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{\f36\fbidi \fswiss\fcharset0\fprq2{\*\panose 020f0302020204030204}Calibri Light;}{\f37\fbidi \fswiss\fcharset0\fprq2{\*\panose 020f0502020204030204}Calibri;}{\f39\fbidi \froman\fcharset0\fprq2{\*\panose 00000000000000000000}Cambria{\*\falt Cambria};}
{\flomajor\f31500\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\fdbmajor\f31501\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}
{\fhimajor\f31502\fbidi \fswiss\fcharset0\fprq2{\*\panose 020f0302020204030204}Calibri Light;}{\fbimajor\f31503\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}
{\flominor\f31504\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\fdbminor\f31505\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}
{\fhiminor\f31506\fbidi \fswiss\fcharset0\fprq2{\*\panose 020f0502020204030204}Calibri;}{\fbiminor\f31507\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\f40\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}
{\f41\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\f43\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\f44\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\f45\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}
{\f46\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\f47\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\f48\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\f380\fbidi \froman\fcharset238\fprq2 Cambria Math CE;}
{\f381\fbidi \froman\fcharset204\fprq2 Cambria Math Cyr;}{\f383\fbidi \froman\fcharset161\fprq2 Cambria Math Greek;}{\f384\fbidi \froman\fcharset162\fprq2 Cambria Math Tur;}{\f387\fbidi \froman\fcharset186\fprq2 Cambria Math Baltic;}
{\f388\fbidi \froman\fcharset163\fprq2 Cambria Math (Vietnamese);}{\f400\fbidi \fswiss\fcharset238\fprq2 Calibri Light CE;}{\f401\fbidi \fswiss\fcharset204\fprq2 Calibri Light Cyr;}{\f403\fbidi \fswiss\fcharset161\fprq2 Calibri Light Greek;}
{\f404\fbidi \fswiss\fcharset162\fprq2 Calibri Light Tur;}{\f407\fbidi \fswiss\fcharset186\fprq2 Calibri Light Baltic;}{\f408\fbidi \fswiss\fcharset163\fprq2 Calibri Light (Vietnamese);}{\f410\fbidi \fswiss\fcharset238\fprq2 Calibri CE;}
{\f411\fbidi \fswiss\fcharset204\fprq2 Calibri Cyr;}{\f413\fbidi \fswiss\fcharset161\fprq2 Calibri Greek;}{\f414\fbidi \fswiss\fcharset162\fprq2 Calibri Tur;}{\f417\fbidi \fswiss\fcharset186\fprq2 Calibri Baltic;}
{\f418\fbidi \fswiss\fcharset163\fprq2 Calibri (Vietnamese);}{\f430\fbidi \froman\fcharset238\fprq2 Cambria CE{\*\falt Cambria};}{\f431\fbidi \froman\fcharset204\fprq2 Cambria Cyr{\*\falt Cambria};}
{\f433\fbidi \froman\fcharset161\fprq2 Cambria Greek{\*\falt Cambria};}{\f434\fbidi \froman\fcharset162\fprq2 Cambria Tur{\*\falt Cambria};}{\f437\fbidi \froman\fcharset186\fprq2 Cambria Baltic{\*\falt Cambria};}
{\f438\fbidi \froman\fcharset163\fprq2 Cambria (Vietnamese){\*\falt Cambria};}{\flomajor\f31508\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\flomajor\f31509\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}
{\flomajor\f31511\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\flomajor\f31512\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\flomajor\f31513\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}
{\flomajor\f31514\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\flomajor\f31515\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\flomajor\f31516\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}
{\fdbmajor\f31518\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\fdbmajor\f31519\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\fdbmajor\f31521\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}
{\fdbmajor\f31522\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\fdbmajor\f31523\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\fdbmajor\f31524\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}
{\fdbmajor\f31525\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\fdbmajor\f31526\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\fhimajor\f31528\fbidi \fswiss\fcharset238\fprq2 Calibri Light CE;}
{\fhimajor\f31529\fbidi \fswiss\fcharset204\fprq2 Calibri Light Cyr;}{\fhimajor\f31531\fbidi \fswiss\fcharset161\fprq2 Calibri Light Greek;}{\fhimajor\f31532\fbidi \fswiss\fcharset162\fprq2 Calibri Light Tur;}
{\fhimajor\f31535\fbidi \fswiss\fcharset186\fprq2 Calibri Light Baltic;}{\fhimajor\f31536\fbidi \fswiss\fcharset163\fprq2 Calibri Light (Vietnamese);}{\fbimajor\f31538\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}
{\fbimajor\f31539\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\fbimajor\f31541\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\fbimajor\f31542\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}
{\fbimajor\f31543\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\fbimajor\f31544\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\fbimajor\f31545\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}
{\fbimajor\f31546\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\flominor\f31548\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\flominor\f31549\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}
{\flominor\f31551\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\flominor\f31552\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\flominor\f31553\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}
