This form contains 46 fields organized into 12 sections, giving it a Form Complexity Index of 48/100 (moderate). Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Court and Case Information
Judicial Circuit	Text	Enter the name or number of the judicial circuit where this case is filed (the circuit designation for the Florida court).
County	Text	Enter the name of the Florida county in which the court is located and where this case is filed.
Case Number	Text	Enter the court-assigned case number for this matter exactly as it appears on court documents, including any letters, dashes, or slashes.
Division	Text	Enter the court division or section handling this case (such as the division letter, number, or name used by the court).
Husband Residence
Husband County of Residence	Text	Enter the name of the county where the husband currently lives (do not include the word “County” after the name).
Husband State of Residence	Text	Enter the name of the state where the husband currently resides.
Date Husband Began Living There	Date	Enter the date when the husband began living at the stated county and state. Fill only if 'Husband County of Residence', 'Husband State of Residence' are filled (any). Depends on: Husband County of Residence, Husband State of Residence
Husband signature and contact info
Date	Date	Enter the date when the husband signs or dates this form.
Address	Text	Enter the husband's full street address, including apartment or unit number if applicable.
City, State, Zip	Text	Enter the husband's city, state, and ZIP code in the space provided.
Telephone Number	Text	Enter the husband's primary telephone number, including area code.
Fax Number	Text	Enter the husband's fax number, including area code, or leave blank if none.
E-mail Address(es)	Text	Enter the husband's e-mail address or addresses; separate multiple addresses with commas.
Marital Settlement Agreement (checkbox)
Marital settlement agreement attached (Florida Family Law Rules Form 12.902(f)(3))	Checkbox	Check this box if you have attached the signed Marital Settlement Agreement (Form 12.902(f)(3)) and both parties signed it freely and voluntarily and intend to be bound by it.
Marital settlement agreement statement
Our marital settlement agreement is not in writing	Checkbox	Check this box if you do not have a written marital settlement agreement and you prefer to keep your financial agreements private.
Marriage Date and Place
City of Marriage	Text	Enter the name of the city where the marriage took place.
Marriage Date	Date	Enter the date on which the parties were married.
State of Marriage	Text	Enter the U.S. state where the marriage took place, or leave blank if married outside the United States. Fill only if 'Country of Marriage' is filled (any). Depends on: Country of Marriage
Country of Marriage	Text	Enter the country where the marriage occurred.
Nonlawyer Assistance
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] Check if form was prepared for the husband	CheckBox	Check this box if a nonlawyer prepared the form for the husband.
Check if form was prepared for the wife	CheckBox	Check this box if a nonlawyer prepared the form for the wife.
name of nonlawyer who assisted	Text	Enter the full name of the nonlawyer who assisted in filling out the form.
name of business	Text	Enter the name of the business associated with the nonlawyer assistance, if applicable.
address	Text	Enter the address of the nonlawyer or business that provided assistance.
telephone number	Text	Enter the telephone number of the nonlawyer or assisting business.
state	Text	Enter the state where the nonlawyer or assisting business is located.
city	Text	Enter the city where the nonlawyer or assisting business is located.
Party Names (Husband and Wife)
Name of Husband	Text	Enter the husband’s commonly used name for identification purposes.
Name of Wife	Text	Enter the wife’s commonly used name for identification purposes.
Husband's Full Legal Name	Text	Enter the husband's full legal name (first, middle, last) exactly as it appears on legal records.
Wife's Full Legal Name	Text	Enter the wife's full legal name (first, middle, last) exactly as it appears on legal records.
Husband's Name (caption)	Text	Enter the husband's name as it should appear in the case caption.
Wife's Name (caption)	Text	Enter the wife's name as it should appear in the case caption.
Wife former name (Yes/No and former name)
Yes - wife wants to be known by former name	Checkbox	Check this box if the wife wants to be known by her former name and you will provide her former full legal name on the line provided.
Wife's former (full legal) name	Text	Enter the wife's former full legal name exactly as she wishes to be known (leave blank if she is not using a former name). Fill only if 'Yes - wife wants to be known by former name' is 'Yes'. Depends on: Yes - wife wants to be known by former name
No - wife does not want to be known by former name	Checkbox	Check this box if the wife does not want to be known by her former name (do not enter a former name on the line).
Wife Info
Address	Text	Enter the street address of the wife.
City, State, Zip	Text	Enter the city, state, and zip code associated with the wife's address.
Wife Residence
Wife - City or Town of Residence	Text	Enter the name of the city, town, or municipality where the wife currently lives.
Wife - State of Residence	Text	Enter the name or abbreviation of the state where the wife currently lives.
Wife - Date Since Living There	Date	Provide the date the wife began living at the residence stated above. Fill only if 'Wife - City or Town of Residence', 'Wife - State of Residence' are filled (any). Depends on: Wife - City or Town of Residence, Wife - State of Residence
Wife signature and contact info
Date signed (Wife)	Date	Enter the date the Wife signed this petition.
City, State, ZIP (Wife)	Text	Enter the Wife's city, state, and ZIP code for her mailing address.
Telephone number (Wife)	Text	Enter the Wife's primary telephone number, including area code and any extension if applicable.
Fax number (Wife)	Text	Enter the Wife's fax number, including area code if applicable, or leave blank if none.
E‑mail address(es) (Wife)	Text	Enter the Wife's e-mail address or addresses (separate multiple addresses with commas).

Form 12.901(a), Petition for Simplified Dissolution of Marriage Instructions