Special Interrogatories for Dissolution of Marriage Cases - Lee County, Florida

The Florida Courts has released this version of the "Special Interrogatories for Dissolution of Marriage Cases" on January 20, 2015.

This form may be used by all Florida residents: download the printable PDF by clicking the link below and use it according to the applicable legal guidelines.

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IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT, IN AND FOR
LEE COUNTY, FLORIDA
CIVIL DIVISION
Petitioner
No: ___________________________
Case
vs.
Respondent
SPECIAL INTERROGATORIES FOR DISSOLUTION OF MARRIAGE CASES
NOTE: You must answer every question correctly, either by typing or printing legibly in ink. If a
question does not apply to your case, write “N/A” in the blank or select “NO”.
STATE OF FLORIDA COUNTY OF LEE
I, the undersigned, under oath and under penalty of perjury, swear or affirm as follows:
1. (a) List your full legal name __________________________________________________________
(b) List the name of the person you are married to _________________________________________
(c) List the City, State you were married in ______________________________________________
(d) List the date you were married _____________________________________________________
2. If everything said in the Petition for Dissolution of Marriage is true and correct to the best of your
knowledge, state that below. If there is anything you need to correct in your Petition, briefly state the
corrections below.
Everything is true and correct
Petition needs corrections listed below:
_________________________________________________________________________________
_________________________________________________________________________________
3. Are you or your spouse a member of the armed forces?
Yes
No
4. (a) Your Petition for Dissolution of Marriage was filed on __________________________________.
(Date)
(b) Have either you or your spouse resided in the State of Florida continuously as a permanent
resident for more than six months before the date the petition was filed?
Yes
No
(c) Which spouse?
Husband
Wife
Both
5. (a) “Irretrievably broken” means that the marriage cannot be put back together or salvaged in any
way, not even with the help of marriage counseling. Is your marriage irretrievably broken?
Yes
No
Rev. 1/20/15
IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT, IN AND FOR
LEE COUNTY, FLORIDA
CIVIL DIVISION
Petitioner
No: ___________________________
Case
vs.
Respondent
SPECIAL INTERROGATORIES FOR DISSOLUTION OF MARRIAGE CASES
NOTE: You must answer every question correctly, either by typing or printing legibly in ink. If a
question does not apply to your case, write “N/A” in the blank or select “NO”.
STATE OF FLORIDA COUNTY OF LEE
I, the undersigned, under oath and under penalty of perjury, swear or affirm as follows:
1. (a) List your full legal name __________________________________________________________
(b) List the name of the person you are married to _________________________________________
(c) List the City, State you were married in ______________________________________________
(d) List the date you were married _____________________________________________________
2. If everything said in the Petition for Dissolution of Marriage is true and correct to the best of your
knowledge, state that below. If there is anything you need to correct in your Petition, briefly state the
corrections below.
Everything is true and correct
Petition needs corrections listed below:
_________________________________________________________________________________
_________________________________________________________________________________
3. Are you or your spouse a member of the armed forces?
Yes
No
4. (a) Your Petition for Dissolution of Marriage was filed on __________________________________.
(Date)
(b) Have either you or your spouse resided in the State of Florida continuously as a permanent
resident for more than six months before the date the petition was filed?
Yes
No
(c) Which spouse?
Husband
Wife
Both
5. (a) “Irretrievably broken” means that the marriage cannot be put back together or salvaged in any
way, not even with the help of marriage counseling. Is your marriage irretrievably broken?
Yes
No
Rev. 1/20/15
(b) State very briefly why your marriage is irretrievably broken:
_________________________________________________________________________________
_________________________________________________________________________________
6. (a) Are there children born of this marriage who are still minors (under 18)?
Yes
No
(b) If so, state their full names and dates of birth.
Name
Date of Birth
_________________________________________________
__________________
_________________________________________________
__________________
_________________________________________________
__________________
_________________________________________________
__________________
(c) Is the wife pregnant at this moment?
Yes
No
7. (a) Have both you and your spouse signed a written agreement settling all issues in this case?
Yes
No
NA
(b) Do you recognize both your signature and the signature of your spouse on that agreement?
Yes
No
NA
8. (a) Do you believe the agreement is fair?
Yes
No
NA
(b) Have both of you fully disclosed all assets, liabilities, and incomes to each other?
Yes
No
NA
(c) Did both you and your spouse sign this agreement freely and voluntarily?
Yes
No
NA
(d) Do you want the judge to adopt the agreement as a part of the Final Judgment?
Yes
No
NA
9. Is the Wife asking the court to restore her prior name or maiden name?
Yes
No
(The court can only restore a legal name the wife once had, either by birth or marriage. The court
cannot grant a new name the wife has never had before.)
If so, state the full restored name desired:______________________________________________
(Print the Full Name Requested)
Rev. 1/20/15
10. If there is anything you believe the court ought to know that has not been covered above, briefly state
it below.
Everything is true and correct
Court should know the following:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
11. I hereby waive my right to a trial, the filing of a Notice for Trial, entry of a Trial Order, and all time
periods and waiting periods required by law in connection with my Petition for Dissolution of
Marriage filed ______________ (date of filing), and request that a copy of the Final Judgment of
Dissolution of Marriage entered in this case be provided to me at the address provided below.
NOTE: You must show separate proof that you have been a permanent and continuous resident of the
State of Florida for at least six months before the date of filing for divorce. You may do this in one of two
ways:
1. Submitting an enlarged, readable photocopy of either your driver’s licenses or voter’s registration
card. Remember, the date of issue must prove your residency. If it does not, you have failed to prove
residency and your case will be held up until proper proof is received; OR
2. Submitting an Affidavit from a witness who can prove your residency. The witness must be an adult
who is a Florida resident.
______________________________________________________
______________________
Petitioner’s Signature
Date
________________________________________ Address Line 1
________________________________________ Address Line 2
________________________________________ Address Line 3
STATE OF FLORIDA
COUNTY OF LEE
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 ID Produced________________________________
Rev. 1/20/15

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