Form 12.995(A) - Florida Supreme Court Approved Family Law - Parenting Plan Page 17
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17I certify that I have been open and honest in entering into this Parenting Plan. I am satisfied with this
Plan and intend to be bound by it.
Dated:________________________
_________________________________
Signature of Father
Printed Name: ___________________________
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es):____________
____________________________________
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 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] This form was prepared for the: {choose only one} (
) Mother (
) Father
This form was completed with the assistance of:
{name of individual} ________________________________________________________________,
{name of business} _________________________________________________________________,
{address} _________________________________________________________________________,
{city} _________________, {state} ______, {zip code} _________, {telephone number} ______________.
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (11/15)
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