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IN THE CIRCUIT COURT OF THE IN AND FOR

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

, Petitioner, and , Respondent.

FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) This cause came before this Court for a trial on a Petition for Dissolution of Marriage. The Court, having reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of law: 1. The Court has jurisdiction over the subject matter and the parties. 2. At least one party has been a resident of the State of Florida for more than 6 months immediately before filing the Petition for Dissolution of Marriage. 3. The marriage between the parties is irretrievably broken. Therefore, the marriage between the parties is dissolved, and the parties are restored to the status of being single. SECTION I. MARITAL ASSETS AND LIABILITIES A. Date of Valuation of Property. The assets and liabilities listed below are divided as indicated. The date of valuation of these assets and liabilities is, unless otherwise indicated: a. ___ date of filing petition for dissolution of marriage. b. ___ date of separation. c. ___ date of divorce trial. B. Division of Assets. 1. The assets listed below are nonmarital assets. Each party shall keep, as his or her own, the assets found to be nonmarital, and the other party shall have no further rights or responsibilities regarding these assets.
ASSETS: DESCRIPTION OF ITEM(S) (Describe each item as clearly as possible. You do not need to list account numbers.) Current Fair Market Value Wife=s Nonmarital Property Husband=s Nonmarital Property

$

$

$

Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)

ASSETS: DESCRIPTION OF ITEM(S) (Describe each item as clearly as possible. You do not need to list account numbers.)

Current Fair Market Value

Wife=s Nonmarital Property

Husband=s Nonmarital Property

Total Nonmarital Assets 2. The assets listed below are marital assets. Each party shall keep, as his or her own, the assets awarded in this section, and the other party shall have no further rights or responsibilities regarding these assets. Any personal item(s) not listed below are awarded to the party currently in possession or control of the item(s).
Current Fair Market Value Husband Shall Receive

ASSETS: DESCRIPTION OF ITEM(S) (Describe each item as clearly as possible. You do not need to list account numbers.)

Wife Shall Receive

Cash (on hand or in banks/credit unions)

$

$

$

Stocks/bonds Notes

Business interests
Real estate: (Home) Automobiles

Boats Furniture & furnishings

Jewelry Life insurance (cash surrender value) Retirement Plans (Profit sharing, Pension, IRA, 401(k)s, etc.)

Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)

ASSETS: DESCRIPTION OF ITEM(S) (Describe each item as clearly as possible. You do not need to list account numbers.)

Current Fair Market Value

Wife Shall Receive

Husband Shall Receive

Other assets

Total Marital Assets

$

$

$

C. Division of Liabilities/Debts. 1. The liabilities listed below are nonmarital liabilities and, therefore, are owed as indicated. Each party shall owe, as his or her own, the liabilities found to be nonmarital, and the other party shall have no responsibilities regarding these debts.
Current Amount Owed Wife=s Nonmarital Liability Husband=s Nonmarital Liability

LIABILITIES: DESCRIPTION OF DEBT(S) (Describe each item as clearly as possible. You do not need to list account numbers.)

$

$

$

Total Nonmarital Liabilities

$

$

$

2. The liabilities listed below are marital liabilities and are divided as indicated. Each party shall hold the other party harmless and pay, as his or her own, the marital liabilities awarded below.
Current Amount Owed

LIABILITIES: DESCRIPTION OF DEBT(S) (Describe each item as clearly as possible. You do not need to list account numbers.)

Wife Shall Pay

Husband Shall Pay

Mortgages on real estate: (Home) (Other)

$

$

$

Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)

LIABILITIES: DESCRIPTION OF DEBT(S) (Describe each item as clearly as possible. You do not need to list account numbers.)

Current Amount Owed

Wife Shall Pay

Husband Shall Pay

Charge/credit card accounts

Auto loan Auto loan Bank/Credit Union loans

Other

Total Marital Liabilities

$

$

$

D. Contingent assets and liabilities will be divided as follows: _________________________________ ________________________________________________________________________________ ________________________________________________________________________________ E. The distribution of assets and liabilities in this final judgment is equitable; if each party does not receive approximately one-half, the distribution is based on the following facts and reasoning: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ SECTION II. EXCLUSIVE USE AND POSSESSION OF HOME [all that apply] 1. ___ ( ) Petitioner ( ) Respondent, as a condition of support, shall have exclusive use and possession of the dwelling located at the following address:________________________ ____________________________________________________________________ until:
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)

{date or event} ____________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 2. ___ ( ) Petitioner ( ) Respondent may make visits to the premises described in the paragraph above for the purpose of obtaining any items awarded in this Final Judgment. These visits shall occur after notice to the person granted exclusive use and possession of the dwelling and at the earliest convenience of both parties or as ordered in paragraph 4 below. 3. ___Upon the termination of the right of exclusive use and possession, the dwelling shall be sold and the net proceeds divided % to Petitioner and % to Respondent, with the following credits and/or setoffs being allowed: ________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 4. ___Other: ______________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ SECTION III. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING WITH DEPENDENT OR MINOR CHILD(REN) 1. Jurisdiction. The Court has jurisdiction to determine parental responsibility, to establish or adopt a Parenting Plan, and a time-sharing schedule with regard to the minor child(ren) listed in paragraph 2 below. 2. The parties' dependent or minor child(ren) is (are): Name Birth date ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 3. Parenting Plan. The parties shall comply with the Parenting Plan which is attached and incorporated herein as Exhibit ___. SECTION IV. ALIMONY 1. ( ) The Court denies the request(s) for alimony; OR ( ) The Court finds that ( ) Petitioner ( ) Respondent has a need for, and that
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)

