Florida Supreme Court Approved Law Form 12901B3 Petition

Florida Supreme Court Approved Family Law Form 12.901(b)(1)
Petition for Dissolution of Marriage with Dependent or Minor Child(ren)

IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,

IN AND FOR COUNTY, FLORIDA

In re: The Marriage of:

,

Petitioner,

and

,

Respondent.

PETITION FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN)

I, , the Petitioner, being sworn, certify that the following statements are true:

1. JURISDICTION/RESIDENCE

Petitioner Respondent Both has (have) lived in Florida for at least 6 months before filing.

2. Petitioner is or is not a member of the military service.

Respondent is or is not a member of the military service.

3. MARRIAGE HISTORY

Date of marriage:

Date of separation: Please indicate if approximate

Place of marriage:

4. DEPENDENT OR MINOR CHILD(REN) (Choose all that apply)

a. Petitioner is pregnant. Baby is due on:

b. Respondent is pregnant. Baby is due on:

c. The minor (under 18) child(ren) common to both parties are:

Name Birth date

d. The minor child(ren) born or conceived during the marriage who are not common to both parties are:

Name Birth date

The birth parent(s) of the above minor child(ren) is (are):

e. The child(ren) common to both parties who are 18 or older but dependent due to a mental or physical disability are:

Name Birth date

5. A completed Family Law Financial Affidavit is filed with this petition or will be timely filed.

6. A completed UCCJEA Affidavit is filed with this petition.

7. A completed Notice of Social Security Number is filed with this petition.

8. This petition for dissolution of marriage should be granted because:

The marriage is irretrievably broken.

One of the parties has been adjudged mentally incapacitated for a period of 3 years prior to filing. A copy of the Judgment of Incapacity is attached.

SECTION I. MARITAL ASSETS AND LIABILITIES

There are no marital assets or liabilities.

There are marital assets or liabilities. All marital and nonmarital assets and liabilities are listed in the financial affidavits.

Indicate all that apply:

All marital assets and liabilities have been divided by a written agreement attached to be incorporated into the final judgment.

The Court should determine how the assets and liabilities of this marriage are to be distributed.

Petitioner Respondent should be awarded an interest in the other spouse’s property because:

SECTION II. SPOUSAL SUPPORT (ALIMONY)

Petitioner Respondent forever gives up any right to spousal support (alimony) from the other spouse.

OR

Petitioner Respondent requests spousal support (alimony) in the amount of $ every week other week month beginning and continuing until

Explain why the Court should order payment and any specific request(s) for type of alimony:

Other provisions relating to alimony, including any tax treatment and consequences:

Petitioner requests life insurance on the other spouse’s life to secure such support.

SECTION III. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING

The minor child(ren) currently reside(s) with Petitioner Respondent Other:

2. Parental Responsibility. It is in the child(ren)’s best interests that parental responsibility be:

shared by both parents;

awarded solely to Petitioner Respondent.

Shared parental responsibility would be detrimental because:

3. Parenting Plan and Time-Sharing. It is in the best interests of the child(ren) that the family be ordered to comply with a Parenting Plan that includes does not include parental time-sharing.

For purposes of a Parenting Plan, the Petitioner will be referred to as , and the Respondent will be referred to as .

The Petitioner states that it is in the best interests of the child(ren) that:

The attached proposed Parenting Plan should be adopted by the court. The parties have have not agreed to the Parenting Plan.

Each child will have time-sharing with both parents as follows:

Indicate if a separate sheet is attached.

The court should establish a Parenting Plan with the following provisions:

No time-sharing for Parent

Limited time-sharing with Parent

Supervised Time-Sharing for Parent

Supervised or third-party exchange of the child(ren).

Explain:

4. Explain why this request is in the best interests of the child(ren):

SECTION IV. CHILD SUPPORT

Petitioner requests child support as determined by Florida’s child support guidelines. A completed Child Support Guidelines Worksheet is, or will be filed.

Such support should be ordered retroactive to:

the date of separation

the date of filing of this petition.

other

Petitioner requests child support beyond age 18 because:

the following child(ren) are dependent because of a mental or physical incapacity which began before age 18.

the following child(ren) are dependent in fact, in high school, and between ages 18 and 19.

Petitioner requests child support amount more than or less than Florida’s guidelines.

Medical/dental insurance for the minor child(ren) be provided by Petitioner.

Medical/dental insurance for the minor child(ren) be provided by Respondent.

Uninsured medical/dental expenses for the child(ren) be paid:

by Petitioner;

by Respondent;

equally by the spouses;

according to the percentages in the Child Support Guidelines Worksheet;

Other:

Petitioner requests life insurance to secure child support be provided by the other spouse.

SECTION V. OTHER

1. Petitioner requests to be known by the following former legal name:

2. Other relief:

SECTION VI. REQUEST

Petitioner requests that the Court enter an order dissolving the marriage and:

distributing marital assets and liabilities as requested in Section I;

awarding spousal support (alimony) as requested in Section II;

adopting or establishing a Parenting Plan as requested in Section III;

establishing child support as requested in Section IV;

restoring Petitioner’s former name as requested in Section V;

awarding other relief as requested in Section V; and any other terms the Court deems necessary.

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.

STATE OF FLORIDA

COUNTY OF

Sworn to or affirmed and signed before me on by

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:

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: