Nonlawyer Disclosure

IN THE CIRCUIT COURT OF THE ___________________JUDICIAL CIRCUIT, IN AND FOR ______________________COUNTY, FLORIDA

Case No.: _________________
Division: _________________

_____________, told me that he/she is a nonlawyer and may not give legal advice, cannot tell me what my rights or remedies are, cannot tell me how to testify in court, and cannot represent me in court.

Rule 10-2.1(b) of the Rules Regulating The Florida Bar defines a paralegal as a person who works under the supervision of a member of The Florida Bar and who performs specifically delegated substantive legal work for which a member of The Florida Bar is responsible. Only persons who meet the definition may call themselves paralegals. ________________, informed me that he/she is not a paralegal and cannot call himself/herself a paralegal.

________________, told me that he/she may only type the factual information provided by me in writing into the blanks on the form. Ruth Tick , may not help me fill in the form and may not complete the form for me. If using a form approved by the Supreme Court of Florida, ____________________, may ask me factual questions to fill in the blanks on the form and may also tell me how to file the form.

[x one only] _x_ I can read English. ___ I cannot read English, but this disclosure was read to me [fill in both blanks] by {name} ____________________in {language} _______________________ , which I understand.

Dated: ___________________________

___________________________________________
Signature of Party
_____________________
Signature of NONLAWYER

Printed Name: ________________
Name of Business: _______________
Address: __________________
City/ State/ Zip: ____________________
Telephone Number: ______________________