Fill and Sign the Emergency Motion Form

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.941(d) EMERGENCY VERIFIED MOTION FOR CHILD PICK-UP ORDER (11/15) When should this form be used? You may use this form to request that the court enter an order directing the sherif or other law enforcement ofcer to take a minor child(ren) from the person who currently has physical possession of the child(ren) and deliver the child(ren) to your physical custody or possession. This form should only be used in an emergency by a person who has a pre-existing legal right to physical possession of a minor child. This means that you already have a court order awarding you legal custody of or time-sharing with the child(ren) OR you are the birth mother of one or more children born out of wedlock and no court order has addressed any other person’s parental rights. Before proceeding, you should read General Information for Self-Represented Litigants found at the beginning of these forms. This form should be typed or printed in black ink. This form presumes that you want the court to enter an ex parte order without giving the other side advance notice of the hearing . You should explain your reasons for why such an ex parte order should be entered in paragraph 7 of this form. After completing this form, you should sign the form before a notary public or deputy clerk . You should fle the original, along with all of the other forms required, with the clerk of the circuit court in the county where the child(ren) is (are) physically located and keep a copy for your records. You should also ask the clerk to process your motion though their emergency procedures. IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be fled electronically except in certain circumstances. Self- represented litigants may fle petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to fle 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 fle. 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 Sherif or certifed 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 Instructions for Florida Supreme Court Approved Family Law Form 12.941(d), Emergency Verifed Motion for Child Pick-Up Order (11/15) 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 fnd 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: Certifcate 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. What should I do next? If the court enters an order without advance notice to the other party, you should take a certifed copy of the order to the sherif’s ofce for further assistance. You must have this form and the court’s order served by personal service on the other party. You should read the court’s order carefully. The order may require the sherif to place the child(ren) somewhere other than in your physical possession. Look for directions in the order that apply to you and note the time and place of the hearing scheduled in the order. You should go to the hearing with whatever evidence you have regarding your motion. If the court will not enter an order without advance notice to the other side, you should check with the clerk of court, judicial assistant , or family law intake staff for information on the local procedure for scheduling a hearing on your motion, unless the court sets a hearing in its order denying your request for an ex parte hearing. When you know the date and time of your hearing, you should fle Notice of Hearing (General) , Florida Supreme Court Approved Family Law Form 12.923, and use personal service to notify the other party of your motion, the court’s order, if any, and the hearing. Special notes... With this form you must also fle the following:  Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit , Florida Supreme Court Approved Family Law Form 12.902(d).  A certifed copy of the court order showing that you have legal custody of or time-sharing with the child(ren), if any. OR  A certifed copy of the child(ren)’s birth certifcate(s), if you are the birth mother of a child born out of wedlock and no court order addressing paternity Instructions for Florida Supreme Court Approved Family Law Form 12.941(d), Emergency Verifed Motion for Child Pick-Up Order (11/15) exists. OR  A certifed copy of any judgment establishing paternity, time-sharing with or custody of the minor child(ren). Order These family law forms contain an Order to Pick-Up Minor Child(ren) , Florida Supreme Court Approved Family Law Form 12.941(e), which the judge may use. You should check with the clerk, family law intake staf, or judicial assistant to see if you need to bring a blank order form 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. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fll 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 fll 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 12.941(d), Emergency Verifed Motion for Child Pick-Up Order (11/15) IN THE CIRCUIT COURT OF THE _______________________ JUDICIAL CIRCUIT, IN AND FOR ________________________ COUNTY, FLORIDA Case No.: ___________________________ ___ Division: __________________________________________________________________________________ ________ _______________________ _ __________, Petitioner, and _______________________ _ __________, Respondent, EMERGENCY VERIFIED MOTION FOR CHILD PICK-UP ORDER I, {full legal name} __________________________________________________________ being sworn, certify that the following information is true: 1. This is a motion to enforce existing custody or time -sharing rights (as an operation of law or court-ordered) regarding the following minor child(ren): Name Sex Birth Date Race Physical Description _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 2. Currently, the child(ren) subject to this motion is (are) in the physical possession of {full legal name} _________________________________________________________________ whose address or present physical location is: _________________________________________ _______________________________________________________________________________ This individual ’s relationship to the minor child(ren) is: _________________________________ _______________________________________________________________________________ 3. I _____ am _____ am not married to the person named in paragraph 2. 