Wife requests that the Court enter an order establishing support and:
[Choose all that apply]
a. ____ awarding spousal support (alimony) pursuant to Section I of this petition;
b. ____ awarding other relief as specified in Section II of this petition; and any other terms the Court
deems necessary.
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
petition and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.
Dated: ______________________
_____________________________________________
Signature of ( ) Husband ( ) Wife
Printed Name: ______________________________
Address: ______________________________________
City, State, Zip: _________________________________
Telephone Number: _____________________________
Fax Number: __________________________________
E-mail Address: _____________________________
Florida Supreme Court Approved Family Law Form 12.904(b), Petition for Support Unconnected with Dissolution of
Marriage with No Dependent or Minor Child(ren) (07/13)
- 40 -
STATE OF FLORIDA
COUNTY OF ____________________
Sworn to or affirmed and signed before me on ____________ by _______________________________.
_____________________________________________
NOTARY PUBLIC or DEPUTY CLERK
_____________________________________________
[Print, type, or stamp commissioned name of notary or deputy clerk.]
____
____
____
Personally known
Produced identification
Type of identification produced ________________
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the: {choose only one} ( ) Husband ( ) Wife
This form was completed with the assistance of:
{ name of individual} ______________________________________________________________,
{name of business} ________________________________________________________________,
{address} _________________________________________________________________________,
{city} _________________________,{state} ______, {telephone number} _____________________.
Florida Supreme Court Approved Family Law Form 12.904(b), Petition for Support Unconnected with Dissolution of
Marriage with No Dependent or Minor Child(ren) (07/13)
- 41 -
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.943,
MOTION TO DEVIATE FROM CHILD SUPPORT GUIDELINES (07/13)
When should this form be used?
Child support in Florida is determined by the child support guidelines found in section 61.30, Florida
Statutes. The court, at its discretion, may raise or lower the child support guidelines amount by up to
5%. In addition, the court may raise or lower the guidelines support amount by more than 5%, if written
reasons are given for the adjustment. The court may make these additional adjustments based on
certain considerations, which are reflected in this form. You should review this form to determine if any
of the reasons for adjusting the child support guidelines amount apply to your situation and you should
complete this form only if you want the court to order more child support or less child support than the
amount required by the child support guidelines.
This form should be typed or printed in black ink. After completing this form, you should file the original
with the clerk of the circuit court in the county where your case is filed and keep a copy for your
records.
What should I do next?
A copy of this form must be mailed or hand delivered to the other party in your case.
Where can I look for more information?
Before proceeding, you should read General Information for Self-Represented Litigants found at the
beginning of these forms. For further information, see section 61.30, Florida Statutes.
Special notes...
More information on the child support guidelines as well as a chart for converting income and expenses
to monthly amounts if paid or incurred on other than a monthly basis is contained in the instructions to
Florida Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), and
the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e).
With this form you must also file the following, if not already filed:
•
Florida Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or
(c).
•
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). (If
you do not know the other party’s income, you should file this worksheet as soon as you receive
Instructions for Florida Supreme Court Approved Family Law Form 12.943, Motion to Deviate from Child Support
Guidelines (07/13)
- 42 -
a copy of his or her financial affidavit.)
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms
also must put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.
Instructions for Florida Supreme Court Approved Family Law Form 12.943, Motion to Deviate from Child Support
Guidelines (07/13)
- 43 -
IN THE CIRCUIT COURT OF THE
IN AND FOR
JUDICIAL CIRCUIT,
COUNTY, FLORIDA
Case No.:
Division:
,
Petitioner,
and
,
Respondent.
MOTION TO DEVIATE FROM CHILD SUPPORT GUIDELINES
(
) Petitioner (
) Respondent requests that the Court enter an order granting the following:
SECTION I
[Choose only one]
A.___ MORE child support than the amount required by the child support guidelines. The Court should
order MORE child support than the amount required by the child support guidelines because of:
[Choose all that apply to your situation]
1. ____Extraordinary medical, psychological, educational, or dental expenses;
2. ____Seasonal variations in one or both parent's income or expenses
3. ____Age(s) of the child(ren), taking into account the greater needs of older child(ren);
4. ____Special needs, such as costs that may be associated with the disability of a child or
child(ren), that have traditionally been met within the family budget even though the
fulfilling of those needs will cause support to exceed the presumptive amount established
by the guidelines;
5. ____Total available assets of obligee, obligor, and the child(ren);
6. ____Impact of the Internal Revenue Service Child & Dependent Care Tax Credit, Earned
Income Tax Credit, and dependency exemption and waiver of that exemption;
7. ____The Parenting Plan, such as where the child or children spend a significant amount of
time, but less than 20 percent of the overnights, with one parent, thereby reducing the
financial expenditures incurred by the other parent, or the refusal of a parent to become
involved in the activities of the child(ren) has increased the financial expenditure incurred by
the obligee;
8. ____The obligee parent’s low income and ability to maintain the basic necessities of the
home for the child(ren);
9. ____The likelihood that either parent will actually exercise the time-sharing schedule set
forth in the parenting plan and/or whether all the children are exercising the same timesharing schedule;
Florida Supreme Court Approved Family Law Form 12.943, Motion to Deviate from Child Support Guidelines
(07/13)
- 44 -
10. ____Any other adjustment that is needed to achieve an equitable result, which may include
reasonable and necessary expenses or debts jointly incurred during the marriage.
Explain any items marked above: _____________________________________________
_________________________________________________________________________
_________________________________________________________________________.
B.___ LESS child support than the amount required by the child support guidelines. The Court should
order LESS child support than the amount required by the child support guidelines because of:
[Choose all that apply to your situation]
1. ____ Extraordinary medical, psychological, educational, or dental expenses;
2. ____Independent income of child(ren), excluding the child(ren)’s SSI (supplemental security
income)
3. ____Payment of support for a parent which has been regularly paid and for which there is
a demonstrated need;
4. ____Seasonal variations in one or both parent's income or expenses;
5. ____Age of the child(ren), taking into account the greater needs of older child(ren);
6. ____ Total available assets of obligee, obligor, and child(ren);
7. ____ Impact of the Internal Revenue Service Child & Dependent Care Tax Credit, Earned
Income Tax Credit, and dependency exemption and waiver of that exemption;
8. ____ Application of the child support guidelines which requires the obligor to pay more
than 55% of gross income for a single support order;
9. ____ Residency of subsequently born or adopted child(ren) with the obligor, include
consideration of the subsequent spouse's income;
10. ____ The Parenting Plan, where the child(ren) spend a significant amount of time, but less
than 20 percent of the overnights, with one parent, thereby reducing the financial
expenditures incurred by the other parent; or the refusal of a parent to become involved in
the activities of the child(ren)has reduced the financial expenditure of that parent;
11. ____Any other adjustment that is needed to achieve an equitable result, which may include
reasonable and necessary expenses or debts jointly incurred during the marriage.
Explain any items marked above:___________________________
_________________
.
SECTION II. INCOME AND ASSETS OF CHILD(REN) COMMON TO BOTH PARTIES
List the total of any independent income or assets of the child(ren) common to both parties (income
from Social Security, gifts, stocks/bonds, employment, trust fund(s), investment(s), etc.). Attach an
explanation.
TOTAL VALUE OF ASSETS OF CHILD(REN)
$
____
TOTAL MONTHLY INCOME OF CHILD(REN)
$
____
Florida Supreme Court Approved Family Law Form 12.943, Motion to Deviate from Child Support Guidelines
(07/13)
- 45 -
SECTION III. EXPENSES FOR CHILD(REN) COMMON TO BOTH PARTIES
All amounts must be MONTHLY. See the instructions with this form to figure out money amounts for
anything that is NOT paid monthly. Attach more paper, if needed. Items included under “other” should
be listed separately with separate dollar amounts.
1. $ ______ Monthly nursery, babysitting, or other child care
2. $ _______ Monthly after-school care
3. $ _______ Monthly school tuition
4. $ _______ Monthly school supplies, books, and fees
5. $ _______ Monthly after-school activities
6. $ _______ Monthly lunch money
7. $ _______ Monthly private lessons/tutoring
8. $ _______ Monthly allowance
9. $ _______ Monthly clothing
10. $ _______ Monthly uniforms
11. $ _______ Monthly entertainment (movies, birthday parties, etc.)
12. $ _______ Monthly health and dental insurance premiums
13. $ _______ Monthly medical, dental, prescription charges (unreimbursed)
14. $ _______ Monthly psychiatric/psychological/counselor (unreimbursed)
15. $ _______ Monthly orthodontic (unreimbursed)
16. $ _______ Monthly grooming
17. $ _______ Monthly non-prescription medications/cosmetics/toiletries/sundries
18. $ _______ Monthly gifts from children to others (other children, relatives, teachers, etc.)
19. $ _______ Monthly camp or other summer activities
20. $ _______ Monthly clubs (Boy/Girl Scouts, etc.) or recreational fees
21. $ _______ Monthly visitation expenses (for nonresidential parent)
{Explain} ______________________________________________________
22. $ ________Monthly insurance (life, etc.)
{explain}: ______________________________________________________
Other {explain}:
23. ____________________________________________________
24. _____________________________________________________
25. ____________________________________________________
26. $________TOTAL EXPENSES FOR CHILD(REN) COMMON TO BOTH PARTIES
(add lines 1 through 25)
I have filed, will file, or am filing with this form the following additional documents:
1. Florida Family Law Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form
12.902(b) or (c).
2. Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e).
Florida Supreme Court Approved Family Law Form 12.943, Motion to Deviate from Child Support Guidelines
(07/13)
- 46 -
I certify that a copy of this document was [choose only one]( ) mailed ( ) faxed and mailed ( ) handdelivered to the person(s) listed below on {date} ____________________.
Other party or his/her attorney:
Name: ____________________________________
Address: __________________________________
City, State, Zip: ______________________________
Fax Number: _______________________________
E-mail Address: __________________________
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
motion and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.
__________________________________________
Signature of Party or his/her attorney
Printed Name: _______________________________
Address: ___________________________________
City, State, Zip: ______________________________
Telephone Number:___________________________
Fax Number:________________________________
E-mail Address: _____________________________
STATE OF FLORIDA
COUNTY OF __________________________
Sworn to or affirmed and signed before me on ________________ by __________________________
____________________________________________
NOTARY PUBLIC or DEPUTY CLERK
___________________________________________
[Print, type, or stamp commissioned name of notary or clerk.]
____ Personally known
____ Produced identification
Type of identification produced_____________________________________________________
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the: {choose only one} ( ) Petitioner ( ) Respondent
This form was completed with the assistance of:
{name of individual} _________________________________________________________________,
{name of business} __________________________________________________________________,
{address} __________________________________________________________________________,
{city} _______________________________, {state}________, {telephone number}________________.
Florida Supreme Court Approved Family Law Form 12.943, Motion to Deviate from Child Support Guidelines
(07/13)
- 47 -
IN THE CIRCUIT COURT OF THE
IN AND FOR
JUDICIAL CIRCUIT,
COUNTY, FLORIDA
Case No.: ________________
Division: ________________
,
Petitioner,
and
,
Respondent.
TEMPORARY ORDER OF SUPPORT, TIME-SHARING, AND OTHER RELIEF
WITH DEPENDENT OR MINOR CHILD(REN)
This cause came before this Court for a hearing on a Motion for Temporary Support, Time-Sharing, and
Other Relief with Dependent or Minor Child(ren). The Court, having reviewed the file and heard the
testimony, makes these findings of fact and ORDERS as follows:
The Court has jurisdiction over the subject matter and the parties.
SECTION I. MARITAL ASSETS AND LIABILITIES
A. Injunction.
1. ( ) Petitioner ( ) Respondent is (are) prohibited and enjoined from disposing of any
marital assets without the written permission of the other party or a court order. If checked
here ( ), the person(s) prohibited and enjoined from disposing of any marital assets may
continue to pay all ordinary and usual expenses.
2. The Court may enforce compliance with the terms of this injunction through civil and/or
indirect criminal contempt proceedings, which may include arrest, incarceration, and/or the
imposition of a fine.
3. Violation of this injunction may constitute criminal contempt of court.
4. Bond. This order is conditioned upon ( ) Petitioner ( ) Respondent posting bond in the
sum of $
with the clerk of this Court.
B. Temporary Use of Assets.
1. The assets listed below are temporarily determined to be marital assets. Each party shall
temporarily have the use of, as his/her own, the assets awarded in this section, and the
other party shall temporarily have no further use of said assets. Any personal property not
listed below shall be for the use of party currently in possession of that item(s), and he or
she may not dispose of that item(s) without the written permission of the other party or a
court order.
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing, and
Other Relief with Dependent or Minor Child(ren) (07/13)
- 48 -
Wife Shall
ASSETS: DESCRIPTION OF ITEM(S) (Please describe each item as clearly as
Have
possible. You do not have to list account numbers.)
Temporary
Use
Husband
Shall Have
Temporary
Use
Automobiles
Furniture & furnishings in home
Furniture & furnishings elsewhere
Jewelry
Business interests
Other Assets
C. Temporary Responsibility for Liabilities/Debts.
1. The liabilities listed below are temporarily determined to be marital. Each party shall pay as his
or her own the marital liabilities indicated below and shall keep said payments current. The
other party shall temporarily have no further responsibility for the payment of these debts.
LIABILITIES: DESCRIPTION OF DEBT(S)(Please describe each item as Current
clearly as possible. You do not have to list account numbers.)
Amount
Owed
Wife
Husband
Shall Pay Shall Pay
Mortgages on real estate: (home)
$
$
$
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing, and
Other Relief with Dependent or Minor Child(ren) (07/13)
- 49 -
LIABILITIES: DESCRIPTION OF DEBT(S)(Please describe each item as Current
clearly as possible. You do not have to list account numbers.)
Amount
Owed
Wife
Husband
Shall Pay Shall Pay
Charge/credit card accounts
Auto loan
Auto loan
Bank/Credit Union loans
Money owed (not evidenced by a note)
Other
SECTION II. TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME
[Choose all that apply]
1. ____ ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the
dwelling located at: {address}
until: {date or event} ________________________________________________________.
2. ____ ( ) Petitioner ( ) Respondent may make a visit to the premises described in the
paragraph above for the purpose of obtaining his or her clothing and items of personal health
and hygiene and to obtain any items awarded in this order. This visit shall occur after notice to
the person granted temporary exclusive use and possession of the dwelling and at the earliest
convenience of both parties.
3. ____ Other: ____________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
SECTION III. TEMPORARY PARENTAL RESPONSIBILITY AND TIME-SHARING WITH DEPENDENT OR
MINOR CHILD(REN)
1. Jurisdiction. The Court has jurisdiction to determine temporary parental responsibility and
time-sharing for the parties’ minor child(ren) listed in paragraph 2 below.
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing, and
Other Relief with Dependent or Minor Child(ren) (07/13)
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2. The parties’ dependent or minor child(ren) is (are):
Name
Birth date
3. Temporary Parental Responsibility for the Minor Child(ren).
[Choose only one]
a. ____ The parties shall have temporary shared parental responsibility for the parties’
minor child(ren).
b. ____ ( ) Mother ( ) Father shall have temporary sole parental responsibility for the
parties’ minor child(ren). Temporary shared parental responsibility would be
detrimental
to
the
child(ren)
at
this
time
because:
_____________________________________
________________________________________________________________
___________________________________________________________________.
c. ____( ) Mother ( ) Father shall have ultimate decision making authority regarding the
following: __________________________________________________________
___________________________________________________________________
___________________________________________________________________.
Other provisions: _________________________________________________________
______________________________________________________________________
________________________________________________________________________
4. Temporary Time-sharing Schedule with Minor Child(ren). The parent(s) shall have:
[Choose only one]
a. ___ reasonable time-sharing schedule with the parties’ minor child(ren) as agreed to by the
parties, subject to any limitations in paragraph 5 below. The Court reserves jurisdiction to
set a specific schedule.
b. ___the following specified time-sharing schedule with the parties’ minor child(ren), subject
to any limitations set out in paragraph 5 below: {specify days and times} ______________
___________________________________________________________________________
Mother’s Temporary Time-Sharing Schedule .
___________________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing, and
Other Relief with Dependent or Minor Child(ren) (07/13)
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___________________________________________________________________________
___________________________________________________________________________
Father’s Temporary Time-sharing Schedule.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
c. ___ Time-sharing in accordance with the temporary Parenting Plan attached as Exhibit ___.
d. ___ ( ) Mother ( ) Father shall have no contact with the parties’ minor child(ren) until
further order of the Court, due to the existing conditions that are detrimental to the welfare
of the minor child(ren): {explain}: _____________________________________________
______________________________________________________________
______________________________________________________________________________.
5. Limitations on Time-sharing. Neither parent shall take the child(ren) from the other parent, any
child care provider, or other person entrusted by the other parent with the care of the child(ren)
without the agreement of the other party during the other party’s time-sharing. The above
time-sharing shall be:
[Choose if applicable]
a. ____ supervised by a responsible adult who is mutually agreeable to the parties. If the
parties cannot agree, the supervising adult shall be: {name} __________________________.
b. ____ at a supervised visitation center located at: {address} __________________________
______________________________________________________________________,
subject to the available times and rules of the supervised visitation center. The cost of such
visits shall be paid by ( ) Mother ( ) Father ( ) Both.
6. Communication Arrangements, Parental Responsibility and Time-sharing with Minor
Child(ren).
[Choose if applicable]
____ The parties’ communications to arrange time-sharing and discuss issues relating to the
child(ren) (if temporary shared parenting, or time-sharing is provided in paragraph 3 above) are
restricted as follows: ( ) telephone, ( ) fax, ( ) e-mail, or ( ) letter. ( ) A responsible person
shall coordinate the time-sharing arrangements of the minor child(ren). If the parties cannot
agree, the responsible person shall be: {name} ___________________________________.
( ) other conditions for arrangements or discussions: {explain} ______________________
________________________________________________________________________
________________________________________________________________________.
7. Exchange of Minor Child(ren). The exchange of the minor child(ren) shall be on time as
scheduled and as agreed to by the parties. The following conditions, if checked below, shall also
apply.
