Florida Emergency Form – Fill Out and Use This PDF

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW

FORM 12.941(d)

EMERGENCY VERIFIED MOTION FOR CHILD PICK-UP ORDER (11/15)

When should this form be used?

You may use this form to request that the court enter an order directing the sheriff or other law enforcement officer to take a minor child(ren) from the person who currently has physical possession of the child(ren) and deliver the child(ren) to your physical custody or possession. This form should only be used in an emergency by a person who has a pre-existing legal right to physical possession of a minor child. This means that you already have a court order awarding you legal custody of or time-

sharing with the child(ren) OR you are the birth mother of one or more children born out of wedlock a d o ou t o de has add essed a y othe pe so ’s pa e tal ights. Before proceeding, you should

read General Information for Self-Represented Litigants found at the beginning of these forms.

This form should be typed or printed in black ink. This form presumes that you want the court to enter an ex parte order without giving the other side advance notice of the hearing. You should explain your reasons for why such an ex parte order should be entered in paragraph 7 of this form. After completing this form, you should sign the form before a notary public or deputy clerk. You should file the original, along with all of the other forms required, with the clerk of the circuit court in the county where the child(ren) is (are) physically located and keep a copy for your records. You should also ask the clerk to process your motion though their emergency procedures.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be filed electronically except in certain circumstances. Self-represented litigants may file petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to 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. The rules and procedures should be carefully read and followed.

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.

Instructions for Florida Supreme Court Approved Family Law Form 12.941(d), Emergency Verified Motion for Child Pick-Up Order (11/15)

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.

What should I do next?

If the court enters an order without advance notice to the other party, you should take a certified copy of

the o de to the she iff’s office for further assistance. You	ust ha e this fo	a d the ou t’s o de
served by personal service on the other party. You should	ead the ou t’s o de	a efully. The order

may require the sheriff to place the child(ren) somewhere other than in your physical possession. Look for directions in the order that apply to you and note the time and place of the hearing scheduled in the order. You should go to the hearing with whatever evidence you have regarding yourmotion.

If the court will not enter an order without advance notice to the other side, you should check with the clerk of court, judicial assistant, or family law intake staff for information on the local procedure for scheduling a hearing on your motion, unless the court sets a hearing in its order denying your request for an ex parte hearing. When you know the date and time of your hearing, you should file Notice of

Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, and use personal service to notify the othe pa ty of you otio , the ou t’s o de , if a y, a d the hearing.

Special notes...

With this form you must also file the following:

∙Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d).

∙A certified copy of the court order showing that you have legal custody of or time-sharing with the child(ren), if any.

OR

∙ A certified copy of the hild e ’s birth certificate(s), if you are the birth mother of a child born out of wedlock and no court order addressing paternity exists.

OR

∙A certified copy of any judgment establishing paternity, time-sharing with or custody of the minor child(ren).

Order These family law forms contain an Order to Pick-Up Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.941(e), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a blank order form with you to the hearing.

If so, you should type or print the heading, including the circuit, county, case number, division, and the pa ties’ a es, a d lea e the est la k fo the judge to o plete at you hearing.

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 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.

Instructions for Florida Supreme Court Approved Family Law Form 12.941(d), Emergency Verified Motion for Child Pick-Up Order (11/15)

IN THE CIRCUIT COURT OF THE _______________________ JUDICIAL CIRCUIT,

IN AND FOR ________________________ COUNTY, FLORIDA

Case No.: ___________________________ ___

Division: __________________________________________________________________________________ ________

__________________________________,

Petitioner,

and

__________________________________,

Respondent,

EMERGENCY VERIFIED MOTION FOR CHILD PICK-UP ORDER

I, {full legal name} __________________________________________________________ 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):

Name Sex Birth Date Race Physical Description

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

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

{full legal name} _________________________________________________________________

whose address or present physical location is: _________________________________________

_______________________________________________________________________________

This individual’s elatio ship to the i o hild e 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 {date} _____ in {name of court} ___________________________________

{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): {list name(s) of the child(ren) or write all}

Florida Supreme Court Approved Family Law Form 12.941(d), Emergency Verified Motion for Child Pick- Up Order (11/15)

_______________________________________________________________________________

_______________________________________________________________________________

A certified copy of said final judgment or order is attached, has not been modified, and is still in effect. {Indicate if applicable} _____. 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): {list name(s) of the child(ren) or write all}

________________________________________________________________________________

______________________________________________________________________________

1. _____ Paternity has NOT been established. A certified copy of the minor hild e ’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 thismotion.

6. Facts relati g to the i or child re ’s curre t situation.

[Indicate ALL that apply]

a._____ The person named in paragraph 2 wrongfully removed or wrongfully detained the minor child(ren) on {date} __________ 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

e o al f o this ou t’s ju isdi tio hile ith the pe so a ed i pa ag aph 2 ased o 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 {list both the address and the people you believe will be there}: ________________________________________________

______________________________________________________________________________

Florida Supreme Court Approved Family Law Form 12.941(d), Emergency Verified Motion for Child Pick- Up Order (11/15)