Notice Of Filing Return Receipt - Florida Circuit Court Page 2
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3IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA
Case No: ________________________
Division: ________________________
_________________________________,
Petitioner,
and
_________________________________,
Respondent.
NOTICE OF FILING RETURN RECEIPT
{Name} ________________________________________________________________, the
[check only one] ( )Petitioner (
)Respondent, files the attached Return Receipt in reference
to the Notice to Payor sent by certified mail to {Payor’s name} __________________________,
the [check only one] ( ) Petitioner’s ( ) Respondent’s employer.
I certify that a copy of this document was [check all used]: ( ) emailed ( ) mailed ( ) faxed
( ) hand delivered to the persons(s) listed below on {date} ____________________________.
Other party or his/her attorney:
Name: _______________________________________
Address: ______________________________________
City, State, Zip: _________________________________
Fax Number: ___________________________________
Email Address(es):_______________________________
________________________________________________
Signature of Party or his/her Attorney
Printed Name: ___________________________
Address: ________________________________
City, State, Zip: ___________________________
Telephone Number: _______________________
Fax Number: _____________________________
Email Address(es):______________________
Florida Bar Number:________________________
Florida Family Law Rules of Procedure Form 12.996(c), Notice of Filing Return Receipt (09/12)
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