IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT IN AND FOR ___________________ COUNTY, FLORIDA JUVENILE DIVISION In the Interest of ) ) ) ) ) Case No. a child JUDGMENT AND RESTITUTION ORDER THIS CAUSE was heard on , on the state's motion for an order requiring the child, his her parent(s), to pay restitution costs for the benefit of the victim born , 20 , or pursuant to sections 985.0301(5)(i), 985.437, and 775.089, Florida Statutes. Name of victim: Attorney or Advocate: Address: The court being fully advised in the premises, it is ORDERED AND ADJUDGED: The state's motion is granted and the above as follows: $____________ for medical and related services and devices relating to physical, psychiatric, and psychological care, including nonmedical care rendered in accordance with a recognized method of healing. $____________ for necessary physical and occupational therapy and rehabilitation. $____________ to reimburse the victim for income lost as a result of the offense. $____________ for necessary funeral and related services, if the offense caused bodily injury resulting in the death of the victim. $____________ for damages resulting from the offense. $____________ for The total amount of restitution due is $____________ Payment shall be made to the clerk of the circuit court. Payment schedule: Installment payments of $ Payment is due in full. payable on a weekly monthly basis. child child's parent(s), (name(s)) , shall pay restitution for the benefit of the victim named Judgment And Restitution Order {8.950} Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com The court finds that the child hours of community service in lieu of child's parent(s) is (are) unable to pay and orders the child to perform partial total restitution. The court retains jurisdiction over this child beyond his her nineteenth birthday in order to enforce the provisions of this order and retains jurisdiction to modify the restitution in this case. Other, specified conditions: IT IS FURTHER ORDERED AND ADJUDGED that the clerk of the court shall provide the victim named above a certified copy of this order for the victim to record this judgment as a lien, pursuant to section 55.10, Florida Statutes. IT IS FURTHER ORDERED AND ADJUDGED that this judgment may be enforced by the state or the victim in order to receive restitution in the same manner as a judgment in a civil action. Execution shall issue for all payments required under this order. DONE AND ORDERED at , Florida, on , 20 . __________________________________ Circuit Judge Copies to: State Attorney Counsel for Child Victim Department of Juvenile Justice Parent(s) Judgment And Restitution Order {8.950} Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com