Fill and Sign the Fl Disclosure Form

IN THE CIRCUIT COURT OF THE       JUDICIAL CIRCUIT, IN AND FOR       COUNTY, FLORIDA Case No.:       Division:             , Petitioner and       , Respondent DISCLOSURE FROM NONLAWYER {Name}       , told me that he/she is a nonlawyer and may not give legal advice, cannot tell me what my rights or remedies are, cannot tell me how to testify in court, and cannot represent e in court. Rule 10-2.1(b) of the Rules Regulating The Florida Bar defines a paralegal as a person who works under the supervision of a member of The Florida Bar and who performs specifically delegated substantive legal work for which a member of The Florida Bar is responsible. Only persons who meet the definition may call themselves paralegals. {Name}       , informed me that he/she is not a paralegal and cannot call himself/herself a paralegal. {Name}       , told me that he/she may only type the factual information provided by me in writing into the blanks on the form. {Name}       , may not help me fill in the form and may not complete the form for me. If using a form approved by the Supreme Court of Florida, {name}       , may ask me factual questions to fill in the blanks on the form and may also tell me who to file the form. (x one only) I can read English. I cannot read English, but this disclosure was read to me by [fill in both blanks] by {name}       , in {language]       which I understand. Dated: Printed Name:       Name of Business:       Address:             Telephone Number: