Supplemental Petition To Modify Parental Responsibility, Visitation, Or Parenting Plan/time-Sharing Schedule And Other Relief - Florida Circuit Court Page 7

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I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
petition and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.
Dated:
Signature of Petitioner
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 Petitioner.
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 12.905(a), Supplemental Petition to Modify Parental
Responsibility, Visitation, or Parenting Plan/Time-Sharing Schedule and Other Relief(11/15)

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