In Re: Amendments to the Florida Supreme Court Approved Family Law Forms – Corrected Opinion

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Supreme Court of Florida ______________ No. SC16-1253 ______________ IN RE: AMENDMENTS TO THE FLORIDA SUPREME COURT APPROVED FAMILY LAW FORMS. [September 29, 2016] CORRECTED OPINION PER CURIAM. Pursuant to the procedures approved by this Court in Amendments to the Florida Family Law Rules of Procedure & Family Law Forms, 810 So. 2d 1, 14 (Fla. 2000), this Court has internally reviewed the Florida Supreme Court Approved Family Law Forms and has determined that amendments to forms 12.982(a), Petition for Change of Name (Adult), 12.982(c), Petition for Change of Name (Minor Child(ren)), and 12.982(f), Petition for Change of Name (Family) are necessary in light of certain statutory amendments. Input on these issues was received from the Advisory Workgroup on the Florida Supreme Court Approved Family Law Forms, which provided valuable assistance. We have jurisdiction. See art. V, § 2(a), Fla. Const. Section 68.07, Florida Statutes, was amended, effective October 1, 2014, to require that the result of a state and national criminal history records check for the purposes of obtaining a name change must indicate whether the petitioner has registered as a sexual predator or sexual offender. See ch. 2014-5, § 1, Laws of Fla. Additionally, subsection 68.07(3)(i) requires that petitions for name change must state “whether the petitioner has ever been required to register as a sexual predator under s. 775.21 or as a sexual offender under s. 943.0435.” § 68.07(3)(i), Fla. Stat. (2014). The amendments to the forms incorporate this new requirement. The amended forms are adopted as set forth in the appendix to this opinion, fully engrossed, effective for immediate use. The forms may also be accessed and downloaded from the Florida State Court’s website at http://www.flcourts.org/resources-and-services/court-improvement/problemsolving-courts/family-courts/family-law-forms.stml. By adoption of the amended forms, we express no opinion as to their correctness or applicability. We also direct that the new and amended forms be published for comment. Interested persons shall have sixty days from the date of this opinion to file comments with the Court.1 1. All comments must be filed with the Court on or before November 28, 2016, as well as a separate request for oral argument if the person filing the -2- It is so ordered. LABARGA, C.J., and PARIENTE, LEWIS, QUINCE, CANADY, POLSTON, and PERRY, JJ., concur. THE FILING OF A MOTION FOR REHEARING SHALL NOT ALTER THE EFFECTIVE DATE OF THESE AMENDMENTS. Original Proceeding – Florida Supreme Court Approved Family Law Forms comment wishes to participate in oral argument, which may be scheduled in this case. If filed by an attorney in good standing with The Florida Bar, the comment must be electronically filed via the Portal in accordance with In re: Electronic Filing in the Supreme Court of Florida via the Florida Courts E-Filing Portal, Fla. Admin. Order No. AOSC13-7 (Feb. 18, 2013). If filed by a non-lawyer or a lawyer not licensed to practice in Florida, the comment must be electronically filed via e-mail in accordance with In re Mandatory Submission of Electronic Copies of Documents, Fla. Admin. Order No. AOSC04-84 (Sept. 13, 2004). Electronically filed documents must be submitted in Microsoft Word 97 or higher. Any person unable to submit a comment electronically must mail or hand deliver the originally signed comment to the Florida Supreme Court, Office of the Clerk, 500 South Duval Street, Tallahassee, Florida 32399-1927; no additional copies are required or will be accepted. -3- INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.982(a) PETITION FOR CHANGE OF NAME (ADULT) (09/16) When should this form be used? This form should be used when an adult wants the court to change his or her name. This form is not to be used in connection with a dissolution of marriage or for adoption of child(ren). If you want a change of name because of a dissolution of marriage or adoption of child(ren) that is not yet final, the change of name should be requested as part of that case. This form should be typed or printed in black ink and must be signed before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in the county where you live and keep a copy for your records. What should I do next? Unless you are seeking to restore a former name, you must have fingerprints submitted for a state and national criminal records check. The fingerprints must be taken in a manner approved by the Department of Law Enforcement and must be submitted to the Department for a state and national criminal records check. You may not request a hearing on the petition until the clerk of court has received the results of your criminal history records check. The clerk of court can instruct you on the process for having the fingerprints taken and submitted, including information on law enforcement agencies or service providers authorized to submit fingerprints electronically to the Department of Law Enforcement. The process may take several weeks and you will have to pay for the cost of processing the fingerprints and conducting the state and national criminal history records check. Please note that the state and national criminal records check must indicate whether you have registered as a sexual predator or a sexual offender and you must also indicate on this petition whether you have ever been required to register as a sexual predator under section 775.21, Florida Statutes, or as a sexual offender under section 943.0435, F.S. Next, you must obtain a hearing date for the court to consider your request. If you are seeking to restore a former name, a hearing on the petition MAY be held immediately after the petition is filed. The final hearing on any other petition for a name change may be held immediately after the clerk of court receives the results of your criminal history records check. You should ask the clerk of court, family law intake staff, or judicial assistant about the local procedure for setting a hearing. You may be required to attend the final hearing. Included in these forms is a Final Judgment of Change of Name (Adult), Florida Supreme Court Approved Family Law Form 12.982(b), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant, to see if you need to bring a final judgment form with you. 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 Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (09/16) -4- your hearing or trial. If the judge grants your petition, he or she will sign this order. This officially changes your name. The clerk can provide you with certified copies of the signed order. There will be charges for the certified copies, and the clerk can tell you the amount of the charges. 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 68.07, Florida Statutes. IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be filed electronically except in certain circumstances. Self-represented litigants may file petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to file your pleadings or other documents electronically, you must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. The rules and procedures should be carefully read and followed. IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION After the initial service of process of the petition or supplemental petition by the Sheriff or certified process server, the Florida Rules of Judicial Administration now require that all documents required or permitted to be served on the other party must be served by electronic mail (e-mail) except in certain circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial Administration. If you elect to participate in electronic service, which means serving or receiving pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the A-Z Topical Index. SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the procedures must always be followed once the initial election is made. To serve and receive documents by e-mail, you must designate your e-mail addresses by using the Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915, and you must provide your e-mail address on each form on which your signature appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516. Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (09/16) -5- Special notes... The heading of the form calls for the name of the petitioner. Your current name should go there, as you are the one who is asking the court for something. The judicial circuit, case number, and division may be obtained from the clerk of court’s office when you file the petition. It may be helpful to compile a list of all of the people and/or places that will need a copy of your final judgment. This list may include the driver’s license office, social security office, banks, schools, etc. A list will help you know how many copies of your order you should get from the clerk of court after your hearing. 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 12.982(a), Petition for Change of Name (Adult) (09/16) -6- IN THE CIRCUIT COURT OF THE ____________JUDICIAL CIRCUIT, IN AND FOR______________________COUNTY, FLORIDA Case No.: ________________________ Division: _________________________ _______________________________, Petitioner. PETITION FOR CHANGE OF NAME (ADULT) I, {full legal name} _________________________________, being sworn, certify that the following information is true: 1. My complete present name is: _______________________________________________________ I request that my name be changed to: ________________________________________________ 2. I live in _________________ County, Florida, at {street address} _____________________________ _________________________________________________________________________________ 3. I was born on {date}______________, in {city} _________________________, {county} __________ , {state} ______________________, {country} _________________. 4. My father’s full legal name: __________________________________________________________ My mother’s full legal name: _________________________________________________________ My mother’s maiden name: __________________________________________________________ 5. I have lived in the following places since birth: Dates (to/from) Address _______/_________ ____________________________________________________ _______/_________ ____________________________________________________ _______/_________ ____________________________________________________ _______/_________ ____________________________________________________ (___ Please indicate here if you are continuing these facts on an attached page.) 6. Family [Indicate all that apply] ____ I am not married. ____ I am married. My spouse’s full legal name is: _____________________________________ Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (09/16) -7- ____ I do not have child(ren). ____ The name(s), age(s), and address(es) of my child(ren) are as follows (all children, including those over 18, must be listed): Name {last, first, middle initial} Age Address, City, State __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ (____ Please indicate here if you are continuing these facts on an attached page.) 7. Former names [Indicate all that apply] My name has never been changed by a court. My name previously was changed by court order from ______________________________ to _____________________________________on {date} _______________________________ , by {court, city, and state} . A copy of the court order is attached. My name previously was changed by marriage from __________________________________ to on {date} , in {city, county, and state} . A copy of the marriage certificate is attached. I have never been known or called by any other name. I have been known or called by the following other name(s): {list name(s) and explain where you were known or called by such name(s)} __________________________________________________________________________________ 8. Occupation My occupation is: I am employed at: {company and address} . . During the past 5 years, I have had the following jobs: Dates (to/from) Employer and employer’s address _______/_______ __________________________________________________________ _______/_______ __________________________________________________________ _______/_______ __________________________________________________________ _______/_______ __________________________________________________________ _______/_______ __________________________________________________________ (___ Please indicate here if you are continuing these facts on an attached page.) 9. Business [Choose one only] Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (09/16) -8- I do not own and operate a business. I own and operate a business. The name of the business is: ___________________________ The street address is: . My position with the business is: . I have been involved with the business since: {date} . 10. Profession [Choose one only] I am not in a profession. I am in a profession. My profession is: _________________________________________ I have practiced this profession: Dates (to/from) Place and address _______/_______ __________________________________________________________ _______/_______ __________________________________________________________ _______/_______ __________________________________________________________ _______/_______ __________________________________________________________ (____ Please indicate here if you are continuing these facts on an attached page.) 11. Education I have graduated from the following school(s): Degree Date of Received Graduation School _________ _____________ __________________________________________________ _________ _____________ __________________________________________________ _________ _____________ __________________________________________________ _________ _____________ __________________________________________________ (____ Please indicate here if you are continuing these facts on an attached page.) 12. Criminal History [Indicate all that apply] I have never been arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication. I have a criminal history. In the past I have been arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication. The details of my criminal history are: Date City/State Event (arrest, charge, plea, or adjudication) (______ Please indicate here if you are continuing these facts on an attached page.) Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (09/16) -9- I _____ have____have not ever been required to register as a sexual predator under section 775.21, Florida Statutes. I _____ have ______have not ever been required to register as a sexual offender under section 943.0435, Florida Statutes. 13. Bankruptcy [Choose one only] I have never been adjudicated bankrupt. I was adjudicated bankrupt on {date} , in {city} , {county} , {state} . (____ Please indicate here if you have filed additional bankruptcies, and explain on an attached page.) 14. Creditor(s)’ Judgments [Choose one only] I have never had a money judgment entered against me by a creditor. The following creditor(s)’ money judgment(s) have been entered against me: Date Amount Creditor Court entering judgment and case number {date} if Paid _____ _____ _____ _____ (_____ Please indicate here if these facts are continued on an attached page.) 15. Fingerprints and Criminal History Records Check Unless I am seeking to restore a former name, a copy of my fingerprints has been taken in a manner approved by the Department of Law Enforcement and submitted for a state and national criminal history records check. I understand that I cannot request a hearing on my Petition until the Clerk of Court receives the results of the criminal history records check. I also understand that the state and national records check must indicate whether I have registered as either a sexual predator or sexual offender. 