IN THE CIRCUIT COURT OF THE FIFTH JUDICIAL CIRCUIT, COUNTY, FLORIDA IN AND FOR
, Former Husband or Petitioner, and , Former Wife or Respondent. _________________________________________/
CASE NO.
CERTIFICATE OF SERVING NOTICE OF INTENT TO RELOCATE WITH CHILD(REN) I, {full legal name} , ____________________________________, parent of {child(ren)’s names} _______________________________________________________________________, hereby certify that I served a Notice of Intent to Relocate with Child(ren) pursuant to section 61.13001(2), Florida Statutes upon: Other parent: Name: _______________________________________________________ Address: _____________________________________________________ City, State, Zip: ________________________________________________ Fax Number: __________________________________________________ Other person entitled to visitation with child(ren): Name: _______________________________________________________ Address: _____________________________________________________ City, State, Zip: ________________________________________________ Fax Number: __________________________________________________ Other person entitled to visitation with child(ren): Name: _______________________________________________________ Address: _____________________________________________________ City, State, Zip: _______________________________________________ Fax Number: _________________________________________________ on {date} _________________________________________. I HEREBY CERTIFY that I furnished a copy of this Certificate of Serving Notice of Intent to Relocate to the persons listed above by (% one only) ( ) certified mail, restricted delivery, return receipt requested ( ) faxed and mail ( ) hand delivery on {date} _____________________________________.
______________________________________________ Signature of party filing motion
1
Printed name Address _________________________________________ ________________________________________________ City State Zip ________________________________________________ Telephone (area code and number) IF A NON-LAWYER HELPED YOU FILL OUT THIS FORM THEY MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {name of non-lawyer} _________________________________________, a non-lawyer, located at {street} __________________________________________ {city} ____________________ {state} __________, {phone} _______________, helped {name} ______________________________, who is the [/ one only] _____ petitioner, ____ respondent, ____ former husband, or ____ former wife, fill out this form.
2
IN THE CIRCUIT COURT OF THE FIFTH JUDICIAL CIRCUIT, COUNTY, FLORIDA IN AND FOR
, Former Husband or Petitioner, and , Former Wife or Respondent. _________________________________________/
CASE NO.
CERTIFICATE OF SERVING NOTICE OF INTENT TO RELOCATE WITH CHILD(REN) I, {full legal name} , ____________________________________, parent of {child(ren)’s names} _______________________________________________________________________, hereby certify that I served a Notice of Intent to Relocate with Child(ren) pursuant to section 61.13001(2), Florida Statutes upon: Other parent: Name: _______________________________________________________ Address: _____________________________________________________ City, State, Zip: ________________________________________________ Fax Number: __________________________________________________ Other person entitled to visitation with child(ren): Name: _______________________________________________________ Address: _____________________________________________________ City, State, Zip: ________________________________________________ Fax Number: __________________________________________________ Other person entitled to visitation with child(ren): Name: _______________________________________________________ Address: _____________________________________________________ City, State, Zip: _______________________________________________ Fax Number: _________________________________________________ on {date} _________________________________________. I HEREBY CERTIFY that I furnished a copy of this Certificate of Serving Notice of Intent to Relocate to the persons listed above by (% one only) ( ) certified mail, restricted delivery, return receipt requested ( ) faxed and mail ( ) hand delivery on {date} _____________________________________.
______________________________________________ Signature of party filing motion
1
Printed name Address _________________________________________ ________________________________________________ City State Zip ________________________________________________ Telephone (area code and number) IF A NON-LAWYER HELPED YOU FILL OUT THIS FORM THEY MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {name of non-lawyer} _________________________________________, a non-lawyer, located at {street} __________________________________________ {city} ____________________ {state} __________, {phone} _______________, helped {name} ______________________________, who is the [/ one only] _____ petitioner, ____ respondent, ____ former husband, or ____ former wife, fill out this form.
2
IN THE CIRCUIT COURT OF THE FIFTH JUDICIAL CIRCUIT, COUNTY, FLORIDA IN AND FOR
, Former Husband or Petitioner, and , Former Wife or Respondent. _________________________________________/
CASE NO.
CERTIFICATE OF SERVING NOTICE OF INTENT TO RELOCATE WITH CHILD(REN) I, {full legal name} , ____________________________________, parent of {child(ren)’s names} _______________________________________________________________________, hereby certify that I served a Notice of Intent to Relocate with Child(ren) pursuant to section 61.13001(2), Florida Statutes upon: Other parent: Name: _______________________________________________________ Address: _____________________________________________________ City, State, Zip: ________________________________________________ Fax Number: __________________________________________________ Other person entitled to visitation with child(ren): Name: _______________________________________________________ Address: _____________________________________________________ City, State, Zip: ________________________________________________ Fax Number: __________________________________________________ Other person entitled to visitation with child(ren): Name: _______________________________________________________ Address: _____________________________________________________ City, State, Zip: _______________________________________________ Fax Number: _________________________________________________ on {date} _________________________________________. I HEREBY CERTIFY that I furnished a copy of this Certificate of Serving Notice of Intent to Relocate to the persons listed above by (% one only) ( ) certified mail, restricted delivery, return receipt requested ( ) faxed and mail ( ) hand delivery on {date} _____________________________________.
______________________________________________ Signature of party filing motion
1
Printed name Address _________________________________________ ________________________________________________ City State Zip ________________________________________________ Telephone (area code and number) IF A NON-LAWYER HELPED YOU FILL OUT THIS FORM THEY MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {name of non-lawyer} _________________________________________, a non-lawyer, located at {street} __________________________________________ {city} ____________________ {state} __________, {phone} _______________, helped {name} ______________________________, who is the [/ one only] _____ petitioner, ____ respondent, ____ former husband, or ____ former wife, fill out this form.
2