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing, and
Other Relief with Dependent or Minor Child(ren) (07/13)
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[Choose all that apply]
a. ____ The parties shall temporarily exchange the child(ren) at the following location(s):
_____________________________________________________________________.
b. ____ ( ) Mother ( ) Father shall not get out of the vehicle, and the other parent shall
not approach the vehicle, during the time the child(ren) are exchanged.
c. ____ A responsible person shall conduct all exchanges of the child(ren). ( ) Mother
(
) Father shall not be present during the exchange. If the parties cannot agree, the
responsible person shall be: {name}
__________________________________________
d. ____ Other conditions for exchange of the child(ren) are as follows: ________________
________________________________________________________________________
______________________________________________________________________
_______________________________________________________________________.
8. ____ Injunction Prohibiting Removing the Child(ren). The Court hereby temporarily prohibits
and enjoins the ( ) Mother ( ) Father ( ) Both from removing the minor child(ren) from the
State of Florida without a court order or the written consent of the other party.
9. ____ Other Temporary Provisions Relating to the Minor Child(ren).
_________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
___________________________________________________________________________.
SECTION IV. TEMPORARY ALIMONY
1.
____ The Court denies the request(s) for temporary alimony.
OR
2.
____ The Court finds that there is a need for, and that ( ) Petitioner ( ) Respondent,
hereinafter Obligor, has/had the present ability to pay temporary alimony as follows:
[Choose all that apply]
a. ____ Temporary Periodic. Obligor shall pay temporary periodic alimony to Obligee in the
amount of $
per month, payable ( ) in accordance with Obligor’s employer’s
payroll cycle, and in any event, at least once a month ( ) other {explain} _____________
_______________________, beginning {date} ____________. This temporary periodic alimony shall
continue until modified by court order, the death of either party, or until,
____________________________________, {date or event} whichever occurs first.
b. ____ Retroactive. Obligor shall pay retroactive alimony in the amount of $
__ for
the period of {date}
_____ through {date}
________________,
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing, and
Other Relief with Dependent or Minor Child(ren) (07/13)
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which shall be paid pursuant to paragraph 4 below.
3.
Reasons for Awarding/Denying Temporary Alimony Award.
The reasons for
awarding/denying temporary alimony are as follows:
a. ____ length of the marriage of the party receiving temporary alimony: years________;
b. ____ age of party receiving temporary alimony: _______ years;
c. ____ health of party receiving temporary alimony: ( ) excellent ( ) good ( ) poor
( ) other______________________________________________________________;
d. ____ other factors ___________________________________________________________
___________________________________________________________________________
______________________________________________________________________________.
____ Please indicate here if additional pages are attached.
4. Retroactive Alimony. ( ) Petitioner ( ) Respondent shall pay to the other party the temporary
retroactive alimony of $
, as of {date} _____________. This amount shall be paid in
the amount of $
per month, payable in accordance with Obligor’s employer’s payroll
cycle, and in any event at least once a month ( ) other {explain} ________________________
beginning: {date}
_________, until paid in full including statutory interest.
5. Insurance.
[Choose all that apply]
a. ____ Health Insurance. ( ) Petitioner ( ) Respondent shall temporarily be required to
pay health insurance premiums for the other party not to exceed $
per month.
Further, ( ) Petitioner ( ) Respondent shall pay any reasonable and necessary uninsured
medical costs for the other party not exceed $
per year. As to these uninsured
medical expenses, the party who is entitled to reimbursement of the uninsured medical
expense shall submit request for reimbursement to the other party within 30 days, and the
other party shall, within 30 days after receipt, submit the applicable reimbursement for that
expense.
b.____ Life Insurance (to secure payment of support). To secure the temporary alimony
obligations set forth in this order, the Obligor shall temporarily maintain life insurance on
his/her life, naming the Obligee as the sole irrevocable beneficiary, so long as reasonably
available. This temporary insurance shall be in the amount of at least $
and shall
remain in effect until this temporary obligation for alimony terminates.
6. ____Other provisions relating to temporary alimony including any tax treatment and
consequences: ______________________________________________________________
_________________________________________________________________________
__________________________________________________________________________.
SECTION V. TEMPORARY CHILD SUPPORT
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing, and
Other Relief with Dependent or Minor Child(ren) (07/13)
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1.
The Court finds that there is a need for temporary child support and that the ( )
Mother
( ) Father (hereinafter Obligor) has the present ability to pay child support.
____The amounts in the Child Support Guidelines Worksheet, Florida Family Law Rules of
Procedure Form 12.902(e), filed by the ( ) Mother ( ) Father are correct
OR
____The Court makes the following findings:
The Mother’s net monthly income is $
.
The Father’s net monthly income is $
.
Monthly child care costs are $
.
Monthly health/dental insurance costs are $
.
2. Amount.
Child support established at the rate of $_________per month for the _____children {total
number of minor or dependent children} shall be paid commencing ___________________
{month, day, year} and terminating _________________________ {month, day, year}. Child
support shall be paid in the amount of $___________ per __________ {week, month, other}
which is consistent with the Obligor’s current payroll cycle.
Upon termination of the obligation of child support for one of the parties’ children, child
support in the amount of $_________ for the remaining ______children {number of
remaining children} shall be paid commencing _________________ {month, day, year} and
terminating _______________________ {month, day, year}. This child support shall be paid in
the amount of $ ________ per __________ {week, month, other} consistent with Obligor’s
current payroll cycle.
{Insert schedule for the child support obligation, including the amount, and commencement
and termination dates, for the remaining minor or dependent children, which shall be payable
as the obligation for each child ceases. Please indicate whether the schedule ____appears
below or____ is attached as part of this form}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
The Obligor shall pay child support until all of the minor or dependent children: reach the age of
18; become emancipated, marry, join the armed services, die, or become self-supporting; or
until further order of the court or agreement of the parties. The child support obligation shall
continue beyond the age of 18 and until high school graduation for any child who is: dependent
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing, and
Other Relief with Dependent or Minor Child(ren) (07/13)
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in fact; between the ages of 18 and 19; and is still in high school, performing in good faith with a
reasonable expectation of graduation before age 19.
If the temporary child support ordered deviates from the guidelines by more than 5%, the factual
findings which support that deviation are: ____________________________________________
______________________________________________________________________________
_______________________________________________________________________________.
3. Retroactive Child Support.
[Choose if applicable]
( ) Mother ( ) Father shall pay to the other party the temporary retroactive child support of
$
, as of {date}
. This amount shall be paid in the amount of $
per month, payable in accordance with Obligor’s employer’s payroll cycle, and in any event at least
once a month ( ) other {explain}
_________________________________________,
beginning {date}
, until paid in full including statutory interest.
4. Insurance.
[Choose all that apply]
Health/Dental Insurance. ____ Mother ____ Father shall be required to temporarily maintain
( ) health ( ) dental insurance for the parties’ minor child(ren), so long as reasonable in cost
and accessible to the child(ren). The party providing insurance shall be required to convey cards
showing coverage to the other party.
OR
( ) Health (
time.
) dental insurance is not reasonable in cost or accessible to the child(ren) at this
Reasonable and necessary uninsured medical/dental/prescription drug costs for the minor
child(ren) shall temporarily be assessed as follows:
( ) Shared equally by both parents.
( ) Prorated according to the child support guideline percentages.
( ) Other {explain}:
As to these uninsured medical/dental/prescription drug expenses, the party who incurs the
expense shall submit request for reimbursement to the other party within 30 days, and the
other party, within 30 days of receipt, shall submit the applicable reimbursement for that
expense, according to the schedule of reimbursement set out in this paragraph.
5. ____Life Insurance (to secure payment of support). To secure the temporary child support
obligations in this order, ( ) Petitioner ( ) Respondent ( ) Each party shall temporarily
maintain life insurance, in an amount of at least $
__, on ( ) his life ( ) her life
( ) his/her life naming the ( ) minor child(ren) as the beneficiary (ies) OR naming the
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing, and
Other Relief with Dependent or Minor Child(ren) (07/13)
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( ) Mother ( ) Father ( ) other {name}: ___________________________________ as trustee
for the minor child(ren), so long as reasonably available. The obligation to maintain the life
insurance coverage shall continue until the Court orders otherwise or until {date/event}
___________________________________________________________________________
___________________________________________________________________________.
6. IRS Income Tax Deduction(s). The assignment of any tax deduction for the child(ren) shall be as
follows:
______________________________________________________________________________.
7. ____Other provisions relating to temporary child support: ____________________________
______________________________________________________________________________
__________________________________________________________________________
_________________________________________________________________________.
SECTION VI. METHOD OF PAYMENT
Obligor shall pay any temporary court-ordered child support/alimony and arrears, if any, as follows:
1. Place of Payment
a. ____ Obligor shall pay temporary court-ordered support directly to either the State
Disbursement Unit or the central depository, as required by statute, along with any fee
required by statute.
OR
b. ____ Both parties have requested, and the court finds that it is in the best interests of the
child(ren), that temporary support payments need not be directed through either the State
Disbursement Unit or the central depository at this time; however, either party may
subsequently apply, pursuant to section 61.13(1)(d)3, Florida Statutes, to require payments
through either the State Disbursement Unit or the central depository.
2. Income Deduction.
_____ Immediate. Obligor shall pay through income deduction, pursuant to a separate Income
Deduction Order which shall be effective immediately. Obligor is individually responsible for
paying this temporary support obligation until all of said support is deducted from Obligor’s
income. Until temporary support payments are deducted from Obligor’s paycheck, Obligor is
responsible for making timely payments directly to the State Disbursement Unit or the Obligee,
as previously set forth in this order.
_____ Deferred. Income deduction is ordered this day, but it shall not be effective until a
delinquency of $
, or, if not specified, an amount equal to one month’s obligation
occurs. Income deduction is not being implemented immediately based on the following
findings: Income deduction is not in the best interests of the child(ren) because: {explain}
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing, and
Other Relief with Dependent or Minor Child(ren) (07/13)
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______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
AND
there is proof of timely payment of a previously ordered obligation without an income
deduction order in cases of modification,
AND
( ) there is an agreement by the Obligor to advise the Title IV-D agency, the clerk of court,
and the Obligee of any change in Payor and/or health insurance OR ( ) there is a signed written
agreement providing an alternative arrangement between the Obligor and the Obligee and, at
the option of the IV-D agency, by the IV-D agency in IV-D cases in which there is an assignment
of support rights to the state, reviewed and entered in the record by the court.
3. Bonus/one-time payments. ( ) All ( )
% ( ) No income paid in the form of a bonus or
other similar one-time payment, up to the amount of any arrearage or the remaining balance
thereof owed pursuant to this order, shall be forwarded to the Obligee pursuant to the payment
method prescribed above.
4. Other provisions relating to method of payment. _____________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
SECTION VII. TEMPORARY ATTORNEY’S FEES, COSTS, AND SUIT MONEY
1. ____ ( ) Petitioner’s ( ) Respondent’s request(s) for temporary attorney’s fees, costs, and suit
money is (are) denied because ___________________________________________________
___________________________________________________________________________
____________________________________________________________________________.
2. ____ The Court finds there is a need for and an ability to pay temporary attorney’s fees, costs,
and suit money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the other party
$
in temporary attorney’s fees, and $
in costs. The Court further finds
that the temporary attorney’s fees awarded are based on the reasonable rate of $
per hour and
reasonable hours. Other provisions relating to temporary attorney’s fees,
costs, and suit money are as follows: _____________________________________________
___________________________________________________________________________
___________________________________________________________________________.
SECTION VIII. OTHER PROVISIONS
Other Provisions:
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing, and
Other Relief with Dependent or Minor Child(ren) (07/13)
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DONE AND ORDERED at _______________________, Florida on {date} _______________________.
_______________________________________
CIRCUIT JUDGE
A copy of the {name of document(s)} ______________________________________ was
[Choose one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the parties listed below on
{date}_________________________.
Petitioner (or his or her attorney)
Respondent (or his or her attorney)
State Disbursement Unit
Central depository
Other:
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support, Time-Sharing, and
Other Relief with Dependent or Minor Child(ren) (07/13)
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IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA
Case No: ________________________
Division: ________________________
_________________________________,
Petitioner,
and
_________________________________,
Respondent.
ORDER FOR TEMPORARY SUPPORT AND OTHER RELIEF
WITH NO DEPENDENT OR MINOR CHILD(REN)
This cause came before this Court for a hearing on a Motion for Temporary Support and Other Relief
with No Dependent or Minor Child(ren). The Court, having reviewed the file and heard the testimony,
makes these findings of fact and ORDERS as follows:
The Court has jurisdiction over the subject matter and the parties.
SECTION I. MARITAL ASSETS AND LIABILITIES
A. Injunction.
1. ( ) Petitioner ( ) Respondent is (are) prohibited and enjoined from disposing of any marital
assets without the written permission of the other party or a court order. If indicated here ( ),
the person(s) prohibited and enjoined from disposing of any marital assets may continue to pay
all ordinary and usual expenses.
2. The Court may enforce compliance with the terms of this injunction through civil and/or indirect
criminal contempt proceedings, which may include arrest, incarceration, and/or the imposition
of a fine.
3. Violation of this injunction may constitute criminal contempt of court.
4. Bond. This order is conditioned upon ( ) Petitioner ( ) Respondent posting bond in the sum of
$__________ with the clerk of this Court.
B. Temporary Use of Assets.
1. The assets listed below are temporarily determined to be marital assets. Each party shall
temporarily have the use of, as his/her own, the assets awarded in this section, and the other
party shall temporarily have no further use of said assets. Any personal property not listed
Florida Supreme Court Approved Family Law Form 12.947(d), Order for Temporary Support and Other Relief With
No Dependent or Minor Child(ren) (07/13)
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below shall be for the use of party currently in possession of that item(s), and he or she may
not dispose of that item(s) without the written permission of the other party or a court order.
ASSETS: DESCRIPTION OF ITEM(S)
(Please describe each item as clearly as possible. You do not need to list
account numbers.)
Wife Shall Husband
Shall Have
Have
Temporary
Temporary
Use
Use
Automobiles
Furniture & furnishings in home
Furniture & furnishings elsewhere
Jewelry
Business interests
Other Assets
C.
Temporary Responsibility for Liabilities/Debts.
1. The liabilities listed below are temporarily determined to be marital. Each party shall pay as his
or her own the marital liabilities indicated below and shall keep said payments current. The
other party shall temporarily have no further responsibility for the payment of these debts.
Florida Supreme Court Approved Family Law Form 12.947(d), Order for Temporary Support and Other Relief With
No Dependent or Minor Child(ren) (07/13)
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LIABILITIES: DESCRIPTION OF DEBT(S)
(Please describe each item as clearly as possible. You do not need
to list account numbers.)
Mortgages on real estate: (home)
Current
Amount
Owed
$
Wife
Husband
Shall Pay Shall Pay
$
$
Charge/credit card accounts
Auto loan
Auto loan
Bank/Credit Union loans
Money owed (not evidenced by a note)
Other
SECTION II. TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME
[ Choose all that apply]
1. ____ ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the
dwelling located at: {address}
until {date or event}
.
2. ____ ( ) Petitioner ( ) Respondent may make a visit to the premises described in the
paragraph above for the purpose of obtaining his or her clothing and items of personal health
and hygiene and to obtain any items awarded in this order. This visit shall occur after notice to
the person granted temporary exclusive use and possession of the dwelling and at the earliest
convenience of both parties.
Florida Supreme Court Approved Family Law Form 12.947(d), Order for Temporary Support and Other Relief With
No Dependent or Minor Child(ren) (07/13)
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3. ____Other:
.
SECTION III. TEMPORARY ALIMONY
1. ____ The Court denies the request(s) for temporary alimony.
OR
2. ____ The Court finds that there is a need for, and that ( ) Petitioner ( ) Respondent,
hereinafter Obligor, has/had the present ability to pay, temporary alimony as follows:
[Choose all that apply]
a. ____ Temporary Periodic. Obligor shall pay temporary periodic alimony to Obligee in the
amount of $__________ per month, payable ( ) in accordance with Obligor’s employer’s
payroll cycle, and in any event, at least once a month ( ) other {explain}
____________
______________________________________________________________________,
beginning {date} ________________. This temporary periodic alimony shall continue until
modified by court order, the death of either party, or until , _______________________
_________________________________________{date or event} whichever occurs first.
b. ____ Retroactive. Obligor shall pay retroactive alimony in the amount of $__________ for
the period of {date} ___________________ through {date} _______________________,
which shall be paid pursuant to paragraph 4 below.
3. Reasons for Awarding/Denying Temporary Alimony Award. The reasons for awarding/denying
temporary alimony are as follows:
a.
____ length of the marriage of the party receiving temporary alimony:
years;
b. ____ age of party receiving temporary alimony:
;
c.
____ health of party receiving temporary alimony: ( ) excellent ( ) good ( ) poor ( )
other
;
d.
____ other factors
____ Please indicate here if additional pages are attached.
4. Retroactive Alimony. ( ) Petitioner ( ) Respondent shall pay to the other party the temporary
retroactive alimony of $__________, as of {date} _____________. This amount shall be paid in
the amount of $__________ per month, payable in accordance with Obligor’s employer’s payroll
cycle, and in any event at least once a month ( ) other {explain}: ______________________
,
beginning {date} ____________________________, until paid in full including statutory interest.
5. Insurance.
[Choose all that apply]
Florida Supreme Court Approved Family Law Form 12.947(d), Order for Temporary Support and Other Relief With
No Dependent or Minor Child(ren) (07/13)
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a. ___ Health Insurance. ( ) Petitioner ( ) Respondent shall temporarily be required to pay
health insurance premiums for the other party not to exceed $__________ per month.
