Sheet Family Form – Fill Out and Use This PDF

INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.928, COVER SHEET FOR FAMILY COURT CASES (11/13)

When should this form be used?

The Cover Sheet for Family Court Cases and the information contained in it neither replace nor supplement the filing and service of pleadings or other documents as required by law. This form shall be filed by the petitioner/party opening or reopening a case for the use of the clerk of the circuit court for the purpose of reporting judicial workload data pursuant to Florida Statutes section 25.075.

This form should be typed or printed in black ink. The petitioner must file this cover sheet with the first pleading or motion filed to open or reopen a case in all domestic and juvenile cases.

What should I do next?

Follow these instructions for completing the form:

I.Case Style. Enter the name of the court, the appropriate case number assigned at the time of filing of the original petition, the name of the judge assigned (if applicable), and the name (last, first, middle initial) of the petitioner(s) and respondent(s).

II.Type of Action /Proceeding. Place a check beside the proceeding you are initiating. If you are simultaneously filing more than one type of proceeding against the same opposing party, such as a modification and an enforcement proceeding, complete a separate cover sheet for each action being filed.

(A)	Initial Action/Petition
(B)	Reope i g Case. If ou he k Reope i g Case, i di ate hethe ou a e fili g a
	modification or supplemental petition or an action for enforcement by placing a check
	beside the appropriate action/petition.

1.Modification/Supplemental Petition

2.Motion for Civil Contempt/ Enforcement

3.Other – All reopening actions not involving modification/supplemental petitions or petition enforcement.

III.Type of Case. Place a check beside the appropriate case. If the case fits more than one category, select the most definitive. Definitions of the categories are provided below.

(A) Simplified Dissolution of Marriage‐ petitio s fo	the te		i atio of	a iage pu sua t to
Florida Family Law Rule of Procedure 12.105.
(B) Dissolutio of Ma iage ‐ petitio s fo the te	i atio	of	a iage pu sua		t to Chapte
61, Florida Statutes, other than simplified dissolution.
(C) Domestic Viole e ‐ all atte s elati g to i ju	tio	s fo	p ote tio	agai	st do esti
violence pursuant to section 741.30, Florida Statutes.

Instructions for Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases (11/13)

(D) Dati g Viole		e ‐ all	atte s elati g to i ju	tio s fo	p ote tio	agai	st dati g
	violence pursuant to section 784.046, Florida Statutes.
(E)	Repeat Viole	e ‐ all	atte s elati g to i ju	tio s fo	p ote tio	agai	st epeat
	violence pursuant to section 784.046, Florida Statutes.
(F)	“e ual Viole	e ‐ all	atte s elati g to i ju	tio s fo	p ote tio	agai	st se ual
	violence pursuant to section 784.046, Florida Statutes.

(G)Stalking-all matters relating to injunctions for protection against stalking pursuant to section 784.0485, Florida Statutes

(H) “uppo t ‐ IV‐D ‐ all

atte s elati g to

hild o

spousal suppo t i

hi h a

appli ation

for assistance has been filed with the Department of Revenue, Child Support

E fo e e

t u

de

Title IV‐D, “o ial “e u it A t, e ept fo su h

atte s

elati g to

dissolution of marriage petitions (sections 409.2564, 409.2571, and 409.2597, Florida

Statutes), paternity, or UIFSA.

(I)

“uppo t‐No

IV‐D ‐ all

atte s

elati g to hild o

spousal suppo t i

hi h a

application for assistance has not

ee

filed u

de

Title IV‐D, “o ial “e u it A t.

(J)

UIF“A‐ IV‐D ‐ all

atte s elati

g to Chapte

, Flo ida “tatutes, in which an application

fo assista

e has

ee

filed u

de

Title IV‐D, “o ial “e u it A t.

(K)

UIF“A ‐ No

IV‐D ‐ all

atte s

elati

g to Chapte

, Flo ida “tatutes, i

hi h a

application for assistance has not

ee

filed u

de

Title IV‐D, “o ial Security Act.

(L)Other Family Court ‐ all matters involving time-sharing and/or parenting plans relating to minor child(ren), support unconnected with dissolution of marriage, annulment, delayed birth certificates pursuant to Florida Statutes section 382.0195, expedited affirmation of parental status pursuant to Florida Statutes section 742.16, termination of parental rights proceedings pursuant to Florida Statutes section 63.087, declaratory judgment actions related to premarital, marital, post-marital agreements, or other matters not included in the categories above.

