Fla. R. Juv. P. Form 8.964

PETITION FOR DEPENDENCY

COMES NOW, Petitioner, .....(name)....., by and through

undersigned counsel, and petitions this court to adjudicate the

above-named minor child(ren) to be dependent within the meaning

and intent of chapter 39, Florida Statutes. As grounds, petitioner

alleges the following:

1. This court has jurisdiction over the minor child(ren),

.....(name(s))....., a.....(gender)..... child, whose date(s) of birth is/are

.........., and who, at the time the dependency arose, was/were in

the custody of.....(name(s))......

2. The natural mother of the minor child(ren) is

.....(name)....., a resident of.....(state)....., whose address is ………..

3. The father of the minor child(ren), .....(name(s))..... is

.....(name)....., whose address is ……….. The father..... is..... is not

married to the mother, and..... is..... is not listed on the child(ren)’s

birth certificate(s). The mother filed a Sworn Statement About

Identity or Location of Father with this court on.....(date)....., which

named ………. as the father.

4. The UCCJEA Affidavit..... is attached..... was filed with

the Court on.....(date)..... and is incorporated by reference.

5. The child(ren) is/are dependent within the meaning and

intent of chapter 39, Florida Statutes, in that the

mother/father/parents/legal custodian/caregiver(s) abused,

abandoned, or neglected the minor child(ren) on or about

.....(date)....., by: .................... and that these activities and

environments cause the child(ren)’s physical, mental, or emotional

health to be in danger of being significantly impaired.

OR

5. The above named child(ren) is/are presently under

substantial risk or imminent threat of harm or abuse or neglect,

within the meaning and intent of chapter 39, Florida Statutes,

which is likely to cause the child(ren)’s physical health to be

significantly impaired because.....................

6. The department is unable to ensure the protection of the

minor child(ren) without judicial intervention.

7. The mother/father/parents has/have received the

following services: .....................

8. A shelter hearing was held on.....(date)....., and the

child(ren) was/were placed in the custody of.....................

9. An arraignment hearing

..... needs to be scheduled.

..... is scheduled for.....(date and time)......

10. A guardian ad litem

..... needs to be appointed.

..... was appointed at the shelter hearing to represent

the child(ren).

11. .....(name of child(ren))..... has/have special needs as

defined in Chapter 39, Florida Statutes. An attorney:

..... needs to be appointed.

..... has been appointed.

12. Under chapter 39, Florida Statutes, the clerk of the court

is required to issue a summons to the following parents or

custodians:

The natural mother, .....(name)....., whose address is

The natural father, .....(name)....., whose address is

.....(Additional fathers and their addresses)......

WHEREFORE, the petitioner asks that process may issue in

due course to bring the above-named parties before the court to be

dealt with according to the law, to adjudicate the named minor

child(ren) named to be dependent.

….(Petitioner’s name)……

…… (Attorney’s name)…..

….. (address and telephone number)

Florida Bar Number:……….

Verification

Certificate of service

NOTICE OF RIGHTS

PLEASE READ THIS PETITION BEFORE ENTERING THE

COURTROOM.

YOU HAVE A RIGHT TO HAVE COUNSEL PRESENT AT THIS

HEARING.

BY COPY OF THIS PETITION, THE PARENTS, CAREGIVERS,

AND/OR LEGAL CUSTODIANS ARE NOTIFIED OF THEIR RIGHT

TO HAVE LEGAL COUNSEL PRESENT FOR ANY PROCEEDING

RESULTING FROM THIS PETITION OR TO REQUEST THE

COURT TO HAVE COUNSEL APPOINTED, IF INDIGENT.

Further, these persons are informed of the following:

An arraignment is set on this matter for.....(date)....., at

..... a.m./p.m., at.....(location)...... The purpose of the

arraignment is to advise as to the allegations contained in the

Petition For Dependency. When your case is called, the Judge

will ask you to enter a plea to this petition. The plea entered

may be one of the following:

1. Admit: This means you admit that the petition states

the truth and you do not want a trial.

2. Consent: This means you neither admit nor deny the

petition, but do not want a trial.

(If you enter either of the above two pleas, the court will

set a disposition date for the matter. At disposition, the court

will decide where the child will stay and under what

conditions).

3. Deny: This means you deny the allegations of the

petition and wish the state to attempt to prove them at a trial.

4. Continue: This means you wish time to confer with

an attorney, before entering a plea. If you enter this plea, the

court will schedule another hearing in approximately 2 weeks.

At that time, another arraignment hearing will be held, and you

(or your attorney) must enter one of the above three pleas.

COMMENT: The following paragraph must be in bold, 14 pt. Times

New Roman or Courier font.

If you are a person with a disability who needs any

accommodation in order to participate in this proceeding, you

are entitled, at no cost to you, to the provision of certain

assistance. Please contact.....(name, address, and telephone

number)..... at least 7 days before your scheduled court

appearance, or immediately upon receiving this notification if

the time before the scheduled appearance is less than 7 days. If

you are hearing or voice impaired, call 711.