Further, ( ) Petitioner ( ) Respondent shall pay any reasonable and necessary uninsured
medical costs for the other party not exceed $__________ per year. As to these uninsured
medical expenses, the party who is entitled to reimbursement of the uninsured medical
expense shall submit request for reimbursement to the other party within 30 days, and the
other party shall, within 30 days after receipt, submit the applicable reimbursement for that
expense.
b. ___ Life Insurance (to secure payment of support). To secure the temporary alimony
obligations set forth in this order, the Obligor shall temporarily maintain any existing life
insurance coverage on his/her life naming the Obligee as the sole irrevocable beneficiary, so
long as reasonably available. This temporary insurance shall be in the amount of at least
$__________ and shall remain in effect until this temporary obligation for alimony
terminates.
6. ____ Other provisions relating to temporary alimony including any tax treatment and
consequences: _________________________________________________________________
SECTION IV. METHOD OF PAYMENT
Obligor shall pay any temporary court-ordered alimony and arrears, if any, as follows:
1. Place of Payment.
a. ____ Obligor shall pay temporary court-ordered support directly to either the State
Disbursement Unit or the central depository, as required by statute, along with any fee required
by statute.
OR
b. ____ Both parties have requested and the court finds that temporary support payments need
not be directed through either the State Disbursement Unit or the central depository at this
time; however, either party may subsequently apply, pursuant to section 61.13(1)(d)3, Florida
Statutes, to require payments through either the State Disbursement Unit or the central
depository.
2. Income Deduction.
[ if applicable]
a. ____ Immediate. Obligor shall pay through income deduction, pursuant to a separate
Income Deduction Order which shall be effective immediately. Obligor is individually
responsible for paying this temporary support obligation until all of said support is deducted
from Obligor’s income. Until support payments are deducted from Obligor’s paycheck,
Obligor is responsible for making timely payments directly to the State Disbursement Unit or
the Obligee, as previously set forth in this order.
Florida Supreme Court Approved Family Law Form 12.947(d), Order for Temporary Support and Other Relief With
No Dependent or Minor Child(ren) (07/13)
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b. ____ Deferred. Income deduction is ordered this day, but it shall not be effective until a
delinquency of $___________, or, if not specified, an amount equal to one month’s
obligation occurs. Income deduction is not being implemented immediately based on the
following findings: there are no minor child(ren) common to the parties,
AND
there is proof of timely payment of a previously ordered obligation without an income deduction order
in cases of modification,
AND
( ) there is an agreement by the Obligor to advise the Title IV-D agency, the clerk of court, and the
Obligee of any change in Payor and/or health insurance OR ( ) there is a signed written agreement
providing an alternative arrangement between the Obligor and the Obligee and, at the option of the IVD agency, by the IV-D agency in IV-D cases in which there is an assignment of support rights to the state,
reviewed and entered in the record by the court.
3. Bonus/one-time payments. ( ) All ( ) __________% ( ) No income paid in the form of a
bonus or other similar one-time payment, up to the amount of any arrearage or the remaining
balance thereof owed pursuant to this order, shall be forwarded to the Obligee pursuant to the
payment method prescribed above.
4. Other provisions relating to method of temporary payment: ____________________________
.
SECTION V. TEMPORARY ATTORNEY’S FEES, COSTS, AND SUIT MONEY
1. ____ ( ) Petitioner’s ( ) Respondent’s request(s) for temporary attorney’s fees, costs, and suit
money is (are) denied because
.
2. ____ The Court finds there is a need for and an ability to pay temporary attorney’s fees, costs,
and suit money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the other party
$__________ in temporary attorney’s fees, and $__________ in costs. The Court further finds
that the temporary attorney’s fees awarded are based on the reasonable rate of $__________
per hour and _____reasonable hours. Other provisions relating to temporary attorney fees,
costs, and suit money are as follows:
SECTION VI. OTHER PROVISIONS
Other Provisions:
Florida Supreme Court Approved Family Law Form 12.947(d), Order for Temporary Support and Other Relief With
No Dependent or Minor Child(ren) (07/13)
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.
DONE AND ORDERED in _______________________, Florida, on {date} __________________.
____________________________________________
CIRCUIT JUDGE
COPIES TO:
Petitioner (or his or her attorney)
Respondent (or his or her attorney)
State Disbursement Unit
Other:
Florida Supreme Court Approved Family Law Form 12.947(d), Order for Temporary Support and Other Relief With
No Dependent or Minor Child(ren) (07/13)
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IN THE CIRCUIT COURT OF THE
IN AND FOR
JUDICIAL CIRCUIT,
COUNTY, FLORIDA
Case No.:
Division:
,
Petitioner,
and
,
Respondent.
FINAL JUDGMENT OF PATERNITY
This cause came before the Court upon a Petition to Determine Paternity and for Related Relief, under
chapter 742, Florida Statutes. The Court having reviewed the file and having heard the testimony,
makes these findings of fact and reaches these conclusions of law:
1. The Court has jurisdiction of the subject matter and the parties.
2. Paternity. [Choose only one] ( ) By operation of law, ( ) The Court finds that
{full legal name}
is the natural and biological father of the minor child(ren), listed below:
The parties’ dependent or minor child(ren) is (are):
Name
Birth date
SECTION I. PARENTAL RESPONSIBILITY AND PARENTING PLAN ESTABLISHING TIME-SHARING WITH
DEPENDENT OR MINOR CHILD(REN)
1. Jurisdiction. The Court has jurisdiction to determine parental responsibility and to adopt or
establish a Parenting Plan with time-sharing with regard to the child(ren) listed in paragraph 2
above.
2. Parental Responsibility and Parenting Plan for the Minor Child(ren).
[Choose only one]
a. ____Not adjudicated. Since no request for relief was made in this action, parental
Florida Supreme Court Approved Family Law Form 12.983(g), Final Judgment of Paternity (07/13)
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,
responsibility of and time-sharing with the minor child(ren) is governed by sections 742.031
and 744.301, Florida Statutes.
b. ____Parenting Plan. The parties shall comply with the Parenting Plan which is attached
hereto and incorporated herein as Exhibit ____.
SECTION II. CHILD SUPPORT
1. The Court finds that there is a need for child support and that the (
(hereinafter Obligor) has the present ability to pay child support.
) Mother (
) Father
_____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 $
The Father’s net monthly income is $
Monthly child care costs are $
__ .
Monthly health/dental insurance costs are $
_ , (Child Support Guidelines ____%).
__, (Child Support Guidelines ____%).
__.
2. Amount.
Child support established at the rate of $___________per month for the _______children {total number
of parties’ minor or dependent children} shall be paid commencing _________________ {month, day,
year} and terminating ___________________ {month, day, year}. Child support shall be paid in the
amount of $______ __ per _____ ______ {week, month, other} which is consistent with the Obligor’s
current payroll cycle.
Upon the termination of the obligation of child support for one of the parties’ oldest children, child
support in the amount of $__________for the remaining _____children {total number of remaining
children} shall be paid commencing __________________________ {month, day, year} and
terminating____________________________{month, day, year}. This child support shall be paid in the
amount of $_________ per ___________ {week, month, other} consistent with Obligor’s current payroll
cycle.
{Insert schedule for the child support obligation, including the amount, and commencement and
termination dates, for the remaining minor or dependent children, which shall be payable as the
obligation for each child ceases. Please indicate whether the schedule ____appears below or ____ is
attached as part of this form.}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.983(g), Final Judgment of Paternity (07/13)
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The Obligor shall pay child support until all of the minor or dependent children: reach the age of 18;
become emancipated, marry, join the armed services, die, or become self-supporting; or until further
order of the court or agreement of the parties. The child support obligation shall continue beyond the
age of 18 and until high school graduation for any child who is: dependent in fact; between the ages of
18 and 19; and is still in high school, performing in good faith, with a reasonable expectation of
graduation before the age of 19.
If the child support ordered deviates from the guidelines by more than 5%, the factual findings which
support that deviation are:
.
3. Arrearage/Retroactive Child Support.
a. ____There is no retroactive child support or arrearage at the time of this Final Judgment.
b. ____ ( ) Mother ( ) Father ( ) both has (have) incurred medical expenses in the
on behalf of the minor child(ren), including hospital and other
amount of $
expenses incidental to the birth of the minor child(ren). Petitioner shall pay
___%,
Respondent shall pay
__%, which shall be paid as follows: ( ) added to arrearage in
paragraph c below ( ) other {explain}
_________________________________________________________________________
__________________________________________________________________________
c. ____ ( ) Mother ( ) Father shall pay to the other party the child support arrearage of:
$________ for retroactive child support, as of {date}______________________________.
$
for previously ordered unpaid child support, as of {date} _________________.
$
for previously incurred medical expenses.
The total of $
in child support arrearage shall be repaid at the rate of $_____
per month, payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any event at least
once a month ( ) other {explain} ___________________________________
___________________________________________________________________________,
beginning {date} ________________________, until paid in full including statutory interest.
4. Insurance.
[Choose all that apply]
a. ___ Health/Dental Insurance. The ( ) Mother ( ) Father shall be required to maintain:
( ) health and/or (
) dental insurance for the parties’ minor child(ren), so long as it is reasonable in
cost and accessible to the child(ren). The party providing insurance shall be required to convey
insurance cards demonstrating said coverage to the other party;
OR
( ) health ( ) dental insurance is not reasonable in cost or accessible to the child(ren) at this time.
b. ____ Reasonable and necessary uninsured medical/dental/prescription drug costs for the
Florida Supreme Court Approved Family Law Form 12.983(g), Final Judgment of Paternity (07/13)
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minor child(ren) shall be assessed as follows:
) Shared equally by both parents.
) Prorated according to the child support guideline percentages.
) Other {explain}: _______________________________________________________
_____________________________________________________________________
As to these uninsured medical/dental/prescription drug expenses, the party who incurs the expense
shall submit request for reimbursement to the other party within 30 days, and the other party, within 30
days of receipt, shall submit the applicable reimbursement for that expense, according to the schedule
of reimbursement set out in this paragraph.
(
(
(
5. ____Life Insurance (to secure payment of support). To secure the child support obligations in
this judgment, ( ) Mother ( ) Father ( ) each party shall maintain life insurance coverage,
in an amount of at least $
_, on ( ) his life ( ) her life ( ) his/her life naming
the ( ) minor child(ren) as the beneficiary(ies) OR naming the ( ) Mother ( ) Father ( )
other {name} ____________________________________as Trustee for the minor child(ren), so
long as reasonably available. The obligation to maintain the life insurance coverage shall
continue until the youngest child turns 18, becomes emancipated, marries, joins the armed
services, dies, or otherwise becomes self-supporting.
6. IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall
be as follows: ___________________________________________________________________
.
Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of this
paragraph.
7. Other provisions relating to child support: ___________________________________________
SECTION III. METHOD OF PAYMENT
Obligor shall pay court-ordered child support/alimony and arrears, if any, as follows:
1. Place of Payment
a. ____Obligor shall pay court-ordered support directly to either the State Disbursement Unit,
or the central depository, as required by statute, along with any fee required by statute.
OR
b. ____Both parties have requested and the court finds that it is in the best interests of the
child(ren) that support payments need not be directed through either the State
Disbursement Unit or the central depository at this time; however, either party may
subsequently apply, pursuant to section 61.13(1)(d)3, Florida Statutes, to require payments
through either the State Disbursement Unit or the central depository.
Florida Supreme Court Approved Family Law Form 12.983(g), Final Judgment of Paternity (07/13)
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2. Income Deduction.
a. ____Immediate. Obligor shall pay through income deduction, pursuant to a separate
Income Deduction Order which shall be effective immediately. Obligor is individually
responsible for paying this support obligation until all of said support is deducted from
Obligor’s income. Until support payments are deducted from Obligor’s paycheck, Obligor is
responsible for making timely payments directly to the State Disbursement Unit or the
Obligee, as previously set forth in this order.
b. ____Deferred. Income deduction is ordered this day, but it shall not be effective until a
, or, if not specified, an amount equal to one month’s obligation
delinquency of $
occurs. Income deduction is not being implemented immediately based on the following
findings: Income deduction is not in the best interests of the child(ren) because: {explain}
,
AND
there is proof of timely payment of a previously ordered obligation without an income deduction order
in cases of modification,
AND
( ) there is an agreement by the Obligor to advise the Title IV-D agency, the clerk of court, and the
Obligee of any change in Payor and/or health insurance OR (
) there is a signed written agreement
providing an alternative arrangement between the Obligor and the Obligee and, at the option of the IVD agency, by the IV-D agency in IV-D cases in which there is an assignment of support rights to the state,
reviewed and entered in the record by the court.
3. Bonus/one-time payments. ( ) All ( )
% ( ) No income paid in the form of a bonus
or other similar one-time payment, up to the amount of any arrearage or the remaining balance
thereof owed pursuant to this order, shall be forwarded to Obligee pursuant to the payment
method prescribed above.
4. Other provisions relating to method of payment.
________________________________
.
SECTION IV. CHILD(REN)’S NAME(S)
a. ____There shall be no change to the child(ren)’s name(s).
b. ____It is in the child(ren)’s best interests that the child(ren)’s present name(s):
(1)
(2)
(3)
(4)
_______________________________
_______________________________
_______________________________
________________________________
Florida Supreme Court Approved Family Law Form 12.983(g), Final Judgment of Paternity (07/13)
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(5) _______________________________
(6) ________________________________
shall be changed to the following by which they shall hereafter be known:
(1) _________________________________
(2) ________________________________
(3) ________________________________
(4) ________________________________
(5) ________________________________
(6) ________________________________
c. The name change is in the best interest(s) of the child(ren) because:__________________
________________________________________________________________________
SECTION V. ATTORNEY’S FEES, COSTS, AND SUIT MONEY
1. ( ) Petitioner’s ( ) Respondent’s request(s) for attorney’s fees, costs, and suit money is (are)
denied because
.
2. ____The Court finds there is a need for and an ability to pay attorney’s fees, costs, and suit
money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the other party
in attorney’s fees, and $
in costs. The Court further finds that the
$
per hour and
attorney’s fees awarded are based on the reasonable rate of $
reasonable hours. Other provisions relating to attorney’s fees, costs, and suit money
are as follows:__________________________________________________________________
______________________
(
3. The costs of the scientific paternity testing shall be assessed:
) against Petitioner ( ) against Respondent ( ) Other {explain}
SECTION VI. OTHER PROVISIONS
1. Other Provisions.
The Court reserves jurisdiction to modify and enforce this Final Judgment.
Florida Supreme Court Approved Family Law Form 12.983(g), Final Judgment of Paternity (07/13)
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.
DONE AND ORDERED at _____________________, Florida, on
.
CIRCUIT JUDGE
COPIES TO:
Petitioner (or his or her attorney)
Respondent (or his or her attorney)
Central depository
State Disbursement Unit
_ Other: _______________________________________
I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the
County, Florida, and that I have furnished copies of this order as
Circuit Court of
indicated above.
CLERK OF THE CIRCUIT COURT
(SEAL)
By:
Deputy Clerk
Florida Supreme Court Approved Family Law Form 12.983(g), Final Judgment of Paternity (07/13)
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IN THE CIRCUIT COURT OF THE
IN AND FOR
JUDICIAL CIRCUIT,
COUNTY, FLORIDA
Case No.:_______________
Division: _______________
In re the Marriage of:
,
Husband,
and
,
Wife.
FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE
WITH DEPENDENT OR MINOR CHILD(REN)
This cause came before this Court for a trial on a Petition for Dissolution of Marriage. The Court, having
reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of
law:
1. The Court has jurisdiction over the subject matter and the parties.
2. At least one party has been a resident of the State of Florida for more than 6 months immediately
before filing the Petition for Dissolution of Marriage.
3. The marriage between the parties is irretrievably broken. Therefore, the marriage between the
parties is dissolved, and the parties are restored to the status of being single.
SECTION I. MARITAL ASSETS AND LIABILITIES
A. Date of Valuation of Property. The assets and liabilities listed below are divided as indicated. The
date of valuation of these assets and liabilities is, unless otherwise indicated:
a. ___ date of filing petition for dissolution of marriage.
b. ___ date of separation.
c. ___ date of final hearing .
d. ___ other: {specify date}_____________________________________________
B. Division of Assets.
1. The assets listed below are nonmarital assets. Each party shall keep, as his or her own, the
assets found to be nonmarital, and the other party shall have no further rights or responsibilities
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (07/13)
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regarding these assets.
Husband’s
NonMarital
Property
$
$
$
Total Nonmarital Assets
Wife’s
Nonmarital
Property
$
ASSETS: DESCRIPTION OF ITEM(S)
(Please describe each item as clearly as possible. You do not need
to list account numbers.)
Current
Fair
Market
Value
$
$
2. The assets listed below are marital assets. Each party shall keep, as his or her own, the assets
awarded in this section, and the other party shall have no further rights or responsibilities regarding
these assets. Any personal item(s) not listed below are awarded to the party currently in
possession or control of the item(s).
ASSETS: DESCRIPTION OF ITEM(S)
(Please describe each item as clearly as possible. You do not need
to list account numbers.)
Current
Fair
Market
Value
$
Cash (on hand or in banks/credit unions)
Wife
Shall
Receive
$
Husband
Shall
Receive
$
Stocks/bonds
Notes
Business interests
Real estate: (Home)
Automobiles
Boats
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (07/13)
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Current
Fair
Market
Value
ASSETS: DESCRIPTION OF ITEM(S)
(Please describe each item as clearly as possible. You do not need
to list account numbers.)
Wife
Shall
Receive
Husband
Shall
Receive
Furniture & furnishings
Jewelry
Life Insurance (cash surrender value)
Retirement Plans (Profit sharing, Pension, IRA, 401(k)(s) etc)
Other assets
Total Marital Assets
$
$
$
C. Division of Liabilities/Debts.
1. The liabilities listed below are nonmarital liabilities and, therefore, are owed as indicated. Each
party shall owe, as his or her own, the liabilities found to be nonmarital, and the other party
shall have no responsibilities regarding these debts.
Current
Amount
Owed
Wife’s
NonMarital
Liability
Husband’s
NonMarital
Liability
$
LIABILITIES: DESCRIPTION OF DEBTS
(Please describe each item as clearly as possible. You do not need
to list account numbers.)
