Florida Supreme Court Approved Family Law Form 941D

Emergency Verified Motion for Child Pick-Up Order

Florida Supreme Court Approved Family Law Form 12.941(d) (11/15)

IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR COUNTY, FLORIDA

, Petitioner,

and

, Respondent,

EMERGENCY VERIFIED MOTION FOR CHILD PICK-UP ORDER

I, 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):

2. Currently, the child(ren) subject to this motion is (are) in the physical possession of 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.

A final judgment or order awarding custody of or time-sharing with the minor child(ren) was made on in case number . This order awarded custody of or specific time-sharing with the minor child(ren) to me.

This final judgment or order applies to the following minor child(ren):

A certified copy of said final judgment or order is attached, has not been modified, and is still in effect. 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 final judgment or order awarding custody of or time-sharing with the following minor child(ren):

1. Paternity has NOT been established. A certified copy of the minor child(ren)’s birth certificate is attached and has not been amended.

2. Paternity has been established. A certified copy of the final 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 effect.

c. Other:

5. A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), is filed with this 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 as follows:

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:

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:

Name of Contact Person:

Address:

Telephone number(s) where I (or my designee) can be reached:

9. Attorneys’ Fees, Costs, and Suit Monies.

[Indicate if applicable] I have filed 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 sheriffs of the State of Florida or other authorized law enforcement officers in this state or any other state to pick up the previously named minor child(ren) and deliver them to my physical custody.

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 fines and/or imprisonment.

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 .

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:

This form was prepared for the: Petitioner Respondent

This form was completed with the assistance of: