NAME:_______________________________ CASE NO.:___________________________ NOTICE AND ACKNOWLEDGMENT OF LIMITATION OF SERVICES PROVIDED By signing this disclaimer, the undersigned self-represented litigant acknowledges he/she understands the limitation of services that can be provided by Family Court Self Help personnel. 1. The personnel in this self-help program are not acting as your lawyer or providing legal advice to you. 2. Self-help personnel are not acting on behalf of the Court or any judge. 3. The presiding judge in your case may require amendment of a form or substitution of a different form other than any you may have obtained from the clerk’s office, the self-help office or a legal forms provider. 4. The form(s) you file are only a request of the Court. The judge is not required to grant the relief requested in a form. 5. The personnel in this self-help program cannot tell you what your legal rights or remedies are, represent you in court or tell you how to testify in court. 6. Self-help services are available to all persons who are or will be parties to a family case. 7. The information you give to and receive from self-help personnel is not confidential and may be subject to disclosure at a later date. Nothing you may tell family court personnel is confidential. 8. If another person involved in your case seeks assistance from this self-help program, that person will be given the same type of assistance you receive. 9. I understand that in all cases, it is best to consult with your own attorney, especially if your case presents significant issues regarding children, child support, alimony, retirement or pension benefits, assets or liabilities. ( ) I can read English ( ) I cannot read English, this notice was read to me by____________________________ in __________________________. (NAME) (LANGUAGE) _______________________________________ Signature (Litigant) ________________________ Date ______________________________________ Signature (Family Law or Clerk Staff) ________________________ Date American LegalNet, Inc. www.FormsWorkflow.com