IN THE CIRCUIT COURT OF THE
JUDICIAL CIRCUIT,
IN AND FOR
COUNTY, FLORIDA
Case No.:
Division:
,
Petitioner,
and
,
Respondent.
CERTIFICATE OF COMPLIANCE WITH MANDATORY DISCLOSURE
ONLY THE ORIGINAL OF THIS COMPLETED FORM IS
FILED WITH THE COURT. EXCEPT FOR THE FINANCIAL
AFFIDAVIT AND CHILD SUPPORT GUIDELINES WORKSHEET,
NO DOCUMENTS SHALL BE FILED IN THE COURT FILE
WITHOUT A PRIOR COURT ORDER. THE DOCUMENTS
LISTED BELOW ARE TO BE GIVEN TO THE OTHER PARTY.
I, {full legal name}
, certify that I have complied
with the mandatory disclosure required by Florida Family Law Rule 12.285 as follows:
1. FOR TEMPORARY FINANCIAL RELIEF, ONLY:
The date the following documents were served:
.
[Check all that apply]
a. ____ Financial Affidavit
(
) Florida Family Law Rules of Procedure Form 12.902(b) (short form)
( ) Florida Family Law Rules of Procedure Form 12.902(c) (long form)
b. ____ All personal (1040) federal tax, gift tax, and intangible personal property tax
returns for the preceding year; or
(
) Transcript of tax return as provided by IRS form 4506-T; or
( ) IRS forms W-2, 1099, and K-1 for the past year because the income tax return
for the past year has not been prepared.
c. ____ Pay stubs or other evidence of earned income for the 3 months before the service of the
financial affidavit.
2. FOR INITIAL, SUPPLEMENTAL, AND PERMANENT FINANCIAL RELIEF:
The date the following documents were served:
.
[Check all that apply]
a. ____ Financial Affidavit
(
) Florida Family Law Rules of Procedure Form 12.902(b) (short form)
Florida Family Law Rules of Procedure Form 12.932, Certificate of Compliance with Mandatory Disclosure (09/12)