Your Information
First name:
Last name:
Street:
City:
County:
State:
Zip:
Home Phone:	* required
Work Phone:
Email address:	* required
Best way to contact you:	Telephone Email address Mailing address Select One
Who lived in Florida for at least 6 months before the filing for Dissolution of Marriage?	Select One WIFE HUSBAND BOTH
Are you a member of the military service?	Select One YES NO
Your Spouse's Information
First name:
Last name:
Street:
City:
County:
State:
Zip:
Home Phone:
Is your spouse a member of the military service?	Select One YES NO I DO NOT KNOW
Marriage Information
Date of Marriage:
Place of Marriage:
Date of Separation:
Is Alimony to be Paid?	Select one NO YES
If yes, how much?
Alimony to be paid by?	Select one Husband Wife Not applicable
Your combined income with your spouse	Select one BELOW $50,000/year ABOVE $50,000/year
Wife's Former Name
Wife requests to have former name restored:	Select One Yes No
Indicate former name:
Property and Debt Information
Wife transfers to Husband the following property or assets:
Husband transfers to Wife the following property and or assets:
Husband shall be responsible for paying the following debts: Specify credit cards by the name of the issuing bank
Wife shall be responsible for paying the following debts:
Minor Child(ren) Information
Names, Birthdates, Place of Birth, and Sex of Minor children you have with your spouse.
List all addresses (start with the current) where the children have lived in the past 5 years.    Also, include name, present address and relationship of person child lived with:
Minor Child(ren) Custody Information
Has there ever been any court proceeding prior involving the custody or support of the minor child(ren)?	Select One NO YES
If YES, please indicate name of the child(ren),type of proceedings, court and state, date of Final Judgment or Order (if any).
Minor Child(ren) Support Information
Indicate who will have Primary custody of the minor child(ren):	Select One MOTHER FATHER
It is in the child(ren)’s best interests that parental responsibility be:	Select One SHARED BY BOTH PARENTS AWARDED SOLELY TO MOTHER AWARDED SOLELY TO FATHER
Indicate whether visitation should be listed as:	Select One Liberal Limited Visitation Supervised No Visitation
Explain the agreed visitation including the terms.
Indicate the agreed upon amount for child support in $ per month:
To be paid by	Select One Father Mother
OR would you prefer the amount of child support left blank so that the court may set it or you and your spouse may discuss an agreed upon amount and enter it on the form?	Select One Let Court Specify As Specifed Above
Medical insurance for the minor child(ren) will be provided by:	Select One Husband Wife Medicaid
SHIPPING METHOD/ Select one
Please deliver documents via Express Mail (1-2 business days after prepared) Add $39.95 Please deliver documents via Priority Mail (3-5 business days after prepared) Add $19.95 Please deliver documents via Email (Delivered as soon as prepared) Add $0.00 Billing Information
Name as it appears on your credit card:	* required
Billing Address	* required
State	* required
City	* required
Zip	* required
Credit Card Type	Visa Master Discover
Credit Card Number	* required
Expiration Date	* required
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If the forms are not accepted for any reason, a full refund is provided with verification of any denial of acceptance. Any mistakes/misprints on the forms will be corrected upon your request within 10 days of your initial order at no additional charge if they were caused by our fault/ error and or misprint. Any person using this website/ and or our services does so at his or her own risk, and agrees to indemnify and hold harmless the Florida Document Preparation Services its agencies, representatives, officers, employees and agents from any damages of any nature that may result from the use of this website. Florida Document Preparation services is not responsible for any damage, loss, injury, claim or the results arising from any use or reference to our website and or our services. The use of our website and or our services does not mean that a judge/clerk will accept your documents. You may be required to re-do your documents or obtain and file additional documents once the judge has reviewed your case. Each case has its own particular set of circumstances, and an attorney may advise you of what is best for you in your individual situation. If you have questions or concerns regarding your legal rights, it is strongly recommended that you talk to an attorney. If you do not know an attorney, you may call the Lawyer Referral Service in your local area. By using our website and or our services, user acknowledges and accepts the terms and conditions contained in this Disclaimer and Agreement and agrees to be bound by each of the terms and conditions. Our website site and or Florida Document Preparation Services its agencies, representatives, officers, employees and agents does not provide legal advice regarding your case. 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