{\flominor\f31554\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\flominor\f31555\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\flominor\f31556\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}
{\fdbminor\f31558\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\fdbminor\f31559\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\fdbminor\f31561\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}
{\fdbminor\f31562\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\fdbminor\f31563\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\fdbminor\f31564\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}
{\fdbminor\f31565\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\fdbminor\f31566\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\fhiminor\f31568\fbidi \fswiss\fcharset238\fprq2 Calibri CE;}
{\fhiminor\f31569\fbidi \fswiss\fcharset204\fprq2 Calibri Cyr;}{\fhiminor\f31571\fbidi \fswiss\fcharset161\fprq2 Calibri Greek;}{\fhiminor\f31572\fbidi \fswiss\fcharset162\fprq2 Calibri Tur;}
{\fhiminor\f31575\fbidi \fswiss\fcharset186\fprq2 Calibri Baltic;}{\fhiminor\f31576\fbidi \fswiss\fcharset163\fprq2 Calibri (Vietnamese);}{\fbiminor\f31578\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}
{\fbiminor\f31579\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\fbiminor\f31581\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\fbiminor\f31582\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}
{\fbiminor\f31583\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\fbiminor\f31584\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\fbiminor\f31585\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}
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\ql \li0\ri0\sa160\sl259\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 }\noqfpromote {\stylesheet{\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
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\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \snext11 \ssemihidden \sunhideused Normal Table;}}
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{\operator Susan Proctor}{\creatim\yr2018\mo6\dy29\hr13\min15}{\revtim\yr2018\mo6\dy29\hr13\min15}{\printim\yr2018\mo6\dy29\hr13\min14}{\version2}{\edmins0}{\nofpages4}{\nofwords1214}{\nofchars6924}{\nofcharsws8122}{\vern57445}}{\*\xmlnstbl {\xmlns1 http:
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\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f31506\insrsid5907114\charrsid15605013 \hich\af31506\dbch\af31505\loch\f31506 Instructions for Florida Supreme Court Appro}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f31506\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 
ved Family Law Form 12.902(j), }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f31506\insrsid5907114\charrsid15605013 \hich\af31506\dbch\af31505\loch\f31506 No}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f31506\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 
tice of Social Security Number }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f31506\insrsid15080332 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f31506\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 (06/18)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f31506\insrsid15080332\charrsid15605013 
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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.902(j),
\par \hich\af39\dbch\af31505\loch\f39 NOTICE OF SOCIAL SECURITY NUMBER 
\par \hich\af39\dbch\af31505\loch\f39 (}{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \b\f39\fs28\insrsid5907114 \hich\af39\dbch\af31505\loch\f39 06}{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \b\f39\fs28\insrsid5907114\charrsid292715 \hich\af39\dbch\af31505\loch\f39 /}{
\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \b\f39\fs28\insrsid5907114 \hich\af39\dbch\af31505\loch\f39 18}{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \b\f39\fs28\insrsid5907114\charrsid292715 \hich\af39\dbch\af31505\loch\f39 )
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\par \hich\af39\dbch\af31505\loch\f39 When should this form be used?}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f39\fs24\insrsid5907114\charrsid292715 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f31502\fs24\insrsid5907114\charrsid4225990 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 This form must be completed and filed by each party in all }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 
\b\f31506\fs22\ul\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 paternity}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 , }{\rtlch\fcs1 \ab\af0\afs22 
\ltrch\fcs0 \b\f31506\fs22\ul\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 child support}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 , and }{\rtlch\fcs1 
\ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\ul\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 dissolution of \hich\af31506\dbch\af31505\loch\f31506 marriage}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506  cases, regardless of whether the case involves a minor child(ren) and/or property.  
