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Order Granting Petition For Concurrent Custody By Extended Family Form. This is a Florida form and can be use in Family Law Statewide.
Tags: Order Granting Petition For Concurrent Custody By Extended Family, 12.970(f), Florida Statewide, Family Law
IN THE CIRCUIT COURT OF THE _________________________ JUDICIAL CIRCUIT
IN AND FOR __________________________ COUNTY, FLORIDA
Case No: ______________________
Division: ______________________
__________________________________,
Petitioner,
and
__________________________________,
Respondent/Father
__________________________________,
Respondent/Mother.
ORDER GRANTING PETITION FOR
CONCURRENT CUSTODY BY EXTENDED FAMILY
This case came before this Court for a hearing on a Petition for Concurrent Custody by
Extended Family. The Court, having reviewed the file and heard the testimony, makes these
findings of fact and reaches these conclusions of law:
SECTION I. FINDINGS:
1. The Court has jurisdiction over the subject matter and the parties.
2. The minor child(ren) at issue in this matter are:
Name
Date of Birth
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
3. The Petitioner, {full legal name} _____________________________________ is the
{extended family relationship}___________________________________________ of
the child(ren).
4. The Petitioner currently has physical custody of the child(ren) and has had physical
custody of the child(ren) for at least 10 days in any 30-day period within the last 12
months.
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (03/12)
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5. The Petitioner does not have signed, written documentation from the parent(s) which is
sufficient to enable the custodian to do all the things necessary to care for the child(ren)
which are available to custodians who have an order for temporary custody by extended
family.
6. The Mother {full legal name} _________________________________ of the child(ren):
(choose one only)
___
Filed a Waiver and Consent
___
Was served with the petition and failed to file an Answer
___ Is deceased as evidenced by: _______________________________________
7. The Father {full legal name} _________________________________ of the child(ren):
(choose one only)
___
Filed a Waiver and Consent
___
Was served with the petition and failed to file an Answer
___ Is deceased as evidenced by: _______________________________________
8. It is in the best interest of the child(ren) for the Petitioner to have concurrent custody.
SECTION II: CONCURRENT CUSTODY
1. The Petitioner,___________________________________________________, is granted
concurrent custody of the minor child(ren).
2. The Petitioner shall have all the concurrent rights and responsibilities of a legal parent.
3. The Petitioner is authorized to make all reasonable and necessary decisions for the
minor child(ren), including but not limited to:
a) Consent to all necessary and reasonable medical and dental care for the
child(ren), including nonemergency surgery and psychiatric care;
b) Secure copies of the child(ren)’s records, held by third parties, that are necessary
for the care of the child(ren), including, but not limited to:
i. Medical, Dental, and psychiatric records;
ii. Birth certificates and other records; and
iii. Educational records.
4. Enroll the child(ren) in school and grant or withhold consent for the child(ren) to be
tested or placed in special school programs, including exceptional education; and
5. Do all other things necessary for the care of the child(ren).
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (03/12)
American LegalNet, Inc.
www.FormsWorkFlow.com
SECTION III. CHILD SUPPORT
1. The Petitioner ____ did ____ did not request the establishment of child support.
2. ___ If child support is requested, the parents have received personal or substituted
service of process, the petition requests an order for support of the child(ren), and there
is evidence of the parents’ ability to pay the support ordered. The ( ) Mother ( ) Father
has the present ability to pay child support
(Choose one only)
___ The amounts in the Child Support Guidelines Worksheet, Florida Family Law Rules
of Procedure Form 12.902(e) filed by the ( ) Mother ( ) Father are correct;
OR
___ The Court makes the following findings: The Mother’s net monthly income is
$_______________, (Child Support Guidelines ___%). The Father’s net monthly income
is $____________________, (Child Support Guidelines ____%) Monthly child care costs
are $_________________. Monthly health/dental insurance costs are $_____________.
OR
___ The ( ) Mother ( ) Father is currently ordered to pay child support to the other
parent in the amount of $_____________ per ________________ as established in the
case of (style of case and number} _________________________________________
_____________________________________________________________________.
( ) All of the child support or ( ) a portion of the child support in the amount of
$_________ shall be redirected to the Petitioner.