$
$
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (07/13)
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LIABILITIES: DESCRIPTION OF DEBTS
(Please describe each item as clearly as possible. You do not need
to list account numbers.)
Current
Amount
Owed
Wife’s
NonMarital
Liability
Husband’s
NonMarital
Liability
Total Nonmarital Liabilities
$
$
$
2. The liabilities listed below are marital liabilities and are divided as indicated. Each party shall
hold the other party harmless and pay, as his or her own, the marital liabilities awarded below.
LIABILITIES: DESCRIPTION OF DEBTS
(Please describe each item as clearly as possible. You do not need
to list account numbers.)
Current
Amount
Owed
Wife
Husband
Shall Pay Shall Pay
Mortgages on real estate: (Home)
$
$
$
(Other)
Charge/Credit card accounts
Auto loan
Auto loan
Bank. Credit Union loans
Other
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (07/13)
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LIABILITIES: DESCRIPTION OF DEBTS
(Please describe each item as clearly as possible. You do not need
to list account numbers.)
Current
Amount
Owed
Wife
Husband
Shall Pay Shall Pay
$
$
Total Marital Liabilities
$
D. Contingent assets and liabilities will be divided as follows: _________________________________
________________________________________________________________________________
________________________________________________________________________________
E. The distribution of assets and liabilities in this final judgment is equitable; if each party does not
receive approximately one-half, the distribution is based on the following facts and reasoning:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________.
SECTION II. EXCLUSIVE USE AND POSSESSION OF HOME
[Choose all that apply]
1. ____ ( ) Husband ( ) Wife, as a condition of support, shall have exclusive use and possession of
the dwelling located at the following
address:________________________________________________________________________
________________________________________________________________________________
until: {date or event} ______________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________.
2. ___ _ ( ) Husband ( ) Wife may make visits to the premises described in the paragraph above
for the purpose of obtaining any items awarded in this Final Judgment. These visits shall occur after
notice to the person granted exclusive use and possession of the dwelling and at the earliest
convenience of both parties or as ordered in paragraph 4 below.
3. ____Upon the termination of the right of exclusive use and possession, the dwelling shall be sold
and the net proceeds divided
_% to Husband and
_% to Wife, with the following credits
and/or setoffs being allowed:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (07/13)
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________________________________________________________________________________.
4. ____Other: ______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________.
SECTION III. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING WITH
DEPENDENT OR MINOR CHILD(REN)
1. Jurisdiction. The Court has jurisdiction to determine parental responsibility, to establish or adopt a
Parenting Plan, and a time-sharing schedule with regard to the minor child(ren) listed in paragraph 2
below.
2. The parties’ dependent or minor child(ren) is (are):
Name
Birth date
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
3. Parenting Plan. The parties shall comply with the Parenting Plan which is attached and incorporated
herein as Exhibit _____.
SECTION IV. ALIMONY
1. ____ The Court denies the request(s) for alimony;
OR
2. ____ The Court finds that ( ) Husband ( ) Wife, (hereinafter Obligee), has an actual need
for, and that ( ) Husband ( ) Wife (hereinafter Obligor) has the present ability to pay,
alimony as follows:
[Choose all that apply]
a._____Permanent Periodic.
1. The Court finds that no other form of alimony is fair and reasonable under the
circumstances of the parties.
2. As a marriage of: (Choose only one)
_______ Long Duration (17 years or greater) alimony is appropriate upon consideration of all
relevant factors;
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (07/13)
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_______Moderate Duration (greater than 7 years but less than 17) alimony is appropriate based
upon clear and convincing evidence after consideration of all relevant factors; or
_______Short Duration (less than 7 years) alimony is appropriate based upon the following
exceptional circumstances:________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
3. Obligor shall pay permanent periodic alimony to Obligee in the amount of $
per
month, payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any event, at
least once a month ( ) other {explain} ____________________________________________
______________________________________________________________________________
beginning {date} ___________________. This alimony shall continue until modified by court
order, the death of either party, or remarriage of Obligee, whichever occurs first. The alimony
may be modified or terminated based upon either a substantial change in circumstances, or the
existence of a supportive relationship in accordance with section 61.14, Florida Statutes.
b._____ Bridge-the-Gap. Obligor shall pay bridge-the-gap alimony to Obligee in the amount of
$________per month, payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any
event, at least once a month ( ) other {explain}_________________________________________
beginning {date}_____________________and continuing until {date}________________________
{a period not to exceed two (2) years}, death of either party, or remarriage of the Obligee, whichever
occurs first.
c.______Rehabilitative. Obligor shall pay rehabilitative alimony to Obligee in the amount of
$__________ per month, payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in
any event, at least once a month ( ) other {explain}_____________________________________
beginning {date}___________________. This rehabilitative alimony shall continue until modified by
court order, the death of either party or until {date/event} ________________________________,
whichever occurs first. The rehabilitative plan presented demonstrated the following: __________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________.
d._____Durational. Obligor shall pay durational alimony to Obligee in the amount of $_______
per month payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any event, at least
once a month ( ) other {explain}____________________________________________
beginning {date}_____________________and terminating on {date}______________________, the
death of either party, remarriage of the Obligee, or until modified by court order in accordance with
section 61.08(7), Florida Statutes, whichever occurs first.
e._____Lump Sum. Obligor shall pay lump sum alimony to Obligee in the amount of $________,
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
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which shall be paid as follows:_______________________________________________________.
f. _____Retroactive. Obligor shall pay retroactive alimony in the amount of $
for the period
of {date} _______________, through {date} __________________, which shall be paid pursuant to
paragraph 4 below.
3. Reasons for ( ) Awarding ( ) Denying Alimony. The Court has considered all of the following in
awarding/denying alimony:
a. The standard of living established during the marriage;
b. The duration of the marriage;
c. The age and the physical and emotional condition of each party;
d. The financial resources of each party, including the nonmarital and marital assets and
liabilities distributed to each;
e. The earning capacities, educational levels, vocational skills, and employability of the parties
and, when applicable, the time necessary for either party to acquire sufficient education or
training to enable such party to find appropriate employment;
f. The contribution of each party to the marriage, including, but not limited to, services rendered
in homemaking, child care, education, and career building of the other party;
g. The responsibilities each party will have with regard to any minor or dependent children they
have in common;
h. The tax treatment and consequences to both parties of any alimony award, including the
designation of all or a portion of the payment as a nontaxable, nondeductible payment;
i. All sources of income available to either party, including income available to either party
through investments of any asset held by that party and
j. Any other factor necessary to do equity and justice between the parties: {explain}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
_______ Please indicate here if additional pages are attached.
4. Arrearage/Retroactive Alimony.
a.____There is no alimony arrearage at the time of this Final Judgment.
OR
b. ____The ( ) Husband ( ) Wife shall pay to the other spouse the alimony arrearage of:
$
for retroactive alimony, as of {date}_______________________;
$
for previously ordered unpaid alimony, as of {date} _________________.
The total of $ ______ in alimony arrearage shall be repaid in the amount of $
_ _ per month,
payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any event at least once a
month ( ) other {explain} __________________________________________________________
_________________________________________________________________________________
__________________________________________________________________________________
beginning {date}____________________________, until paid in full including statutory interest.
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5. ____ Life Insurance (to secure payment of support). To secure the alimony obligations set forth
in this judgment, Obligor shall maintain life insurance on his/her life naming Obligee as the
sole irrevocable beneficiary, so long as reasonably available. This insurance shall be in the
amount of at least $_______ and shall remain in effect until the obligation for alimony
terminates.
6. ____Other provisions relating to alimony, including any tax treatment and consequences:
a. The award of alimony ( ) does not ( ) does leave the Obligor with significantly less net
income than the net income of the recipient/Obligee. If the award does leave the Obligor
with significantly less net income than that of the Obligee, the Court finds the following
exceptional circumstances:
_______________________________________________________________________
________________________________________________________________________
________________________________________________________________________.
b. Other_____________________________________________________________
__________________________________________________________________
__________________________________________________________________.
SECTION V. CHILD SUPPORT
1. The Court finds that there is a need for child support and that the (
(hereinafter Obligor) has the present ability to pay child support.
) Wife (
) Husband
The amounts in the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form
12.902(e), filed by the ( ) Wife ( ) Husband are correct;
OR
The Court makes the following findings:
The Wife’s net monthly income is $
__, (Child Support Guidelines ____%).
The Husband’s net monthly income is $
__, (Child Support Guidelines ____%).
Monthly child care costs are $
_____.
Monthly health/dental insurance costs are $
___.
2. Amount.
Child support established at the rate of $_________per month for the _______children {total
number of parties’ minor or dependent children} shall be paid commencing
__________________
{month, day, year} and terminating ________________________________ {month, day, year}. Child
support shall be paid in the amount of $________ per _______________ {week, month, other}
consistent with the Obligor’s current payroll cycle.
Upon the termination of the obligation of child support for one of the parties’ children, child support in
the amount of $__________for the remaining__________children {total number of remaining children}
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
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shall be paid commencing _______________________________ {month, day, year} and
terminating_____________________________ {month, day, year}. This child support shall be paid in the
amount of $________per __________ {week, month, other} consistent with the Obligor’s current payroll
cycle.
{Insert schedule for the child support obligation, including the amount, and commencement and
termination dates, for the remaining minor or dependent children, which shall be payable as the
obligation for each child ceases. Please indicate whether the schedule ____appears below or
____ is attached as part of this form.}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
The Obligor shall pay child support until all of the minor or dependent children: reach the age of 18;
become emancipated, marry, join the armed services, die, or become self-supporting; or until further
order of the court or agreement of the parties. The child support obligation shall continue beyond the
age of 18 and until high school graduation for any child who is: dependent in fact; between the ages of
18 and 19; and is still in high school, performing in good faith, with a reasonable expectation of
graduation before the age of 19.
If the child support ordered deviates from the guidelines by more than 5%, the factual findings which
support that deviation are: ____________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
3. Arrearage/Retroactive Child Support.
[Choose one only]
a. ____There is no child support arrearage at the time of this Final Judgment.
OR
b. ____The ( ) Wife ( ) Husband shall pay to the other spouse the child support arrearage of:
$
for retroactive child support, as of {date} ______________;
$
for previously ordered unpaid child support, as of {date}
______.
The total of $
in child support arrearage shall be repaid in the amount of
$
per month, payable ( ) in accordance with Obligor’s employer’s payroll cycle, and
in any event at least a month ( ) other {explain}
______________________________________________________________________________
______________________________________________________________________________
beginning {date}_________________________, until paid in full including statutory interest.
4. Insurance.
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (07/13)
- 83 -
[Choose all that apply]
a. ____Health/Dental Insurance. ( ) Wife ( ) Husband shall be required to maintain ( ) health
and/or ( ) dental insurance for the parties’ minor child(ren), so long as reasonable in cost and
accessible to the child(ren). The party providing insurance shall be required to convey insurance
cards demonstrating said coverage to the other party;
OR
( ) health and/or ( ) dental insurance is not reasonable in cost or accessible to the child(ren)
at this time.
b. ___Reasonable and necessary uninsured medical/dental/prescription drug costs for the minor
child(ren) shall be assessed as follows:
( ) Shared equally by husband and wife.
( ) Prorated according to the child support guideline percentages.
( ) Other {explain}:
______________________________________________________________________________
______________________________________________________________________________
As to these uninsured medical/dental/prescription drug expenses, the party who incurs the
expense shall submit request for reimbursement to the other party within 30 days, and the
other party, within 30 days of receipt, shall submit the applicable reimbursement for that
expense, according to the schedule of reimbursement set out in this paragraph.
5. ____Life Insurance (to secure payment of support). To secure the child support obligations in this
judgment, ( ) Husband ( ) Wife ( ) Each party shall maintain life insurance, in an amount of
at least $______, on ( ) his life ( ) her life ( ) naming ( ) minor child(ren) as the
beneficiary(ies) OR naming the ( ) Wife ( ) Husband ( ) other _______________________
{name} asTrustee for the minor child(ren), so long as reasonably available. The obligation to
maintain the life insurance shall continue until the youngest child turns 18, becomes
emancipated, marries, joins the armed services, dies, or becomes self-supporting.
6. ____IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall
be as follows:
_____________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of
this paragraph.
7. ____Other provisions relating to child support:
_________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (07/13)
- 84 -
SECTION VI. METHOD OF PAYMENT
Obligor shall pay court-ordered child support/alimony and arrears, if any, as follows:
1. Place of Payment.
a. ____Obligor shall pay court-ordered support directly to either the State Disbursement
Unit, or the central depository, as required by statute, along with any fee required by
statute.
OR
b. ____Both parties have requested and the court finds that it is in the best interests of the
child(ren) that support payments need not be directed through either the State
Disbursement Unit or the central depository at this time; however, either party may
subsequently apply, pursuant to section 61.13(1)(d)3, Florida Statutes, to require
payment through either the State Disbursement Unit or the central depository.
2. Income Deduction.
a. ___Immediate. Obligor shall pay through income deduction, pursuant to a separate Income
Deduction Order which shall be effective immediately. Obligor is individually responsible for
paying this support obligation until all of said support is deducted from Obligor’s income. Until
support payments are deducted from Obligor’s paycheck, Obligor is responsible for making
timely payments directly to the State Disbursement Unit or the Obligee, as previously set forth
in this order.
b. ____Deferred. Income deduction is ordered this day, but it shall not be effective until a
delinquency of $__________, or, if not specified, an amount equal to one month’s obligation
occurs. Income deduction is not being implemented immediately based on the following
findings: Income deduction is not in the best interests of the child(ren) because: {explain}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________,
AND
There is proof of timely payment of a previously ordered obligation without an income
deduction order in cases of modification,
AND
( ) There is an agreement by the Obligor to advise the Title IV-D agency, the clerk of court,
and the Obligee of any change in Payor and/or health insurance OR
( ) there is a signed written agreement providing an alternative arrangement between the
Obligor and the Obligee and, at the option of the IV-D agency, by the IV-D agency in IV-D cases
in which there is an assignment of support rights to the state, reviewed and entered in the
record by the court.
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (07/13)
- 85 -
3. Bonus/one-time payments. ( ) All ( ) ________% ( ) No income paid in the form of a bonus or
other similar one-time payment, up to the amount of any arrearage or the remaining balance
thereof owed pursuant to this order, shall be forwarded to Obligee pursuant to the payment
method prescribed above.
4. Other provisions relating to method of payment. _________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
SECTION VII. ATTORNEY’S FEES, COSTS, AND SUIT MONEY
1. ____( ) Husband’s ( ) Wife’s request(s) for attorney’s fees, costs, and suit money is (are) denied
because:
_______________________________________________________________________________
________________________________________________________________________________.
2. ____The Court finds there is a need for and an ability to pay attorney’s fees, costs, and suit money.
( ) Husband ( ) Wife is hereby ordered to pay to the other spouse $_______ in attorney’s fees, and $
_______ in costs. The Court further finds that the attorney’s fees awarded are based on the reasonable
rate of $ _______ per hour and __________ reasonable hours. Other provisions relating to attorney’s
fees, costs, and suit money are as follows:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________.
SECTION VIII. OTHER PROVISIONS
1. Former Name. The wife’s former name of {full legal name} _________________________________
is restored.
2. Other Provisions. ___________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________.
3. The Court reserves jurisdiction to modify and enforce this Final Judgment.
DONE AND ORDERED at
____, Florida, on ________________________.
_______________________________________
CIRCUIT JUDGE
A copy of the {name of document(s)} _________________________________ was [Choose one only] ( )
mailed ( ) faxed and mailed ( ) hand delivered to the parties listed below on {date}________________
by {clerk of court or designee} ______________________________________.
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (07/13)
- 86 -
____Husband (or his attorney)
____Wife Respondent (or her attorney)
____Central Depository
____State Disbursement Unit
____Other __________________________________
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with
Dependent or Minor Child(ren) (07/13)
- 87 -
IN THE CIRCUIT COURT OF THE _______________ JUDICIAL CIRCUIT
IN AND FOR
____ COUNTY, FLORIDA
Case No.: _________________
Division: _________________
In re the Marriage of:
______________________
Husband,
and
_________,
Wife.
FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH
PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN)
This cause came before this Court for a trial on a Petition for Dissolution of Marriage. The Court, having
reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of
law:
1. The Court has jurisdiction over the subject matter and the parties.
2. At least one party has been a resident of the State of Florida for more than 6 months
immediately before filing the Petition for Dissolution of Marriage.
3. The parties have no minor children in common, and the wife is not pregnant.
4. The marriage between the parties is irretrievably broken. Therefore, the marriage between the
parties is dissolved and the parties are restored to the status of being single.
SECTION I. MARITAL ASSETS AND LIABILITIES
A. Date of Valuation of Property. The assets and liabilities listed below are divided as indicated.
date of valuation of these assets and liabilities is, unless otherwise indicated:
1.____ date of filing petition for dissolution of marriage
.
2.____ date of separation
.
3. ____ date of final hearing
.
4. _____other: {specify date}____________________________________________.
The
B. Division of Assets.
1. The assets listed below are nonmarital assets. Each party shall keep, as his or her own, the
assets found to be nonmarital, and the other party shall have no further rights or responsibilities
Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (07/13)
- 88 -
regarding these assets.
Wife’s Husband’s
Non
Non
marital
marital
Property Property
$
$
$
Total Nonmarital Assets
Current
Fair
Market
Value
$
ASSETS: DESCRIPTION OF ITEM(S)
(Please describe each item as clearly as possible. You do not need
to list account numbers
$
$
2. The assets listed below are marital assets. Each party shall keep, as his or her own, the assets
awarded in this section, and the other party shall have no further rights or responsibilities
regarding these assets. Any personal item(s) not listed below are awarded to the party
currently in possession or control of the item(s).
ASSETS: DESCRIPTION OF ITEM(S)
(Please describe each item as clearly as possible. You do not need
to list account numbers.)