16. I have no ulterior or illegal purpose for filing this petition, and granting it will not in any manner invade the property rights of others, whether partnership, patent, good will, privacy, trademark, or otherwise. 17. My civil rights have never been suspended, or, if my civil rights have been suspended, they have been fully restored. Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (09/16) - 10 - I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: ______________________ _____________________________________________ Signature of PETITIONER Printed Name: _________________________________ Address: _____________________________________ City, State, Zip: ________________________________ Telephone Number: _____________________________ Fax Number: __________________________________ Designated E-Mail Address(es):____________________ _____________________________________________ 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 Petitioner. This form was completed with the assistance of: {name of individual} _____________________________________ , {name of business} , {address} ______________________________________________ , {city} ________________, {state}_____,{zip code}_________,{telephone number} __________________ Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult) (09/16) - 11 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.982(c) PETITION FOR CHANGE OF NAME (MINOR CHILD(REN)) (09/16) When should this form be used? This form should be used when parents want the court to change the name of their minor child(ren). For the purposes of this proceeding, a person under the age of 18 is a minor. This form is not to be used in connection with an adoption, dissolution of marriage, or paternity action. If you want a change of name for your child(ren) because of an adoption or paternity action that is not yet final, the change of name should be requested as part of that case. This form should be typed or printed in black ink and must be signed 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. The Petition should only be completed by one Petitioner for one child. If you wish to change the name of more than one child or if there is more than one Petitioner, you should complete and file a Supplemental Form for Petition for Change of Name (Minor Child) for each child and/or a Supplemental Form for Petition for Change of Name. The supplemental form(s) is an attachment to the petition. Be sure that the bottom of each page of each supplemental form is initialed by the petitioner(s). What should I do next? Unless you are seeking to restore a former name, each adult petitioner(s)’s fingerprints must be submitted for a state and national criminal history records check. The fingerprints must be taken in a manner approved by the Department of Law Enforcement. The fingerprints must be submitted to the Department of Law Enforcement for a state and national criminal history records check. The Petitioner(s) may not request a hearing on the Petition until the copy of the fingerprints are filed and the clerk of court has received the results of the criminal history records check. The clerk of court can instruct you on the process for having the fingerprints taken and submitted, including information on law enforcement agencies or service providers authorized to submit fingerprints electronically to the Department of Law Enforcement. The process may take several weeks and the parent or guardian of the minor must pay the cost of processing the fingerprints and conducting the state and national history records check. Please note that the state and national criminal records check must indicate whether you have registered as either a sexual predator or a sexual offender and you must also indicate on this petition whether you have ever been required to register as a sexual predator under section 775.21, Florida Statutes, or as a sexual offender under section 943.0435, Florida Statutes. Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren)) (09/16) - 12 - If both parents agree to the change of name and live in the county where the change of name is sought, you may both file as petitioners. In this situation, service is not necessary, and you need only to set a hearing. You should ask the clerk of court, family law intake staff, or judicial assistant about the local procedure for setting a hearing. If only one parent is a resident of the county where the change of name(s) is sought or only one parent asks for the child(ren)’s name(s) to be changed, the other parent must be notified and his or her consent obtained, if possible. If the other parent consents to the change of name, a Consent for Change of Name (Minor Child(ren)), Florida Supreme Court Approved Family Law Form 12.982(d), should be filed. If the other parent does not consent to the change of name, you may still have a hearing on the petition if you have properly notified the other parent about your petition and the hearing. If you know where he or she lives, you must use personal service. If you absolutely do not know where he or she lives, you may use constructive service. For more information about personal and constructive service, you should refer [to] the “General Instructions for Self-Represented Litigants” found at the beginning of these forms and the instructions to Florida Family Law Rules of Procedure Forms 12.910(a) and 12.913(b) and Florida Supreme Court Approved Family Law Form 12.913(a). However, the law regarding constructive service is very complex and you may wish to consult an attorney regarding that issue. Next, you must obtain a final hearing date for the court to consider your request. If you are seeking to restore a former name, a hearing on the petition MAY be held immediately after the petition is filed. The final hearing on any other petition for a name change may be held immediately after the clerk of court receives the results of your criminal history records check. You should ask the clerk of court, family law intake staff, or judicial assistant about the local procedure for setting a hearing. You may be required to attend the hearing. Included in these forms is a Final Judgment of Change of Name (Minor Child(ren)), Florida Supreme Court Approved Family Law Form 12.982(e), which may be used when a judge grants a change of name for a minor child(ren). If you attend the hearing, you should take the final judgment with you. You should complete the top part of the form, including the circuit, county, case number, division, and the name(s) of the petitioner(s) and leave the rest blank for the judge to complete. It should be typed or printed in black ink. If the judge grants your petition, he or she will sign this order. This officially changes your child(ren)’s name(s). The clerk can provide you with certified copies of the signed order. There will be charges for the certified copies, and the clerk can tell you the amount of the charges. Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren)) (09/16) - 13 - 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 68.07, Florida Statutes. IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be filed electronically except in certain circumstances. Self-represented litigants may file petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to file your pleadings or other documents electronically, you must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. The rules and procedures should be carefully read and followed. IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION After the initial service of process of the petition or supplemental petition by the Sheriff or certified process server, the Florida Rules of Judicial Administration now require that all documents required or permitted to be served on the other party must be served by electronic mail (e-mail) except in certain circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial Administration. If you elect to participate in electronic service, which means serving or receiving pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the A-Z Topical Index. SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by email, the procedures must always be followed once the initial election is made. To serve and receive documents by e-mail, you must designate your e-mail addresses by using the Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915, and you must provide your e-mail address on each form on which your signature appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren)) (09/16) - 14 - Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516. Special notes... The heading of the form calls for the name(s) of the petitioner(s). This means the parent(s) who is (are) requesting the change of their child(ren)’s name(s). The judicial circuit, case number, and division may be obtained from the clerk of court’s office when you file the petition. It may be helpful to compile a list of all of the people and places that will need a copy of the final judgment. This list may include the driver’s license office, social security office, banks, schools, etc. A list will help you know how many copies of your order you should get from the clerk of court after your hearing. 