\par 
\par \hich\af31506\dbch\af31505\loch\f31506 This form should be }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 typed or printed in black ink. }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 After completing this form, you should }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\ul\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 file}
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\hich\af31506\dbch\af31505\loch\f31506 clerk of the circuit court}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506  in the county whe\hich\af31506\dbch\af31505\loch\f31506 
re your case was filed and keep a copy for your records.}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 
\par 
\par }\pard \ltrpar\qc \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f39\fs24\insrsid5907114\charrsid3681754 \hich\af39\dbch\af31505\loch\f39 CONFIDENTIAL INFORMATION
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f39\fs24\ul\insrsid5907114 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 
Under Rule 2.420 of the Florida Rules of Judicial Administration, Social Security Numbers are confidential; however, this information is required by the Florida Statutes. A\hich\af31506\dbch\af31505\loch\f31506 
 Notice of Confidential Information within Court Filing must be filed with the Notice of Social Security Number. This Notice is an appendix to rule 2.420.}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid8724412 
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f39\fs24\ul\insrsid5907114\charrsid1710417 
\par }\pard \ltrpar\qc \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f39\fs24\insrsid5907114 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f39\fs24\insrsid5907114 \tab \tab \tab }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f39\fs24\insrsid5907114\charrsid15605013 
\hich\af39\dbch\af31505\loch\f39 IMPORTANT INFORMATION REGARDING E-FILING
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\tx2140\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid5907114 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid5907114 \hich\af37\dbch\af31505\loch\f37 The Florida Rules of Judicial Administration now requi
\hich\af37\dbch\af31505\loch\f37 re that all petitions, pleadings, and documents be filed electronically except in certain circumstances. }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid5907114 \hich\af37\dbch\af31505\loch\f37 
Self-represented litigants may file petitions or other pleadings or documents electronically; however, they are not required to do so. }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid5907114 \hich\af37\dbch\af31505\loch\f37 If you choose to
\hich\af37\dbch\af31505\loch\f37  file 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 file. }{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid5907114 \hich\af37\dbch\af31505\loch\f37 The rules and procedures should be carefu\hich\af37\dbch\af31505\loch\f37 lly read and followed.}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\b\f37\fs22\insrsid5907114\charrsid14434071 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 
\par }\pard \ltrpar\qc \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f31502\fs24\insrsid5907114\charrsid4225990 \hich\af31502\dbch\af31505\loch\f31502 What should I do next?}{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \f31502\fs24\insrsid5907114\charrsid4225990 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f31502\fs24\insrsid5907114\charrsid4225990 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 A copy of this form must be mailed}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 
\hich\af31506\dbch\af31505\loch\f31506 , e-mailed,}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506  or hand delivered to the other party in your case, if it is not }{\rtlch\fcs1 
\ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\ul\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 served}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 
 on him or her with your initial papers.}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 
\par 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f39\fs24\insrsid5907114 \tab \tab 
\par \tab \tab \hich\af39\dbch\af31505\loch\f39 IMPORTANT }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f39\fs24\insrsid5907114\charrsid7342649 \hich\af39\dbch\af31505\loch\f39 INFORMATION REGARDING E-SERVICE}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\b\f39\fs24\insrsid5907114 \hich\af39\dbch\af31505\loch\f39  ELECTION}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f39\fs24\insrsid5907114\charrsid7342649 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f39\fs24\insrsid5907114\charrsid7342649 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid5907114 \hich\af37\dbch\af31505\loch\f37 
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
\hich\af37\dbch\af31505\loch\f37  party must be served by electronic mail (e-mail) except in certain circumstances. }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid5907114 \hich\af37\dbch\af31505\loch\f37 
You must strictly comply with the format requirements set forth in the Rules of Judicial Administration.}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid5907114\charrsid3881089 \hich\af0\dbch\af31505\loch\f0  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid5907114\charrsid3881089 \hich\af31506\dbch\af31505\loch\f31506 
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 }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 
\b\f31506\fs22\insrsid5907114\charrsid3881089 \hich\af31506\dbch\af31505\loch\f31506 must }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid3881089 \hich\af31506\dbch\af31505\loch\f31506 
review Florida Rule of Judicial Administration 2.516. You may find this rule \hich\af31506\dbch\af31505\loch\f31506 at }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid1774592 \hich\af31506\dbch\af31505\loch\f31506 www.flcourts.org
}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid3881089 \hich\af31506\dbch\af31505\loch\f31506 
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. }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid5907114\charrsid3881089 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid5907114 
\par \hich\af37\dbch\af31505\loch\f37 SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE \hich\af37\dbch\af31505\loch\f37 NOT REQUIRED TO DO SO. }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid5907114 
\hich\af37\dbch\af31505\loch\f37 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.
\par 
\par \hich\af37\dbch\af31505\loch\f37 To serve and receive documents by e-mail, you must designate your e-mail addre\hich\af37\dbch\af31505\loch\f37 sses by using the }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid5907114 
\hich\af37\dbch\af31505\loch\f37 Designation of Current Mailing and E-mail Address}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid5907114 \hich\af37\dbch\af31505\loch\f37 
, 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 }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid5907114 \hich\af37\dbch\af31505\loch\f37 
CAREFULLY}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid5907114 \hich\af37\dbch\af31505\loch\f37  read the rules and instructi\hich\af37\dbch\af31505\loch\f37 ons for: }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid5907114 
\hich\af37\dbch\af31505\loch\f37 Certificate of Service (General),}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid5907114 \hich\af37\dbch\af31505\loch\f37  Florida Supreme Court Approved Family Law Form 12.914; }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\b\f37\fs22\insrsid5907114 \hich\af37\dbch\af31505\loch\f37 Designation of Current Mailing and E-mail Address}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid5907114 \hich\af37\dbch\af31505\loch\f37 
, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid5907114\charrsid3869108 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid5907114 
\par }\pard \ltrpar\qc \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f31502\fs24\insrsid5907114\charrsid4225990 \hich\af31502\dbch\af31505\loch\f31502 Where can I look for more information?}{
\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f31502\fs24\insrsid5907114\charrsid4225990 
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid5907114 
\par }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 Before proceeding, you should read General Information for Self-Represented Litigants found at the beginning of these forms.  }{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 The words that are in }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid5907114\charrsid4225990 
\loch\af31506\dbch\af31505\hich\f31506 \'93}{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\ul\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 bold underline}{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 
\b\f31506\fs22\insrsid5907114\charrsid4225990 \loch\af31506\dbch\af31505\hich\f31506 \'94}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506  in these i}{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 nstructions are defined there. }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 
For further information, see }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 chapter 61}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 
\hich\af31506\dbch\af31505\loch\f31506 , Florida Statutes.
\par 
\par }\pard \ltrpar\qc \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f31502\fs24\insrsid5907114\charrsid4225990 \hich\af31502\dbch\af31505\loch\f31502 Special notes...}{\rtlch\fcs1 \af0\afs24 
\ltrch\fcs0 \f31502\fs24\insrsid5907114\charrsid4225990 
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid5907114 
\par }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 
If this is a domestic violence case and you want to keep your address confidential for safety reasons, do not enter the address, telephone, fax}{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 
, or e-mail}{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506  information at the bott\hich\af31506\dbch\af31505\loch\f31506 om of this form.}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 Instead, file }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 a }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 Request for Confidential Filing of Address}{\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 , Florida Supreme Court Approved Family Law Form 12.980(i).
\par 
\par \hich\af31506\dbch\af31505\loch\f31506 Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that per\hich\af31506\dbch\af31505\loch\f31506 son must give you a copy of a }{\rtlch\fcs1 
\ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 Disclosure from Nonlawyer}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 
\hich\af31506\dbch\af31505\loch\f31506 , Florida Family Law Rules of Procedure Form 12.900(a}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 ), before he or she helps you. }{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 A nonlawyer helping you fill out these forms also }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid5907114\charrsid4225990 
\hich\af31506\dbch\af31505\loch\f31506 must}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506  put his or her name, address, and telephone number on the bott
\hich\af31506\dbch\af31505\loch\f31506 om of the last page of every form he or she helps you complete.}{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid5907114\charrsid4225990 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 
\par 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid5907114 
\par 
\par 
\par \sect }\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid13784193\sftnbj \pard\plain \ltrpar\qc \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\loch\af0\hich\af0\dbch\af31505\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 IN THE CIRCUIT COURT OF THE }{\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506                    }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506  JUDICIAL CIRCUIT,

\par \hich\af31506\dbch\af31505\loch\f31506 IN AND FOR }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506                                  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506   COUNTY, FLORIDA
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 
\par }\pard \ltrpar\ql \li5040\ri0\nowidctlpar\tqr\tx9360\wrapdefault\faauto\rin0\lin5040\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 Case No.: }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114\charrsid4225990 \tab }{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 
\par \hich\af31506\dbch\af31505\loch\f31506 Division}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid5907114 \hich\af0\dbch\af31505\loch\f0 :  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\ul\insrsid5907114 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid5907114 
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\ul\insrsid5907114 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid5907114\charrsid292715 \hich\af0\dbch\af31505\loch\f0  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\ul\insrsid5907114 \tab \tab \tab \tab \tab \tab \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid5907114\charrsid292715 \hich\af0\dbch\af31505\loch\f0                                            
\par }\pard \ltrpar\ql \fi720\li2880\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin2880\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid292715 \hich\af31506\dbch\af31505\loch\f31506 Petitioner,
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 
\par }\pard \ltrpar\ql \li1440\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin1440\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 and
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid5907114 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\ul\insrsid5907114 \tab \tab \tab \tab \tab \tab \tab \hich\af0\dbch\af31505\loch\f0              \hich\af0\dbch\af31505\loch\f0                                 }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid5907114 \hich\af0\dbch\af31505\loch\f0  
\par }\pard \ltrpar\ql \li3600\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin3600\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506    }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 Respondent.
