Long Distance Parenting Plan Page 32
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32HAVE WRITTEN SOMEONE ELSE’S ADDRESS
SUBSTITUTE PHONE NUMBER
BECAUSE YOU FEAR HARASSMENT OR HARM.
By signing this Parenting Plan, I confirm that I have read all of the pages and any attachments, I
understand it and I believe that it is in the best interest of my child(ren). I am freely and voluntarily
entering into this Agreement and I request that the Judge approve it.
Date Signed: ______________________
_____________________________
Signature of Mother
______________________________
______________________________
Witness
Witness
______________________________
______________________________
Address
Address
STATE OF FLORIDA
COUNTY OF ___________________
I HEREBY CERTIFY that on this day personally appeared before me, an officer duly authorized to administer oaths and take
acknowledgements, __________________________________(MOTHER’S NAME), to me well known to be the person described in
or who produced a Florida Driver’s License as identification, who executed the foregoing Parenting Plan and acknowledged before me
that she executed the same freely and voluntarily and for the purpose therein expressed. WITNESS my hand and official seal in the
County and state last aforesaid this _____ day of _________________, 2____.
Notary Seal:
Notary Signature: ___________________________
By signing this Parenting Plan, I confirm that I have read all of the pages and any attachments, I
understand it and I believe that it is in the best interest of my child(ren). I am freely and voluntarily
entering into this Agreement and I request that the Judge approve it.
Date Signed: ______________________
_____________________________
Signature of Father
______________________________
______________________________
Witness
Witness
______________________________
______________________________
Address
Address
STATE OF FLORIDA
COUNTY OF ___________________
I HEREBY CERTIFY that on this day personally appeared before me, an officer duly authorized to administer oaths and take
acknowledgements, __________________________________(FATHER’S NAME), to me well known to be the person described in
or who produced a Florida Driver’s License as identification, who executed the foregoing Parenting Plan and acknowledged before me
that he executed the same freely and voluntarily and for the purpose therein expressed. WITNESS my hand and official seal in the
County and state last aforesaid this _____ day of _________________, 2____.
Notary Seal:
Notary Signature: ___________________________
_______
______
Basic LDPP
Page 24 of 24
Mother
Father
Rev. 9/09/08
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