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Designation of Current Address and E-mail Address - System Generated

Bert Damian Lewis has submitted a document to the Circuit Court of Broward County, Florida, providing his current mailing address and email address for the purposes of serving and receiving legal documents. His mailing address is in Cincinnati, OH, and he has designated the email address [email protected] for electronic communication. The document includes instructions regarding the maintenance of current contact information and the consequences of choosing to receive documents electronically.

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chefdamianlewis
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1 views

Designation of Current Address and E-mail Address - System Generated

Bert Damian Lewis has submitted a document to the Circuit Court of Broward County, Florida, providing his current mailing address and email address for the purposes of serving and receiving legal documents. His mailing address is in Cincinnati, OH, and he has designated the email address [email protected] for electronic communication. The document includes instructions regarding the maintenance of current contact information and the consequences of choosing to receive documents electronically.

Uploaded by

chefdamianlewis
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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IN THE CIRCUIT COURT OF THE SEVENTEENTH JUDICIAL CIRCUIT,

IN AND FOR Broward COUNTY, FLORIDA

Case No.:
Division:
Bert Damian Lewis ,
Petitioner,

and

Stephen P Pattee ,
Respondent.

DESIGNATION OF CURRENT MAILING AND E-MAIL ADDRESS

I, {full legal name}, Bert Damian Lewis , being sworn, certify that:

MAILING ADDRESS:

My current mailing address is:


769 Rue Center Court
{Street or Post Office Box} _________________________________________________________,
Cincinnati
{City}, ___________________________________, OH
{State}, _____________, 45245
{Zip}_____________.
{Telephone No.} 4159372149
_____________ {Fax No.} ______________________.

E-MAIL ADDRESS:
{Do not provide an e-mail address unless you choose to serve and receive all documents in the future
only by e-mail. If you are a self-represented litigant (appearing without an attorney), you are not
required to serve or receive documents by electronic mail (e-mail); however, once you designate an e-
mail address, that address will be the exclusive means of serving and receiving documents. Once you
choose to serve and receive documents by e-mail, you cannot change your decision.}
I wish to designate the following e-mail address(es) for the purposes of serving and receiving
documents:
[email protected]
___________________________________________________________________________________

Instructions for Florida Supreme Court Approved Family Law Form 12.915, Designation of Current Mailing and
E-mail Address (06/18)
I understand that I must keep the clerk’s office and the opposing party or parties notified of my
current mailing and e-mail address(es) and that all future papers in this lawsuit will be served at the
address(es) on record at the clerk’s office.
I certify that a copy of this document was _____ e-mailed _____ mailed _____ faxed and mailed
_____ hand-delivered to the person(s) listed below on {date}__________________________.

Other party or his/her attorney:


Name: _____________________________
Address: ____________________________
City, State, Zip: _______________________
Fax Number: _________________________
Designated E-mail Address(es): ___________
__________________________________

_____________________________________________
Signature of Party

STATE OF FLORIDA
COUNTY OF
Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

____________________________________________
[Print, type, or stamp commissioned name of notary
or clerk.]

_ Personally known
_ Produced identification
Type of identification produced

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the: {choose only one} _____ Petitioner _____ Respondent
This form was completed with the assistance of:
{name of individual} ______________________________________________________________,
{name of business} _______________________________________________________________,
{street} ______________________________________________,
{city} ,{state} __, {zip code}______,{telephone number}____

Instructions for Florida Supreme Court Approved Family Law Form 12.915, Designation of Current Mailing and
E-mail Address (06/18)

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