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid5907114 
\par }\pard \ltrpar\qc \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \ab\af0\afs28 \ltrch\fcs0 \b\f31502\fs28\insrsid5907114\charrsid4225990 \hich\af31502\dbch\af31505\loch\f31502 NOTICE OF SOCIAL SECURITY NUMBER}{
\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \f31502\fs28\insrsid5907114\charrsid4225990 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid5907114 
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\tx720\tqr\tx9360\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 I, }{\rtlch\fcs1 
\ai\af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114\charrsid4225990 \{\hich\af31506\dbch\af31505\loch\f31506 full legal name\}}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506  }{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 ___________________________________________________________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 ,}{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 
certify that my social security number is }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 ___________________________, }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 as required }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 by the applicable section of the Florida Statutes. }{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 My date of birth is }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 
______________________________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 .}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid2040318 
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114\charrsid15605013 \hich\af31506\dbch\af31505\loch\f31506 [Choose }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\i\f31506\fs22\insrsid5907114\charrsid15605013 
\hich\af31506\dbch\af31505\loch\f31506 one}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114\charrsid15605013 \hich\af31506\dbch\af31505\loch\f31506  only]}{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 
\b\i\f31506\fs22\insrsid5907114\charrsid15605013 
\par }\pard \ltrpar\ql \fi-1080\li1080\ri0\nowidctlpar
\tx-1200\tx-720\tx0\tx360\tx720\tx1080\tx1440\tx1800\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\tx9360\tx10080\tx10800\tx11520\tx12240\tx12960\tx13680\tx14400\tx15120\tx15840\tx16560\tx17280\tx18000\tx18720
\wrapdefault\faauto\rin0\lin1080\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114\charrsid4225990 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 __}{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \tab \hich\af31506\dbch\af31505\loch\f31506 1.\tab This notice is being filed in a dissolution of marriage case in which the parties have }{\rtlch\fcs1 \ab\af0\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 no}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506  minor }{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 or dependent }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 child}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 (}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 ren}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 )}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506  in comm\hich\af31506\dbch\af31505\loch\f31506 on.