3. Amount
a) Father’s Obligation
The Father shall be obligated to pay child support in the amount of $__________ for the
_______children {total number of parties’ minor or dependent children} commencing
_________________ {month, day, year} and terminating ________________________
{month, day, year}.
Upon the termination of child support for one of the parties’ children, child support in
the amount of $_____________ for the remaining _________ children {total number of
remaining children} shall be paid commencing __________________ {month, day, year}
and terminating _________________________ {month, day, year}.
{Insert paragraph for the child support obligation, including the amount,
commencement, and termination dates, for the remaining minor or dependent
children, which shall be payable as the obligation for each child ceases.}
The Father shall pay child support until all of the minor or dependent children: reach the
age of 18, become emancipated, marry, join the armed services, die, or become selfFlorida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (03/12)
American LegalNet, Inc.
www.FormsWorkFlow.com
supporting; or until further order of the court or agreement of the parties. The child
support obligation shall continue beyond the age of 18 and until high school graduation
for any child who is dependent in fact, between the ages of 18 and 19, and is still in high
school, performing in good faith with a reasonable expectation of graduation before the
age of 19.
If the child support ordered deviates from the guidelines more than 5%, the factual
findings which support that deviation are: ____________________________________
_______________________________________________________________________
_______________________________________________________________________.
Child support shall be payable ( ) at least once a month and in accordance with the
Father’s employer’s payroll cycle, or ( ) other {explain}___________________________
________________________________________________________________________
b) Mother’s Obligation
The Mother shall be obligated to pay child support in the amount of $____________ for
the ________children {total number of parties’ minor or dependent children}
commencing {month, day, year} and terminating __________________ {month, day,
year}.
Upon the termination of the obligation of child support for one of the parties’ children,
child support in the amount of $__________ for the remaining ______ children {total
number of remaining children} shall be paid commencing _____________________
{month, day, year} and terminating ________________________ month, day, year}.
{Insert paragraph for the child support obligation, including the amount,
commencement, and termination dates, for the remaining minor or dependent
children, which shall be payable as the obligation for each child ceases.}
The Mother shall pay child support until all of the minor or dependent children: reach
the age of 18; become emancipated, marry, join the armed services, die, or become selfsupporting; or until further order of the court or agreement of the parties. The child
support obligation shall continue beyond the age of 18 and until high school graduation
for any child who is dependent in fact, between the ages of 18 and 19, and is still in high
school, performing in good faith with a reasonable expectation of graduation before the
age of 19.
If the child support ordered deviates from the guidelines more than 5%, the factual
findings which support that deviation are:______________________________________
________________________________________________________________________
_______________________________________________________________________.
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (03/12)
American LegalNet, Inc.
www.FormsWorkFlow.com
Child support shall be payable ( ) at least once a month and in accordance with the
Mother’s employer’s payroll cycle, or ( ) other {explain}__________________________
_______________________________________________________________________.
4. Arrearages/Retroactive Child Support
a) The ( ) Mother ( ) Father owes child support arrearages in the amount of
$_________ as of {date} ________________ to the other parent. The child
support arrearages shall be repaid in the amount of $_______ per month,
payable ( ) in accordance with the employer’s payroll cycle, and in any event at
least once per month ( )other {explain} ________________________________
__________________________________________________________________
commencing {date} ______________________, until paid in full including
statutory interest.
b) The ( ) Mother ( ) Father owes retroactive child support in the amount of
$_________ as of {date} ________________ to the Petitioner. The retroactive
child support shall be repaid in the amount of $_______ per month, payable ( )
in accordance with the employer’s payroll cycle, and in any event at least once
per month ( )other {explain} __________________________________________
__________________________________________________________________
commencing {date} ______________________, until paid in full including
statutory interest.
5. Insurance
(Choose all that apply)
a) ( ) Mother ( ) Father shall be required to maintain ( ) health and/or ( ) dental
insurance for the parties’ minor child(ren), so long as reasonable in cost and
accessible to the child(ren). The party providing insurance shall be required to
convey insurance cards demonstrating said coverage to the Petitioner and other
parent.
OR
( ) health and/or ( ) dental insurance is either not reasonable in cost or
accessible to the child(ren) at this time.
b) ___ Reasonable and necessary uninsured medical/dental/prescription drug costs
for the minor child(ren) shall be assessed as follows:
( ) Shared equally by both parents.
