Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit - Florida - Edit, Fill, Sign Online

Instructions for Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction

and Enforcement Act (UCCJEA) Affidavit (03/15)

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW

FORM 12.902(d)

UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT

(UCCJEA) AFFIDAVIT (03/15)

When should this form be used?

This form should be used in any case involving custody of, visitation with, or time-sharing with any minor

child(ren). This affidavit is required even if the custody of, visitation, or time-sharing with the minor

child(ren) are not in dispute.

This form should be typed or printed in black ink. After completing this form, you should sign the form

before a notary public or deputy clerk. You should then file the original with the clerk of the circuit

court in the county where the petition was filed and keep a copy for your records.

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.

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 12.902(d), Uniform Child Custody Jurisdiction

and Enforcement Act (UCCJEA) Affidavit (03/15)

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.

Where can I look for more information?

Before proceeding, you should read General Information for Self-Represented Litigants found at the

beginning of these forms. The words that are in bold underline in these instructions are defined there.

For further information, see sections 61.501-61.542, Florida Statutes.

Special notes...

Chapter 2008-61, Laws of Florida, effective October 1, 2008, eliminated such terms as custodial parent,

noncustodial parent, primary residential parent, secondary residential parent, and visitation from

Chapter 61, Florida Statutes. Instead, parents are to develop a Parenting Plan that includes, among

other things, their time-sharing schedule with the minor child(ren). If the parents cannot agree, a

parenting plan will be established by the Court. However, because the UCCJEA uses the terms custody

and visitation, they are included in this form.

If you are the petitioner in an injunction for protection against domestic violence case and you have filed

a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form

12.980(h), you should write confidential in any space on this form that would require you to write the

address where you are currently living.

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

these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules

of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms

also must put his or her name, address, and telephone number on the bottom of the last page of every

form he or she helps you complete.

Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement

Act (UCCJEA) Affidavit (03/15)

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

(From/To)

Address (including city and

state) where child lived

Name and present address of

person child lived with

Relationship

to child

/present*

____/____

Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement

Act (UCCJEA) Affidavit (03/15)

____/____

* 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

(From/To)

Address (including city and

state) where child lived

Name and present address of

person child lived with

Relationship

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

(From/To)

Address (including city and

state) where child lived

Name and present address of

person child lived with

Relationship

to child

/present

Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement

Act (UCCJEA) Affidavit (03/15)

____/____

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, concerning custody of or time-sharing 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, concerning custody of or time-sharing 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 custody or time-sharing proceeding pending in a court of this

or any other state concerning a child subject to this proceeding.

____ I HAVE THE FOLLOWING INFORMATION concerning a custody or time-sharing 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:

b. Type of proceeding:

c. Court and state:

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

4. Persons not a party to this proceeding:

[Choose only one]

____ I DO NOT KNOW OF ANY PERSON not a party to this proceeding who has physical custody or

claims to have custody, visitation or time-sharing 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 custody, visitation, or time-sharing with respect to any

Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement

Act (UCCJEA) Affidavit (03/15)

child subject to this proceeding:

a. Name and address of person:

_____ has physical custody _____ claims custody rights _____ claims visitation or time-sharing

Name of each child:

b. Name and address of person:

_____ has physical custody _____ claims custody rights _____ claims visitation. or time-sharing

Name of each child:

c. Name and address of person:

_____ has physical custody _____ claims custody rights _____claims visitation or time-sharing

Name of each child:

5. Knowledge of prior child support proceedings:

[Choose only one]

_____ The child(ren) described in this affidavit are NOT subject to existing child support

order(s) in this or any state or territory.

_____ 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): ___________________________________________

e. Amount of child support paid and by whom:

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

time-sharing, child support, or guardianship proceeding (including dissolution of marriage,

separate maintenance, child neglect, or dependency) concerning the child(ren) in this state or

any other state about which information is obtained during this proceeding.

I certify that a copy of this document was ( ) mailed ( ) faxed and mailed

( ) e-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):____________________

_____________________________________________

Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement

Act (UCCJEA) Affidavit (03/15)

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

[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}________________.

Fillable Printable Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit - Florida

Fillable Printable Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit - Florida

Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit - Florida