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IN THE CIRCUIT COURT OF THE IN AND FOR

JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division:

, Petitioner, and , Respondent. ORDER TO PICK-UP MINOR CHILD(REN) An Emergency Verified Motion for Child Pick-Up Order has been filed by ( ) Petitioner ( ) Respondent, alleging facts which under existing law are determined to be sufficient to authorize taking into custody the minor child(ren) named below. Based on this motion, this Court makes the following findings, notices, and conclusions: JURISDICTION This Court has jurisdiction over issues surrounding the minor child(ren) listed below based on the following: [ all that apply] a. ___ This Court exercised and continues to exercise original jurisdiction over the minor children listed below under the Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA), specifically, section 61.514, Florida Statutes. b. ___ A certified out-of-state custody decree has been presented to this Court with a request for full faith and credit recognition and enforcement under the Parental Kidnapping Prevention Act, 28 U.S.C. Section 1738A. This Court has jurisdiction to enforce this decree under the UCCJEA, specifically sections 61.501-61.542, Florida Statutes. c. ___ By operation of Florida law governing the custody of or time-sharing with child(ren) born out of wedlock, this Court has jurisdiction over the child(ren) listed below because this (these) child(ren) was (were) born in the State of Florida and no prior court action involving the minor child(ren) has addressed a putative father's rights to time-sharing or other parental rights. See sections 742.031 and 744.301, Florida Statutes. d. ___ Pursuant to the UCCJEA, specifically section 61.516, Florida Statutes, this Court has jurisdiction to modify a custody decree of another state and has consulted with the Court which took initial jurisdiction over the minor child(ren) to determine this authority. e. ___ Other: NOTICE OF HEARING Because this Order to Pick-Up Minor Child(ren) has been issued without prior notice to the nonmovant {name} , all parties involved in this matter are informed that they are scheduled to appear and testify at a hearing regarding this matter on {date} , at {time} ,at which time the Court will
Florida Supreme Court Approved Family Law Form 12.941(e), Order to Pick-Up Minor Child(ren) (03/09)

consider whether the Court should issue a further order in this case, and whether other things should be ordered, including who should pay the filing fees and costs. The hearing will be before The Honorable {name} ______________________________________________________________________________ at {room name/number, location, address, city}_______________________________________, Florida. If a party does not appear, this order may be continued in force, extended, or dismissed, and/or additional orders may be issued, including the imposition of court costs. If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {name} _________________________________________________, {address}____________________ ___________________________________________________________________________________, {telephone} _____________________, within 2 working days of your receipt of this order. If you are hearing or voice impaired, call TDD 1-800-955-8771. ORDER This Court ORDERS AND DIRECTS any and all sheriffs of the State of Florida (or any other authorized law enforcement officer in this state or in any other state) to immediately take into custody the minor child(ren) identified below from anyone who has possession and: 1. ___ Place the minor child(ren) in the physical custody of {name} ________________ who ( ) may ( ) may not remove the minor child(ren) from the jurisdiction of this Court. OR ___ Accompany the minor child(ren) to the undersigned judge, if the minor child(ren) is (are) picked up during court hours, for immediate hearing on the issue of custody or time-sharing. It is the intention of this Court that the nonmoving party, minor child(ren), and movant appear immediately upon service of this order before the undersigned judge, if available, or duty judge to conduct a hearing as to which party is entitled to lawful custody of the minor child(ren) at issue. It is not the intention of the court to turn over the child(ren) to the movant on an ex parte basis. Neither party should be permitted to remove the child(ren) from the jurisdiction of this Court pending a hearing. If unable to accomplish the above, the sheriff/officer shall take the child(ren) into custody and place them with the Department of Children and Family Services of the State of Florida pending an expedited hearing herein. OR ___ Place the minor child(ren) in the physical custody of {agency} ________________________ who shall contact the undersigned judge for an expedited hearing. The sheriff/officer shall not delay the execution of this court order for any reason or permit the situation to arise where the nonmoving party is allowed to remove the child(ren) from the jurisdiction of this court. 2. NEITHER PARTY OR ANYONE AT THEIR DIRECTION, EXCEPT PURSUANT TO THIS ORDER, MAY REMOVE THE CHILD(REN) FROM THE JURISDICTION OF THIS COURT PENDING FURTHER HEARING. SHOULD THE NONMOVING PARTY IN ANY WAY VIOLATE THE MANDATES OF THIS ORDER IN THE PRESENCE OF THE LAW ENFORCEMENT OFFICER, THIS OFFICER IS TO IMMEDIATELY ARREST AND INCARCERATE THE OFFENDING PARTY UNTIL SUCH TIME AS THE
Florida Supreme Court Approved Family Law Form 12.941(e), Order to Pick-Up Minor Child(ren) (03/09)

OFFENDING PARTY MAY BE BROUGHT BEFORE THIS COURT FOR FURTHER PROCEEDINGS. All sheriffs of the State for Florida are authorized and ORDERED to serve (and/or execute) and enforce this order in the daytime or in the nighttime and any day of the week, except as limited by this order above. Except as limited by the above, if necessary, the sheriff/officer is authorized to take all reasonable, necessary, and appropriate measures to effectuate this order. The sheriff/officer shall not delay the execution of this order for any reason or permit the situation to arise where the child(ren) is (are) removed from the jurisdiction of this Court before execution of this order. The minor child(ren) is (are) identified as follows: Name Sex Birth date Race

Physical Description

Current location/address of minor child(ren) or of party believed to have possession of the minor child(ren):

ORDERED on {date}

, at {time}

.

CIRCUIT JUDGE

A copy of the {name of document(s)} ______________________________________________ was [ only one] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the parties listed below on {date}________________ by {clerk of court or designee}______________________________________. Petitioner (or his or her attorney) Respondent (or his or her attorney)

Florida Supreme Court Approved Family Law Form 12.941(e), Order to Pick-Up Minor Child(ren) (03/09)