(M) Adoption Arising Out Of Chapter 63 ‐ all	atte s	elati g to adoptio pu sua t to
Chapter 63, Florida Statutes, excluding any matters arising out of Chapter 39, Florida
Statutes.
(N) Na e Cha ge ‐ all atte s elati g to a	e ha	ge, pu sua t to se tio	.0 , Flo ida
Statutes.

(O)Paternity/Disestablishment of Paternity – all matters relating to paternity pursuant to Chapter 742, Florida Statutes.

(P) Ju e ile Deli ue	‐ all atte s elati g to ju e ile deli ue	pu sua t to Chapte
985, Florida Statutes.
(Q) Petition for Depe de	‐ all atte s elating to petitions for dependency.

(R)Shelter Petition – all matters relating to shelter petitions pursuant to Chapter 39, Florida Statutes.

(S)Termination of Parental Rights Arising Out Of Chapter 39 – all matters relating to termination of parental rights pursuant to Chapter 39, Florida Statutes.

(T)Adoption Arising Out Of Chapter 39 – all matters relating to adoption pursuant to Chapter 39, Florida Statutes.

(U)CINS/FINS – all matters relating to children in need of services (and families in need of services) pursuant to Chapter 984, Florida Statutes.

Instructions for Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases (11/13)

ATTORNEY OR PARTY SIGNATURE. Sign the Cover Sheet for Family Court Cases. Print legibly the name of the person signing the Cover Sheet for Family Court Cases. Attorneys must include a Florida Bar number. Insert the date the Cover Sheet for Family Court Cases is signed. Signature is a certification that filer has provided accurate information on the Cover Sheet for Family Court Cases.

Nonlawyer 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.

Where can I look for more information?

Before proceedi g, you should read Ge eral I for atio for “elf-Represe ted Litiga ts found at the beginning of these forms. For further information, see Rule 12.100, Florida Family Law Rules of Procedure.

Instructions for Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases (11/13)

COVER SHEET FOR FAMILY COURT CASES

I.Case Style

IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT,

IN AND FOR __________________ COUNTY, FLORIDA

Case No.: ________________

Judge: __________________

_____________________________

Petitioner

and

_____________________________

Respondent

II.Type of Action/Proceeding. Place a check beside the proceeding you are initiating. If you are simultaneously filing more than one type of proceeding against the same opposing party, such as a modification and an enforcement proceeding, complete a separate cover sheet for each action being filed. If you are reopening a case, choose one of the three options below it.

(A)____ Initial Action/Petition

(B)____ Reopening Case

1.____ Modification/Supplemental Petition

2.____ Motion for Civil Contempt/Enforcement

3.____ Other

III.Type of Case. If the case fits more than one type of case, select the most definitive.

(A)____ Simplified Dissolution of Marriage

(B)____ Dissolution of Marriage

(C)____ Domestic Violence

(D)____ Dating Violence

(E)____ Repeat Violence

(F)____ Sexual Violence

(G)____ Stalking

(H)____ “uppo t IV‐D (Department of Revenue, Child Support Enforcement)

(I)____ “uppo t No ‐IV‐D (not Department of Revenue, Child Support Enforcement)

(J)____ UIF“A IV‐D (Department of Revenue, Child Support Enforcement)

(K)____ UIF“A No ‐IV‐D (not Department of Revenue, Child Support Enforcement)

(L)____ Other Family Court

(M)____ Adoption Arising Out Of Chapter 63

(N)____ Name Change

Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases (11/13)

(O)____ Paternity/Disestablishment of Paternity

(P)____ Juvenile Delinquency

(Q)____ Petition for Dependency

(R)____ Shelter Petition

(S)____ Termination of Parental Rights Arising Out Of Chapter 39

(T)____ Adoption Arising Out Of Chapter 39

(U)____ CINS/FINS

IV. Rule of Judicial Administration 2.545(d) requires that a Notice of Related Cases Form, Family Law Form 12.900(h), be filed with the initial pleading/petition by the filing attorney or self- represented litigant in order to notify the court of related cases. Is Form 12.900(h) being filed with this Cover Sheet for Family Court Cases and initial pleading/petition?

____ No, to the best of my knowledge, no related cases exist.

____ Yes, all related cases are listed on Family Law Form 12.900(h).

ATTORNEY OR PARTY SIGNATURE

I CERTIFY that the information I have provided in this cover sheet is accurate to the best of my knowledge and belief.

Signature________________________________________ FL Bar No.: _____________________

Attorney or party	(Bar number,if attorney)
________________________________________	__________________________
(Type or print name)	(E-mail Address(es))
____________________________
Date

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}______ , {telephone number }__________________.

Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases (11/13)