4. Status of minor child(ren). I have a superior right to custody of or time- sharing with the minor child(ren) over the person named in paragraph 2 because: {Indicate all that apply}: a. _____ Custody or Time-Sharing has been established by a court. Florida Supreme Court Approved Family Law Form 12.941(d), Emergency Verifed Motion for Child Pick-Up Order (11/15) A fnal judgment or order awarding custody of or time-sharing with the minor child(ren) was made on {date} _____ in {name of court} ___________________________________ {case number} ____________________. This order awarded custody of or specifc time-sharing with the minor child(ren) to me. This fnal judgment or order applies to the following minor child(ren): {list name(s) of the child(ren) or write all} _______________________________________________________________________________ _______________________________________________________________________________ A certifed copy of said fnal judgment or order is attached, has not been modifed, and is still in efect. {Indicate if applicable} _____. This order is an out-of-state court order which is entitled to full faith and credit enforcement under the Uniform Child Custody Jurisdiction and Enforcement Act and/or the federal Parental Kidnaping Prevention Act. b. _____ Custody or time-sharing is established as an operation of law. I am the birth mother of the minor child(ren) who was (were) born out of wedlock and there is no fnal judgment or order awarding custody of or time-sharing with the following minor child(ren): {list name(s) of the child(ren) or write all} _______________________________________________________________________________ _ ______________________________________________________________________________ 1. _____ Paternity has NOT been established. A certifed copy of the minor child(ren)’s birth certifcate is attached and has not been amended. 2. _____ Paternity has been established. A certifed copy of the fnal judgment of paternity, which shows no award of custody or time-sharing was made, is attached. This order has not been changed and is still in efect. c. _____ Other: _ ___ ____________________________________________________________ _______________________________________________________________________________ _ ______________________________________________________________________________ _______________________________________________________________________________ _ 5. A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Afdavit, Florida Supreme Court Approved Family Law Form 12.902(d), is fled with this motion. 6. Facts relating to the minor child(ren)’s current situation. [Indicate all that apply] a. _____ The person named in paragraph 2 wrongfully removed or wrongfully detained the minor child(ren) on {date} __________ as follows: ______________________________________ ______________________________________________________________________________ _______________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.941(d), Emergency Verifed Motion for Child Pick-Up Order (11/15) _ ______________________________________________________________________________ _______________________________________________________________________________ _ ______________________________________________________________________________ Please indicate here if you are attaching additional pages to continue these facts. b. _____ I believe that the minor child(ren) is (are) in immediate danger of harm or removal from this court’s jurisdiction while with the person named in paragraph 2 based on the following: ______________________________________________________________________ _______________________________________________________________________________ _ ______________________________________________________________________________ c. The current location of the minor child(ren) is: {choose only one } ( ) unknown ( ) believed to be at the following address(es) with the following people {list both the address and the people you believe will be there} : ________________________________________________ ______________________________________________________________________________ _______________________________________________________________________________ _ 7. Advance notice of this motion to the individual named in paragraph 2 should not be required because: ____________________________________________________________ ___________________________________________________________________________ ____________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 8. If needed, I can be contacted for notice of an emergency or expedited hearing at the following addresses/locations: __________________________________________________ Name of Contact Person: ______________________________________________________ Address: ____________________________________________________________________ Telephone number(s) where I (or my designee) can be reached: {give name of individual to call} _______________________________________________________________________ Name of Contact Person: ______________________________________________________ Address: ____________________________________________________________________ Telephone number(s) where I (or my designee) can be reached: {give name of individual to call} _______________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.941(d), Emergency Verifed Motion for Child Pick-Up Order (11/15) 9. Attorneys’ Fees, Costs, and Suit Monies. [Indicate if applicable] _____ I have fled this motion because of wrongful acts of the person listed in paragraph 2 above. I request that this Court award reasonable attorney’s fees, costs, and suit monies as applicable or authorized under Florida law, the UCCJEA, and other legal authorities. WHEREFORE, I request an Emergency Order to Pick-Up Minor Child(ren), without advance notice, directing all sherifs of the State of Florida or other authorized law enforcement ofcers in this state or any other state to pick up the previously named minor child(ren) and deliver them to my physical custody. Florida Supreme Court Approved Family Law Form 12.941(d), Emergency Verifed Motion for Child Pick-Up Order (11/15) I understand that I am swearing or affirming under oath to the truthfulness of the claims made above and that the punishment for knowingly making a false statement includes fnes and/or imprisonment. Dated:_______________________ ____________________________________________ Signature of Party Printed Name: _______________________________ Address:____________________________________ City, State, Zip: ______________________________ Telephone Number: __________________________ Fax Number: ________________________________ Designated E-mail Address(es):__________________ ___________________________________________ STATE OF FLORIDA COUNTY OF _______________________ Sworn to or afrmed and signed before me on __________ by _________________________________. _____________________________________________ NOTARY PUBLIC or DEPUTY CLERK _____________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] _____ Personally known _____ Produced identifcation Type of identifcation produced ____________________________________. IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fll 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} _____, {zip code}_________,{telephone number}_________________. Florida Supreme Court Approved Family Law Form 12.941(d), Emergency Verifed Motion for Child Pick-Up Order (11/15)