Fill and Sign the Florida Child Custody Form

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.902(d) UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) AFFIDAVIT (02/18) When should this form be used? This form should be used in any case involving parental responsibility for, custody of, or time-sharing or visitation with, any minor child(ren). This affidavit is required even if the parental responsibility for, custody of, or time-sharing or visitation with, the minor child(ren) is not in dispute. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or deputy clerk . You should then fle it with the clerk of the circuit court in the county where the petition was fled and keep a copy for your records. 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 What should I do next? A copy of this form must be mailed, e-mailed, or hand delivered to the other party in your case, if it is not served on him or her with your initial papers. 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 Instructions for Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Afdavit (02/18) 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 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. Where can I look for more information? Before proceeding, you should read General Information for Self - Represented Litigants found at the beginning of these forms. The words that are in bold underline in these instructions are defned there. For further information, see sections 61.501-61.542, Florida Statutes. Special notes... With this form, you must also fle a Notice of Confdential Information within Court Filing, Florida Rules of Judicial Administration Appendix to Rule 2.420 Form. Efective October 1, 2008, terms such as custodial parent, noncustodial parent, primary residential parent, secondary residential parent, and visitation were removed from Chapter 61, Florida Statutes; however, because the UCCJEA uses the terms, custody and visitation, they are included in this form. Parents must develop a Parenting Plan that includes, among other things, their time-sharing schedule with the minor child(ren). If the parents cannot agree, a parenting plan will be established by the Court. If you are the petitioner in an injunction for protection against domestic violence case and you have fled a Request for Confdential Filing of Address , Florida Supreme Court Approved Family Law Form 12.980(h), you should write confdential in any space on this form that would require you to write the address where you are currently living. Instructions for Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Afdavit (02/18) 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 a 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 12.902(d), Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Afdavit (02/18) IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR COUNTY, FLORIDA Case No.: Division: , Petitioner, and , Respondent. UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) AFFIDAVIT I, {full legal name} ____________ , being sworn, certify that the following statements are true: 1. The number of minor child(ren) subject to this proceeding is . The name, place of birth, birth date, and sex of each child; the present address, periods of residence, and places where each child has lived within the past fve (5) years ; and the name, present address, and relationship to the child of each person with whom the child has lived during that time are: THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # 1 : Child’s Full Legal Name: Place of Birth: Date of Birth: Sex: Child’ s Residence for the past 5 years: Dates (From/To) Address (including city and state) where child lived Name and present address of person child lived with Relationsh ip to child /present * ____/____ ____/____ Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Afdavit (02/18) ____/____ ____/____ ____/____ * If you are the petitioner in an injunction for protection against domestic violence case and you have fled a Request for Confdential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), you should write confdential in any space on this form that would require you to enter the address where you are currently living. THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # : Child’s Full Legal Name: Place of Birth: Date of Birth: Sex: Child’s Residence for the past 5 years: Dates (From/To) Address (including city and state) where child lived Name and present address of person child lived with Relationsh ip to child /present ____/____ ____/____ ____/____ ____/____ ____/____ THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # : Child’s Full Legal Name: Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Afdavit (02/18) Place of Birth: Date of Birth: Sex: Child’s Residence for the past 5 years: Dates (From/To) Address (including city and state) where child lived Name and present address of person child lived with Relationsh ip to child /present ____/____ ____/____ ____/____ ____/____ ____/____ 2. Participation in custody or time-sharing proceeding(s): [ Choose only one ] ______ I HAVE NOT participated as a party, witness, or in any capacity in any other litigation or custody proceeding in this or any other state, jurisdiction, or country, concerning parental responsibility for, custody of, or time-sharing or visitation with a child subject to this proceeding. ______ I HAVE participated as a party, witness, or in any capacity in any other litigation or custody proceeding in this or another state, jurisdiction, or country, concerning parental responsibility for, custody of, or time-sharing or visitation with a child subject to this proceeding . Explain: a. Name of each child: b. Type of proceeding: c. Court and state: d. Date of court order or judgment (if any): 3. Information about custody or time-sharing proceeding(s): [ Choose only one ] ______ I HAVE NO INFORMATION of any parental responsibility, custody, time-sharing, or visitation proceeding pending in a court of this or any other state, jurisdiction, or country concerning a child subject to this proceeding. Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Afdavit (02/18) ______ I HAVE THE FOLLOWING INFORMATION concerning a parental responsibility, custody, time-sharing, or visitation proceeding pending in a court of this or another state concerning a child subject to this proceeding, other than set out in item 2. Explain: a. Name of each child involved in said litigation: b. Type of proceeding: c. Court and state: d. Date of court order or judgment (if any): e. Case Number: _______________________________________________________________ 4. Persons not a party to this proceeding: [ Choose only one ] ______ I DO NOT KNOW OF ANY PERSON in this or any other state, jurisdiction, or country, who is not a party to this proceeding and who has physical custody or claims to have parental responsibility for, custody of, or time-sharing or visitation with respect to any child subject to this proceeding. ______ I KNOW THAT THE FOLLOWING NAMED PERSON(S), not a party to this proceeding, has (have) physical custody or claim(s) to have parental responsibility for, custody of, , or time-sharing or visitation with respect to any child subject to this proceeding: a. Name and address of person: _____ has physical custody _____ claims parental responsibility or custody rights _____ claims time-sharing or visitation Name of each child: Relationship to child, if any:________________________________________________________ b. Name and address of person: _____ has physical custody _____ claims parental responsibility or custody rights _____ claims time-sharing or visitation Name of each child: Relationship to child, if any:________________________________________________________ c. Name and address of person: _____ has physical custody _____ claims parental responsibility or custody rights _____claims time-sharing or visitation Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Afdavit (02/18) Name of each child: Relationship to child, if any:________________________________________________________ 5. Knowledge of prior child support proceedings: [ Choose only one ] _____ The child(ren) described in this afdavit are NOT subject to existing child support order(s) in this or any other state, jurisdiction, or country.. _____ The child(ren) described in this afdavit are subject to the following existing child support order(s): a. Name of each child: ______________________________________________________ b. Type of proceeding: ______________________________________________________ c. Court and address: _______________________________________________________ d. Date of court order/judgment (if any): ___________________________________________ e. Amount of child support ordered to be paid and by whom: 6. I acknowledge that I have a continuing duty to advise this Court of any parental responsibility, custody, time-sharing or visitation , child support, or guardianship proceeding (including dissolution of marriage, separate maintenance, child neglect, or dependency) concerning the child(ren) in this state or any other state about which information is obtained during this proceeding. 7. A completed Notice of Confdential Information within Court Filing , Florida Rules of Judicial Administration Appendix to Rule 2.420 Form, is fled with this Afdavit. I certify that a copy of this document was ( ) e-served ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} . Other party or his/her attorney: Name: Address: City, State, Zip: ______ Fax Number: Designated E-mail Address(es):____________________ _____________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that the punishment for knowingly making a false statement includes fnes and/or imprisonment. Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Afdavit (02/18) 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 12.902(d), Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Afdavit (02/18)