IN THE CIRCUIT COURT OF THE FIRST JUDICIAL CIRCUIT, IN AND FOR ESCAMBIA COUNTY, FLORIDA IN THE INTEREST OF: , Date of Birth:________________________ ___________________________________ Date of Birth:________________________ Case No.: Division: “ ” WAIVER OF PERSONAL APPEARANCE ON FINAL JUDGMENT FOR TEMPORARY LEGAL CUSTODY I/We, {full legal name(s)} __________________________________________________ _ being sworn, certify that the following information is true: 1. I/We have filed a Verified Petition for Legal Custody pursuant to Chapter 751, Florida Statutes. 2. I/We am/are qualified to petition for this action for temporary custody. 3. (a) The child's name is_______________________________________________. (b) The child's date of birth is_________________________________________. 4. The current address of the child is_______________________________________ 5. The names and addresses of the child(ren)'s parents are: ______________________________ ______________________________ Mother Father ______________________________ ______________________________ Street Address Street Address ______________________________ ______________________________ City, State, Zip Code City, State, Zip Code 6. The child's parent(s) have filed a Consent to give Temporary Custody of the child to me/us or a Default was entered by the Court. 7. All of the information stated in the Verified Petition for Temporary Legal Custody is true and accurate. 8. I/We understand that the the parent(s) may request that the Court return custody to them at any time. 9. I/We have no information of any custody proceeding pending in a court of this state or any other state concerning the child(ren) subject to this proceeding. 10. I/We respectfully request that the Court waive the requirement that I/We personally appear or testify before the Court on this matter. I/We understand that the effect of the waiver is that the Final Judgment will be entered without further evidence or testimony. 11. I/We respectfully request that a copy of the Final Judgment be mailed to me/us at the address(es) listed below. American LegalNet, Inc. www.FormsWorkflow.com I have read completely the Waiver and fully understand the document. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this request and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: __________________________________________ Signature of Petitioner Printed Name:______________________________ Address:___________________________________ __________________________________________ __________________________________________ STATE OF FLORIDA COUNTY OF ESCAMBIA Sworn to or affirmed and signed before me on ___________________________________ by NOTARY PUBLIC or DEPUTY CLERK ___________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] Personally known Produced identification Type of identification produced I have read completely the Waiver and fully understand the document. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this request and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated:_________________________ __________________________________________ Signature of Petitioner Printed Name:______________________________ Address:___________________________________ __________________________________________ __________________________________________ STATE OF FLORIDA COUNTY OF ESCAMBIA Sworn to or affirmed and signed before me on ___________________________________ by NOTARY PUBLIC or DEPUTY CLERK ___________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] Personally known Produced identification Type of identification produced C:\MyFiles\Web Forms-wpd\Waiver of Hearing Temporary Custody.wpd American LegalNet, Inc. www.FormsWorkflow.com