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar
\tx-1200\tx-720\tx0\tx360\tx720\tx1080\tx1440\tx1800\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\tx9360\tx10080\tx10800\tx11520\tx12240\tx12960\tx13680\tx14400\tx15120\tx15840\tx16560\tx17280\tx18000\tx18720
\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 
\par }\pard \ltrpar\ql \fi-1080\li1080\ri0\nowidctlpar
\tx-1200\tx-720\tx0\tx360\tx720\tx1080\tx1440\tx1800\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\tx9360\tx10080\tx10800\tx11520\tx12240\tx12960\tx13680\tx14400\tx15120\tx15840\tx16560\tx17280\tx18000\tx18720
\wrapdefault\faauto\rin0\lin1080\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114\charrsid4225990 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 __}{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \tab \hich\af31506\dbch\af31505\loch\f31506 2.\tab This notice is being}{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid5907114\charrsid4225990 
\hich\af31506\dbch\af31505\loch\f31506  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 
filed in a paternity or child support case, or in a dissolution of marriage in which the parties }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 have minor or dependent children}{\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f31506\fs22\cf6\insrsid5907114\charrsid1800390 \hich\af31506\dbch\af31505\loch\f31506  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 in common. }{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 The minor }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 or dependent }{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 child(ren)'s name(s), date(s) of birth, and social security\hich\af31506\dbch\af31505\loch\f31506  number(s) is/are:
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar
\tx-1200\tx-720\tx0\tx360\tx720\tx1080\tx1440\tx1800\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\tx9360\tx10080\tx10800\tx11520\tx12240\tx12960\tx13680\tx14400\tx15120\tx15840\tx16560\tx17280\tx18000\tx18720
\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \tab \tab \tab 
\par }\pard \ltrpar\ql \fi-4320\li4320\ri0\nowidctlpar
\tx-1200\tx-720\tx0\tx360\tx720\tx1080\tx1440\tx1800\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\tx9360\tx10080\tx10800\tx11520\tx12240\tx12960\tx13680\tx14400\tx15120\tx15840\tx16560\tx17280\tx18000\tx18720
\wrapdefault\faauto\rin0\lin4320\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 
\par 
\par }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 Name\tab \tab \tab \tab \tab \tab \tab \tab Birth date\tab       Social Security Number}{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 
\b\f31506\fs22\insrsid5907114 
\par \hich\af31506\dbch\af31505\loch\f31506 ____________________________________________________________________________________
\par \hich\af31506\dbch\af31505\loch\f31506 ____________________________________________________________________________________
\par \hich\af31506\dbch\af31505\loch\f31506 ____________________________________________________________________________________
\par \hich\af31506\dbch\af31505\loch\f31506 ____________________________________________________________________________________
\par \hich\af31506\dbch\af31505\loch\f31506 _____________________________________________________________________________________
\par \hich\af31506\dbch\af31505\loch\f31506 _____________________________________________________________________________________
\par \hich\af31506\dbch\af31505\loch\f31506 _____________________________________________________________________________________
\par \hich\af31506\dbch\af31505\loch\f31506 ____________________________________________________________________________________\hich\af31506\dbch\af31505\loch\f31506 _
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar
\tx-1200\tx-720\tx0\tx360\tx720\tx1080\tx1440\tx1800\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\tx9360\tx10080\tx10800\tx11520\tx12240\tx12960\tx13680\tx14400\tx15120\tx15840\tx16560\tx17280\tx18000\tx18720
\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \ai\af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114\charrsid4225990 \{\hich\af31506\dbch\af31505\loch\f31506 Attach additional pages if necessary.\}}{\rtlch\fcs1 \ab\af0\afs22 
\ltrch\fcs0 \b\f31506\fs22\ul\insrsid5907114\charrsid4225990 
\par }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid5907114\charrsid4225990 
\par \hich\af31506\dbch\af31505\loch\f31506 Disclosure of social security numbers shall be limited}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid4225990 \hich\af31506\dbch\af31505\loch\f31506 
 to the purpose of administration of the Title IV-D program for child support enforcement.
\par 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid5907114 \page }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid5907114\charrsid2040318 \hich\af31506\dbch\af31505\loch\f31506 I understand that I am swearing or affirming under oath to the 
\hich\af31506\dbch\af31505\loch\f31506 truthfulness of the claims made in this notice and that the punishment for knowingly making a false statement includes fines and/or imprisonment}{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\fs22\insrsid5907114 .}{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\ul\insrsid5907114 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid5907114 
\par }\pard \ltrpar\ql \fi-4320\li4320\ri0\nowidctlpar\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\tqr\tx9360\wrapdefault\faauto\rin0\lin4320\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid5907114 
\par \hich\af0\dbch\af31505\loch\f0 Dated: ___________________\tab _____________________________________________
\par }\pard \ltrpar\ql \fi-3600\li4320\ri0\nowidctlpar
\tx-1200\tx-720\tx0\tx360\tx720\tx1080\tx1440\tx1800\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\tx9360\tx10080\tx10800\tx11520\tx12240\tx12960\tx13680\tx14400\tx15120\tx15840\tx16560\tx17280\tx18000\tx18720
