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Order Upon Petition For Temporary-Emergency Parental Responsibility Of Minor Children By Extended Family Form. This is a Florida form and can be use in Brevard Local County.
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Tags: Order Upon Petition For Temporary-Emergency Parental Responsibility Of Minor Children By Extended Family, Law 1040, Florida Local County, Brevard
IN THE CIRCUIT COURT IN THE EIGHTEENTH JUDICIAL CIRCUIT
FOR BREVARD COUNTY, FLORIDA.
CASE NO.:
IN THE INTEREST OF:
Bar Code Label
/
Minor Child(ren)
(___)ORDER UPON PETITION FOR TEMPORARY PARENTAL
RESPONSIBILITY OF MINOR CHILD(REN) BY EXTENDED FAMILY
(___) ORDER UPON PETITION FOR EMERGENCY TEMPORARY
PARENTAL RESPONSIBILITY OF MINOR CHILD(REN) BY EXTENDED
FAMILY
THIS CAUSE came to be heard on {date} _____________________________, 20____,
before this Court, upon the (___) Petition for Temporary Parental Responsibility of Minor
Child(ren) By Extended Family or (___)Petition for Emergency Temporary Parental
Responsibility pursuant to Chapter 751, Florida Statutes and the Court having reviewed the file
and being fully advised in the premises finds as follows:
of the minor child(ren) and has
1. Petitioner is the
physical parental responsibility of the minor child(ren) to wit:
NAME
BIRTH DATE
2.
This Court has jurisdiction over the above-referenced child(ren).
3.
The Mother of the child(ren) is
4.
The Mother (___) has (___) has not consented in writing to the entry of this Order for
Temporary Parental Responsibility.
5.
The Mother is unwilling or unable to consent in writing for the following reasons:
6.
The Father of the child(ren) is
.
.
7. The Father (___) has (___)has not consented in writing to the entry of this Order for
Temporary Parental Responsibility.
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Case No:______________________
8.
The Father is unwilling or unable to consent in writing for the following reasons:
9.
(___) Petitioner(s) is/are fit, able and willing to care for the minor child(ren).
10. (___) Placement of the child(ren) with Petitioner(s) is in the best interest of the minor
child(ren).
11. (___) Parental Responsibility is requested as a result of abuse, neglect and/or abandonment
of the child(ren) by the (___)Mother ____________________________________________
.
and/or by the (___)Father
12. (___) This is an emergency because:
THEREFORE, IT IS HEREBY ORDERED AND ADJUDGED:
1. (___) That the Petition for Temporary Parental Responsibility of the Minor Child(ren)
By Extended Family is HEREBY GRANTED.
2. (___) That the Petition for Emergency Temporary Parental Responsibility of Minor
Child(ren) is HEREBY GRANTED.
3. (___) That the Petitioner, ____________________________________, shall have
physical and legal parental responsibility until further order of the Court of the minor
child(ren) to wit:
NAME
BIRTH DATE
4. (___) Petitioner is HEREBY AUTHORIZED to obtain necessary medical treatment
for the child(ren).
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Case No:______________________
5.
6.
(___) Petitioner is HEREBY AUTHORIZED to secure copies of the child(ren)’s
records, held by third parties, that are necessary for the care of the child(ren)
including, but not limited to:
A. Medical, dental and psychiatric records;
B. Birth certificates and other records; and,
C. Educational records.
(___) Petitioner is HEREBY AUTHORIZED to enroll the child(ren) in school and
grant or withhold consent for a child to be tested or placed in special school
programs, including exceptional education.
7. (___) Petitioner is HEREBY AUTHORIZED to do all other things necessary for the
care of the minor child(ren).
8.
(
) CHILD SUPPORT: The child support shall be redirected as follows:
The Respondent {name}
, shall promptly pay
address
for support and maintenance of the minor child/ren, the sum of $
,
per
plus Clerk's costs of 4% of said payment but not more than
$5.25 per payment and not less than $1.25 per payment, to the State of Florida
Disbursement Unit, P.O. Box 8500, Tallahassee, Fl. 32314-8500, commencing
on
, 20
, and continuing each
thereafter, for
disbursement to thePetitioner,
,
address
.
9.
CHILD SUPPORT ARREARAGE: Payments of previously ordered support not
paid is $__________. Said payments are owed to {name}
address
, and shall be paid as follows:
.
10.
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Case No:______________________
11. This Court shall retain jurisdiction over this cause and the minor child(ren) to enter
any and all orders deemed necessary to assure the safety and welfare of the minor
child(ren).
ORDERED on this __________ day of __________________________, 200______.
CIRCUIT JUDGE
COPIES TO:
_______________________________________
_______________________________________
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