IN THE CIRCUIT COURT OF THE FIRST JUDICIAL CIRCUIT IN AND FOR ESCAMBIA COUNTY, FLORIDA IN THE INTEREST OF: __________________________________ __________________________________ __________________________________ Minor Child(ren) Case No.________________ Division: ________________ FINAL JUDGMENT GRANTING TEMPORARY LEGAL CUSTODY THIS CAUSE came before the Court on a Verified Petition for Temporary Legal Custody of Minor Child(ren) by an Extended Family Member, pursuant to Chapter 751, Florida Statutes. The Court, having considered the Petition and being otherwise fully advised hereby finds as follows: 1. The children's names and dates of birth are: ________________________________, born ___________, __________________ __________________________, born ___________ and_______________________________________, born __________. 2. The names and current addresses of the child(ren)'s parent(s) are as follows: Mother:____________________________________________________________ Father:____________________________________________________________ 3. This Court has jurisdiction of the children and the subject matter of the Petition. 4. The Petitioner•s name and mailing address: address:____________________________________ Petitioner's _________________________________________________________________________ 5. Petitioner is related to the child(ren) by virtue of being the ___________________ of the child(ren)•s ( child(ren)'s )Parent or ( )Stepparent. 6. The notarized consent of the parent(s) _____was _____was not attached to the Petition. 7. Petitioner requests temporary legal custody for a period of: _____ months _____ indefinitely. American LegalNet, Inc. www.FormsWorkflow.com 8. The evidence presented to the Court establishes that the above-named child(ren) is/are in need of care by the Petitioner and it is in the child(ren)'s best interest to award temporary legal custody to the Petitioner. ORDERED AND ADJUDGED: A. Petitioner, ___________________________, is awarded temporary legal custody of the child(ren), _______________________________ , _____________________________ and ____________________________________. B. Visitation by the parent(s) ___ is ___ is not in the child(ren)'s best interest.Said visitation children•s best interest. Said visitation should be reasonable, as determined by the custodian of the child(ren). C. Petitioner, as temporary legal custodian of the child(ren), is vested with the power to make all necessary provisions for the care of the child(ren) including, but not limited to, consenting to reasonable and necessary medical care (including mental health treatment, dental care and nonemergency surgery); securing copies of the children's records, including birth certificates, educational and medical records; granting or denying consent to special educational programs; and all other things necessary for the adequate care and custody of the child(ren). D. The existing Child Support Obligation is redirected to be paid to the Petitioner who is granted temporary custody. Arrears in the amount of _______________ are to be paid to the Petitioner in the amount of _____________ per ______________ beginning __________________. This order shall be recorded and filed in the original action in which child support was determined and a copy of the order shall be filed with the child support state depository. The depository shall maintain separate accounts and separate account numbers for individual obligees. American LegalNet, Inc. www.FormsWorkflow.com E. Either or both of the child(ren)'s parents may petition the court to modify or terminate the child(ren)•s Order Granting Temporary Legal Custody in accordance with the provisions of Chapter 751, Florida Statutes. DONE AND ORDERED at Pensacola, Escambia County, Florida, this ___ day of ______________________, 20____. ____________________________________ CIRCUIT JUDGE Copies furnished to: Petitioner(s) Parent(s) Domestic Relations American LegalNet, Inc. www.FormsWorkflow.com