\wrapdefault\faauto\rin0\lin4320\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid5907114 \tab \tab \tab \tab \tab \tab \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 
\hich\af31506\dbch\af31505\loch\f31506 Signature}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506  of Party}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 
\par }\pard \ltrpar\ql \li4320\ri0\nowidctlpar\tqr\tx9360\wrapdefault\faauto\rin0\lin4320\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506 Printed Name: }{\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114\charrsid12007003 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 
\par }\pard \ltrpar\ql \fi-3600\li4320\ri0\nowidctlpar\tx5040\tqr\tx9360\wrapdefault\faauto\rin0\lin4320\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 \tab \hich\af31506\dbch\af31505\loch\f31506 
Address:  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114\charrsid12007003 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 
\par \tab \hich\af31506\dbch\af31505\loch\f31506 City, State, Zip:  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114\charrsid12007003 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 
\par \tab \hich\af31506\dbch\af31505\loch\f31506 Telephone Number:}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506   \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid5907114\charrsid12007003 
\par \tab \hich\af31506\dbch\af31505\loch\f31506 Fax Number}{\rtlch\fcs1 \af0\afs18 \ltrch\fcs0 \fs18\insrsid5907114 \hich\af0\dbch\af31505\loch\f0 : }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\ul\insrsid5907114 \tab 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid5907114 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 Designated E-mail Address(es):____________________
\par \tab \hich\af31506\dbch\af31505\loch\f31506 _____________________________________________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid15605013 
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar
\tx-1200\tx-720\tx0\tx360\tx720\tx1080\tx1440\tx1800\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\tx9360\tx10080\tx10800\tx11520\tx12240\tx12960\tx13680\tx14400\tx15120\tx15840\tx16560\tx17280\tx18000\tx18720
\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506 STATE OF FLORIDA
\par \hich\af31506\dbch\af31505\loch\f31506 COUNTY OF}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid5907114 \hich\af0\dbch\af31505\loch\f0  _________________
\par 
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\tx720\tx1440\tx2160\tqr\tx9360\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506 
Sworn to or affirmed and signed before me on by }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506  \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid5907114\charrsid12007003 .
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar
\tx-1200\tx-720\tx0\tx360\tx720\tx1080\tx1440\tx1800\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\tx9360\tx10080\tx10800\tx11520\tx12240\tx12960\tx13680\tx14400\tx15120\tx15840\tx16560\tx17280\tx18000\tx18720
\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 
\par }\pard \ltrpar\ql \fi-1800\li1800\ri0\nowidctlpar
\tx-1200\tx-720\tx0\tx360\tx720\tx1080\tx1440\tx1800\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\tx9360\tx10080\tx10800\tx11520\tx12240\tx12960\tx13680\tx14400\tx15120\tx15840\tx16560\tx17280\tx18000\tx18720
\wrapdefault\faauto\rin0\lin1800\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid5907114 \tab \tab \tab \tab \tab 
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar
\tx-1200\tx-720\tx0\tx360\tx720\tx1080\tx1440\tx1800\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\tx9360\tx10080\tx10800\tx11520\tx12240\tx12960\tx13680\tx14400\tx15120\tx15840\tx16560\tx17280\tx18000\tx18720
\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 Date:__________________________\tab \tab _____________________________________________}{\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114\charrsid4028855 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 \tab \tab \tab \tab \tab \tab \tab \tab \tab \hich\af31506\dbch\af31505\loch\f31506 NOTARY PUBLIC or DEPUTY CLERK
\par 
\par \tab \tab \tab \tab \tab \tab \tab \tab \tab 
\par \tab \tab \tab \tab \tab \tab \tab \tab \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114\charrsid12007003 \tab \tab \tab \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114 
\hich\af31506\dbch\af31505\loch\f31506 ___________________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 
\par \tab \tab \tab \tab \tab \tab \tab \tab \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506 [Print, type, or stamp commissioned name of notary or \tab 
\par \tab \tab \tab \tab \tab \tab \tab \tab \tab \hich\af31506\dbch\af31505\loch\f31506 clerk] 
\par }\pard \ltrpar\ql \li1080\ri0\nowidctlpar
\tx-1200\tx-720\tx0\tx360\tx720\tx1080\tx1440\tx1800\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\tx9360\tx10080\tx10800\tx11520\tx12240\tx12960\tx13680\tx14400\tx15120\tx15840\tx16560\tx17280\tx18000\tx18720
\wrapdefault\faauto\rin0\lin1080\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506      
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar
\tx-1200\tx-720\tx0\tx360\tx720\tx1080\tx1440\tx1800\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\tx9360\tx10080\tx10800\tx11520\tx12240\tx12960\tx13680\tx14400\tx15120\tx15840\tx16560\tx17280\tx18000\tx18720
\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506        }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid5907114\charrsid12007003 \tab \hich\af31506\dbch\af31505\loch\f31506 Personally known
\par }\pard \ltrpar\ql \fi-720\li720\ri0\nowidctlpar
\tx-1200\tx-720\tx0\tx360\tx720\tx1080\tx1440\tx1800\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\tx9360\tx10080\tx10800\tx11520\tx12240\tx12960\tx13680\tx14400\tx15120\tx15840\tx16560\tx17280\tx18000\tx18720
