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Petition For Concurrent Custody By Extended Family Form. This is a Florida form and can be use in Family Law Statewide.
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Tags: Petition For Concurrent Custody By Extended Family, 12.970(b), Florida Statewide, Family Law
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.970(b), PETITION FOR CONCURRENT CUSTODY BY EXTENDED
FAMILY (04/11)
When should this form be used?
This form should be used by an extended family member to obtain concurrent custody of a child or
children pursuant to Chapter 751, Florida Statutes. This form should not be used if you are a parent
seeking to establish parental responsibility or time-sharing with a child or children. “Concurrent
custody” means that an eligible extended family member is awarded custodial rights to care for a child
or children concurrently with the child(ren)’s parent or parents.
An Extended Family Member is:
A relative of a minor child within the third degree by blood or marriage to the parent;
OR
The stepparent of a minor child if the stepparent is currently married to the parent of the child and is
not a party in a pending dissolution, separate maintenance, domestic violence, or other civil or criminal
proceeding in any court of competent jurisdiction involving one or both of the child(ren)’s parents as an
adverse party.
You may file a Petition for Concurrent Custody if:
You have the signed, notarized consents of the child(ren)’s legal parents;
OR
You are an extended family member who is caring full time for the child(ren) in the role of a substitute
parent and with whom the child(ren) is (are) presently living.
In addition, you must currently have physical custody of the child(ren) and have had physical custody of
the child(ren) for at least 10 days in any 30-day period within the last 12 months; and not have signed,
written documentation from a parent which is sufficient to enable you to do all the things necessary to
care for the child(ren).
If you do not meet the qualifications above, you should talk to an attorney about other options. You
may also report any suspected abuse, abandonment, or neglect to the appropriate authorities.
This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in
the county where you live and keep a copy for your records.
What should I do next?
IF YOU HAVE SIGNED AND NOTARIZED WAIVERS OF SERVICE OF PROCESS AND CONSENTS from the
child(ren)’s mother and father, you may call the clerk, family law intake staff, or judicial assistant, to set
a final hearing. You must notify the child(ren)’s parents of the hearing by using a Notice of Hearing
Instructions for Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By
Extended Family (04/11)
American LegalNet, Inc.
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(General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of
hearing form.
If one of the parents is deceased, you must file a certified copy of the proof of death.
If one of the minor child(ren)’s parents objects to the Petition for Concurrent Custody in writing, the
court may not grant the petition even if the other parent consents, in writing, to the entry of the order.
If a parent objects, you have the option of converting the Petition to a Petition for Temporary Custody
by Extended Family, Florida Supreme Court Approved Family Law Form 12.970(a). If the Petition is not
converted into a Petition for Temporary Custody by Extended Family, it shall be dismissed without
prejudice.
At any time, the Petitioner or either or both of the child(ren)’s parents may move the court to terminate
the order granting concurrent custody. The court shall terminate the order upon a finding that either or
both of the child(ren)’s parents objects to the order. The fact that the order for concurrent custody has
been terminated does not preclude any person who is otherwise eligible to petition for temporary
custody from filing such petition.
Where can I look for more information?
Before proceeding, you should read General Information for Self-Represented Litigants found at the
beginning of these forms. The words that are in bold underline in these instructions are defined there.
For further information, see Chapter 751 and Chapter 39, Florida Statutes.
Special Notes. . .
If you do not have the money to pay the filing fee, you may obtain an application for Determination of
Civil Indigent Status, fill it out, and the clerk will determine whether you are eligible to have filing fees
deferred.
With this petition, you must file the following and provide a copy to the other party:
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme
Court Approved Family Law Form 12.902(d).
Notice of Related Cases, Florida Family Law Rules of Procedure Form 12.900(h).
Family Court Cover Sheet, Florida Family Law Rules of Procedure Form 12.928.
Non-Military Affidavit, Florida Supreme Court Approved Family Law Form 12.912(b). (Required
only for obtaining a default on petitions that have been personally or constructively served. Not
required if both parents have signed a waiver and consent.)
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms
must also put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.
Instructions for Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By
Extended Family (04/11)
American LegalNet, Inc.
www.FormsWorkFlow.com
IN THE CIRCUIT COURT OF THE _______________ JUDICIAL CIRCUIT,
IN AND FOR _______________________________ COUNTY, FLORIDA
Case No: _______________________
Division: _______________________
__________________________________,
Petitioner,
and
__________________________________,
Respondent/Mother,
__________________________________,
Respondent/Father.
PETITION FOR CONCURRENT CUSTODY BY EXTENDED FAMILY
Petitioner, {full legal name} _________________________________, being sworn, certifies that
the following information is true:
1. This is an action for concurrent custody pursuant to Chapter 751, Florida Statutes.
2. Petitioner requests concurrent custody of the following minor child(ren):
Name
Date of Birth
Current Address
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
3. Petitioner completed a Uniform Child Custody Jurisdiction and Enforcement Act Affidavit,
Florida Supreme Court Approved Family Law Form 12.902(d), which was filed with this Petition.
