IN THE CIRCUIT COURT OF THE FOURTH JUDICIAL CIRCUIT IN AND FOR DUVAL COUNTY, FLORIDA CASE NO.: DIVISION: , Petitioner, And , Respondent, MOTION COMES NOW the ( ) Petitioner ( in this matter, and requests the Court to: 1. ) Respondent 2. 3. CERTIFICATE OF SERVICE I certify that a copy of this document was ( ) mailed ( ) faxed and mailed ( ) e-mailed ( ) hand-delivered to the person(s) listed below on {date} _________________________________. Other party or his/her attorney: Name:________________________________________ Address:______________________________________ City, State, Zip:_________________________________ Fax Number: __________________________________ Designated E-mail Address(es):____________________ ______________________________________________ FCS (Duval) Local Form ­ Revised 05/05/15 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 answer and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Date: Signature of Party Printed Name: Address: Tel. No.: E-Mail: 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 or notary or clerk.] Personally known Produced identification Type of Identification produced FCS (Duval) Local Form ­ Revised 05/05/15 American LegalNet, Inc. www.FormsWorkFlow.com