Sworn Statement Of True Name And Pseudonym {8.988}

IN THE COUNTY COURT IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT IN AND FOR ___________________ COUNTY, FLORIDA ______________________ DIVISION ) ) ) ) ) ) ) ) , Petitioner, -vs, Respondent(s). Case No. Judge SWORN STATEMENT OF TRUE NAME AND PSEUDONYM NOTICE TO THE CLERK OF COURT: A CERTIFIED COPY OF THIS DECLARATION WITH THE CASE NUMBER NOTED ON IT SHALL BE GIVEN TO THE MINOR AFTER SHE SIGNS IT. THE ORIGINAL SHALL IMMEDIATELY BE PLACED IN A SEALED ENVELOPE WHICH SHALL BE FILED UNDER SEAL AND KEPT UNDER SEAL AT ALL TIMES. (1) My true name is , and my address is (2) My date of birth is . (3) I have filed a Petition for Judicial Waiver of Parental Notice of Termination of Pregnancy under the name or initials on , 20 . I understand that by signing this form I am swearing to or affirming the truthfulness of the information herein and that the punishment for knowingly making a false statement includes fines, imprisonment or both. Dated: Signature: __________________________________ (You must sign your true name.) Sworn Statement Of True Name And Pseudonym (8.988} American LegalNet, Inc. www.USCourtForms.com