IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT, IN AND FOR PALM BEACH COUNTY, FLORIDA. FAMILY DIVISION CASE NO.: IN RE: THE MARRIAGE OF: ___________________________, Petitioner, TESTIMONY AT FINAL HEARING -vs___________________________, Respondent. ________________________________________/ Directions: Please provide the court with all the information requested. Print the information clearly as this will assist the courts in the collection of monies etc. RESPONDENT: Name:_______________________________________ PETITIONER: Date of birth:_________________________________ Name:____________________________________ Date of issue of D/L_________________________ Date of birth:_______________________________ Driver's license No#__________________________ Driver's license No#_________________________ Car tag no#__________________________________ Date of issue of D/L_________________________ Car tag no#________________________________ RESIDENCE: Address________________________________________ RESIDENCE: [city]______________[state]____zip________________ Address:__________________________________ Home telephone no____________________________ [city]______________[state]____zip__________ How long a Florida resident _____________ Home telephone no____________________ Since what date_______________________ How long a Florida resident _____________ Since what date_______________________ EMPLOYMENT: Name:___________________________________ EMPLOYMENT: Address:___________________________________ Name:___________________________________ [city]________________[state]______[zip]______ Address:___________________________________ Telephone no_______________________________ [city]________________[state]______[zip]______ Telephone no_______________________________ MINOR CHILDREN- NAME DOB _____________________________, ________, _____________________________, ________, _____________________________, ________, _____________________________, ________, MARRIAGE INFORMATION Date of Marriage: ________________ Place of Marriage___________________________________ Date of Separation: _______________ Separation Agreement________________________________ Is Marriage Irretrievably Broken? _______ (Why)________________________________________________ Is Wife’s former name to be restored? _____ No _____ Yes (write out name; no initials)______________________________________________________ EVIDENCE OF RESIDENCY Name of Residency Witness [if applicable]: _____________________________________________________. Driver's license No#_______________________________________________________________________ PRESENT AT FINAL HEARING Petitioner: _______________________________ Attorney:__________________________ Respondent: ______________________________ Attorney:__________________________ APPROVED BY: Dated:_______________________________ Circuit Judge American LegalNet, Inc. www.FormsWorkflow.com