CASE NUMBER IN THE CIRCUIT COURT, EIGHTEENTH JUDICIAL CIRCUIT, BREVARD COUNTY, FLORIDA 05 JUDGE: CLOCK IN - XXXX-XX PETITIONER RESPONDENT FAMILY COURT COVER SHEET 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, choose one of the three options below it. Initial Action/Petition Reopening Case Modification/Supplemental Petition Motion for Civil Contempt/Enforcement Other Type of Case. If the case fits more than one type of case, select the most definitive. Simplified Dissolution of Marriage Dissolution of Marriage Domestic Violence Dating Violence Repeat Violence Sexual Violence Support IV-D (Department of Revenue, Child Support Enforcement) Support Non-IV-D (not Department of Revenue, Child Support Enforcement UIFSA IV-D (Department of Revenue, Child Support Enforcement) UIFSA Non IV-D (not Department of Revenue, Child Support Enforcement) Other Family Court Adoption Arising Out of Chapter 63 Name Change Paternity/Disestablishment of Paternity Juvenile Delinquency Petition for Dependency Shelter Petition Termination of Parental Rights Arising Out of Chapter 39 Adoption Arising Out of Chapter 39 CINS/FINS LAW 181 Rev. 01/2010 BAR CODE LABEL American LegalNet, Inc. www.FormsWorkFlow.com Page 2 CASE NUMBER FAMILY COURT COVER SHEET 05 - XXXX-XX JUDGE Rule of Judicial Administration 2.545(d) requires that a Notice of Related Cases Form, Family Law Form 12.900(h), be filed w ith 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 w ith this Cover Sheet for Family Court Cases and initial pleading/petition. No, to the best of my know ledge, 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 know ledge and belief. Signature:_______________________________________ Attorney or Party FL Bar No.:_______________________________________ (Bar number, if attorney) Type or Print Name:_______________________________ Date:_____________________________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, { full legal name and trade name of nonlaw yer} _________________________________________, a nonlaw yer, w hose address is { street} ___________________________________, { city} ____________________________________, { state} ________________, { phone} __________________, helped { name} ____________________________________, w ho is the [choose one only] petitioner or respondent, fill out this form. LAW 181 Rev. 01/2010 American LegalNet, Inc. www.FormsWorkFlow.com