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 12.982(c), Petition for Change of Name (Minor Child(ren)) (09/16) - 15 - IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: IN RE: THE NAME CHANGE OF , Petitioner/Father, , Petitioner/Mother. PETITION FOR CHANGE OF NAME (MINOR CHILD(REN)) I/We, {full legal name(s)} that the following information is true: , being sworn, certify I am/We are the birth or legal parent(s) or guardian of the minor child(ren) named in this petition. [Choose only one] a. ____ There is only one minor child named in this petition. b. ____ There are {enter number of children} information on the first child is entered below. supplemental forms for each other child. children named in this petition. The I/We have attached the completed The adult petitioner(s)’s fingerprints have been taken in a manner approved by the Department of Law Enforcement and submitted for a state and national criminal history records check. I /We understand that I/we cannot request a hearing on my/our Petition until the clerk of court receives the results of the criminal history records check. I/We also understand that the state and national records check must indicate whether I/we have registered as either a sexual predator or a sexual offender. A. THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # 1 : 1. Minor child’s complete present name is: I/We request that this minor child’s name be changed to: Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren)) (09/16) - 16 - 2. The minor child lives in County, Florida, at {street address} . 3. The minor child was born on {date} , in {city, county, state, country} . 4. The minor child’s father’s full legal name: The minor child’s mother’s full legal name: The minor child’s mother’s maiden name: . . . 5. The minor child has lived in the following places since birth: Dates (to/from) Address _______/________ ______________________________________________________ _______/________ ______________________________________________________ _______/________ _______________________________________________________ _______/________ ______________________________________________________ _______/________ ______________________________________________________ (____ Please indicate here if you are continuing these facts on an attached page.) 6. [Choose one only] _____The minor child is not married. _____ The minor child is married to: {full legal name} __________________________________. 7. [Choose one only] _____The minor child has no children. _____The minor child is the parent of the following child(ren): {enter full name(s) and date(s) of birth} ___________________________________________________________________. 8. Former names. [Indicate all that apply] _____The minor child’s name has never been changed by a court. _____The minor child’s name previously was changed by court order from _______________ to on {date} , by {court, city, and state} . A copy of the court order is attached. _____The minor child’s name previously was changed by marriage from _________________ to on {date} , in {city, county, and state} A copy of the marriage certificate is attached. Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren)) (09/16) - 17 - . _____The minor child has never been known or called by any other name. _____The minor child has been known or called by the following other name(s): {list name(s) and explain where child was known or called by such name(s)} ____________________ _____________________________________________________________________ _____. 9. The minor child is not employed in an occupation or profession, does not own and operate a business, and has received no educational degrees. If the minor child has a job, explain: . 10. Criminal History. [Indicate all that apply] _____ The minor child has never been arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication. _____ The minor child has a criminal history. In the past, the minor child was arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication. The details of the criminal history are: Date City/State Event (arrest, charge, plea, or adjudication) (_____Please indicate here if you are continuing these facts on an attached page.) _____ The minor child _____ has _____has not ever been required to register as a sexual predator under section 775.21, Florida Statutes. _____ The minor child _____has _____has not ever been required to register as a sexual offender under section 943.0435, Florida Statutes 11. Money Judgments. [Choose one only] _____ The minor child has never been adjudicated bankrupt, and no money judgment has ever been entered against him or her. _____ The following money judgment(s) has been entered against him or her: Date Amount Creditor Court entering judgment and case number if Paid {date} _____ _____ _____ _____ Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren)) (09/16) - 18 - B. THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER(S): ( ) FATHER ( ) MOTHER ( ) GUARDIAN ( ) A Supplemental Form has been attached for the other parent or petitioner. 1. My complete present name is: __________________________________________________. 2. I live in ________________ County, Florida, at {street address} ___________________________ _________________________________________________________________ . 3. Bankruptcy [Choose one only] I have never been adjudicated bankrupt. I was adjudicated bankrupt on {date} , in {city} , {county} , {state} . (___ Please indicate here if you have filed additional bankruptcies, and explain on an attached page.) 4. Creditor(s)’ Judgments [Choose one only] I have never had a money judgment entered against me by a creditor. The following creditor(s)’ money judgment(s) have been entered against me: Date Amount Creditor Court entering judgment and case number if Paid {date} _____ _____ _____ _____ 5. Criminal History Indicate all that apply I have never been arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication. I have a criminal history. In the past I have been arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication. The details of my criminal history are: Date City/State Event (arrest, charge, plea, or adjudication) Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren)) (09/16) - 19 - (______ Please indicate here if you are continuing these facts on an attached page.) I _____ have____have not ever been required to register as a sexual predator under section 775.21, Florida Statutes. I _____ have ______have not ever been required to register as a sexual offender under section 943.0435, Florida Statutes. 6. I have no ulterior or illegal purpose for filing this petition, and granting it will not in any manner invade the property rights of others, whether partnership, patent, good will, privacy, trademark, or otherwise. 7. My civil rights have never been suspended, or, if ever suspended, they have been fully restored. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: ______________________ _____________________________________________ Signature of PETITIONER Printed Name: _________________________________ Address: _____________________________________ City, State, Zip: ________________________________ Telephone Number: _____________________________ Fax Number: __________________________________ Designated E-Mail Address(es):____________________ _____________________________________________ STATE OF FLORIDA COUNTY OF ____________________ Sworn to or affirmed and signed before me on ____________ by _______________________________ . _____________________________________________ NOTARY PUBLIC or DEPUTY CLERK Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren)) (09/16) - 20 - _____________________________________________ [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 Petitioner. This form was completed with the assistance of: {name of individual} _____________________________________ , {name of business} , {address} ______________________________________________ , {city} ________________, {state}_____,{zip code}_________,{telephone number} __________________ Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren)) (09/16) - 21 - ADULT SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME (MINOR CHILDREN) Case No.: ______________________________ THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER(S): ( ) FATHER ( ) MOTHER ( ) GUARDIAN 1. My complete present name is: __________________________________________________ ______________________________________________________________________________ . 2. I live in ________________ County, Florida, at {street address} ___________________________ ______________________________________________________________________________. 3. Bankruptcy [Choose one only] I have never been adjudicated bankrupt. I was adjudicated bankrupt on {date} , in {city} , {county} , {state} . (___ Please indicate here if you have filed additional bankruptcies, and explain on an attached page.) 4. Creditor(s)’ Judgments [Choose one only] I have never had a money judgment entered against me by a creditor. The following creditor(s)’ money judgment(s) have been entered against me: Date Amount Creditor Court entering judgment and case number {date} ______ ________ _________ ________________________________ ______ ________ _________ ________________________________ ______ ________ _________ ________________________________ ______ ________ _________ ________________________________ ______ ________ _________ ________________________________ (____ Please indicate here if these facts are continued on an attached page.) if Paid 5. Criminal History [Indicate all that apply] I have never been arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication. I have a criminal history. In the past I have been arrested for or charged with, pled guilty Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren)) (09/16) - 22 - or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication. The details of my criminal history are: Date City/State Event (arrest, charge, plea, or adjudication) (____ Please indicate here if you are continuing these facts on an attached page.) I _____ have____have not ever been required to register as a sexual predator under section 775.21, Florida Statutes. I _____ have ______have not ever been required to register as a sexual offender under section 943.0435, Florida Statutes. 6. I have no ulterior or illegal purpose for filing this petition, and granting it will not in any manner invade the property rights of others, whether partnership, patent, good will, privacy, trademark, or otherwise. 7. My civil rights have never been suspended, or, if ever suspended, they have been fully restored. Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren)) (09/16) - 23 - I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: ______________________ _____________________________________________ Signature of PETITIONER Printed Name: _________________________________ Address: _____________________________________ City, State, Zip: ________________________________ Telephone Number: _____________________________ Fax Number: __________________________________ Designated E-Mail Address(es):____________________ _____________________________________________ 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 Petitioner. This form was completed with the assistance of: {name of individual} _____________________________________ , {name of business} , {address} ______________________________________________ , {city} ________________, {state}_____,{zip code}_________,{telephone number} __________________ . Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren)) (09/16) - 24 - SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME (MINOR CHILD(REN)) Case No.: THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # : 1. Minor child’s complete present name is: I/We request that this minor child’s name be changed to: 2. The minor child lives in County, Florida, at {street address} . 3. The minor child was born on {date} , in {city, county, state, country} . 4. The minor child’s father’s full legal name: The minor child’s mother’s full legal name: The minor child’s mother’s maiden name: . . . 5. The minor child has lived in the following places since birth: Dates (to/from) Address _______/________ ______________________________________________________ _______/________ ___________________________________________________________ ______/_________ ___________________________________________________________ ______/_________ ___________________________________________________________ ______/_________ ___________________________________________________________ ______/_________ ___________________________________________________________ (_____ Please indicate here if you are continuing these facts on an attached page.) Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren)) (09/16) - 25 - MINOR CHILD # ________, continued 6. [Choose one only] _____The minor child is not married. _____ The minor child is married to: {full legal name} __________________________________. 7. [Choose one only] _____The minor child has no children. _____The minor child is the parent of the following child(ren): {enter full name(s) and date(s) of birth} ___________________________________________________________________. 8. Former names. [Indicate all that apply] _____The minor child’s name has never been changed by a court. _____The minor child’s name previously was changed by court order from _______________ to on {date} , by {court, city, and state} . A copy of the court order is attached. _____The minor child’s name previously was changed by marriage from _________________ to on {date} , in {city, county, and state} . A copy of the marriage certificate is attached. _____The minor child has never been known or called by any other name. _____The minor child has been known or called by the following other name(s): {list name(s) and explain where child was known or called by such name(s)} ____________________ _____________________________________________________________________ _____________________________________________________________________ 9. The minor child is not employed in an occupation or profession, does not own and operate a business, and has received no educational degrees. If the minor child has a job, explain: . 