Form 12 902D – Fill Out and Use This PDF

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW

FORM 12.902(d)

UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT

(UCCJEA) AFFIDAVIT

(02/18)

When should this form be used?

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

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

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

Instructions for Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit (02/18)

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...

With this form, you must also file a Notice of Confidential Information within Court Filing, Florida Rules of Judicial Administration Appendix to Rule 2.420 Form.

Effective October 1, 2008, terms such as custodial parent, noncustodial parent, primary residential parent, secondary residential parent, and visitation were removed from Chapter 61, Florida Statutes; however, because the UCCJEA uses the terms, custody and visitation, they are included in this form. Parents must 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.

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.

Instructions for Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit (02/18)

IN THE CIRCUIT COURT OF THE								JUDICIAL CIRCUIT,
IN AND FOR					COUNTY, FLORIDA
				Case No.:
				Division:
		,
Petitioner,
and
			,
Respondent.

UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT

(UCCJEA) AFFIDAVIT

I, {full legal name}

____________, 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:

Dates			Address (including city and	Name and present address of	Relationship
(From/To)			state) where child lived	person child lived with	to child
	/present*
____/____
____/____
____/____

Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit (02/18)

____/____

____/____

*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 #

:

Child’s Full Legal Name:

Place of Birth:

Date of Birth:

Sex:

Child’s Residence for the past 5 years:

Dates

Address (including city and

Name and present address of

Relationship

(From/To)

state) where child lived

person child lived with

to child

/present

____/____

____/____

____/____

____/____

____/____

THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD #					:
Child’s Full Legal Name:
Place of Birth:			Date of Birth:				Sex:

Child’s Residence for the past 5 years:

Dates			Address (including city and	Name and present address of	Relationship
(From/To)			state) where child lived	person child lived with	to child
	/present

Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit (02/18)

____/____

____/____

____/____

____/____

____/____

2.Participation in custody or time-sharing proceeding(s): [Choose only ONE]

______ I HAVE NOT participated as a party, witness, or in any capacity in any other litigation or custody proceeding in this or any other state, jurisdiction, or country, concerning parental responsibility for, custody of, or time-sharing or visitation with a child subject to this proceeding.

______ I HAVE participated as a party, witness, or in any capacity in any other litigation or

custody proceeding in this or another state, jurisdiction, or country, concerning parental responsibility for, custody of, or time-sharing or visitation with a child subject to this proceeding. Explain:

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): [Choose only ONE]

______ I HAVE NO INFORMATION of any parental responsibility, custody, time-sharing, or

visitation proceeding pending in a court of this or any other state, jurisdiction, or country concerning a child subject to this proceeding.

______ I HAVE THE FOLLOWING INFORMATION concerning a parental responsibility, custody,

time-sharing, or visitation proceeding pending in a court of this or another state concerning a child subject to this proceeding, other than set out in item 2. Explain:

a.Name of each child involved in said litigation:

b.Type of proceeding:

c.Court and state:

d.Date of court order or judgment (if any):

e.Case Number: _______________________________________________________________

Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit (02/18)

4.Persons not a party to this proceeding: [Choose only ONE]

______ I DO NOT KNOW OF ANY PERSON in this or any other state, jurisdiction, or country, who is not a party to this proceeding and who has physical custody or claims to have parental responsibility for, custody of, or time-sharing or visitation with respect to any child subject to this proceeding.

______ I KNOW THAT THE FOLLOWING NAMED PERSON(S), not a party to this proceeding,

has (have) physical custody or claim(s) to have parental responsibility for, custody of, or time- sharing or visitation with respect to any child subject to this proceeding:

a. Name and address of person:

_____ has physical custody

_____ claims parental responsibility or custody rights

_____ claims time-sharing or visitation

Name of each child:

Relationship to child, if any:________________________________________________________

b. Name and address of person:

_____ has physical custody

_____ claims parental responsibility or custody rights

_____ claims time-sharing or visitation

Name of each child:

Relationship to child, if any:________________________________________________________

c. Name and address of person:

_____ has physical custody

_____ claims parental responsibility or custody rights

_____claims time-sharing or visitation

Name of each child:

Relationship to child, if any:________________________________________________________

5.Knowledge of prior child support proceedings: [Choose only ONE]

_____		The child(ren) described in this affidavit are NOT subject to existing child support
order(s) in this or any other state, jurisdiction, or country..
_____		The child(ren) described in this affidavit are subject to the following existing child

support order(s):

a.Name of each child: ______________________________________________________

b.Type of proceeding: ______________________________________________________

c.Court and address: _______________________________________________________

d.Date of court order/judgment (if any): ___________________________________________

Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit (02/18)

e. Amount of child support ordered to be paid and by whom:

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

7.A completed Notice of Confidential Information within Court Filing, Florida Rules of Judicial Administration Appendix to Rule 2.420 Form, is filed with this Affidavit.

I certify that a copy of this document was (

) e-served (

) mailed (

) faxed and mailed

(

) hand delivered to the person(s) listed below on {date}

.

Other party or his/her attorney:

Name:

Address:

City, State, Zip:

______

Fax Number:

Designated E-mail Address(es):____________________

_____________________________________________

I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment.

Dated: ______________________
		Signature of Party
		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			.
NOTARY PUBLIC or DEPUTY CLERK

Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit (02/18)

	__________________________________________________
	[Print, type, or stamp commissioned name of notary or clerk.]
__	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:

[fill in all blanks] This form was prepared for the {choose only ONE} _____ Petitioner _____ Respondent

This form was completed with the assistance of:

{name of individual} _________________________________________________________________,

{name of business} ____________________________________________________________________,

{address}____________________________________________,

{city} _____________,{state} ___, {zip code}____________,{telephone number}________________.

Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit (02/18)