Division B – Judge Steven M. Fahlgren, Circuit Court
CHECKLIST FOR UNCONTESTED DISSOLUTIONS, PATERNITY CASES AND MODIFICATIONS

CASE NAME: 						    CASE NO.:   ___________ -DR- ___________  Division: A

NOTICE OF RELATED CASES FILED:  ________Yes           _______No          _________Not Applicable	

NOITICE OF TODAY’S HEARING SERVED AND FILED:      _____ Yes    _______ No

WAIVER OF APPEARANCE AT FINAL HEARING FILED: _____ Husband ______Wife  ______Pet _______Resp	

RESIDENCY EVIDENCE:
              FL Driver’s License / FL Photo ID; Date issued: _______________________ (please provide)
(License must be issued at least 6 months prior to filing of the action.)
              Affidavit of Residency signed by Witness and Notarized
______  FL Voter Registration Card issued on __________________
______  Testimony of party regarding residency
DO THE PARTIES HAVE MINOR CHILDREN?	                      Yes                   No		
							 
IF YES, PLEASE MARK:
UNIFORM CHILD CUSTODY JURISDICTION ACT AFFIDAVIT FILED BY: 	
              Wife’s 			___________ Petitioner					
              Husband’s 	               __________  Respondent

GUIDELINE CHILD SUPPORT WORKSHEET FILED:                  Yes                 No  Attached: ____ Yes _____ No
Does Child Support Guideline Worksheet match Guideline Calculation (preferably DPA):  ______ Yes  ______ No

CHILD SUPPORT DEMOGRAPHIC INFO SHEET:  Completed and Filed         Yes           No	 Attached: ____ Yes _____ No

PARENTING CLASS CERTIFICATE OF COMPLETION FILED:
              Wife’s 	             _________ Petitioner’s
              Husband’s           _________ Respondent’s

FINANCIAL AFFIDAVITS FILED:    _____ Husband’s   _______ Wife’s   ________ Petitioner’s _____Respondent’s
ALIMONY worksheet showing gross, deductions, net for each party (preferably DPA)  _________ Yes  __________ No
Marital Settlement Agreement signed by both parties: ______ Yes  ______ No
Consent Final Judgment or other Consent Order signed by both parties: _______ Yes  ________ No

Are there any of the following issues in any way involved in this action?  Please circle yes or no for each item below. 
Dependency:  yes / no		Child Sexual Abuse: yes / no		Domestic Violence: yes / no	
Mental Health: yes / no		Substance Abuse: yes / no			Involvement by D.C.F. with either parent:  yes / no	
									If yes, circle which parent:  mother / father

I, the undersigned attorney, do hereby certify that I have personally reviewed the above court file and that the above relevant pleadings and documents are contained in the court file or will be presented to the Court with this form.

Date:                             					____________________________________
						             Attorney
							____________________________________
							Print Attorney Name
	
Appearances     ______ Husband  ________Wife  _________Petitioner  _________Respondent

Attorneys For   ______ Husband  _______ Wife  ________Petitioner _________Respondent 
This completed form will be filed by the Court at the entry of the consent judgment.