The affidavit includes the names and current addresses of the persons with whom the child(ren)
has (have) lived during the past 5 years, the places where the child(ren) has(have) lived during
the past 5 years, and information concerning any custody proceeding in this or any other state
with respect to the child(ren). If the Affidavit is not completely filled out, signed under oath,
and filed with the Petition, the case may be dismissed without a hearing.
4. Petitioner is an extended family member who is: [Choose one only]
_____ Related to the minor child(ren) within the third degree by blood or marriage to a parent;
OR
_____ The stepparent of the minor child(ren), is married to the ( )Mother ( )Father and is not
a party in a pending dissolution, separate maintenance, domestic violence, or other civil or
criminal proceeding in any court of competent jurisdiction involving one or both of the
child(ren)’s parents as an adverse party.
5. Petitioner’s relationship to the minor child(ren) is: ____________________________________.
Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By Extended Family
(04/11)
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6. The residence and post office address of the Petitioner is: ______________________________
______________________________________________________________________________.
7. The legal mother of the child(ren) is _____________________________________, whose
current address is:__________________________________________________________.
8. The legal father of the child(ren) is ______________________________________, whose
current address is: ______________________________________________________________.
9. 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. Detail the time
periods during the past 12 months when the child(ren) have resided with the Petitioner:
______________________________________________________________________________
_____________________________________________________________________________
______________________________________________________________________________.
10. Petitioner does not have signed, written documentation from a parent which is sufficient to
enable the Petitioner to do all of the things necessary to care for the child(ren).
11. {If applicable} Describe the type of documents, if any, provided by the parent or parents which
enables the Petitioner to act on behalf of the child(ren): ________________________________
______________________________________________________________________________.
These documents are attached to this Petition as Exhibit ________.
12. Petitioner is unable to obtain or undertake the following services or actions without an order of
custody:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
13. The Consents of ______Father and/or _________ Mother is/are attached to the Petition.
OR
[If applicable] The Consent of the _________________ is not attached because that parent is
deceased. A certified copy of the proof of death is attached.
14. Petitioner requests concurrent custody be granted for the following period of
time:________________________________________________________________________.
The reasons that support this request are: ___________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
15. It is in the best interests of the child(ren) that the Petitioner have concurrent custody of the
child(ren) for the following reasons: ________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________.
Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By Extended Family
(04/11)
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16. ORDER OF PROTECTION
___
Petitioner IS NOT aware of any temporary or permanent order for protection entered
on behalf of or against either parent, the Petitioner, or the child(ren) in Florida or any
other jurisdiction.
OR
___
Petitioner IS aware of the following temporary or permanent orders for protection
entered on behalf of or against either parent, the Petitioner, or the child(ren) in Florida
or any other jurisdiction. The court entering the order and the case number is: _______
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________.
17. TEMPORARY OR PERMANENT CHILD SUPPORT ORDERS
___
Petitioner IS NOT aware of any temporary or permanent orders for child support for the
minor child(ren).
OR
___
Petitioner IS aware of the following temporary or permanent order for child support for
the minor child(ren). The court entering the order and the case number is:__________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________.
18. CHILD SUPPORT (If Petitioner is seeking child support) [Choose one only]
(You must have proof of service upon or waiver of process by the parent(s) or a Waiver of
Service of Process and Consent for the court to consider an award for child support)
___
___
___
Petitioner requests the court to order the parents to pay child support.
Petitioner requests the court to redirect all or part of Mother’s and/or Father’s existing
child support obligation to the Petitioner.
Petitioner requests the court to redirect all or part of Mother’s and/or Father’s existing
child support obligation to the Petitioner, and to award the Petitioner child support
arrearages.
19. Petitioner ____ requests _____ does not request that the court establish reasonable visitation
or a time-sharing schedule with the parents.
20. Other _______________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________
WHEREFORE, Petitioner requests that this Court grant the Petitioner concurrent custody of the
child(ren) subject to this proceeding; award the Petitioner other relief as requested; and award any
other relief that the Court deems necessary.
Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By Extended Family
(04/11)
American LegalNet, Inc.
www.FormsWorkFlow.com
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in
this petition and that the punishment for knowingly making a false statement includes fines
and/or imprisonment.
Dated: _____________________________
_________________________________________
Signature of Petitioner
Printed Name: _____________________________
Address: __________________________________
City, State, Zip Code: ________________________
Telephone Number: _________________________
Fax Number: _______________________________
STATE OF FLORIDA
COUNTY OF __________________________________
Sworn to or affirmed and signed before me on _______________ by ___________________________.
_______________________________________
NOTARY PUBLIC OR DEPUTY CLERK
________________________________________
Print, type, or stamp commissioned name of notary or
deputy clerk.
____ Personally known
____ Produced identification
Type of identification produced _________________________
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in
all blanks]
I, {full legal name and trade name of nonlawyer} ________________________________________
a nonlawyer, whose address is {street} ________________________________________________,
{city} _______________________, {state} ___________, {phone} _______________________, helped
{name} ______________________________________________ who is the Petitioner, fill out this form.
Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By Extended Family
(04/11)
American LegalNet, Inc.
www.FormsWorkFlow.com