Amendments to Florida Family Law Forms

Full title: AMENDMENTS TO FLORIDA SUPREME COURT APPROVED FAMILY LAW FORMS — SEXUAL…

Court: Supreme Court of Florida

Date published: Mar 25, 2004

871 So. 2d 113 (Fla. 2004)

Opinion

No. SC04-132.

March 25, 2004.

PER CURIAM.

The 2003 Florida Legislature amended section 784.046, Florida Statutes (2002), to create a new cause of action for protection against sexual violence and to prohibit the assessment of fees for the filing of petitions for protection against repeat, dating, and sexual violence. See ch. 2003-117, § 2, at 733-40, Laws of Fla. These amendments became effective on July 1, 2003, see ch. 2003-117, § 3, at 740, Laws of Fla., and significantly affect the Florida Supreme Court Approved Family Law Forms, which are used by unrepresented litigants throughout the state to gain meaningful access to the courts.¹

1 We note that this is the second time in two years that statutory changes have required amendments to these forms. See Amendments to Fla. Supreme Court Approved Family Law Forms — Domestic Violence, Repeat Violence and Dating Violence Forms, 849 So.2d 1003 (Fla. 2003).

Pursuant to the procedures approved by this Court in Amendments to the Florida Family Law Rules of Procedure Family Law Forms, 810 So.2d 1, 14 (Fla. 2000), this Court has internally reviewed the Florida Supreme Court Approved Family Law Forms and determined that both new forms and amendments to existing domestic, repeat, and dating violence forms are necessary as a result of the legislation.² Input on this issue was sought and received from the Advisory Workgroup on The Florida Supreme Court Approved Family Law Forms, which provided valuable assistance.

2 We have jurisdiction. See art. V, § 2(a), Fla. Const.

Because the Legislature has prohibited the assessment of a filing fee for petitions for protection against repeat, dating, or sexual violence, we hereby delete Florida Supreme Court Approved Family Law Form 12.980(a), Affidavit and Motion for Waiver of Fees for Petition for Injunction for Protection Against Repeat Violence or Dating Violence. In response to the creation of a new cause of action for sexual violence, we create the following Supreme Court Approved Family Law Forms: Petition for Injunction for Protection Against Sexual Violence, Florida Supreme Court Approved Family Law Form 12.980(q); Temporary Injunction for Protection Against Sexual Violence, Florida Supreme Court Approved Family Law Form 12.980(r); Final Judgment of Injunction for Protection Against Sexual Violence (After Notice), Florida Supreme Court Approved Family Law Form 12.980(s).³

