IN THE CIRCUIT COURT IN THE EIGHTEENTH JUDICIAL CIRCUIT IN AND FOR BREVARD COUNTY, FLORIDA. Case No.: IN RE: The Marriage of Bar Code Label __________________________________, Husband and , Wife MOTION FOR PSYCHOLOGICAL EVALUATION The [ ] Husband [ ] Wife respectfully requests that the Court order psychological evaluations of the parties and minor child(ren) in this case, and states: 1. The psychological condition of the party is at issue in this case and good cause therefore exists for a psychological evaluation of the: [ ] Husband [ ] Wife [ ] New spouse(s) [ ] Child(ren) 2. Payment for psychological evaluations: [ ] The [ ] Husband [ ] Wife is/are unable to pay and a request for suspension of fees and costs in this case [ ] has [ ] has not been filed. [ ] The [ ] Husband [ ] Wife is/are gainfully employed and well able to pay the costs of such evalutions. [ ] The [ ] Husband [ ] Wife both work and request the Court order costs of evaluations paid by each according to their earnings. _______________________________________ Signature of Moving Party Name__________________________________ Address________________________________ Telephone No.___________________________ ____________________________________ Date I CERTIFY that I have ___ mailed, ___ telefaxed and mailed, or ___ hand delivered a copy of this motion on _____________________________, to: Name_________________________________ Address_______________________________ Telefax No.____________________________ Law 1041 - Rev. 10/2005 American LegalNet, Inc. www.FormsWorkflow.com