10. Criminal History. [Indicate all that apply] _____ The minor child has never been arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication. _____ The minor child has a criminal history. In the past, the minor child was arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication. The details of the criminal history are: Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren)) (09/16) - 26 - MINOR CHILD # ________, continued Date City/State Event (arrest, charge, plea, or adjudication) (_____ Please indicate here if you are continuing these facts on an attached page.) _____ The minor child _____ has _____has not ever been required to register as a sexual predator under section 775.21, Florida Statutes. _____ The minor child _____has _____has not ever been required to register as a sexual offender under section 943.0435, Florida Statutes 11. Money Judgments. [Choose one only] _____ The minor child has never been adjudicated bankrupt, and no money judgment has ever been entered against him or her. _____ The following money judgment(s) has been entered against him or her: Date Amount Creditor Court entering judgment and case number {date} if Paid _____ _____ _____ Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor Child(ren)) (09/16) - 27 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.982(f) PETITION FOR CHANGE OF NAME (FAMILY) (09/16) When should this form be used? This form should be used when a family wants the court to change its name. This form is not to be used in connection with a dissolution of marriage, paternity, or adoption action. If you want a change of name because of a dissolution of marriage, paternity, or adoption action that is not yet final, the change of name should be requested as part of that case. This form should be typed or printed in black ink and must be signed 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. The petition should only be completed for one adult. If you wish to change the name(s) of another adult and/or any child(ren), you should complete and file with the clerk of court the attached Supplemental Form(s) for Petition for Change of Name (Family) for each additional family member. Be sure that the bottom of each page of each supplemental form is initialed. What should I do next? Unless you are seeking to restore a former name, each adult petitioner must have fingerprints submitted for a state and national criminal history records check. The fingerprints must be taken in a manner approved by the Department of Law Enforcement and must be submitted to the Department for a state and national criminal history records check. You may not request a hearing on the petition until the clerk of court has received the results of your criminal history records check. The clerk of court can instruct you on the process for having the fingerprints taken and submitted, including information on law enforcement agencies or service providers authorized to submit finger prints electronically to the Department of Law Enforcement. The process may take several weeks and you will have to pay for the cost of processing the fingerprints and conducting the state and national criminal history records check. Please note that the state and national criminal records check must indicate whether you have registered as either a sexual predator or a sexual offender and you must also indicate on this petition whether you have ever been required to register as a sexual predator under section 775.21, Florida Statutes, or as a sexual offender under section 943.0435, Florida Statutes. If any of the children for whom you are requesting this change of name are not the legal children of both adults filing this petition, you must obtain the consent of the legal parent(s). A parent not named as a petitioner in this action may consent by submitting a Consent for Change of Name (Minor Child(ren)), Florida Supreme Court Approved Family Law Form 12.982(d). If the other parent does not consent to the change of name, you may still have a hearing on the petition if you have properly notified the other parent about your petition and the hearing. If you know where he or she lives, you must use personal service. If you absolutely do not know where he or she lives, you Instructions for Florida Supreme Court Approved Family Law Form 12.982(f), Petition for Change of Name (Family) (09/16) - 28 - may use constructive service. For more information about personal and constructive service, you should refer to the “General Instructions for Self-Represented Litigants” found at the beginning of these forms and the instructions to Florida Family Law Rules of Procedure Forms 12.910(a) and 12.913(b) and Florida Supreme Court Approved Family Law Form 12.913(a). The law on constructive service is very complex and you may wish to consult an attorney regarding constructive service. Next, you must obtain a final hearing date for the court to consider your request. If you are seeking to restore a former name, hearing on the petition MAY be held immediately after the petition is filed. The final hearing on any other petition for a name change may be held immediately after the clerk of court receives the results of your criminal history records check. You should ask the clerk of court, family law intake staff, or judicial assistant about the local procedure for setting a hearing. You may be required to attend the hearing. Included in these forms is a Final Judgment of Change of Name (Family), Florida Supreme Court Approved Family Law Form 12.982(g), which may be used when a judge grants a change of name for a family. If you attend the hearing, you should take the final judgment form with you. You should complete the top part of this form, including the circuit, county, case number, division, the name(s) of the petitioner(s) and leave the rest blank for the judge to complete. It should be typed or printed in black ink. If the judge grants your petition, he or she will sign this order. This officially changes your family’s name. The clerk can provide you with certified copies of the signed order. There will be charges for the certified copies, and the clerk can tell you the amount of the charges. 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 68.07, Florida Statutes. IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be filed electronically except in certain circumstances. Self-represented litigants may file petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to file your pleadings or other documents electronically, you must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. The rules and procedures should be carefully read and followed. IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION After the initial service of process of the petition or supplemental petition by the Sheriff or certified process server, the Florida Rules of Judicial Administration now require that all documents required or permitted to be served on the other party must be served by electronic mail (e-mail) except in certain circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial Administration. If you elect to participate in electronic service, which means serving or Instructions for Florida Supreme Court Approved Family Law Form 12.982(f), Petition for Change of Name (Family) (09/16) - 29 - receiving pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the A-Z Topical Index. SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the procedures must always be followed once the initial election is made. To serve and receive documents by e-mail, you must designate your e-mail addresses by using the Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915, and you must provide your e-mail address on each form on which your signature appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516. Special notes... The heading of the form calls for the name(s) of the petitioner(s). This is (are) the parent(s) who is/are requesting the change of their family’s name(s). The judicial circuit, case number, and division may be obtained from the clerk of court’s office when you file the petition. It may be helpful to compile a list of all of the people and places that will need a copy of the final judgment. This list may include the driver’s license office, social security office, banks, schools, etc. A list will help you know how many copies of your order you should get from the clerk of court after your hearing. 