Cash (on hand or in banks/credit unions)
Current
Fair
Market
Value
$
Wife
Shall
Receive
$
Husband
Shall
Receive
$
Stocks/bonds
Notes
Business interests
Real estate: (Home)
Automobiles
Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (07/13)
- 89 -
Boats
Furniture & furnishings
Jewelry
Life insurance (cash surrender value)
Retirement Plans (Profit sharing, Pension, IRA, 401(k)s, etc.)
Other assets
Total Marital Assets
$
$
$
C. Division of Liabilities/Debts.
1. The liabilities listed below are nonmarital liabilities and, therefore, are owed as indicated. Each
party shall owe, as his or her own, the liabilities found to be nonmarital, and the other party
shall have no responsibilities regarding these debts.
Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (07/13)
- 90 -
LIABILITIES: DESCRIPTION OF DEBT(S)
(Please describe each item as clearly as possible. You do not
need to list account numbers.)
Current
Amount
Owed
Wife’s Husband’s
NonNonmarital
marital
Liability
Liability
$
$
$
Total Nonmarital Liabilities
$
$
$
2. The liabilities listed below are marital liabilities and are divided as indicated. Each party shall
hold the other party harmless and pay, as his or her own, the marital liabilities awarded below.
LIABILITIES: DESCRIPTION OF DEBT(S)
(Please describe each item as clearly as possible You do not need
to list account numbers.)
Mortgages on real estate: (Home)
Current
Amount
Owed
$
Wife
Husband
Shall Pay Shall Pay
$
$
(Other)
Charge/credit card accounts
Auto loan
Auto loan
Bank/Credit Union loans
Other
Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (07/13)
- 91 -
Total Marital Liabilities
$
$
$
D. Contingent
assets
and
liabilities
will
be
divided
as
follows:_________________________________________________________________
________________________________________________
E. The distribution of assets and liabilities in this final judgment is equitable; if each party does not
receive approximately one-half, the distribution is based on the following facts and reasoning:
SECTION II. EXCLUSIVE USE AND POSSESSION OF HOME
[Choose all that apply]
1. _____ ( ) Husband ( ) Wife, as a condition of support, shall have exclusive use and possession of
the dwelling located at the following address:
______________________________________________________________________________
until {date or event}______________________________________________________________
______________________________________________________________________________.
2. _____ ( ) Husband ( ) Wife may make visits to the premises described in the paragraph above for
the purpose of obtaining any items awarded in this Final Judgment. These visits shall occur after notice
to the person granted exclusive use and possession of the dwelling and at the earliest convenience of
both parties or as ordered in paragraph 4 below.
3. _____Upon the termination of the right of exclusive use and possession, the dwelling shall be sold
and the net proceeds divided
% to Husband and
% to Wife, with the following credits and/or
setoffs being allowed:______________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________________
4. _____Other: __________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (07/13)
- 92 -
SECTION III. ALIMONY
1. ____ The Court denies the request(s) for alimony
OR
2. ____ The Court finds that there is an actual need for, and that (
Obligor) has/had the present ability to pay, alimony as follows:
[Choose all that apply]
a. _____ Permanent Periodic.
) Husband (
) Wife (hereinafter
1. The Court finds that no other form of alimony is fair and reasonable under the
circumstances of the parties.
2. As a marriage of: (Choose only one)
_____Long Duration (17 years or greater) alimony is appropriate upon consideration of all
relevant factors;
_____Moderate Duration (greater than 7 years but less than 17) alimony is appropriate
based upon clear and convincing evidence after consideration of all relevant factors; or
_____Short Duration (less than 7 years) alimony is appropriate based upon the following
exceptional circumstances:________________________________________________
_____________________________________________________________________
_____________________________________________________________________.
3. Obligor shall pay permanent periodic alimony to Obligee in the amount of $ __________
per month, payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any
event, at least once a month or ( ) other {explain}: _____________________________
______________________________________________________________________
beginning {date}
___________. This alimony shall continue until modified by
court order, the death of either party, or remarriage of Obligee, whichever occurs first. The
alimony may be modified or terminated based upon either a substantial change in
circumstances or the existence of a supportive relationship in accordance with section 61.14,
Florida Statutes.
b._____Bridge-the-Gap. Obligor shall pay bridge-the-gap alimony to Obligee in the amount of
$_________ per month, payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any
event, at least once a month or ( ) other {explain} ________________________________________
beginning {date}__________________and continuing until {date}___________________________
{a period not to exceed two years}, the death of either party, or remarriage of the Obligee,
whichever occurs first
Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (07/13)
- 93 -
c.______Rehabilitative. Obligor shall pay rehabilitative alimony to Obligee in the amount of
$ ______ per month, payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any
event, at least once a month or ( ) other {explain________________________________________
beginning {date} ______________. This rehabilitative alimony shall continue until modified by court
order, the death of either party or until {date/event} ______________________________________,
whichever occurs first. The rehabilitative plan presented demonstrated the following:
___________________________________________________________________________
___________________________________________________________________________.
d._____Durational. Obligor shall pay durational alimony to Obligee in the amount of $____________
per month ( ) payable in accordance with Obligor’s employer’s payroll cycle, and in any event, at least
once a month or (
) {explain}__________________________beginning {date}_____________ and
terminating on {date}______________________, the death of either party, remarriage of Obligee, or
until modified by court order in accordance with section 61.08(7), Florida Statutes, whichever occurs
first.
e._____ Lump Sum. Obligor shall pay lump sum alimony to Obligee in the amount of
$_____________,which shall be paid as follows:_______________________________________
_____________________________________________________________________________.
f._____Retroactive. Obligor shall pay retroactive alimony in the amount of $
for the period of {date}
paragraph 4 below.
______, through {date}
______, which shall be paid pursuant to
3. Reasons for ( ) Awarding ( ) Denying Alimony. The Court has considered all of the following in
awarding/denying alimony:
a. The standard of living established during the marriage;
b. The duration of the marriage;
c. The age and the physical and emotional condition of each party;
d. The financial resources of each party, including, the nonmarital and the marital assets and liabilities
distributed to each;
e. The earning capacities, educational levels, vocational skills, and employability of the parties and,
when applicable, the time necessary for either party to acquire sufficient education or training to
enable such party to find appropriate employment;
f. The contribution of each party to the marriage, including, but not limited to, services rendered in
homemaking, child care, education, and career building of the other party;
g. The tax treatment and consequences to both parties of any alimony award, including the designation
of all or a portion of the payment as a nontaxable, nondeductible payment;
h. All sources of income available to either party, including income available to either party through
investments of any asset held by the party; and
i. Any other factor necessary to do equity and justice between the parties: {explain}______________
Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (07/13)
- 94 -
______ Please indicate here if additional pages are attached.
4. Arrearage/Retroactive Alimony.
a. ____ There is no alimony arrearage at the time of this Final Judgment.
OR
b.____ The ( ) Husband ( ) Wife shall pay to the other party the alimony arrearage of:
$
for retroactive alimony, as of {date}
;
$
for previously ordered unpaid alimony, as of {date}
_____.
The total of $
in alimony arrearage shall be repaid in the amount of $
per
month, payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any event at
least once a month ( ) other {explain}______________________________________________
beginning {date}
______________, until paid in full including statutory interest.
3. ____Life Insurance (to secure payment of support). To secure the alimony obligations set forth in this
judgment, Obligor shall maintain life insurance coverage on his/her life naming Obligee as the
sole irrevocable beneficiary, so long as reasonably available. This insurance shall be in the
amount of at least $
________ and shall remain in effect until the obligation for alimony
terminates.
4. _____Other provisions relating to alimony, including any tax treatment and consequences:
a. The award of alimony ( ) does not ( ) does leave the Obligor with significantly less net income than
the net income of the recipient/Obligee. If yes, the court finds the following exceptional circumstances:
_______________________________________________________________________________
______________________________________________________________________________.
b. Other:_______________________________________________________________________
______________________________________________________________________________.
SECTION IV. METHOD OF PAYMENT
Obligor shall pay court-ordered alimony and arrears, if any, as follows:
1. Place of Payment.
a. ____ Obligor shall pay court-ordered support directly to either the State Disbursement Unit
Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (07/13)
- 95 -
or the central depository, as required by statute, along with any fee required by statute .
OR
b. ____ Both parties have requested and the court finds that support payments need not be
directed through either the State Disbursement Unit or the central depository at this time at
this time; however, either party may subsequently apply, pursuant to section 61.13(1)(d)3,
Florida Statutes, to require payments through either the State Disbursement Unit or the
central depository.
2. Income Deduction.
a. ___ Immediate. Obligor shall pay through income deduction, pursuant to a separate Income
Deduction Order which shall be effective immediately. Obligor is individually responsible for
paying this support obligation until all of said support is deducted from Obligor’s income.
Until support payments are deducted from Obligor’s paycheck, Obligor is responsible for
making timely payments directly to the State Disbursement Unit or the Obligee, as
previously set forth in this order.
b. ___ Deferred. Income Deduction is ordered this day, but it shall not be effective until a
delinquency of $
, or, if not specified, an amount equal to one month’s obligation
occurs. Income deduction is not being implemented immediately based on the following
findings:
There are no minor or dependent child(ren) common to the parties,
AND
There is proof of timely payment of a previously ordered obligation without an income
deduction order in cases of modification,
AND
( ) There is an agreement by the Obligor to advise the Title IV-D agency, the clerk of court,
and the Obligee of any change in Payor and/or health insurance OR ( ) there is a signed
written agreement providing an alternative arrangement between the Obligor and the
Obligee and, at the option of the IV-D agency, by the IV-D agency in IV-D cases in which there
is an assignment of support rights to the state, reviewed and entered in the record by the
court.
3. Bonus/one-time payments. ( ) All ( )
% ( ) No income paid in the form of a
bonus or other similar one-time payment, up to the amount of any arrearage or the remaining
balance thereof owed pursuant to this order, shall be forwarded to Obligee pursuant to the
payment method prescribed above.
4. Other provisions relating to method of payment. _____________________________________
SECTION V. ATTORNEY’S FEES, COSTS, AND SUIT MONEY
Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (07/13)
- 96 -
1. ____( ) Husband’s ( ) Wife’s request(s) for attorney’s fees, costs, and suit money is (are)
denied because ____________________________________________________________
.
OR
2. ____ The Court finds there is a need for and an ability to pay attorney’s fees, costs, and suit
money. ( ) Husband ( ) Wife is hereby ordered to pay to the other spouse $_____________in
attorney’s fees, and $
in costs. The Court further finds that the attorney’s fees
awarded are based on the reasonable rate of $
per hour and ______reasonable
hours. Other provisions relating to attorney’s fees, costs, and suit money are as follows:
______________________________________________________________________________
.
SECTION VI. OTHER PROVISIONS
1. Former Name. The wife’s former name of {full legal name} ______________________________
is restored.
2. Other Provisions.
.
3. The Court reserves jurisdiction to modify and enforce this Final Judgment.
DONE AND ORDERED on ___________ in __________________________, Florida.
____________________________________
CIRCUIT JUDGE
COPIES TO:
____Husband (or his attorney)
____Wife (or her attorney)
____Central depository
____State Disbursement Unit
____Other:
Florida Supreme Court Approved Family Law Form 12.990(c)(2), Final Judgment of Dissolution of Marriage with
Property but No Dependent or Minor Child(ren) (07/13)
- 97 -
IN THE CIRCUIT COURT OF THE ________________________JUDICIAL CIRCUIT,
IN AND FOR _______________________ COUNTY, FLORIDA
Case No.: ______________
Division: ______________
_________________________________,
Petitioner,
and
_________________________________,
Respondent.
SUPPLEMENTAL FINAL JUDGMENT MODIFYING PARENTAL
RESPONSIBILITY, VISITATION, OR PARENTING
PLAN/TIME-SHARING SCHEDULE AND OTHER RELIEF
This cause came before this Court on a Supplemental Petition to Modify Parental Responsibility,
Visitation, or Parenting Plan/Time-Sharing Schedule and Other Relief. The Court, having reviewed the
file, having heard the testimony, and being otherwise fully advised, makes these findings of fact and
reaches these conclusions of law:
SECTION I. FINDINGS
1. The Court has jurisdiction over the subject matter and the parties.
2. The last order establishing or modifying parental responsibility, visitation, a Parenting Plan, or timesharing was entered on {date} ________________________.
3. There has been a substantial change in circumstances of the parties since the entry of the last order,
specifically: ________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
4. It is in the best interests of the minor child(ren) that the current parental responsibility, visitation,
time-sharing schedule or Parenting Plan be changed because:________________________________
__________________________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental
Responsibility, Visitation, or Parenting Plan/Time-Sharing Schedule and Other Relief (07/13)
- 98 -
__________________________________________________________________________________
_________________________________________________________________________________.
SECTION II. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING WITH
DEPENDENT OR MINOR CHILD(REN)
1. Jurisdiction. The Court has jurisdiction to determine parental responsibility, to establish or approve
a Parenting Plan, and time-sharing with regard to the parties’ minor child(ren) listed in paragraph 2
below.
2. The parties’ dependent or minor child(ren) is (are):
Name
Birth date
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
3. Parenting Plan. The parties shall comply with the Parenting Plan which is attached and
incorporated herein as Exhibit ____.
SECTION III. CHILD SUPPORT
1. Modification of Child Support.
[Choose one only]
a. ___The modification of parental responsibility or time-sharing entered above does not
necessitate a modification of child support. The previous order or final judgment establishing or
modifying child support shall remain in effect.
OR
b. ___ The Court finds that there is a need for modification of child support and that the
( ) Mother ( ) Father (hereinafter Obligor) has the present ability to pay child support.
The amounts in the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form
12.902(e), filed by the ( ) 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 $___________.
2. Amount.
Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental
Responsibility, Visitation, or Parenting Plan/Time-Sharing Schedule and Other Relief (07/13)
- 99 -
Child support established at the rate of $__________per month for the _______children {total number
of parties’ minor or dependent children} shall be paid commencing ____________________ {month, day,
year} and terminating ________________________________ {month, day, year}. Child support shall be
paid in the amount of $_________ per ______________ {week, month, other} which is consistent with
the Obligor’s current payroll cycle.
Upon the termination of the obligation of child support for one of the parties’ children, child support in
the amount of $___________for the remaining_______children {total number of remaining children}
shall be paid commencing___________________________________{month, day, year} and
terminating_________________________________ {month, day, year}. This child support shall be paid
in the amount of $_______ per ________ {week, month, other} consistent with the Obligor’s current
payroll cycle.
{Insert schedule for the child support obligation, including the amount, and commencement and
termination dates, for the remaining minor or dependent children, which shall be payable as the
obligation for each child ceases. Please indicate whether the schedule ____appears below or
____ is attached as part of this form.}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
The Obligor shall pay child support until all of the minor or dependent child(ren): reach the age of 18;
become emancipated, marry, join the armed services, die, or become self-supporting; or until further
order of the court or agreement of the parties. The child support obligation shall continue beyond the
age of 18 and until high school graduation for any child who is: dependent in fact; between the ages of
18 and 19; and is still in high school, performing in good faith with a reasonable expectation of
graduation before the age of 19.
If the child support ordered deviates from the guidelines by more than 5%, the factual findings which
support that deviation are: ______________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.
3. Arrearage/Retroactive Child Support.
[Choose one only]
a.____There is no child support arrearage at the time of this Supplemental Final Judgment.
OR
b.____The ( ) Mother ( ) Father shall pay to the other party the child support arrearage of:
$_____________ for retroactive child support, as of {date}_____________.
$_____________ for previously ordered unpaid child support, as of {date}_____________.
Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental
Responsibility, Visitation, or Parenting Plan/Time-Sharing Schedule and Other Relief (07/13)
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The total of $________________ in child support arrearage shall be repaid in the amount of
$________________, per month payable ( ) in accordance with Obligor’s employer’s
payroll cycle, and in any event at least once a month ( ) other {explain} ________________
___________________________________________________________________________
beginning {date} _________________ until paid in full including statutory interest.
4. Insurance.
[Choose all that apply]
a. ____Health/Dental Insurance. ( ) 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 other party;
OR
( ) health and/or ( ) dental insurance is not reasonable in cost or accessible to the child(ren) at this
time.
b. ____Reasonable and necessary uninsured medical/dental/prescription drug costs for the
minor child(ren) shall be assessed as follows:
( ) Shared equally by both parents.
( ) Prorated according to the child support guideline percentages.
( ) Other {explain}: ___________________________________________________________
___________________________________________________________________________
As to these uninsured medical/dental/prescription drug expenses, the party who incurs the expense
shall submit a request for reimbursement to the other party within 30 days, and the other party, within
30 days of receipt, shall submit the applicable reimbursement for that expense, according to the
schedule of reimbursement set out in this paragraph.
5. ____Life Insurance (to secure payment of support). To secure the child support obligations in this
judgment, ( ) Mother ( ) Father ( ) Each parent shall maintain life insurance , in an amount of
at least $ _________, on ( ) his life ( ) her life ( ) his/her life naming the ( ) minor
child(ren) as the beneficiary(ies) OR naming the ( ) Mother ( ) Father ( ) other
{name}___________________________________________________________as Trustee for the minor
child(ren), so long as reasonably available. The obligation to maintain the life insurance shall continue
until the youngest child turns 18, becomes emancipated, marries, joins the armed services, dies, or
becomes self-supporting.
6. ____IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall
be as follows: _____________________________________________________________________
_________________________________________________________________________________.
Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of this
paragraph.
7. Other provisions relating to child support: ______________________________________________
Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental
Responsibility, Visitation, or Parenting Plan/Time-Sharing Schedule and Other Relief (07/13)
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__________________________________________________________________________________
__________________________________________________________________________________
SECTION IV. METHOD OF PAYMENT
Obligor shall pay court-ordered child support and arrears, if any, as follows:
1. Place of Payment.
a. ____Obligor shall pay court-ordered support directly to either the State Disbursement Unit or
the central depository as required by statute, along with any fee required by statute.
OR
b. ____Both parties have requested and the court finds that it is in the best interests of the
child(ren) that support payments need not be directed through either the State Disbursement
Unit or the central depository at this time; however, either party may subsequently apply,
pursuant to section 61.13(1)(d)3, Florida Statutes, to require payments through either the State
Disbursement Unit or the central depository.
2. Income Deduction.
a. ____Immediate. Obligor shall pay through income deduction, pursuant to a separate Income
Deduction Order which shall be effective immediately. Obligor is individually responsible for
paying this support obligation until all of said support is deducted from Obligor’s income. Until
support payments are deducted from Obligor’s paycheck, Obligor is responsible for making
timely payments directly to the State Disbursement Unit or the Obligee, as previously set forth
in this order.
b. ____Deferred. Income deduction is ordered this day, but it shall not be effective until a
delinquency of $____________, or, if not specified, an amount equal to one month’s obligation
occurs. Income deduction is not being implemented immediately based on the following
findings: Income deduction is not in the best interests of the child(ren) because: {explain}
______________________________________________________________________________
______________________________________________________________________________,
AND
There is proof of timely payment of a previously ordered obligation without an income
deduction order,
AND
( ) There is an agreement by the Obligor to advise the Title IV-D agency, the clerk of court,
and the Obligee of any change in Payor and/or health insurance OR
( ) there is a signed written agreement providing an alternative arrangement between
the Obligor and the Obligee and, at the option of the IV-D agency, by the IV-D agency in IV-D
Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental
Responsibility, Visitation, or Parenting Plan/Time-Sharing Schedule and Other Relief (07/13)
- 102 -
cases in which there is an assignment of support rights to the state, reviewed and entered in the
record by the court .
3. Bonus/one-time payments. ( ) All ( ) ____________% ( ) No income paid in the form of a bonus
or other similar one-time payment, up to the amount of any arrearage or the remaining balance
thereof owed pursuant to this order, shall be forwarded to the Obligee pursuant to the payment
method prescribed above.
4. Other provisions relating to method of payment. ________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.
SECTION V. ATTORNEY’S FEES, COSTS, AND SUIT MONEY
1. ____( ) Mother’s ( ) Father’s request(s) for attorney’s fees, costs, and suit money is (are)
denied because: ____________________________________________________________________
_________________________________________________________________________________.
2. ____The Court finds there is a need for and an ability to pay attorney’s fees, costs, and suit money.
( ) Mother ( ) Father is hereby ordered to pay to the other party $____________ in attorney’s
fees, and $____________ in costs. The Court further finds that the attorney’s fees awarded are
based on the reasonable rate of $____________ per hour and ____________ reasonable hours.
Other provisions relating to attorney’s fees, costs, and suit money are as follows:
_________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
SECTION VI. OTHER
1. Other Provisions. ___________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
2. The Court reserves jurisdiction to modify and enforce this Supplemental Final Judgment.
3. Unless specifically modified by this Supplemental Final Judgment, the provisions of all final
judgments or orders in effect remain the same.
DONE AND ORDERED at __________________________, Florida, on _____________________.
Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental
Responsibility, Visitation, or Parenting Plan/Time-Sharing Schedule and Other Relief (07/13)
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_____________________________________________
CIRCUIT JUDGE
A copy of the {name of document(s)} ______________________________________________ was:
[Choose only one] ( ) 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)
____Respondent (or his or her attorney)
____Central Depository
____State Disbursement Unit
Other: ________________________
Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental
Responsibility, Visitation, or Parenting Plan/Time-Sharing Schedule and Other Relief (07/13)
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IN THE CIRCUIT COURT OF THE
IN AND FOR
JUDICIAL CIRCUIT,
COUNTY, FLORIDA
Case No.: _______________
Division: _______________
,
Petitioner,
and
,
Respondent.
SUPPLEMENTAL FINAL JUDGMENT MODIFYING CHILD SUPPORT
This cause came before this Court on a Supplemental Petition for Modification of Child Support. The
Court, having heard the testimony and reviewed the file and financial affidavits of the parties and being
otherwise fully advised, makes these findings of fact and reaches these conclusions of law:
SECTION I. FINDINGS
1. The Court has jurisdiction over the subject matter and the parties.
2. The parties’ dependent or minor child(ren) is (are):
Name
Birth date
3. The last order awarding or modifying child support was entered on {date} _______________
4. There has been a substantial change in circumstances of the parties since the entry of the last
order, specifically: _________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.993(b), Supplemental Final Judgment Modifying Child
Support (07/13)
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5. It is in the best interests of the minor child(ren) that the current child support order be changed
because:
_____________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________.
SECTION II. CHILD SUPPORT
1. The Court finds that there is a need for modification of child support and that the (
) Father (hereinafter Obligor) has the present ability to pay child support.
) Mother (
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 $
.
2. Amount.
Child support established at the rate of $__________per month for the ______children {total number of
parties’ minor or dependent children} shall be paid commencing____________ {month, day, year} and
terminating_______________________ {month, day, year}. Child support shall be paid in the amount of
$________ per _____________ {week, month, other} consistent with the Obligor’s current payroll cycle.
Upon termination of the obligation of child support for one of the parties’ children, child support in the
amount of $_________for the remaining ______ children {total number of remaining children} shall be
paid commencing__________________ {month, day, year} and terminating______________month,
day, year}. This child support shall be paid in the amount of $________per _______ {week, month,
other} consistent with the Obligor’s current payroll cycle.
{Insert schedule for the child support obligation, including the amount, and commencement and
termination dates, for the remaining minor or dependent children, which shall be payable as the
obligation for each child ceases. Please indicate whether the schedule ____ appears below or ____ is
attached as part of this form.}
________________________________________________________________________
________________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.993(b), Supplemental Final Judgment Modifying Child
Support (07/13)
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_________________________________________________________________________
________________________________________________________________________.
The Obligor shall pay child support until all of the minor or dependent children: reach the age of 18;
become emancipated, marry, join the armed services, die, or become self-supporting; or until further
order of the court or agreement of the parties. The child support obligation shall continue beyond the
age of 18 and until high school graduation for any child who is dependent in fact, between the ages of
18 and 19, and is still in high school, performing in good faith with a reasonable expectation of
graduation before the age of 19.
If the child support ordered deviates from the guidelines by more than 5%, the factual findings which
support that deviation are:
.
3. Arrearage/Retroactive Child Support.
a. ____There is no child support arrearage at the time of this Supplemental Final Judgment.
OR
b. ____ ( ) Mother ( ) Father shall pay to the other party the child support arrearage of:
$
for retroactive child support, as of {date}
.
$
for previously ordered unpaid child support, as of {date} _______________.
The total of $
in child support arrearage shall be repaid in the amount of $ ___,
per month payable ( ) in accordance with his or her employer’s payroll cycle, and in any
event at least once a month ( ) other {explain} ____________________________________
beginning {date}
, until paid in full including statutory interest.
4. Insurance.
[Choose all that apply]
a. ____Health/Dental Insurance. ( ) Mother ( ) Father shall be required to maintain
( ) health ( ) dental insurance for the parties’ minor child(ren), so long as it is reasonable
in cost and accessible to the child(ren). The party providing insurance shall be required to
convey insurance cards demonstrating said coverage to the other party. OR ( ) Health ( )
Dental insurance is not reasonable in cost or accessible to the child(ren) at this time.
b. ____Reasonable and necessary uninsured medical/dental/prescription costs for the minor
child(ren) shall be assessed as follows:
( ) Shared equally by both parents.
( ) Prorated according to the child support guideline percentages.
( ) Other {explain}:
As to these uninsured medical/dental/prescription expenses, the party who incurs the expense shall
Florida Supreme Court Approved Family Law Form 12.993(b), Supplemental Final Judgment Modifying Child
Support (07/13)
- 107 -
submit a request for reimbursement to the other party within 30 days, and the other party, within 30
days of receipt, shall submit the applicable reimbursement for that expense, according to the schedule
of reimbursement set out in this paragraph.
5. ____Life Insurance (to secure payment of support). To secure the child support obligations in
this judgment, ( ) Mother ( ) Father ( ) Each party shall maintain life insurance coverage,
in an amount of at least $
__, on ( ) his life ( ) her life ( ) his/her life naming the
( ) minor child(ren) as the beneficiary(ies) OR naming the ( )Mother ( ) Father ( ) other
{name}__________________________________________________________as Trustee for
the minor child(ren), so long as reasonably available. The obligation to maintain the life
insurance coverage shall continue until the youngest child turns 18, becomes emancipated,
marries, joins the armed services, dies or otherwise becomes self-supporting .
6. IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall
be as follows: ________________________________________________________________
.
Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of this
paragraph.
7. Other provisions relating to child support: ________________________________________
_____________________________________________________________________
SECTION III. METHOD OF PAYMENT
1. Place of Payment.
a. ____Obligor shall pay court-ordered support directly to either the State Disbursement
Unit or the central depository, as required by statute, along with any fee required by
statute.
OR
b. ____Both parties have requested and the court finds that it is in the best interests of the
child(ren) that support payments need not be directed through either the State
Disbursement Unit or the central depository at this time; however, either party may
subsequently apply, pursuant to section 61.13(1)(d)3, Florida Statutes, to require
payments through either the State Disbursement Unit or the central depository.
2. Income Deduction.
a. ___Immediate. Obligor shall pay through income deduction, pursuant to a separate Income
Deduction Order which shall be effective immediately. Obligor is individually responsible for
paying this support obligation until all of said support is deducted from Obligor’s income.
Until support payments are deducted from Obligor’s paycheck, Obligor is responsible for
Florida Supreme Court Approved Family Law Form 12.993(b), Supplemental Final Judgment Modifying Child
Support (07/13)
- 108 -
making timely payments directly to the State Disbursement Unit or the Obligee, as
previously set forth in this order.
b. ___Deferred. Income deduction is ordered this day, but it shall not be effective until a
delinquency of $
, or, if not specified, an amount equal to one month’s obligation
occurs. Income deduction is not being implemented immediately based on the following
findings:
Income deduction is not in the best interests of the child(ren) because: {explain}
_____
,
AND
There is proof of timely payment of a previously ordered obligation without an income deduction order,
AND
( ) There is an agreement by the Obligor to advise the Title IV-D agency, the clerk of court, and the
Obligee of any change in Payor and/or health insurance OR ( ) there is a signed written agreement
providing an alternative arrangement between the Obligor and the Obligee and, at the option of the IVD agency, by the IV-D agency in IV-D cases in which there is an assignment of support rights to the state,
reviewed and entered in the record by the court.
3. Bonus/one-time payments. ( ) All ( )
% ( ) No income paid in the form of a
bonus or other similar one-time payment, up to the amount of any arrearage or the remaining
balance thereof owed pursuant to this order, shall be forwarded to the Obligee pursuant to the
payment method prescribed above.
4. Other provisions relating to method of payment ______________________________________
SECTION IV. ATTORNEY’S FEES, COSTS, AND SUIT MONEY
1. ____( ) Mother’s ( ) Father’s request(s) for attorney’s fees, costs, and suit money is (are)
denied because
____________________________________________________________________________
.
2. ____The Court finds there is a need for and an ability to pay attorney’s fees, costs, and suit
money. ( ) Mother ( ) Father is hereby ordered to pay to the other party $
_ in
attorney’s fees, and $
in costs. The Court further finds that the attorney’s fees
awarded are based on the reasonable rate of $
per hour and ______reasonable hours.
Other provisions relating to attorney’s fees, costs, and suit money are as follows:
.
SECTION V. OTHER
Florida Supreme Court Approved Family Law Form 12.993(b), Supplemental Final Judgment Modifying Child
Support (07/13)
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1. Other Provisions.
2. The Court reserves jurisdiction to modify and enforce this Supplemental Final Judgment.
3. Unless specifically modified by this Supplemental Final Judgment, the provisions of all final
judgments or orders in effect remain the same.
DONE AND ORDERED at ____________________________, Florida, on
.
CIRCUIT JUDGE
A copy of the {name of document(s)} ______________________________________________ was
[Choose only one] ( ) 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)
____Respondent (or his or her attorney)
____Central Depository
____State Disbursement Unit
_____Other: _______________________
Florida Supreme Court Approved Family Law Form 12.993(b), Supplemental Final Judgment Modifying Child
Support (07/13)
- 110 -
IN THE CIRCUIT COURT OF THE _____________________JUDICIAL CIRCUIT,
IN AND FOR ________________________COUNTY, FLORIDA
Case No:_______________________
Division: ______________________
___________________________________,
Petitioner,
and
____________________________________,
Respondent.
SUPPLEMENTAL FINAL JUDGMENT MODIFYING ALIMONY
This cause came before this Court on a Supplemental Petition for Modification of Alimony. The Court,
having heard the testimony and reviewed the file and the financial affidavits of the parties and being
otherwise fully advised, makes these findings of fact and reaches these conclusions of law:
SECTION I.
FINDINGS
1. The Court has jurisdiction over the subject matter and the parties.
2. The last order awarding or modifying alimony was entered on {date}______________________.
3. There has been a substantial change in circumstances of the parties since entry of the last order,
specifically: ____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
SECTION II.
ALIMONY
1. ____ The Court denies the request(s) for modification of alimony
OR
2. ____ The Court finds that there is a need to modify alimony and that (
) Petitioner
( ) Respondent (hereinafter Obligor) has/had the present ability to pay alimony as follows:
[Choose all that apply]
a. ______ Permanent Periodic. The permanent periodic alimony is ( ) modified ( ) terminated
based upon either ( ) a substantial change in circumstances, or ( ) the existence of a
supportive relationship in accordance with Section 61.14, Florida Statutes. Obligor shall pay
modified permanent periodic alimony to Obligee in the amount of $___________ per month,
payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any event, at least
once a month, or other:{explain} _______________________________________________
Florida Supreme Court Approved Family Law Form 12.993(c), Supplemental Final Judgment Modifying Alimony
(07/13)
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beginning {date} ______________________. This alimony shall continue until further modified
by court order, the death of either party, or remarriage of Obligee, whichever occurs first
b. _____ Durational. The durational alimony is (
) modified ( ) terminated based upon a
substantial change in circumstances in accordance with section 61.08(7), Florida Statutes. If the
length of the durational alimony is modified, the court finds that the following exceptional
circumstances exist:__________________________________________________________
______________________________________________________________________________.
Obligor shall pay modified durational alimony to Obligee in the amount of $_________ per
month, payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any event, at
least once a month ( ) other {explain}_________________________________
beginning {date} ____________________and terminating on {date}_________________, the
death of either party, remarriage of the Obligee, or until further modified by court order, whichever
occurs first.
c.
______Rehabilitative. The rehabilitative alimony is ( ) modified ( ) terminated based upon:
( ) a substantial change in circumstances, ( ) noncompliance with the rehabilitative plan, or
( ) completion of the rehabilitative plan. Obligor shall pay modified rehabilitative alimony to
Obligee in the amount of $__________ per month, payable ( ) in accordance with Obligor’s
employer’s payroll cycle, and in any event, at least once a month, or ( ) other {explain}
___________________________ beginning {date} ______________________. This modified
rehabilitative alimony shall continue until modified further by court order, the death of either
party or until {date/event} ____________________, whichever occurs first. The rehabilitative
plan presented demonstrated the following: _________________________________________
______________________________________________________________________________
______________________________________________________________________________.
d. ______ Retroactive. Obligor shall pay retroactive alimony in the amount of $___________ for
the period of {date} _____________________, through {date} ________________________,
which shall be paid pursuant to paragraph 4 below.
3. Reasons for ( ) Awarding ( ) Denying Modification of Alimony. The Court has considered all of
the following in awarding/denying the modification of alimony request:
a. The standard of living established during the marriage;
b. The duration of the marriage;
c. The age and the physical and emotional condition of each party;
d. The financial resources of each party, including, the nonmarital and the marital assets and
liabilities distributed to each;
e. The earning capacities, educational levels, vocational skills, and employability of the parties and
when applicable, the time necessary for either party to acquire sufficient education or training
to enable such party to find appropriate employment;
f. The contribution of each party to the marriage, including, but not limited to, services rendered
in homemaking, child care, education, and career building of the other party;
g. The tax treatment and consequences to both parties of any alimony award, including the
designation of all or a portion of the payment as nontaxable, nondeductible payment;
h. All sources of income available to either party, including income available to either party
Florida Supreme Court Approved Family Law Form 12.993(c), Supplemental Final Judgment Modifying Alimony
(07/13)
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through investments of any assets held by that party, and
i. ____ Any other factor necessary to do equity and justice between the parties {Explain}
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
____ Please indicate here if additional pages are attached.
4. Arrearage/Retroactive Alimony.
a. ____There is no alimony arrearage at the time of this Supplemental Final Judgment.
OR
b. ____The ( ) Petitioner ( ) Respondent shall pay to the other party the alimony arrearage of:
$____________for retroactive alimony, as of {date} ______________;
$____________________ for previously ordered unpaid alimony, as of {date} ____________.
The total of $____________________ in alimony arrearage shall be repaid in the amount of
$_______________per month, payable ( ) in accordance with Obligor’s employer’s payroll
cycle, and in any event at least once a month ( ) other {explain} _____________________
__________________________________________________________________________
beginning {date} ________________________, until paid in full including statutory interest.
5.
____Life Insurance (to secure payment of support).
To secure the alimony obligations set forth in this judgment, Obligor shall maintain life insurance
coverage on his/her life naming Obligee as the sole irrevocable beneficiary, so long as reasonably
available. This insurance shall be in the amount of at least $___________________ and shall remain in
effect until the obligation for alimony terminates.
6.
____Other provisions relating to modification of alimony, including any tax treatment and
consequences: _____________________________________________________________
_________________________________________________________________________
__________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
SECTION III. METHOD OF PAYMENT
1. Place of Payment
a. ____Obligor shall pay court-ordered support directly to either the State Disbursement Unit or
the central depository, as required by statute, along with any fee required by statute.
