INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.902(d) UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) AFFIDAVIT (11/15)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.902(d) UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT(UCCJEA) AFFIDAVIT (11/15) When should this form be used?

This form should be used in any case involving custody of, visitation with, or time-sharing with any minor child(ren). This affidavit is required even if the custody of, visitation, or time-sharing with the minor child(ren) are 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 file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records.

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 Sheriff or certified 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 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 find 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: Certificate 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 defined there. For further information, see sections 61.501-61.542, Florida Statutes.

Special notes...

Chapter 2008-61, Laws of Florida, effective October 1, 2008, eliminated such terms as custodial parent, noncustodial parent, primary residential parent, secondary residential parent, and visitation from Chapter 61, Florida Statutes. Instead, parents are to 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. However, because the UCCJEA uses the terms custody and visitation, they are included in this form.

If you are the petitioner in an injunction for protection against domestic violence case and you have filed a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), you should write confidential in any space on this form that would require you to write the address where you are currently living.

Remember, a person who is NOT an attorney is called a nonlawyer.  If a nonlawyer helps you fill 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 fill 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.

Your full legal name:
I am the: I am the:

Your Information:
Address:
City, state, zip:
Phone (area code and number):
Fax (area code and number):
Email(s):

Other Party's Information
Other Party's legal name:
Other Party's Attorney (if applicable):
This affidavit will be served to:
Information for serving this affidavit
Address:
City, state, zip:
Phone (area code and number):
Fax (area code and number):
Email(s):

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

,

,
,
Petitioner,

and

.
Respondent.


UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) AFFIDAVIT

I, , 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 five (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: 1./present *
Address

Name and present address of person child lived with

Relationship to child


2. //
Address

Name and present address of person child lived with

Relationship to child


3. //
Address

Name and present address of person child lived with

Relationship to child


4. //
Address

Name and present address of person child lived with

Relationship to child


5. //
Address

Name and present address of person child lived with

Relationship to child


6. //
Address

Name and present address of person child lived with

Relationship to child


* If you are the petitioner in an injunction for protection against domestic violence case and you have filed a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), you should write confidential 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 #2 :

Child’s Full Legal Name:
Place of Birth:
Date of Birth:
Sex:
Child’s Residence for the past 5 years: 1./present *
Address

Name and present address of person child lived with

Relationship to child


2. //
Address

Name and present address of person child lived with

Relationship to child


3. //
Address

Name and present address of person child lived with

Relationship to child


4. //
Address

Name and present address of person child lived with

Relationship to child


5. //
Address

Name and present address of person child lived with

Relationship to child


6. //
Address

Name and present address of person child lived with

Relationship to child


THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD #3 :

Child’s Full Legal Name:
Place of Birth:
Date of Birth:
Sex:
Child’s Residence for the past 5 years: 1./present *
Address

Name and present address of person child lived with

Relationship to child


2. //
Address

Name and present address of person child lived with

Relationship to child


3. //
Address

Name and present address of person child lived with

Relationship to child


4. //
Address

Name and present address of person child lived with

Relationship to child


5. //
Address

Name and present address of person child lived with

Relationship to child


6. //
Address

Name and present address of person child lived with

Relationship to child


2. Participation in custody or time-sharing proceeding(s):



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):


e. Name of each child:
f. Type of proceeding:
g. Court and state:
h. Date of court order or judgment (if any):

4. Persons not a party to this proceeding:


a. Name and address of person:
has physical custody
claims custody rights
claims visitation or time-sharing
Name of each child:

b. Name and address of person:

has physical custody
claims custody rights
claims visitation or time-sharing
Name of each child:

c. Name and address of person:

has physical custody
claims custody rights
claims visitation or time-sharing
Name of each child:
5. Knowledge of prior child support proceedings:

Name of each child:
Type of proceeding:
Court and address:
Date of court order/judgment (if any):
Amount of child support paid and by whom:

6. I acknowledge that I have a continuing duty to advise this Court of any custody, visitation or time-sharing, 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.

I certify that a copy of this document was delivered to the person(s) listed below on {date}


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.
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks]

{full legal name of Non-Lawyer}
Business:
Address:
City:
State:
Zip code:
Phone:

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