THE ELEVENTH JUDICIAL CIRCUIT OF MIAMI DADE COUNTY, FLORIDA

REQUIRED INFORMATION PER ADMINISTRATIVE ORDER 91-35

Case No.:

Petitioner’s Name:

DOB:

SS No.:

Address:

City, State:

Zip Code:

Home Phone:

Work Phone:

Attorney:	FRANCISCO. J. VARGAS

Attorney Address:	1200 Brickell Avenue, Suite 1950

City, State:	Miami, Florida

Zip Code:	33131

Respondent’s Name:

DOB:

SS No.:

Address:

City, State:

Zip Code:

Home Phone:

Work Phone:

Attorney:

Attorney Address:

City, State:

Zip Code:

Minor Child:

Date of Birth:

SS No.:

Minor Child:

Date of Birth:

SS No.:

The following information is requested for reporting to the Bureau of Vital Statistics.

Place of Marriage:

State/Province:

County:

Date of Marriage:

Wife’s Maiden Name:

ADDITIONAL INFORMATION FOR INTERNAL USE ONLY

Referred by	(general)	______________

Referred by (specific Name)	_____________

Type of case:	______________

(Do not complete #4-8 if prenuptial agreement)

County where case is being filed:	______________

Case No. (only if case already filed):	_____________

Restore Wife’s former name?	________________

If yes, write full former Name:	______________

Have client e-mail a copy of Driver License:	______________

Confirm that Driver’s license issued at least	______________

Six (6) months ago.

If no, then client must show residence

in Florida through Voter’s registration

card or witness affidavit.