( ) Petitioner ( ) Respondent (hereinafter Obligor) has/had the present ability to pay, alimony as follows: [all that apply] a. ___Permanent Periodic. Obligor shall pay permanent periodic alimony to Obligee in the amount of $ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} _________________________ ______________________________________________________________________________ beginning {date} ___________________. This alimony shall continue until modified by court order, the death of either party, or remarriage of Obligee, whichever occurs first. b. ___Lump Sum. Obligor shall pay lump sum alimony to Obligee in the amount of $____________. This amount shall be paid as follows: ________________________________________________ c. ___Rehabilitative. Obligor shall pay rehabilitative alimony to Obligee in the amount of $______ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain}____________________________________________ ______________________________________________________________________________ beginning {date}___________________. This rehabilitative alimony shall continue until modified by court order, the death of either party or until {date/event} ____________________________, whichever occurs first. The rehabilitative plan presented demonstrated the following: ________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ d. ___Retroactive. Obligor shall pay retroactive alimony in the amount of $ for the period of {date}_______________,through {date} __________________, which shall be paid pursuant to paragraph 3 below. 2. Reasons for ( ) Awarding ( ) Denying Alimony. The Court has considered all of the following in awarding/denying alimony: a. The standard of living established during the marriage; b. The duration of the marriage; c. The age and the physical and emotional condition of each party; d. The financial resources of each party, the nonmarital and marital assets and liabilities distributed to each; e. The contribution of each party to the marriage, including, but not limited to, services rendered in homemaking, child care, education, and career building of the other party; and f. All sources of income available to either party. Additionally, the Court has considered the following factors in reaching its decision: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________. _______ Please indicate here if additional pages are attached. 3. Arrearage/Retroactive Alimony. [one only] a. ___There is no alimony arrearage at the time of this Final Judgment.
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)

b. ___The ( ) Petitioner ( ) Respondent shall pay to the other party the alimony arrearage of: $ for retroactive alimony, as of {date}______________. $ for previously ordered unpaid alimony, as of {date} _________________. The total of $ ______ in alimony arrearage shall be repaid in the amount of $ _ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain} ___________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ beginning {date}______________, until paid in full including statutory interest. 4. Insurance. [ all that apply] a. ___ Health Insurance. ( ) Petitioner ( ) Respondent shall be required to pay health insurance premiums for the other party not to exceed $__________ per month. Further, ( ) Petitioner ( ) Respondent shall pay any reasonable and necessary uninsured medical costs for the other party not to exceed $_________ per year. As to these uninsured medical expenses, the party who is entitled to reimbursement of the uninsured medical expense shall submit request for reimbursement to the other party within 30 days, and the other party shall, within 30 days after receipt, submit the applicable reimbursement for that expense. b. ___ Life Insurance (to secure payment of support). To secure the alimony obligations set forth in this judgment, Obligor shall maintain life insurance coverage on his/her life naming Obligee as the sole irrevocable beneficiary, so long as reasonably available. This insurance shall be in the amount of at least $_______ and shall remain in effect until the obligation for alimony terminates. 5. Other provisions relating to alimony: __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ . SECTION V. CHILD SUPPORT 1. The Court finds that there is a need for child support and that the ( ) Mother ( ) Father (hereinafter Obligor) has the present ability to pay child support. The amounts in the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), filed by the ( ) Mother ( ) Father are correct; OR the Court makes the following findings: The Mother's net monthly income is $ , (Child Support Guidelines %). The Fathers net monthly income is $ , (Child Support Guidelines %). Monthly child care costs are $ . Monthly health/dental insurance costs are $ .

Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)

2. Amount. Obligor shall be obligated to pay child support in the amount of $ , per month payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain}: ___________________________________________________________ __________________________________________________________________________________ beginning {date}_____________and continuing until either: ( ) the youngest of the minor child(ren) reaches the age of 18, become(s) emancipated, marries, dies, or otherwise becomes self-supporting ; OR ( ) one of the minor children reaches the age of 18, become(s) emancipated, marries, dies, or otherwise becomes self-supporting and either party files a supplemental petition to modify child support and the court enters such an order; OR ( ) {date/event} ___________________________________________________________________, {explain} __________________________________________________________________________. If the child support ordered deviates from the guidelines by more than 5%, the factual findings which support that deviation are: ______________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 3. Arrearage/Retroactive Child Support. [one only] a. ___There is no child support arrearage at the time of this Final Judgment. b. ___The ( ) Mother ( ) Father shall pay to the other party the child support arrearage of: $ for retroactive child support, as of {date} ________. $ for previously ordered unpaid child support, as of {date} . The total of $ in child support arrearage shall be repaid in the amount of $ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain} _________________________________________________________________ ______________________________________________________________________________ beginning {date}_________________________, until paid in full including statutory interest. 4. Insurance. [all that apply] a. ___Health/Dental Insurance. ( ) Mother ( ) Father shall be required to maintain ( ) health and/or ( ) dental insurance coverage for the parties' minor child(ren), so long as reasonably available. The party providing coverage shall be required to convey insurance cards demonstrating said coverage to the other party; OR ( ) health and/or ( ) dental insurance is not reasonably available at this time.

Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)

b. ___Reasonable and necessary uninsured medical/dental/prescription drug costs for the minor child(ren) shall be assessed as follows: ( ) Shared equally by both parents. ( ) Prorated according to the child support guideline percentages. ( ) Other {explain}: ______________________________________________________________________________ ______________________________________________________________________________ As to these uninsured medical/dental/prescription drug expenses, the party who incurs the expense shall submit request for reimbursement to the other party within 30 days, and the other party, within 30 days of receipt, shall submit the applicable reimbursement for that expense, according to the schedule of reimbursement set out in this paragraph. 5. ___Life Insurance (to secure payment of support). To secure the child support obligations in this judgment, ( ) Petitioner ( ) Respondent ( ) Each party shall maintain life insurance coverage, in an amount of at least $______, on ( ) his life ( ) her life ( ) his/her life naming ( ) minor child(ren) as the beneficiary(ies) OR naming the ( ) Mother ( ) Father ( ) other {name}________________________________________________________________as Trustee for the minor child(ren), so long as reasonably available. The obligation to maintain the life insurance coverage shall continue until the youngest child turns 18, becomes emancipated, marries, dies, or otherwise becomes self-supporting. 6. IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall be as follows: __________________________________________________________________________ __________________________________________________________________________________ _________________________________________________________________________________. Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of this paragraph. 7. Other provisions relating to child support: ______________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ SECTION VI. METHOD OF PAYMENT Obligor shall pay court-ordered child support/alimony and arrears, if any, as follows: 1. Central Governmental Depository. [ if applies] a. ___Obligor shall pay court-ordered support directly to the Central Governmental Depository in {name} ______________________ County, along with any depository service charge.

Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)

b. ___Both parties have requested and the court finds that it is in the best interests of the child(ren) that support payments need not be directed through the Central Governmental Depository. However, either party may subsequently apply to the depository pursuant to section 61.13(1)(d)3, Florida Statutes, to require payments through the Central Governmental Depository. 2. Income Deduction. [if applies] a. ___Immediate. Obligor shall pay through income deduction, pursuant to a separate Income Deduction Order which shall be effective immediately. Obligor is individually responsible for paying this support obligation until all of said support is deducted from Obligor's income. Until support payments are deducted from Obligor's paycheck, Obligor is responsible for making timely payments directly to the Central Governmental Depository or the Obligee, as previously set forth in this order. b. ___Deferred. Income deduction is ordered this day, but it shall not be effective until a delinquency of $__________, or, if not specified, an amount equal to one month's obligation occurs. Income deduction is not being implemented immediately based on the following findings: Income deduction is not in the best interests of the child(ren) because: {explain} ___________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________, AND there is proof of timely payment of a previously ordered obligation without an income deduction order in cases of modification, AND ( ) there is an agreement by the Obligor to advise the central governmental depository of any change in payor and health insurance OR ( ) there is a signed written agreement providing an alternative arrangement between the Obligor and the Obligee. 3. Bonus/one-time payments. ( ) All ( ) ____________________% ( ) No income paid in the form of a bonus or other similar one-time payment, up to the amount of any arrearage or the remaining balance thereof owed pursuant to this order, shall be forwarded to Obligee pursuant to the payment method prescribed above. 4. Other provisions relating to method of payment. _________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ SECTION VII. ATTORNEY FEES, COSTS, AND SUIT MONEY 1. ___( ) Petitioner's ( ) Respondent's request(s) for attorney fees, costs, and suit money is (are) denied because ___________________________________________________________________ ________________________________________________________________________________.

Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)

2. ___The Court finds there is a need for and an ability to pay attorney fees, costs, and suit money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the other party $_______ in attorney fees, and $ _______ in costs. The Court further finds that the attorney fees awarded are based on the reasonable rate of $ _______ per hour and __________ reasonable hours. Other provisions relating to attorney fees, costs, and suit money are as follows: _____________________________________ __________________________________________________________________________________ __________________________________________________________________________________ SECTION VIII. OTHER PROVISIONS 1. Former Name. The wife's former name of {full name} ____________________________________ is restored. 2. Other Provisions. ___________________________________________________________________ __________________________________________________________________________________ ______________________________________________________________________________ 3. The Court reserves jurisdiction to modify and enforce this Final Judgment. ORDERED on . _______________________________________ CIRCUIT JUDGE A copy of the {name of document(s)} _________________________________ was [one only] ( ) 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) Central Governmental Depository Other __________________________________

Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)