( ) Prorated according to the child support guidelines percentages.
( ) Other {explain} ______________________________________________
As to these uninsured medical/dental/prescription drug expenses, the party who
incurs the expense shall submit a request for reimbursement to the parent or
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (03/12)
American LegalNet, Inc.
www.FormsWorkFlow.com
parents within 30 days, and the parent or parents, within 30 days of receipt, shall
submit the applicable reimbursement for that expense.
SECTION IV. METHOD OF PAYMENT
The parent(s) shall pay court-ordered child support and arrearages, if any, as follows:
1. Place of Payment
a) ___Parents shall pay court-ordered support directly to either the State
Disbursement Unit or the central depository, as required by statute, along
with any applicable fee required by statute.
OR
b) ___ The Petitioner and the Parents have requested and the court finds that it is in
the best interest of the child(ren) that support payments need not be directed
through either the State Disbursement Unit or the central depository at this
time; however, any party may subsequently apply, pursuant to section
61.13(1)(d)(3), Florida Statutes, to require payment through either the State
Disbursement Unit or the central depository.
2. Income Deduction
(If applies)
a) ___ Immediate. ( ) Mother ( ) Father, hereinafter, Obligor(s), shall pay through
income deduction, pursuant to a separate Income Deduction Order which shall
be effective immediately. Obligor is individually responsible for paying this
support obligation until all of said support is deducted from his/her income.
Until support payments are deducted, the Obligor is responsible for making
timely payments directly to the State Disbursement Unit or the Petitioner as
previously set forth in this Order.
b) ___ Deferred. Income deduction is ordered this day, but it shall not be effective
until a delinquency of $_____________, or, if not specified, an amount equal to
one month’s obligation occurs. Income deduction is not being implemented
immediately based on the following findings: Income deduction is not in the
best interests of the child(ren) because: {explain} _________________________
_______________________________________________________________
_______________________________________________________________.
AND
There is proof of timely payment of a previously ordered obligation without an
Income Deduction Order,
AND
( ) there is an agreement by the Obligor(s) to advise the State Disbursement
Unit of any change in Payor and/or health insurance OR ( ) there is a signed,
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (03/12)
American LegalNet, Inc.
www.FormsWorkFlow.com
written agreement providing an alternative arrangement between the Petitioner
and Obligor(s).
3. Bonus/one-time payments.
[Choose one only]
( ) All ( ) __________% ( ) No income paid in the form of a bonus or other similar onetime payment, up to the amount of any arrearage or the remaining balance thereof
owed pursuant to this order, shall be forwarded to the Petitioner pursuant to the
payment method prescribed above.
4. Other provisions relating to method of payment: _______________________________
________________________________________________________________________
SECTION V. ATTORNEY FEES, COSTS, AND SUIT MONEY
(Choose one only)
1. ___ ( ) Petitioner’s ( ) Respondents’ request(s) for attorney fees, costs, and suit money
is (are) denied because ____________________________________________________
_____________________________________________________________________.
2. ___ The Court finds there is a need for and ability to pay attorney fees, costs, and suit
money. ( ) Petitioner ( ) Respondent(s) is (are) ordered to pay the other party
$________ in attorney fees, and $ ______ in costs. The Court further finds that the
attorney fees are awarded based on the reasonable rate of $________________ per
hour and ________________ reasonable hours. Other provisions relating to attorney
fees, costs, and suit money are as follows: _____________________________________
_______________________________________________________________________.
SECTION VI. OTHER PROVISIONS
1. Other Provisions _________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
2. The Court reserves jurisdiction to modify and enforce this Order for Concurrent Custody.
3. The granting of concurrent custody does not affect the ability of the child(ren)’s parent
or parents to obtain physical custody of the child(ren) at any time.
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (03/12)
American LegalNet, Inc.
www.FormsWorkFlow.com
DONE AND ORDERED in _____________________, Florida on {date} ____________________
_____________________________
CIRCUIT JUDGE
A copy of this Order for Concurrent Custody was:
[Choose one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the parties listed
below on {date}___________ by____________________________. {Clerk of court or designee}
Petitioner (or his or her attorney)
Respondents (or his or her attorney)
State Disbursement Unit or Central Depository
Other _________________________________
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (03/12)
American LegalNet, Inc.
www.FormsWorkFlow.com