Special Affidavit for Uncontested Dissolution of Marriage

SPECIAL AFFIDAVIT FOR UNCONTESTED DISSOLUTION OF MARRIAGE

WITHOUT FINAL HEARING

**DO NOT RETURN THESE DOCUMENTS TO THE CLERK’S OFFICE.

**DOCUMENTS MUST BE RETURNED BY MAIL ACCORDING TO THE INSTRUCTIONS BELOW.

Attached you will find a Special Affidavit for Uncontested Dissolution of Marriage and other

related forms. The affidavit is to be used if you, as the petitioner in your dissolution of marriage

action, wish to request that a final judgment (completion of your divorce) be entered without

the necessity of a final hearing.

If you do not follow the directions completely, your paperwork will be returned to you.

*Do not return the Special Affidavit for Uncontested Dissolution of Marriage unless twenty

(20) days have passed since you filed your petition.

1. Complete the Special Affidavit for Uncontested Dissolution of Marriage packet in its

entirety. The affidavit must be typed or printed legibly in ink. You must fill in every blank

correctly. If a question does not apply to your case, write N/A or No in the blank. You must

complete every area of the affidavit.

2. The affidavit must be signed in the presence of a notary public.

3. Mail or hand deliver a copy of the completed Special Affidavit for Uncontested

Dissolution of Marriage Packet to your spouse.

4. The following documents must then be mailed to the address below:

a. Completed original Special Affidavit for Uncontested Dissolution of Marriage

Packet (signed and notarized).

b. Two (2) self-stamped, self-addressed legal size envelopes—one addressed to

each party. (It is suggested that if you do not have children, you include at least

$1.22 postage on each envelope and if you do have children, include at least

$1.83 postage on each envelope).

Mail items 4 (a) and (b) above to:

Chris Monroe

Family Law Case Manager

Okaloosa County Courthouse Annex Extension

1940 Lewis Turner Blvd.

Fort Walton Beach, FL 32547

8 Pages

$1.20

IN THE CIRCUIT COURT OF THE FIRST JUDICIAL CIRCUIT,

IN AND FOR OKALOOSA COUNTY, FLORIDA

IN RE: The Marriage of

_________________________________, Petitioner,

and Case No. __________________

_________________________________, Respondent

SPECIAL AFFIDAVIT FOR UNCONTESTED DISSOLUTION OF MARRIAGE

NOTE: YOU MUST ANSWER EVERY QUESTION, EITHER BY TYPING OR PRINTING NEATLY IN INK.

I, the undersigned, under oath and under penalty of perjury, swear or affirm as follows:

1. My name is ___________________________________. I am the Petitioner in the above action. I

am now married to _________________________________________.

We were married at (city & state)__________________________, on (dated) ____________________.

2. My current address is ____________________________________________________________

___________________________________________________________________________________

3. My spouse’s current address is _____________________________________________________

____________________________________________________________________________________.

4 I have carefully re-read my Petition for Dissolution of Marriage. Everything said in it is true.

( ) Yes ( ) No – I have made corrections below.

_____________________________________________________________________________________

5. Have either you or your spouse resided in the State of Florida continuously as a permanent resident

for more than six months before the date the petition was filed?

( ) Yes ( ) No

Which spouse? _________________________ (Write “Husband” Wife” or “Both)

6. Are you or your spouse a member of the United States armed forces? ( ) Yes ( ) No

Which spouse? ______________________ (Write “Husband” “Wife” “Both” or “N/A”)

7. “Irretrievable broken” means that the marriage cannot be put back together or salvaged in any

way, not even with the help of marriage counseling. Is your marriage irretrievably broken?

( ) Yes ( ) No

8. Are there children born during this marriage who are still minors (under age 18 or still in high

school with an anticipated date of graduation prior to age 19)? ( ) Yes ( ) No

If yes, state their names and dates of birth.

Name(s) Date of Birth

_________________________________________ _______________________

Is the Wife pregnant? ( ) No ( ) Yes___________________

9. Have both you and your spouse signed and filed a marital settlement agreement (and parenting

plan if there are children) settling all of the issues in this case? ( ) Yes ( ) No

Answer all the questions below:

A. Do you recognize both you and your spouse’s signature on the agreements(s)?

( ) Yes ( ) No ( ) Not applicable

B. Do you believe the agreement is fair?

( ) Yes ( ) No ( ) Not applicable

C. Have both of you fully disclosed all assets, liabilities and incomes to each other?

( ) Yes ( ) No ( ) Not applicable

D. Did both you and your spouse sign the written agreement(s) freely and voluntarily?

( ) Yes ( ) No ( ) Not applicable

E. Do you want the Court to approve your agreement(s) and make it part of the Final Judgment of

Dissolution of Marriage?

( ) Yes ( ) Not applicable

10. If there IS NO

agreement filed in your case, do you want the Court to enter a Final Judgment

Dissolution of Marriage that:

[check one] ( ) Only grants the dissolution of your marriage

( ) Grants the dissolution of your marriage and the other relief requested in

the Petition for Dissolution of Marriage.

( ) Not applicable

11. Is the wife asking the court to restore her former name? ( ) Yes ( )No

If yes, state the full restored name desired:

______________________________________________________________________

First Middle Last

NOTE: The court can only restore a legal name the wife once had, either by birth or marriage. It

cannot grant a new name the wife has never had before.

