Family Law Assignment

Form 12.928 Cover Sheet for Family Court Cases

Case Style

IN THE CIRCUIT COURT OF THE FIFTH JUDICIAL CIRCUIT

IN AND FOR MARION COUNTY, FLORIDA

CASE NO.____________________________

____________________________ JUDGE: ____________________________

Petitioner,

and

____________________________

Respondent.

I. Type of Action/Proceeding. Place a check in the appropriate box 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, check that line and 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

II. 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) ________ Support IV-D (Department of Revenue/Child Support Enforcement)

(H) ________ Support Non-IV-D (not Department of Revenue/Child Support Enforcement)

(I) ________ UIFSA IV-D (Department of Revenue/Child Support Enforcement)

(J) ________ UIFSA Non-IV-D (not Department of Revenue/Child Support Enforcement)

(K) ________ Other Family Court

(L) ________ Adoption Arising out of chapter 63

(M) ________ Name Change

(N) ________ Paternity/Disestablishment of Paternity

(O) ________ Juvenile Delinquency

(P) ________ Petition for Dependency

(Q) ________ Shelter Petition

(R) ________ Termination of Parental Rights arising out of Chapter 39

(S) ________ Adoption arising out of Chapter 39

(T) ________ CINS/FINS

III. 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).

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

DATE: , 2017

By_____________________________________

Attorney for Petitioner