Family Law Financial Affidavit (Short Form) - Florida Circuit Court Page 8
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9SECTION IV. CHILD SUPPORT GUIDELINES WORKSHEET
(Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet, MUST be
filed with the court at or prior to a hearing to establish or modify child support. This requirement cannot
be waived by the parties.)
[Check one only]
____
A Child Support Guidelines Worksheet IS or WILL BE filed in this case. This case involves the
establishment or modification of child support.
____
A Child Support Guidelines Worksheet IS NOT being filed in this case. The establishment or
modification of child support is not an issue in this case.
I certify that a copy of this document was [check all used]: ( ) e-mailed (
) mailed (
) faxed
(
) hand delivered to the person(s) listed below on {date} ________________________________.
Other party or his/her attorney:
Name: _____________________________
Address: ____________________________
City, State, Zip: _______________________
Fax Number: _________________________
E-mail Address(es): _____________________
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
affidavit and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.
Dated:
Signature of Party
Printed Name: ________________________________
Address: ___________________________________
City, State, Zip: ______________________________
Fax Number: ________________________________
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 deputy clerk.]
____ Personally known
____ Produced identification
Type of identification produced
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form)
(01/15)
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