3 The deletion of form 12.980(a) and creation of forms 12.980(q), (r), and (s) require the renumbering of the remaining 12.980 forms as follows:
Form 12.980(b), Petition for Injunction for Protection Against Domestic Violence, has been renumbered as Form 12.980(a).
Form 12.980(c)(1), Order Setting Hearing on Petition for Injunction for Protection Against Domestic Violence, Repeat Violence, or Dating Violence Without Issuance of an Interim Temporary Injunction, has been renumbered as Form 12.980(b)(1).
Form 12.980(c)(2), Order Denying Petition for Injunction for Protection Against Domestic Violence, Repeat Violence, or Dating Violence, has been renumbered as Form 12.980(b)(2).
Form 12.980(d)(1), Temporary Injunction for Protection Against Domestic Violence With Minor Child(ren), has been renumbered as Form 12.980(c)(1).
Form 12.980(d)(2), Temporary Injunction for Protection Against Domestic Violence Without Minor Child(ren), has been renumbered as Form 12.980(c)(2).
Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic Violence With Minor Child(ren) (After Notice), has been renumbered as Form 12.980(d)(1).
Form 12.980(e)(2), Final Judgment of Injunction for Protection Against Domestic Violence Without Minor Child(ren) (After Notice), has been renumbered as Form 12.980(d)(2).
Form 12.980(f), Order of Dismissal of Temporary Injunction for Protection Against Domestic Violence, Repeat Violence, or Dating Violence, has been renumbered as Form 12.980(e).
Form 12.980(g), Petition for Injunction for Protection Against Repeat Violence, has been renumbered as Form 12.980(f).
Form 12.980(h), Supplemental Affidavit in Support of Petition for Injunction for Protection Against Domestic Violence, Repeat Violence, or Dating Violence, has been renumbered as Form 12.980(g).
Form 12.980(i), Petitioner's Request for Confidential Filing of Address, has been renumbered as Form 12.980(h).
Form 12.980(j), Motion for Extension of Injunction for Protection Against Domestic Violence, Repeat Violence, or Dating Violence, has been renumbered as Form 12.980(i).
Form 12.980(k), Motion for Modification of Injunction for Protection Against Domestic Violence, Repeat Violence, or Dating Violence, has been renumbered as Form 12.980(j).
Form 12.980( l), Temporary Injunction for Protection Against Repeat Violence, has been renumbered as Form 12.980(k).
Form 12.980(m), Final Judgment of Injunction for Protection Against Repeat Violence (After Notice), has been renumbered as Form 12.980( l).
Form 12.980(n), Order Extending Injunction for Protection Against Domestic Violence, Repeat Violence, or Dating Violence, has been renumbered as Form 12.980(m).
Form 12.980(o), Petition for Injunction for Protection Against Dating Violence, has been renumbered as Form 12.980(n).
Form 12.980(p), Temporary Injunction for Protection Against Dating Violence, has been renumbered as Form 12.980(o).
Form 12.980(q), Final Judgment of Injunction for Protection Against Dating Violence (After Notice), has been renumbered as Form 12.980(p).
Form 12.980(r), Petition by Affidavit for Order to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic Violence, Repeat Violence, or Dating Violence, has been renumbered as Form 12.980(t).
Form 12.980(s), Order to Show Cause, has been renumbered as Form 12.980(u).

We also adopt various amendments to the following existing Florida Supreme Court Approved Family Law Forms: Petition for Injunction for Protection Against Domestic Violence, Florida Supreme Court Approved Family Law Form 12.980(b); Order Setting Hearing on Petition for Injunction for Protection Against Domestic Violence, Repeat Violence, or Dating Violence Without Issuance of an Interim Temporary Injunction, Florida Supreme Court Approved Family Law Form 12.980(c)(1); Order Denying Petition for Injunction for Protection Against Domestic Violence, Repeat Violence, or Dating Violence, Florida Supreme Court Approved Family Law Form 12.980(c)(2); Temporary Injunction for Protection Against Domestic Violence With Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.980(d)(1); Temporary Injunction for Protection Against Domestic Violence Without Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.980(d)(2); Final Judgment of Injunction for Protection Against Domestic Violence with Minor Child(ren) (After Notice), Florida Supreme Court Approved Family Law Form 12.980(e)(1); Final Judgment of Injunction for Protection Against Domestic Violence Without Minor Child(ren) (After Notice), Florida Supreme Court Approved Family Law Form 12.980(e)(2); Order of Dismissal of Temporary Injunction for Protection Against Domestic Violence, Repeat Violence, or Dating Violence, Florida Supreme Court Approved Family Law Form 12.980(f); Petition for Injunction for Protection Against Repeat Violence, Florida Supreme Court Approved Family Law Form 12.980(g); Supplemental Affidavit in Support of Petition for Injunction for Protection Against Domestic Violence, Repeat Violence, or Dating Violence, Florida Supreme Court Approved Family Law Form 12.980(h); Petitioner's Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(i); Motion for Extension of Injunction for Protection Against Domestic Violence, Repeat Violence, or Dating Violence, Florida Supreme Court Approved Family Law Form 12.980(j); Motion for Modification of Injunction for Protection Against Domestic Violence, Repeat Violence, or Dating Violence, Florida Supreme Court Approved Family Law Form 12.980(k); Temporary Injunction for Protection Against Repeat Violence, Florida Supreme Court Approved Family Law Form 12.980( l); Final Judgment of Injunction for Protection Against Repeat Violence (After Notice), Florida Supreme Court Approved Family Law Form 12.980(m); Order Extending Injunction for Protection Against Domestic Violence, Repeat Violence, or Dating Violence, Florida Supreme Court Approved Family Law Form 12.980(n); Petition for Injunction for Protection Against Dating Violence, Florida Supreme Court Approved Family Law Form 12.980(o); Temporary Injunction for Protection Against Dating Violence, Florida Supreme Court Approved Family Law Form 12.980(p); Final Judgment of Injunction for Protection Against Dating Violence (After Notice), Florida Supreme Court Approved Family Law Form 12.980(q); Petition by Affidavit for Order to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic Violence, Repeat Violence, or Dating Violence, Florida Supreme Court Approved Family Law Form 12.980(r); and Order to Show Cause, Florida Supreme Court Approved Family Law Form 12.980(s).