12. Is there anything else you believe the Court should know that has not been covered above?

( ) No ( ) Yes – (State briefly below)

__________________________________________________________________________________

13. The Petitioner respectfully requests that any personal appearance and/or further evidence or

testimony on this matter be waived and that a Final Judgment of Dissolution of Marriage be entered

without a final hearing. The Petitioner understands that the Court is not required to grant this request

and that he/she may be required to attend a formal hearing.

( ) Yes ( ) No

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 false statement includes fines and/or

imprisonment.

Dated: ______________________ _______________________________________

PETITIONER SIGNATURE

Printed Name: ___________________________

Address: _______________________________

City, State, Zip: __________________________

Telephone Number: ________________________

Fax Number: _____________________________

Designated E-mail Address(es): _______________

_______________________________________

STATE OF FLORIDA

COUNTY OF OKALOOSA

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 ________________________________

IN THE CIRCUIT COURT OF THE FIRST JUDICIAL CIRCUIT,

IN AND FOR OKALOOSA COUNTY, FLORIDA

IN RE: The Marriage of

_________________________________, Petitioner,

and Case No. __________________

_________________________________, Respondent

NOTICE OF FILING AFFIDAVIT FOR UNCONTESTED

DISSOLUTION OF MARRIAGE

TO: _________________________________________ (Respondent Name)

_________________________________________ (Address)

_________________________________________ (City, State, Zip)

YOU ARE HEREBY NOTIFIED that the undersigned petitioner has filed an Affidavit for

Uncontested Dissolution of Marriage with the Circuit Court in Okaloosa County, Florida, a copy

of which is attached and requests that a Final Judgment of Dissolution of Marriage be entered

without a final hearing.

If you disagree with the facts alleged in this affidavit, you must immediately contact the Family

Law Case Manager at (850) 609-5495 and file your objections in writing with the Clerk of Court

upon receipt of this Notice of Filing.

If you do not contact the Family Law Case Manager with your objections, a Final Judgment of

Dissolution of Marriage will be entered without a final hearing unless determined otherwise.

THIS IS YOUR LAST NOTIFICATION BEFORE THE ENTRY OF THE

FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE

I HEREBY CERTIFY that a copy of the foregoing has been furnished to the Respondent at the

above address by ( ) mail ( ) hand delivery this ______ day of __________________,

20____.

____________________________________

Petitioner Signature

Florida Rules of Civil Procedure, Final Disposition Form 1.998 (01/11)

FORM 1.998 FLORIDA RULES OF CIVIL PROCEDURE FORM 1.998

FORM 1.998. FINAL DISPOSIITON FORM

This form shall be filed by the prevailing party for the use of the Clerk of Court for the purpose

of reporting judicial workload data pursuant to Florida Statutes section 25.075.

_____________________________________________________________________________

I. CASE STYLE

IN THE CIRCUIT COURT OF THE FIRST JUDICIAL CIRCUIT

IN AND FOR OKALOOSA COUNTY, FLORIDA

______________________________________________ Case No. ________________

Plaintiff/Petitioner

Judge: __________________

vs.

______________________________________________

Defendant/Respondent

______________________________________________________________________________

II. MEANS OF FINAL DISPOSITION (Place an “x” in one box for major category

and one subcategory, if applicable, only)

□ Dismissed Before Hearing

□ Dismissed Pursuant to Settlement – Before Hearing

□ Dismissed Pursuant to Mediated Settlement – Before Hearing

□ Other - Before Hearing

□ Dismissed After Hearing

□ Dismissed Pursuant to Settlement – After Hearing

□ Dismissed Pursuant to Mediated Settlement – After Hearing

□ Other After Hearing – After Hearing

□ Disposed by Default

□ Disposed by Judge

□ Disposed by Non-jury Trial

□ Disposed by Jury Trial

□ Other

DATE:____________________________ __________________________________________

SIGNATURE OF ATTORNEY FOR PREVAILING PARTY

IN THE CIRCUIT COURT OF THE FIRST JUDICIAL CIRCUIT,

IN AND FOR OKALOOSA COUNTY, FLORIDA

Case No.:

Division:

,

Petitioner,

and

,

Respondent.

ACKNOWLEDGEMENT OF NOTICE OF LIMITATION OF SERVICES PROVIDED

1. The Family Law Case Manager is not acting as your lawyer or providing legal advice to you.

2. The Family Law Case Manager cannot tell you what your legal rights or remedies are, represent

you in court, or tell you how to testify in court.

3. The Family Law Case Manager is not acting on behalf of the Court or any judge. The presiding

judge in your case may require amendment of a form or substitution of a different form. The

judge is not required to grant the relief requested in the form.

3. The presiding judge in your case may require amendment of a form or substitution of a different

form. The judge is not required to grant the relief requested in the form.

4. Family Law Case Manager services are available to all persons unless limited by statute, who are

or will be parties to a family law case.

5. The information you give to and receive from the Family Law Case Manager is not confidential

and may be subject to disclosure at a later date. If another person involved in your case seeks

assistance from the family law case manager, he or she will be given the same type of assistance

that you receive.

5. In all cases, it is best to consult with your own attorney, especially if your case presents

significant issues regarding children, child support, alimony, retirement or pension benefits,

assets, or liabilities.

Check One (√) ___________ I can

read English.

___________ I cannot read English.

This Notice was read to me by:

{Name}_____________________________________

in {Language}_________________________________

By my signature below, I do hereby acknowledge that I have read this disclaimer and understand

the limitation of the services provided.

___________________ _______________________________________________

DATE SIGNATURE OF SELF REPRESENTED LITIGANT