IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT, IN AND FOR BREVARD COUNTY, FLORIDA Case No.: , Petitioner and , Respondent. Bar Code Label NOTICE OF INTENT TO RELOCATE WITH CHILDREN I,{full legal name} notice to, {full legal name(s)} of my intention to relocate the principal residence of the following child(ren): Name Date of Birth Address , give I am providing the following information as required by section 61.13001(2), Florida Statutes: 1. The location of the intended new residence, including the state, city and physical address, if known is: 2. The mailing address of the new physical residence, if not the same as the physical address is: 3. The home telephone number of the intended new residence, if know, is: 4. The date of the intended move or proposed relocation is: Law 1105 ­ New 10/2007 American LegalNet, Inc. www.FormsWorkFlow.com 5. a. The specific reasons for the proposed relocation of the child(ren) are: b. One of the reasons for the proposed relocation is a job offer [ one only] ( )yes ( )No The Job offer is in writing [ one only] ( )Yes ( ) No. A copy of the written job offer is attached to this notice. 6. a. The proposed post-relocation schedule of visitation is as follows: Attach additional sheets if necessary b. The proposed post-relocation transportation arrangements necessary to effectuate visitation with the child(ren) are as follows: Attach additional sheets if necessary. AN OBJECTION TO THE PROPOSED RELOCATION MUST BE MADE IN WRITING, FILED WITH THE COURT, AND SERVED ON THE PARENT OR OTHER PERSON SEEKING TO RELOCATE WITHIN 30 DAYS AFTER SERVICE OF NOTICE OF THIS INTENT TO RELOCATE. IF YOU FAIL TO TIMELY OBJECT TO THE RELOCATION, THE RELOCATION WILL BE ALLOWED, UNLESS IT IS NOT IN THE BEST INTEREST OF THE CHILD, WITHOUT FURTHER NOTICE AND WITHOUT A HEARING. 7. The mailing address of the parent seeking to relocate to whom the objection must be sent is listed below. Law 1105 ­ New 10/2007 American LegalNet, Inc. www.FormsWorkFlow.com 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: 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 deputy 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] , I, {full legal name and trade name of nonlawyer} , {city} , a nonlawyer, located at {street} , {phone} , helped {name} , {state} who is the [ / one only] petitioner or respondent, fill out this form. Law 1105 ­ New 10/2007 American LegalNet, Inc. www.FormsWorkFlow.com