Finally, some unrelated, minor technical changes have been made to the abovementioned forms as well as to Florida Supreme Court Approved Family Law Form 12.931(a), Notice of Production from Nonparty, and Florida Supreme Court Approved Family Law Form 12.931(b), Subpoena for Production of Documents from Nonparty.

The forms are adopted as set forth in the appendix to this opinion, fully engrossed, effective for immediate use. However, due to the number of new forms and amendments to existing forms, we direct that these forms be published in The Florida Bar News so that any interested person may file comments with this Court by June 1, 2004. By adoption of these forms, we express no opinion as to their correctness or applicability, or on the substance of the new legislation. This opinion and the forms discussed herein may be accessed and downloaded from this Court's website at www.flcourts.org.

It is so ordered.

ANSTEAD, C.J., and WELLS, PARIENTE, LEWIS, QUINCE, CANTERO, and BELL, JJ., concur.

PARIENTE, J., concurs with an opinion, in which ANSTEAD, C.J., concurs.

PARIENTE, J., concurring.

I concur in the adoption of the amendments to these forms. I write separately to point out the important role the Florida Supreme Court Approved Family Law Forms play in providing meaningful access to the courts for unrepresented litigants, and to acknowledge the work of both this Court's staff and the Office of State Courts Administrator in ensuring that the forms remain current.

Providing forms that are in conformity with the substantive law is essential to this Court's goal of simplifying the process in family law cases. See Amendments to the Florida Family Law Rules of Procedure Family Law Forms, 810 So.2d 1, 1 (Fla. 2000) ("Simplifying the process has been, and continues to be, a primary goal of this Court in the family law context."). As we explained in Amendments to the Florida Family Law Rules, simplifying the process is especially important

in the domestic violence context, wherein a great many of the litigants are unrepresented. As found by the Legislature," the incidence of domestic violence in Florida is disturbingly high, and despite efforts of many to curb this violence, . . . one person dies at the hands of a spouse, ex-spouse, or cohabitant approximately every 3 days." § 741.32(1), Fla. Stat. (1999) ("Certification of Batterers' Intervention Programs"); see also Weiand v. State, 732 So.2d 1044, 1053 (Fla. 1999) ("It is now widely recognized that domestic violence `attacks are often repeated over time, and escape from the home is rarely possible without the threat of great personal violence or death.'").

With so much at stake, simplicity in seeking, obtaining, and understanding the relief granted in domestic violence injunction cases is absolutely essential, especially in cases involving pro se litigants. We have in the past recognized that "domestic and repeat violence injunctions are an important and significant responsibility of family courts," In re Family Law [Rules of Procedure], 663 So.2d [1047,] 1049 [(Fla. 1995)], and that it is extremely important to have "domestic violence issues addressed in an expeditious, efficient, and deliberative manner." In re Report of the Comm'n on Family Courts, 646 So.2d 178, 182 (Fla. 1994). We now reiterate that "we do not want these important issues to become bogged down in an administrative morass." Id.

Id. at 2.