OR
b. ____Both parties have requested and the court finds that support payments not be directed
through either the State Disbursement Unit or the central depository at this time; however,
either party may subsequently apply to the depository pursuant to section 61.08, Florida
Statutes, to require payments through either the State Disbursement Unit or the central
depository.
Florida Supreme Court Approved Family Law Form 12.993(c), Supplemental Final Judgment Modifying Alimony
(07/13)
- 113 -
2. Income Deduction.
a. ____Immediate. Obligor shall pay through income deduction, pursuant to a separate Income
Deduction Order which shall be effective immediately. Obligor is individually responsible for
paying this support obligation until all of said support is deducted from Obligor’s income. Until
support payments are deducted from Obligor’s paycheck, Obligor is responsible for making
timely payments directly to the State Disbursement Unit or the Obligee, as previously set forth
in this order.
b. ____Deferred. Income Deduction is ordered this day, but it shall not be effective until a
delinquency of $________________, or, if not specified, an amount equal to one month’s
obligation occurs. Income deduction is not being implemented immediately based on the
following findings:
There is (are) no minor or dependent child(ren) common to the parties,
AND
There is proof of timely payment of a previously ordered obligation without an Income Deduction Order,
AND
( ) There is an agreement by the Obligor to advise the Title IV-D agency, the clerk of court, and the
Obligee of any change in Payor and/or health insurance OR
( ) there is a signed written agreement providing an alternative arrangement between the Obligor and
the Obligee and, at the option of the IV-D agency, by the IV-D agency in IV-D cases in which there is an
assignment of support rights to the state, reviewed and entered in the record by the court.
3. Bonus/one-time payments. ( ) _____________% ( )No income paid in the form of a bonus or
other similar one-time payment, up to the amount of any arrearage of the remaining balance
thereof owed pursuant to this order, shall be forwarded to the Obligee pursuant to the payment
method prescribed above.
4. Other provisions relating to method of payment. _____________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
SECTION IV.
ATTORNEY’S FEES, COSTS, AND SUIT MONEY
1. ____ (
) Petitioner’s (
) Respondent’s request(s) for attorney’s fees, costs, and suit money is
(are) denied because ___________________________________________________________
________________________________________________________________________________
________________________________________________________________________________.
2. ____ The Court finds there is a need for and an ability to pay attorney’s fees, costs, and suit money.
(
) Petitioner (
) Respondent is hereby ordered to pay to the other party $_____________ in
attorney’s fees, and $_________________ in costs. The Court further finds that the attorney’s fees
awarded are based on the reasonable rate of $__________ per hour and ______ reasonable hours.
Florida Supreme Court Approved Family Law Form 12.993(c), Supplemental Final Judgment Modifying Alimony
(07/13)
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Other provisions relating to attorney’s fees, costs, and suit money are as follows:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________.
SECTION V.
OTHER
1.
Other Provisions: _______________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
2.
3.
The Court reserves jurisdiction to modify and enforce this Supplemental Final Judgment.
Unless specifically modified by this Supplemental Final Judgment, the provisions of all final
judgments or orders in effect remain the same.
DONE AND ORDERED on __________________ in __________________________, Florida.
_________________________________
CIRCUIT JUDGE
COPIES TO:
____Petitioner (or his or her attorney)
____Respondent (or his or her attorney)
____Central Depository
____State Disbursement Unit
____Other:_________________________
Florida Supreme Court Approved Family Law Form 12.993(c), Supplemental Final Judgment Modifying Alimony
(07/13)
- 115 -
IN THE CIRCUIT COURT OF THE___________________________JUDICIAL CIRCUIT,
IN AND FOR _______________________COUNTY, FLORIDA
Case No.: _________________________
Division: ________________________
________________________________,
Petitioner,
and
________________________________,
Respondent.
SUPPLEMENTAL TEMPORARY JUDGMENT MODIFYING PARENTING
ISSUES FOR CHILD(REN) OF A PARENT ACTIVATED, DEPLOYED,
OR TEMPORARILY ASSIGNED TO MILITARY SERVICE
This cause came before this Court on a Supplemental Petition for Temporary Modification of Custody or
Parenting Plan/Time-Sharing Schedule for Child(ren) of a Parent Activated, Deployed, or Temporarily
Assigned to Military Service. The Court, having reviewed the file, heard the testimony, and being
otherwise fully advised, makes these findings of fact and reaches these conclusions of law:
SECTION I. FINDINGS
1. The Court has jurisdiction over the subject matter and the parties.
2. The last order establishing or modifying parental responsibility, visitation, or time-sharing was
entered on {date} _______________________.
3. There is clear and convincing evidence that it is in the best interests of the minor child(ren) that the
current order establishing parental responsibility, visitation, and time-sharing be temporarily
modified as the ( ) Mother ( ) Father is activated, deployed, or temporarily assigned to military
service. Specifically:
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.
SECTION II. TEMPORARY PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIMESHARING WITH DEPENDENT OR MINOR CHILD(REN)
1. Jurisdiction. The Court has jurisdiction to determine parental responsibility, to establish or approve
Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment Modifying
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service.
(07/13)
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a Parenting Plan, and time-sharing with regards to the parties’ minor child(ren) listed in paragraph 2
below.
2. The parties’ dependent or minor child(ren) is (are):
Name
Birth date
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
3. Parenting Plan. The parties shall comply with the temporary Parenting Plan which is attached and
incorporated herein as Exhibit ____.
SECTION III. CHILD SUPPORT
1. Temporary Modification of Child Support.
[Choose one only]
a. ____The ( ) Mother’s ( ) Father’s current obligation to pay child support is:(Choose only one)
( ) Abated
( ) Suspended
( ) Modified to $______________ per ________________.
b. ____The Court finds that there is a need for temporary modification of child support and that
the service member ( ) Mother ( ) Father (hereinafter Obligor) has the present ability to pay
child support. The amounts in the Child Support Guidelines Worksheet, Florida Family Law Rules
of Procedure Form 12.902(e), filed by the ( ) 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 $__________________.
2. Amount.
Child support established at the rate of $________per month for the _______children {total number of
parties’ minor or dependent children} shall be paid commencing _________________ {month, day, year}
and terminating _______________ {month, day, year}. Child support shall be paid in the amount of
$_________ per _________ {week, month, other} which is consistent with the Obligor’s current payroll
cycle.
Upon 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
Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment Modifying
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service.
(07/13)
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be paid commencing___________________________ {month, day, year} and
terminating___________________________ {month, day, year}. This child support shall be paid in the
amount of $_________ per __________ {week, month, other} consistent with the Obligor’s current
payroll cycle.
{Insert schedule for the child support obligation, including the amount, and commencement and
termination dates, for the remaining minor or dependent children, which shall be payable as the
obligation for each child ceases. Please indicate whether the schedule ____ appears below or ____ is
attached as part of this form.}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
The Obligor shall pay child support until all of the minor or dependent children: reach the age of 18;
become emancipated, marry, join the armed services, die, or become self-supporting; or until further
order of the court or agreement of the parties. The child support obligation shall continue beyond the
age of 18 and until high school graduation for any child who is dependent in fact, between the ages of
18 and 19, and is still in high school, performing in good faith with a reasonable expectation of
graduation before the age of 19.
If the child support ordered deviates from the guidelines by more than 5%, the factual findings
which support that deviation are: _____________________________________________
________________________________________________________________________
________________________________________________________________________.
3. Arrearage/Retroactive Child Support.
[Choose one only]
a. ____There is no child support arrearage at the time of this Supplemental Temporary Judgment.
OR
b. ____The ( ) Mother ( ) Father shall pay to the other party the child support arrearage of:
$___________ for retroactive child support, as of {date} __________________.
$___________ for previously ordered unpaid child support, as of {date} _________________.
The total of $___________ in child support arrearage shall be repaid in the amount of
$___________, per month payable ( ) in accordance with Obligor’s employer’s payroll cycle,
and in any event at least once a month ( ) other {explain} _________________________
______________________________________________________________________________
beginning {date} ________________, until paid in full including statutory interest.
Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment Modifying
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service.
(07/13)
- 118 -
4. Insurance.
a. ____Health/Dental Insurance.
(Choose one only)
____ The service member ( ) Mother ( ) Father shall enroll the child(ren) as a military dependent(s)
with DEERs, TriCare, or other similar benefits available to military dependents as provided by the service
member’s branch or service and federal regulations;
OR
____ The ( ) Mother ( ) Father shall maintain ( ) health and/or ( ) dental insurance for the
parties’ minor child(ren), so long as it is reasonable in cost and accessible to the child(ren). The party
providing insurance shall be required to convey insurance cards demonstrating said insurance to the
other party;
OR
_____ ( ) Health ( ) dental insurance is not reasonable in cost or accessible to the
child(ren) at this time.
b. ____Reasonable and necessary uninsured medical/dental/prescription drug costs for the minor
child(ren) shall be assessed as follows:
( ) Shared equally by both parents.
( ) Prorated according to the child support guideline percentages.
( ) Other {explain}: _____________________________________________________________
______________________________________________________________________________
As to these uninsured medical/dental/prescription drug expenses, the party who incurs the expense
shall submit a request for reimbursement to the other party within 30 days, and the other party, within
30 days of receipt, shall submit the applicable reimbursement for that expense, according to the
schedule of reimbursement set out in this paragraph.
5. ____Life Insurance (to secure payment of support). To secure the child support obligations in this
judgment, ( ) Mother ( ) Father ( ) Each party shall maintain life insurance, in an amount of
at least $_________, on ( ) his life ( ) her life ( ) his/her life naming the ( ) minor child(ren) as
the beneficiary(ies)
OR
naming the ( ) Mother (
) Father (
) other {name}
____________________________________________ as Trustee for the minor child(ren), so long
as reasonably available. The obligation to maintain the life insurance coverage shall continue until
the youngest child turns 18, becomes emancipated, marries, joins the armed services, dies, or
otherwise becomes self-supporting .
6. ____IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall
be as follows:
_________________________________________________________________________
________________________________________________________________________________.
Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of this
paragraph.
Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment Modifying
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service.
(07/13)
- 119 -
7. Other provisions relating to child support: _____________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
SECTION IV. METHOD OF PAYMENT
Obligor shall pay court-ordered child support and arrears, if any, as follows:
1. Place of Payment .
a. ___Obligor shall pay court-ordered support directly to either the State Disbursement Unit or the
central depository, as required by statute, along with any fee required by statute.
OR
b. ___Both parties have requested and the court finds that it is in the best interests of the
child(ren) that support payments need not be directed through either the State Disbursement
Unit or the central depository at this time; however, either party may subsequently apply,
pursuant to section 61.13(1)(d)3, Florida Statutes, to require payments through the State
Disbursement Unit or the central depository.
2. Income Deduction.
a. ____Immediate. Obligor shall pay through income deduction, pursuant to a separate Income
Deduction Order which shall be effective immediately. Obligor is individually responsible for
paying this support obligation until all of said support is deducted from Obligor’s income. Until
support payments are deducted from Obligor’s paycheck, Obligor is responsible for making
timely payments directly to the State Disbursement Unit or the Obligee, as previously set forth
in this order.
b. ____Deferred. Income deduction is ordered this day, but it shall not be effective until a
delinquency of $______________, or, if not specified, an amount equal to one month’s
obligation occurs. Income deduction is not being implemented immediately based on the
following findings:
Income deduction is not in the best interests of the child(ren) because: {explain}
_______________________________________________________________________
______________________________________________________________________________
AND
( ) There is proof of timely payment of a previously ordered obligation without an income deduction
order,
AND
( ) There is an agreement by the Obligor to advise the Title IV-D agency, clerk of court and Obligee of
any change in Payor and/or health insurance OR ( ) there is a signed written agreement providing an
alternative arrangement between the Obligor and the Obligee and, at the option of the IV-D agency, by
Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment Modifying
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service.
(07/13)
- 120 -
the IV-D agency in IV-D cases in which there is an assignment of support rights to the state, reviewed
and entered in the record by the court.
3. Bonus/one-time payments. ( ) All ( ) _______% ( ) No income paid in the form of a bonus or
other similar one-time payment, up to the amount of any arrearage or the remaining balance
thereof owed pursuant to this order, shall be forwarded to the Obligee pursuant to the payment
method prescribed above.
4. Other provisions relating to method of payment. _________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
SECTION V. ATTORNEY’S FEES, COSTS, AND SUIT MONEY
1. ____ ( ) Petitioner’s ( ) Respondent’s request(s) for attorney’s fees, costs, and suit money is
(are) denied because _______________________________________________________________
__________________________________________________________________________________ .
OR
2. ____ The Court finds there is a need for and an ability to pay attorney’s fees, costs, and suit money.
in
( ) Petitioner ( ) Respondent is hereby ordered to pay to the other party $
in costs. The Court further finds that the attorney’s fees
attorney’s fees, and $
per hour and
reasonable
awarded are based on the reasonable rate of $
hours. Other provisions relating to attorney’s fees, costs, and suit money are as follows:
_________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________.
SECTION VI. OTHER
1. Other Provisions. ___________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
2. The Court reserves jurisdiction to modify and enforce this Supplemental Temporary Judgment.
3. Unless specifically modified by this supplemental temporary judgment, the provisions of all final
judgments or orders in effect remain the same.
DONE AND ORDERED at _________________________, Florida, on ___________________.
Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment Modifying
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service.
(07/13)
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_____________________________________________
CIRCUIT JUDGE
A copy of the {name of document(s)} ______________________________________________ was
[Choose only one] ( ) 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)
____Respondent (or his or her attorney)
____Central Depository
____State Disbursement Unit
____Other: _______________________
Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment Modifying
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service.
(07/13)
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IN THE CIRCUIT COURT OF THE
IN AND FOR
JUDICIAL CIRCUIT,
COUNTY, FLORIDA
Case No.: _______________
Division: ______________
,
Husband,
and
,
Wife.
FINAL JUDGMENT FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF
MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN)
This cause came before this Court on a Petition for Support Unconnected with Dissolution of Marriage
under section 61.09, Florida Statutes. The Court, having reviewed the file and heard the testimony,
makes these findings of fact and reaches these conclusions of law:
1. The Court has jurisdiction over the subject matter and the parties.
2. The following child(ren) are common to the parties:
Name
Birth date
SECTION I. ALIMONY
1. ____ The Court denies the request(s) for alimony.
OR
2. ____ The Court finds that there is a need for alimony and that _____Husband _____Wife
has/had the ability to support his/her spouse and has failed to do so. ____Husband
____Wife(hereinafter Obligor) has the present ability to pay alimony as follows:
[Choose all that apply]
a. ___Permanent Periodic.
1. The court finds that no other form of alimony is fair and reasonable under the
circumstances of the parties.
Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (07/13)
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2. As a marriage of (choose only one):
____Long Duration (17 years or greater) alimony is appropriate upon consideration of all relevant
factors;
____Moderate Duration ( greater than 7 years but less than 17) alimony is appropriate based upon clear
and convincing evidence after consideration of all relevant factors; or
____Short Duration (less than 7 years) alimony is appropriate based upon the following exceptional
circumstances:_________________________________
_______________________________________________________________
_______________________________________________________________.
3. Obligor shall pay permanent periodic alimony to Obligee in the amount of $
____ per
any event, at
month, payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in
least once a month or ( ) other: {explain}________________________
______________________________________________________________________
beginning {date} _____________. This alimony shall continue until modified by court order,
the death of either party, or remarriage of Obligee, whichever occurs first.
The alimony may be modified or terminated based upon either a substantial change
in
circumstances or the existence of a supportive relationship in accordance with
section 61.14,
Florida Statutes.
b.____Bridge-the-Gap. Obligor shall pay bridge-the-gap alimony to Obligee in the amount of
$________ per month, payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any
event, at least once a month, or ( ) other: {explain}________________________________
beginning {date}___________ _________ and continuing until {date}________________ ____
{a period not to exceed two (2) years}, death of either party or remarriage of Obligee.
c.____Rehabilitative. Obligor shall pay rehabilitative alimony to Obligee in the amount of $
per month, payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any event, at least
once a month, or ( ) other {explain} _____________________________
beginning {date}
. This rehabilitative alimony shall continue until modified by
court order, the death of either party or until {date/event} _____________________________,
whichever occurs first. The rehabilitative plan presented demonstrated the following: ________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________.
d.__ __Durational. Obligor shall pay durational alimony to Obligee in the amount of $_________
per month, payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any event, at
least
once a month, or ( ) other: {explain}_________________________________________________
Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (07/13)
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beginning {date}_______________________ and terminating on {date}_____________________ the
death of either party, remarriage of Obligee or until modified by court order in accordance with section
61.08(7), Florida Statutes; whichever occurs first.
e.____Lump Sum. Obligor shall pay lump sum alimony to Obligee in the amount of $_________ which
shall be paid as follows:______________________________________________________.
f.____ Retroactive. Obligor shall pay retroactive alimony in the amount of $ _____________
for the period of {date}
, through {date}
, which shall be paid
pursuant to paragraph 4 below.
3. Reasons for ( ) Awarding ( ) Denying Alimony. The Court has considered all of the following
in awarding/denying alimony:
a. The standard of living established during the marriage;
b. The duration of the marriage;
c. The age and the physical and emotional condition of each party;
d. The financial resources of each party, including the nonmarital and the marital assets and
liabilities distributed to each;
e. The earning capacities, educational levels, vocational skills, and employability of the parties and,
when applicable, the time necessary for either party to acquire sufficient education or training to enable
such party to find appropriate employment;
f. The contribution of each party to the marriage, including, but not limited to, services rendered in
homemaking, child care, education, and career building of the other party;
g. The responsibilities each party will have with regard to any minor children they have in common;
h. The tax treatment and consequences to both parties of any alimony award, including the designation
of all or a portion of the payment as a nontaxable, nondeductible payment;
i. All sources of income available to either party, including income available to either party
through investments of any asset held by that party; and
j. Any other factor necessary to do equity and justice between the parties: {Explain}
______ Please indicate here if additional pages are attached.
4. Arrearage/Retroactive Alimony.
$
$
a. ____There is no alimony arrearage at the time of this Final Judgment.