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 12.982(f), Petition for Change of Name (Family) (09/16) - 30 - IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: IN RE: THE NAME CHANGE OF , Petitioner/Father, , Petitioner/Mother. PETITION FOR CHANGE OF NAME (FAMILY) I/We, {full legal name(s)} ____________________________________________________, being sworn, certify that the following information is true: There are {enter number} __ adults named in this petition. A supplemental form is attached for each adult not set out below. There are {enter number} __ children named in this petition. I am/We are the birth or legal parents or guardian of the minor child(ren) named in this petition. I/We have attached a completed supplemental form for each minor child. Unless I am seeking to restore a former name, a copy of the fingerprints of each adult person seeking a name change in this petition has/have been taken in a manner approved by the Department of Law Enforcement, and submitted for a state and national criminal history records check. I/We understand that I/we cannot request a hearing on my/our Petition until the clerk of court receives the results of the criminal history records check. I/We also understand that the state and national records check must indicate whether I/we have registered as either a sexual predator or sexual offender. THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER: ( ) HUSBAND ( ) WIFE ( ) GUARDIAN ( ) A Supplemental Form has been attached for the other parent or petitioner. 1. My complete present name is: I request that my name be changed to: 2. I live in . . County, Florida, at {street address} . 3. I was born on {date} {state} , {country} , in {city} , {county} 4. My father’s full legal name: , . . Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name (Family) (09/16) - 31 - My mother’s full legal name: My mother’s maiden name: . . 5. I have lived in the following places since birth: Dates (to/from) Address / / / / / / (____ Please indicate here if you are continuing these facts on an attached page.) 6. Family [Indicate all that apply] _____ I am not married. _____ I am married. My spouse’s full legal name is: . _____ I do not have child(ren). _____The name(s), age(s), and address(es) of my child(ren) are as follows (all children, including those over 18, must be listed): Name {last, first, middle initial} Age Address, City, State (____ Please indicate here if you are continuing these facts on an attached page.) 7. Former names [Indicate all that apply] ____My name has never been changed by a court. ____My name previously was changed by court order from to on {date} , by {court, city, and state} . A copy of the court order is attached. _____My name previously was changed by marriage from to {date} , in {city, county, and state} A copy of the marriage certificate is attached. on . _____I have never been known or called by any other name. _____I have been known or called by the following other name(s): {list name(s) and explain where you were known or called by such name(s)} . Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name (Family) (09/16) - 32 - 8. Occupation My occupation is: I am employed at: {company and address} . . During the past 5 years, I have had the following jobs: Dates (to/from) Employer and employer’s address / / / / / / (____ Please indicate here if you are continuing these facts on an attached page.) 9. Business [Choose one only] ____I do not own and operate a business. ____I own and operate a business. The name of the business is: The street address is: My position with the business is: I have been involved with the business since: {date} 10. Profession [Choose one only] ____I am not in a profession. ____I am in a profession. My profession is:___________________________________________ I have practiced this profession: Dates (to/from) Place and address / / / (____ Please indicate here if you are continuing these facts on an attached page.) 11. Education I have graduated from the following school(s): Degree Date of Received Graduation School (____ Please indicate here if you are continuing these facts on an attached page.) 12. Criminal History Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name (Family) (09/16) - 33 - . . . . [Indicate all that apply] _____ I have never been arrested for or charged with, pled guilty or nolo contendere to, or have been found to have committed a criminal offense, regardless of adjudication. _____ I have a criminal history. In the past I have been arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication. The details of my criminal history are: Date City/State Event (arrest, charge, plea, or adjudication) (_____ Please indicate here if you are continuing these facts on an attached page.) I _____ have____have not ever been required to register as a sexual predator under section 775.21, Florida Statutes. I _____ have ______have not ever been required to register as a sexual offender under section 943.0435, Florida Statutes. 13. Bankruptcy [Choose one only] ____ I have never been adjudicated bankrupt. ____ I was adjudicated bankrupt on {date} , in {city} , {county} , {state} . (____ Please indicate here if you have had additional bankruptcies, and explain on an attached page.) 14. Creditor(s)’ Judgments [Choose one only] ____I have never had a money judgment entered against me by a creditor. ____The following creditor(s)’ money judgment(s) have been entered against me: Date Amount Creditor Court entering judgment and case number if Paid {date} ____ ____ ____ ____ ____ (____ Please indicate here if these facts are continued on an attached page.) 15. I have no ulterior or illegal purpose for filing this petition, and granting it will not in any manner invade the property rights of others, whether partnership, patent, good will, privacy, trademark, or otherwise. 16. My civil rights have never been suspended, or, if my civil rights have been suspended, they have Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name (Family) (09/16) - 34 - been fully restored. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: ______________________ _____________________________________________ Signature of PETITIONER Printed Name: _________________________________ Address: _____________________________________ City, State, Zip: ________________________________ Telephone Number: _____________________________ Fax Number: __________________________________ Designated E-Mail Address(es):____________________ _____________________________________________ 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 Petitioner. This form was completed with the assistance of: {name of individual} _____________________________________ , {name of business} , {address} ______________________________________________ , {city} ________________, {state}_____,{zip code}_________,{telephone number} __________________ . Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name (Family) (09/16) - 35 - ADULT SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME (FAMILY) Case No.: THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER: ( ) HUSBAND ( ) WIFE ( ) GUARDIAN 1. My complete present name is: . I request that my name be changed to: . 2. I live in County, Florida, at {street address} . 3. I was born on {date} {state} , {country} , in {city} , {county} , . 4. My father’s full legal name: My mother’s full legal name: My mother’s maiden name: . . . 