\wrapdefault\faauto\rin0\lin720\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506        }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid5907114\charrsid12007003 \tab \hich\af31506\dbch\af31505\loch\f31506 Produced identification 
\par \tab \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506    }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506 
Type of identification produced }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506               }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114 
\hich\af31506\dbch\af31505\loch\f31506                            }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506  
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar
\tx-1200\tx-720\tx0\tx360\tx720\tx1080\tx1440\tx1800\tx2160\tx2880\tx3600\tx4320\tx5040\tx5760\tx6480\tx7200\tx7920\tx8640\tx9360\tx10080\tx10800\tx11520\tx12240\tx12960\tx13680\tx14400\tx15120\tx15840\tx16560\tx17280\tx18000\tx18720
\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 
\par }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid5907114\charrsid12007003 
\par \hich\af31506\dbch\af31505\loch\f31506 IF A NONLAWYER HELPED YOU FILL OUT \hich\af31506\dbch\af31505\loch\f31506 THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:}{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid5907114 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506 [fill in }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid5907114\charrsid12007003 
\hich\af31506\dbch\af31505\loch\f31506 all}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506  blanks]}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 
\hich\af31506\dbch\af31505\loch\f31506  This form was prepared for the: }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114 \{\hich\af31506\dbch\af31505\loch\f31506 choose only }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\b\i\f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 one}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114 \}\hich\af31506\dbch\af31505\loch\f31506  ______}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 
\hich\af31506\dbch\af31505\loch\f31506  Petitioner _____ Respondent}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 This form was completed with the assistance of:}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\tqr\tx9360\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \ai\af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114\charrsid12007003 \{\hich\af31506\dbch\af31505\loch\f31506 name of }{\rtlch\fcs1 
\ai\af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 individual}{\rtlch\fcs1 \ai\af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114\charrsid12007003 \}}{\rtlch\fcs1 \ai\af0\afs22 \ltrch\fcs0 
\i\f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 ___________________________________________________________________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 ,}{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f31506\fs22\insrsid5907114 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114 \{\hich\af31506\dbch\af31505\loch\f31506 name of business\} }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 
____________________________________________________________________,}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\tx720\tx1440\tx2160\tx2880\tx3600\tqr\tx9360\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \ai\af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114\charrsid12007003 \{}{\rtlch\fcs1 \ai\af0\afs22 
\ltrch\fcs0 \i\f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 address}{\rtlch\fcs1 \ai\af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114\charrsid12007003 \}}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f31506\fs22\ul\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506  \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 
_______________________________________________________________________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506 , }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid5907114 
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid5907114 {\rtlch\fcs1 \ai\af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114\charrsid12007003 \{\hich\af31506\dbch\af31505\loch\f31506 city\}}{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid5907114\charrsid12007003 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 
\hich\af31506\dbch\af31505\loch\f31506 _____\hich\af31506\dbch\af31505\loch\f31506 _________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 ,}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 
\hich\af31506\dbch\af31505\loch\f31506  }{\rtlch\fcs1 \ai\af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114\charrsid12007003 \{\hich\af31506\dbch\af31505\loch\f31506 state\}}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 _____}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid5907114\charrsid12007003 ,}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114 \{
\hich\af31506\dbch\af31505\loch\f31506 zip code\}_____________,}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506  }{\rtlch\fcs1 \ai\af0\afs22 \ltrch\fcs0 
\i\f31506\fs22\insrsid5907114\charrsid12007003 \{}{\rtlch\fcs1 \ai\af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 tele}{\rtlch\fcs1 \ai\af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114\charrsid12007003 
\hich\af31506\dbch\af31505\loch\f31506 phone}{\rtlch\fcs1 \ai\af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506  number}{\rtlch\fcs1 \ai\af0\afs22 \ltrch\fcs0 \i\f31506\fs22\insrsid5907114\charrsid12007003 \}}{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114\charrsid12007003 \hich\af31506\dbch\af31505\loch\f31506  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5907114 \hich\af31506\dbch\af31505\loch\f31506 _______}{\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid9664523 
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