Florida Supreme Court Approved Family Law Form 12.923 Page 3

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If this matter is resolved, the moving party shall contact the judge’s office to cancel this hearing.
I certify that a copy of this document was [Choose only one] (
) mailed
( ) faxed and
mailed ( ) hand delivered to the person(s) listed below on {date}_________________.
Other party or his/her attorney:
Name: ________________________________________
Address: ______________________________________
City, State, Zip: _________________________________
Fax Number: ___________________________________
Email Address:_________________________________
Dated: _____________________
_____________________________________________
Signature of Party
___________________________________
Printed Name:
_______________________________________
Address:
___________________________________
City, State, Zip:
________________________________
Telephone Number:
_____________________________________
Fax Number:
Email Address:_________________________________
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 [Choose only one] ___ petitioner or ___ respondent, fill out this form.
Florida Supreme Court Approved Family Law Form 12.923, Notice of Hearing (General) (9/11)

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