5. I have lived in the following places since birth: Dates (to/from) Address / / / / / / / (____ Please indicate here if you are continuing these facts on an attached page.) 6. Family [Indicate all that apply] _____ I am not married. _____I am married. My spouse’s full legal name is: . _____ I do not have child(ren). _____The name(s), age(s), and address(es) of my child(ren) are as follows (all children, including those over 18, must be listed): Name {last, first, middle initial} Age Address, City, State Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name (Family) (09/16) - 36 - (____ Please indicate here if you are continuing these facts on an attached page.) 7. Former names [Indicate all that apply] ____My name has never been changed by a court. ____My name previously was changed by court order from______________________________ to on {date} by {court, city, and state} . A copy of the court order is attached. ____My name previously was changed by marriage from _______________________________ to on {date} in {city, county, and state} . A copy of the marriage certificate is attached. ____I have never been known or called by any other name. ____I have been known or called by the following other name(s): {list name(s) and explain where you were known or called by such name(s)} _____________________________________ 8. Occupation My occupation is: I am employed at: {company and address} . . During the past 5 years, I have had the following jobs: Dates (to/from) Employer and employer’s address / / / / / / (____ Please indicate here if you are continuing these facts on an attached page.) 9. Business [Indicate all that apply] ____ I do not own and operate a business. ____ I own and operate a business. The name of the business is: The street address is: My position with the business is: I have been involved with the business since: {date} . . 10. Profession [Indicate all that apply] Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name (Family) (09/16) - 37 - . . ____I am not in a profession. ____I am in a profession. My profession is: I have practiced this profession: Dates (to/from) Place and address / / / / / (___ Please indicate here if you are continuing these facts on an attached page.) . 11. Education I have graduated from the following school(s): Degree Date of Received Graduation School (___ Please indicate here if you are continuing these facts on an attached page.) 12. Criminal History [Indicate all that apply] ____ I have never been arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication. ____ I have a criminal history. In the past I have been arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication. The details of my criminal history are: Date City/State Event (arrest, charge, plea, or adjudication) (_____ Please indicate here if you are continuing these facts on an attached page.) I _____ have____have not ever been required to register as a sexual predator under section 775.21, Florida Statutes. I _____ have ______have not ever been required to register as a sexual offender under section 943.0435, Florida Statutes. 13. Bankruptcy [Choose one only] ____I have never been adjudicated bankrupt. Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name (Family) (09/16) - 38 - ____I was adjudicated bankrupt on {date} , in {city} , {county} , {state} . (____ Please indicate here if you have had additional bankruptcies, and explain on an attached page.) 14. Creditors’ Judgments [Choose one only] ____I have never had a money judgment entered against me by a creditor. ____The following creditor(s)’ money judgment(s) have been entered against me: Date Amount Creditor Court entering judgment and case number if Paid {date} ____ ____ ____ ____ ____ (____ Please indicate here if you are continuing these facts on an attached page.) 15. I have no ulterior or illegal purpose for filing this petition, and granting it will not in any manner invade the property rights of others, whether partnership, patent, good will, privacy, trademark, or otherwise. 16. My civil rights have never been suspended, or, if my civil rights have been suspended, they have been fully restored. Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name (Family) (09/16) - 39 - I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: ______________________ _____________________________________________ Signature of PETITIONER Printed Name: _________________________________ Address: _____________________________________ City, State, Zip: ________________________________ Telephone Number: _____________________________ Fax Number: __________________________________ Designated E-Mail Address(es):____________________ _____________________________________________ 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 Petitioner. This form was completed with the assistance of: {name of individual} _____________________________________ , {name of business} , {address} ______________________________________________ , {city} ________________, {state}_____,{zip code}_________,{telephone number} __________________ . Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name (Family) (09/16) - 40 - CHILD SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME (FAMILY) Case No.: THE FOLLOWING INFORMATION IS TRUE ABOUT MINOR CHILD # : 1. Minor child’s complete present name is: I/We request that minor child’s name be changed to: 2. The minor child lives in County, Florida, at {street address} . 3. The minor child was born on , in {city, county, state, country} . 4. The minor child’s father’s full legal name: The minor child’s mother’s full legal name: The minor child’s mother’s maiden name: . . . 5. The minor child has lived in the following places since birth: Dates (to/from) Address / / / / / / / (____ Please indicate here if continuing these facts on an attached page.) 6. [Choose one only] ____The minor child is not married ____The minor child is married to: {full legal name} . 7. [Choose one only] ____The minor child has no children. ____The minor child is the parent of the following child(ren): {enter name(s) and date(s) of birth} . 8. Former names [Indicate all that apply] ____The minor child’s name has never been changed by court order. ____The minor child’s name previously was changed by court order from __________ to on {date} __________________ {court, city, and state} . Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name (Family) (09/16) - 41 - A copy of the court order is attached. ____ The minor child’s name previously was changed by marriage from ______________ to on {date} __________, in {city, county, and state} . A copy of the marriage certificate is attached. ____The minor child has never been known or called by any other name. ____ The minor child has been known or called by the following other name(s): {list name(s) and explain where child was known or called by such name(s)} _________ ____________________________________________________________________ ____________________________________________________________________ . 9. The minor child is not employed in an occupation or profession, does not own and operate a business, and has received no educational degrees. If the minor child has a job, explain: _____________________________________________________________ _______________________________________________________________________. 10. Criminal History [Indicate all that apply] ____ The minor child has never been arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication. ____ The minor child has a criminal history. In the past, the minor child was arrested for or charged with, pled guilty or nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication. The details of the criminal history are: Date City/State Event (arrest, charge, plea, or adjudication) (____ Please indicate here if you are continuing these facts on an attached page.) _____ The minor child _____ has _____has not ever been required to register as a sexual predator under section 775.21, Florida Statutes. _____ The minor child _____has _____has not ever been required to register as a sexual offender under section 943.0435, Florida Statutes. 11. Money Judgments [Choose one only] ____ The minor child has never been adjudicated bankrupt, and no money judgment has ever been entered against him or her. ____ The following money judgment(s) has been entered against him or her: Date Amount Creditor Court entering judgment and case number {date} ______ ________ _________ ________________________________ if Paid Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name (Family) (09/16) - 42 - ______ ________ _________ ________________________________ (_____Please indicate here if you are continuing these facts on an attached page.) Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name (Family) (09/16) - 43 -

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