Form 12.995(A) - Florida Supreme Court Approved Family Law - Parenting Plan Page 5
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17IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT
IN AND FOR _________________ COUNTY, FLORIDA
Case No: _____________________
Division: _____________________
_______________________________
Mother,
and
_______________________________
Father
PARENTING PLAN
This parenting plan is: {Choose only one}
_____A Parenting Plan submitted to the court with the agreement of the parties.
_____A proposed Parenting Plan submitted by or on behalf of:
{Parent’s Name}_______________________________________________.
_____A Parenting Plan established by the court.
This parenting plan is: {Choose only one}
_____A final Parenting Plan established by the court.
_____A temporary Parenting Plan established by the court.
_____A modification of a prior final Parenting Plan or prior final order.
I. PARENTS
Mother
Name:__________________________________________________________________
Address: ________________________________________________________________
Telephone Number: ______________________________________________________
E-Mail: _________________________________________________________________
_____ Address Unknown: {Please indicate here if mother’s address is unknown}
_____ Address Confidential: {Please indicate here if mother’s address and phone numbers are
confidential pursuant to either a _____ Final Judgment for Protection Against Domestic Violence,
or _____ other court order ______________________________________________}.
Father
Name:__________________________________________________________________
Address: ________________________________________________________________
Telephone Number: ______________________________________________________
E-Mail: _________________________________________________________________
_____ Address Unknown: {Please indicate here if father’s address is unknown}
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (11/15)
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