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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.902(j), NOTICE OF SOCIAL SECURITY NUMBER When should this form be used? This form must be completed and filed by each party in all paternity, child support, and dissolution of marriage cases, regardless of whether the case involves a minor child(ren) and/or property. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your case was filed and keep a copy for your records. What should I do next? A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served on him or her with your initial papers. Where can I look for more information? Before proceeding, you should read "General Information for Self-Represented Litigants" found at the beginning of these forms. The words that are in "bold underline " in these instructions are defined there. For further information, see sections 61.052 and 61.13, Florida Statutes. Special notes... If this is a domestic violence case and you want to keep your address confidential for safety reasons, do not enter the address, telephone, and fax information at the bottom of this form. Instead, file Petitioner's Request for Confidential Filing of Address, O' Florida Supreme Court Approved Family Law Form 12.980(i). Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, O` Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.

Instructions for Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security Number (9/00)

IN THE CIRCUIT COURT OF THE IN AND FOR Case No.: Division: , Petitioner, and , Respondent.

JUDICIAL CIRCUIT, COUNTY, FLORIDA

NOTICE OF SOCIAL SECURITY NUMBER , I, {full legal name} certify that my social security number is , as required in section 61.052(7), sections 61.13(9) or (10), section 742.031(3), sections 742.032(1)­(3), and/or sections 742.10(1)­(2), Florida Statutes. My date of birth is . [/ one only] 1. This notice is being filed in a dissolution of marriage case in which the parties have no minor children in common. 2. This notice is being filed in a paternity or child support case, or in a dissolution of marriage in which the parties have minor children in common. The minor child(ren)'s name(s), date(s) of birth, and social security number(s) is/are: Name Birth date Social Security Number

{Attach additional pages if necessary.} Disclosure of social security numbers shall be limited to the purpose of administration of the Title IV-D program for child support enforcement.

Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security Number (9/00)

I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this notice and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: Signature
Printed Name: Address: City, State, Zip: Telephone Number: Fax Number:

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: [ N fill in all blanks] I, {full legal name and trade name of nonlawyer} , {city} a nonlawyer, located at {street} , {phone} , helped {name} {state} petitioner or respondent, fill out this form. who is the [ / one only] , , ,

Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security Number (9/00)