IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT IN AND FOR _________________________ COUNTY, FLORIDA JUVENILE DIVISION In the Interest of a child children ) ) ) ) ) Case No. PROPOSED RELATIVE PLACEMENT Pursuant to Chapter 39, Florida Statutes, the mother father hereby provides the court and the parties with the names and location of relatives who might be considered for placement of the child(ren). The mother father will continue to inform the court and the parties of any relative who should be considered for placement of the child(ren) with the filing of subsequent forms. MATERNAL PATERNAL Name: ......................................................................... Name: ................................................................................. Address: ...................................................................... Address: ............................................................................. Phone number: ............................................................ Phone number: ................................................................... Relationship to child(ren): .......................................... Relationship to child(ren): ................................................. Name: ......................................................................... Name: ................................................................................. Address: ...................................................................... Address: ............................................................................. Phone number: ............................................................ Phone number: ................................................................... Relationship to child(ren): .......................................... Relationship to child(ren): ................................................. Name: ......................................................................... Name: ................................................................................. Address: ...................................................................... Address: ............................................................................. Phone number: ............................................................ Phone number: ................................................................... Relationship to child(ren): .......................................... Relationship to child(ren): ................................................. Name: ......................................................................... Name: ................................................................................. Address: ...................................................................... Address: ............................................................................. Phone number:............................................................. Phone number: ................................................................... Relationship to child(ren): .......................................... Relationship to child(ren): ................................................. Name: ......................................................................... Name: ................................................................................. Address: ...................................................................... Address: ............................................................................. Phone number: ............................................................ Phone number: ................................................................... Relationship to child(ren): .......................................... Relationship to child(ren): ................................................. Proposed Relative Placement {8.976} Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com The above information is true and correct to the best of my knowledge. Dated ____________________________________________ (Mother’s Signature) Printed name: Proposed Relative Placement {8.976} , 20 . ____________________________________________ (Father’s Signature) Printed name: Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com