OR
b.
___Respondent shall pay to Petitioner the alimony arrearage of:
for retroactive alimony, as of {date}
.
for previously ordered unpaid alimony, as of {date}
.
Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (07/13)
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_
The total of $
in alimony arrearage shall be repaid in the amount of $
per month,
payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any event, at least once a
month ( ) other {explain}
beginning {date}
__________, until paid in full including statutory interest.
5. ____Life Insurance (to secure payment of support). To secure the alimony obligations set forth
in this judgment, Obligor shall maintain life insurance on his/her life naming Obligee as the sole
irrevocable beneficiary, so long as reasonably available. This insurance shall be in the amount of
at least $
____ and shall remain in effect until the obligation for alimony terminates.
6. ____ Other provisions relating to alimony including any tax treatment and consequences:
a. The award of alimony ( ) does not ( ) does leave the Obligor with significantly less
net income than the net income of the recipient/Obligee. If yes, the court finds the
following exceptional circumstances:_________________________________________
_______________________________________________________________________
________________________________________________________________________.
b. Other:__________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________.
SECTION II. CHILD SUPPORT
1. The Court finds that there is a need for child support and that the (
(hereinafter Obligor) has the present ability to pay child support.
) Mother (
) Father
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 $
.
2. Amount.
Child support established at the rate of $____________ per month for the______ children {total number
of parties’ minor or dependent children} shall be paid commencing _________________ {month, day,
year} and terminating ___________________ {month, day, year}. Child support shall be paid in the
amount of $________ per ______________ {week, month, other} which is consistent with the Obligor’s
current payroll cycle.
Upon termination of the obligation of child support for one of the parties’ children, child support in the
Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (07/13)
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amount of $__________for the remaining ________children {total number of remaining children} shall
be paid commencing ____________________________{month, day, year} and
terminating________________________________{month, day, year}. This child support shall be paid in
the amount of $_______ _per____________ {week, month, other} consistent with the Obligor’s current
payroll cycle.
{Insert schedule for the child support obligation, including the amount, and commencement and
termination dates, for the remaining minor or dependent children, which shall be payable as the
obligation for each child ceases. Please indicate whether the schedule ____appears below or ____ is
attached as part of this form.}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
The Obligor shall pay child support until all of the minor or dependent children: reach the age of 18;
become emancipated, marry, join the armed services, die, or become self-supporting; or until further
order of the court or agreement of the parties. The child support obligation shall continue beyond the
age of 18 and until high school graduation for any child who is dependent in fact, between the ages of
18 and 19, and is still in high school, performing in good faith with a reasonable expectation of
graduation before the age of 19.
If the child support ordered deviates from the guidelines by more than 5%, the factual findings
which support that deviation are:
.
3. Arrearage/Retroactive Child Support.
a. ____ There is no child support arrearage at the time of this Final Judgment.
OR
b. ____ The ( ) Mother ( ) Father shall pay to the other party the child support for
previously ordered unpaid child support, as of {date} _____________________.
The total of $ __ child support arrearage shall be repaid in the amount of $
____
per month,
payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any event, at least once a
month ( ) other {explain}
___________________________________________________________________________
,
beginning {date}
_________, until paid in full including statutory interest.
Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (07/13)
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4. Insurance.
[Choose all that apply]
a. ____ Health/Dental Insurance. ( ) Mother ( ) Father shall be required to maintain
( ) health and/or ( ) dental insurance for the parties’ minor child(ren), so long as it is reasonable in
cost and accessible to the child(ren). The party providing insurance shall be required to convey
insurance cards demonstrating said insurance to the other party.
OR
( ) health ( ) dental insurance is either not reasonable in cost or accessible to the children at this
time.
(
(
(
b. ____ Reasonable and necessary uninsured medical/dental/prescription drug costs for the
minor child(ren) shall be assessed as follows:
) Shared equally by both parents.
) Prorated according to the child support guideline percentages.
) Other {explain}:
As to these uninsured medical/dental/prescription drug expenses, the party who incurs the expense
shall submit a request for reimbursement to the other party within 30 days, and the other party, within
30 days of receipt, shall submit the applicable reimbursement for that expense, according to the
schedule of reimbursement set out in this paragraph.
5. ____Life Insurance (to secure payment of support). To secure the child support obligations in
this judgment, ( ) Mother ( ) Father ( ) Each party shall maintain life insurance, in an
, on ( ) his life ( ) her life ( ) his/her life naming the
amount of at least $
( ) minor child(ren) as the beneficiary(ies) OR naming ( ) Mother ( ) Father
( ) other {name}___________________________________as Trustee for the minor
child(ren). The obligation to maintain the life insurance coverage shall continue until the
youngest child turns 18, becomes emancipated, marries, joins the armed services, dies, or
becomes self-supporting.
6. IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall
be as follows: ___________________________________________________________________
.
Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of this
paragraph.
7. Other provisions relating to child support: ___________________________________________
SECTION III. METHOD OF PAYMENT
Obligor shall pay court-ordered child support/alimony and arrears, if any, as follows:
Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (07/13)
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1. Place of Payment.
a. ____ Obligor shall pay court-ordered support directly to either the State Disbursement
Unit or the central depository, as required by statute, along with any fee required by
statute .
OR
b. ____ Both parties have requested and the court finds that it is in the best interests of
the child(ren) that support payments need not be directed through either the State
Disbursement Unit or the central depository at this time; however, either party may
subsequently apply, pursuant to section 61.08 or 61.13, Florida Statutes, to require
payments through either the State Disbursement Unit or the central depository.
2. Income Deduction.
a. ____Immediate. Obligor shall pay through income deduction, pursuant to a separate
Income Deduction Order which shall be effective immediately. Obligor is individually
responsible for paying this support obligation until all of said support is deducted from
Obligor’s income. Until support payments are deducted from Obligor’s paycheck, Obligor is
responsible for making timely payments directly to the State Disbursement Unit or the
Obligee, as previously set forth in this order.
b. ____ Deferred. Income deduction is ordered this day, but it shall not be effective until a
, or, if not specified, an amount equal to one month’s obligation
delinquency of $
occurs. Income deduction is not being implemented immediately based on the following
findings: Income deduction is not in the best interests of the child(ren) because: {explain}
,
AND
( ) there is proof of timely payment of a previously ordered obligation without an income deduction
order in cases of modification,
AND
( ) there is an agreement by the Obligor to advise the Title IV-D agency, clerk of court, and Obligee of
any change in Payor and/or health insurance OR
( ) there is a signed written agreement providing an alternative arrangement between the Obligor and
the Obligee and, at the option of the IV-D agency, by the IV-D agency in IV-D cases in which there is an
assignment of support rights to the state, reviewed and entered in the record by the court.
3. Bonus/one-time payments. ( ) All ( ) _____% ( ) No income paid in the form of a bonus or
other similar one-time payment, up to the amount of any arrearage or the remaining balance
thereof owed pursuant to this order, shall be forwarded to the Obligee pursuant to the payment
method prescribed above.
4. Other provisions relating to method of payment. _____________________________________
Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with
Dissolution of Marriage with Dependent or Minor Child(ren) (07/13)
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SECTION IV. ATTORNEY’S FEES, COSTS, AND SUIT MONEY
1. ___ ( ) Husband’s ( ) Wife’s request(s) for attorney’s fees, costs, and suit money is (are)
denied because:
____________________________________________________________________________.
2. ____ The Court finds there is a need for and an ability to pay attorney’s fees, costs, and suit
money. ( ) Husband ( ) Wife is hereby ordered to pay to the other party $
____ in
in costs. The Court further finds that the attorney’s fees
attorney’s fees, and $
reasonable hours.
awarded are based on the reasonable rate of $ ___per hour and
Other provisions relating to attorney’s fees, costs, and suit money are as follows:
______________________________________________________________________________
SECTION V. OTHER PROVISIONS
1. Other Provisions:
_______________________________________________________________
______
.
2. The Court reserves jurisdiction to modify and enforce this Final Judgment.
DONE AND ORDERED at
_____, Florida, on _______________________ .
CIRCUIT JUDGE
A copy of the {name of document(s)} _____________________________________________ was
[Choose only one] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the parties listed below on
{date}__________ by {clerk of court or designee} __________________________.
____Husband (or his attorney)
____Wife ( or her attorney)
____Central Depository
____State Disbursement Unit
____Other:
Florida Supreme Court Approved Family Law Form 12.994(b), Final Judgment for Support Unconnected with
Dissolution of Marriage with No Dependent or Minor Child(ren) (07/13)
- 130 -
IN THE CIRCUIT COURT OF THE
IN AND FOR
_________
In re the Marriage of:
JUDICIAL CIRCUIT,
COUNTY, FLORIDA
Case No.: ___________________
Division: ____________________
_____________________________
Husband,
and
___________,
Wife.
FINAL JUDGMENT FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF
MARRIAGE WITH NO DEPENDENT OR MINOR CHILD(REN)
This cause came before this Court on a Petition for Support Unconnected with Dissolution of Marriage
under section 61.09, Florida Statutes. The Court, having reviewed the file and heard the testimony,
makes these findings of fact and reaches these conclusions of law:
1. The Court has jurisdiction over the subject matter and the parties.
2. The parties have no minor or dependent children in common, and the wife is not pregnant.
SECTION I. ALIMONY
1. _____The Court denies the request(s) for alimony.
OR
2. _____The Court finds that there is a need for alimony and that ____Husband ____Wife has/had
the ability to support his/her spouse and has failed to do so. ____Husband ____Wife
(hereinafter Obligor) has the present ability to pay alimony as follows:
[Choose all that apply]
a. ____ Permanent Periodic.
1. The court finds that no other form of alimony is fair and reasonable under the circumstances of the
parties.
2. As a marriage of (choose one only):
____Long Duration (17 years or greater) alimony is appropriate upon consideration of
all relevant factors;
____Moderate Duration (greater than 7 years but less than 17) alimony is appropriate
based upon clear and convincing evidence after consideration of all relevant factors;
____ Short Duration (less than 7 years) alimony is appropriate based upon the following
Florida Supreme Court Approved Family Law Form 12.994(b), Final Judgment for Support Unconnected with
Dissolution of Marriage with No Dependent or Minor Child(ren) (07/13)
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exceptional circumstances:_____________________________________________
___________________________________________________________________
____________________________________________________________________
____________________________________________________________________.
3. Obligor shall pay permanent periodic alimony to Obligee in the amount of $
per
month,
payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any event, at least once a
month, or ( ) other: {explain}_______________________________
beginning {date}
__. This alimony shall continue until modified by court order, the death
of either party, or remarriage of Obligee, whichever occurs first. The alimony may be modified or
terminated based upon either a substantial change in circumstances, or a supportive relationship in
accordance with section 61.14, Florida Statutes.
b. ____Bridge-the-Gap. Obligor shall pay bridge-the-gap alimony to Obligee in the amount of
$______per month, payable ( ) in accordance with Obligor’s employer’s payroll cycle,
beginning {date}________________and continuing until {date}________________ {a
period not to exceed two years}, remarriage of Obligee, or death of either party,
whichever occurs first.
c. _____Rehabilitative. Obligor shall pay rehabilitative alimony to Obligee in the amount of
$ ______ per month, payable ( ) in accordance with Obligor’s employer’s payroll cycle,
and in any event, at least once a month ( ) other {explain}________________________,
beginning {date}
_________
. This rehabilitative alimony shall continue until modified by
court order, the death of either party or until {date/event} ______________________
________________________________________________________________________
whichever occurs first. The rehabilitative plan presented demonstrated the following:
_______________________________________________________________________
___________________________________________________________________.
d. ____Durational. Obligor shall pay durational alimony to Obligee in the amount of
$_______per month payable ( ) in accordance with Obligor’s employer’s payroll cycle,
and in any event, at least once a month, or ( ) other {explain}______________________
beginning {date}_____________and terminating on {date }________________________,
remarriage of the Obligee, death of either party, or until modified by court order in
accordance with section 61.08(7), Florida Statutes; whichever occurs first.
e. ____Lump Sum. Obligor shall pay lump sum alimony to Obligee in the amount of
$__________which shall be paid as follows:_________________________________
.
f.____Retroactive. Obligor shall pay retroactive alimony in the amount of $
for the
, through {date}
________, which shall be paid pursuant
period of {date}
to paragraph 4 below.
3.
Reasons for ( ) Awarding ( ) Denying Alimony. The Court has considered all of the following
in awarding/denying alimony:
a. The standard of living established during the marriage;
b. The duration of the marriage;
Florida Supreme Court Approved Family Law Form 12.994(b), Final Judgment for Support Unconnected with
Dissolution of Marriage with No Dependent or Minor Child(ren) (07/13)
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c. The age and the physical and emotional condition of each party;
d. The financial resources of each party, including the nonmarital and the marital assets and liabilities
distributed to each;
e. The earning capacities, educational levels, vocational skills, and employability of the parties and,
when applicable, the time necessary for either party to acquire sufficient education or training to enable
such party to find appropriate employment;
f. The contribution of each party to the marriage, including, but not limited to, services rendered in
homemaking, child care, education, and career building of the other party;
g. The tax treatment and consequences to both parties of any alimony award, including the designation
of all or a portion of the payment as nontaxable, nondeductible payment;
h. All sources of income available to either party, including income available to either party through
investments of any asset held by the party; and
i. Any other factor necessary to do equity and justice between the parties {Explain}
______ Please indicate here if additional pages are attached.
4.
Arrearage/Retroactive Alimony.
a. ____There is no alimony arrearage at the time of this Final Judgment.
OR
b.____Respondent shall pay to Petitioner the alimony arrearage of:
$
for retroactive alimony, as of {date}
__________.
$
for previously ordered unpaid alimony, as of {date}
________.
The total of $
in alimony arrearage shall be repaid in the amount of
$
per month, payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any
event at least once a month, ( ) or other:{explain}______________________
beginning {date}
________, until paid in full including statutory interest.
5.
____Life Insurance (to secure payment of support). To secure the alimony obligations set forth
in this judgment, Obligor shall maintain life insurance coverage on his/her life naming Obligee as the
sole irrevocable beneficiary, so long as reasonably available. This insurance shall be in the amount of at
least $
______ and shall remain in effect until the obligation for alimony terminates.
6.
_____Other provisions relating to alimony including any tax treatment and consequences:
a. The award of alimony ( ) does not ( ) does leave the Obligor with significantly less net income
than the net income of the recipient/Obligee. If yes, the court finds the following exceptional
circumstances:____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
b. Other _____________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.994(b), Final Judgment for Support Unconnected with
Dissolution of Marriage with No Dependent or Minor Child(ren) (07/13)
- 133 -
.
SECTION II. METHOD OF PAYMENT
Obligor shall pay court-ordered alimony and arrears, if any, as follows:
1.
Place of Payment
a._____Obligor shall pay court-ordered support directly to either the State Disbursement Unit or
the central depository, as required by statute, along with any fee required by statute.
OR
b._____ Both parties have requested and the court finds that support payments need not be
directed through either the State Disbursement Unit or the central depository at this time; however,
either party may subsequently apply, pursuant to section 61.13(1)(d)3, Florida Statutes, to require
payments through either the State Disbursement Unit or the central depository.
2.
Income Deduction.
a. ____Immediate. Obligor shall pay through income deduction, pursuant to a separate Income
Deduction Order which shall be effective immediately. Obligor is individually responsible for paying this
support obligation until all of said support is deducted from Obligor’s income. Until support payments
are deducted from Obligor’s paycheck, Obligor is responsible for making timely payments directly to the
State Disbursement Unit or the Obligee, as previously set forth in this order.
b._____Deferred. Income Deduction is ordered this day, but it shall not be effective until a
, or, if not specified, an amount equal to one month’s obligation occurs.
delinquency of $
Income deduction is not being implemented immediately based on the following findings:
There are no minor child(ren) common to the parties,
AND
There is proof of timely payment of a previously ordered obligation without an income deduction order
in cases of modification,
AND
( ) There is an agreement by the Obligor to advise the Title IV-D agency, clerk of court, and Obligee of
any change in Payor and/or health insurance OR
( ) there is a signed written agreement providing an alternative arrangement between the Obligor and
the Obligee and, at the option of the IV-D agency, by the IV-D agency in IV-D cases in which there is an
assignment of support rights to the state, reviewed and entered in the record by the court.
3.
Bonus/One-Time Payments. ( ) All ( )
% ( ) No income paid in the form of a
bonus or other similar one-time payment, up to the amount of any arrearage or the remaining balance
thereof owed pursuant to this order, shall be forwarded to the Obligee pursuant to the payment
method prescribed above.
4.
Other provisions relating to method of payment:
SECTION III. ATTORNEY’S FEES, COSTS, AND SUIT MONEY
Florida Supreme Court Approved Family Law Form 12.994(b), Final Judgment for Support Unconnected with
Dissolution of Marriage with No Dependent or Minor Child(ren) (07/13)
- 134 -
1. ( ) Husband’s ( ) Wife’s request(s) for attorney’s fees, costs, and suit money is (are)
denied because_________________________________________________________________
.
2. The Court finds there is a need for and an ability to pay attorney’s fees, costs, and suit
in attorney’s
money. ( ) Husband ( ) Wife is hereby ordered to pay to the other party $
in costs. The Court further finds that the attorney’s fees awarded are based on
fees, and $
per hour and ____ reasonable hours.
the reasonable rate of $
Other provisions relating to attorney’s fees, costs, and suit money are as follows:
.
SECTION IV. OTHER PROVISIONS
1.
Other Provisions.
2.
The Court reserves jurisdiction to modify and enforce this Final Judgment.
DONE AND ORDERED on _____________________ in ___________________________, Florida.
CIRCUIT JUDGE
COPIES TO:
____Husband (or his attorney)
____Wife ( or her attorney)
____Central Depository
____State Disbursement Unit
____Other:
Florida Supreme Court Approved Family Law Form 12.994(b), Final Judgment for Support Unconnected with
Dissolution of Marriage with No Dependent or Minor Child(ren) (07/13)
- 135 -
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