In deciding that this Court should be responsible for internally reviewing, revising, and otherwise maintaining the Florida Supreme Court Approved Family Law Forms, we concluded that this was consistent with "our overall vision that `the vast majority of the forms can be continually evaluated and updated . . . , and . . . can be approved by this Court by opinion whenever necessary.'" Id. at 14 (quoting In re Amendments to Fla. Family Laws Rules of Procedure, 724 So.2d 1159, 1160 (Fla. 1998)) (first alteration in original). We further concluded that "this plan frees the [Family Court Steering Committee] to do what this Court originally created it to do." Id. Although I believe that these reasons for placing the responsibility on the Court for the approved family law forms are still valid, I take this opportunity to comment on the resources required to ensure that litigants have access to forms that are consistent with current legislation.

The task of reviewing legislative amendments to the pertinent statutes each year to determine what changes to the forms are necessary is a labor-intensive process that requires attorneys knowledgeable in these issues, who are employed by the Court, to help ensure that the forms accurately reflect the substantive law.⁴ I have no doubt that the changes made by the Legislature are intended to improve family law matters. Eliminating the filing fee for petitions for protection against repeat, dating, or sexual violence undoubtedly allows greater access to the courts for victims of this type of abuse, while creating a new cause of action for sexual violence provides legal protection to a greater number of individuals. However, for these important legislative amendments to be of value to the greatest number of Florida citizens, this Court must labor to provide up-to-date forms. I reiterate this Court's conclusion in Amendments to the Florida Family Law Rules:

4 Over one hundred pages of forms were reviewed in this case alone.

Some might say that, although our goals in the family law context have been simplicity and uniformity, the end result appears to be a proliferation of forms. We acknowledge that there remains significant room for improvement, but we are proud of the fact that Florida remains a leader in this relatively uncharted area.

810 So.2d at 15.

ANSTEAD, C.J., concurs.

INSTRUCTIONS FOR SUPREME COURT APPROVED FAMILY LAW FORMS 12.931(a), NOTICE OF PRODUCTION FROM NONPARTY and 12.931(b), SUBPOENA FOR PRODUCTION OF DOCUMENTS FROM NONPARTY When should these forms be used?

These forms should be used if you need copies of documents (for a purpose relating to your case) from a nonparty in your case. Both forms should be typed or printed in black ink.

Notice of Production from Nonparty, Florida Supreme Court Approved Family Law Form 12.931(a), is used to notify the other party in your case that in 10 days you are going to subpoena documents from a nonparty. Subpoena for Production of Documents from Nonparty, Florida Supreme Court Approved Family Law Form 12.931(b), is the actual subpoena directing the nonparty to produce specific documents. You must file the originals of these forms with the clerk of the circuit court . A copy of these forms must be mailed or hand delivered to any other party in your case.

What should I do next?

Ten days after you serve the Notice of Production from Nonparty, Florida Supreme Court Approved Family Law Form 12.931(a), on the other party in your case (15 days if service is by mail), you should ask the clerk of the court to sign the subpoena. You should contact the deputy sheriff or private process server and have the subpoena personally served on the person named in the subpoena.

Where can I look for more information?

Before proceeding, you should read "General Information for Self-Represented Litigants" found at the beginning of these forms. Because these papers must also comply with rule 12.280, Florida Family Law Rule of Procedure, and rules 1.280, 1.350, 1.351, and 1.410, Florida Rules of Civil Procedure, you also should read those rules.

Special notes . . .

If the other party in your case objects in writing within 10 days (allow an additional 5 days if served by mail) of service of the Notice of Production from Nonparty, Florida Supreme Court Approved Family Law Form 12.931(a), you may not use this procedure to obtain documents from the nonparty unless and until the court orders otherwise.

The nonparty receiving the subpoena may charge you a reasonable fee for copies of the documents. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.

IN THE CIRCUIT COURT OF THE __________________________ JUDICIAL CIRCUIT, IN AND FOR _______________________________________ COUNTY, FLORIDA

Case No.: _____________________________

Division: _____________________________

________________________________, Petitioner,

and

_________________________________, Respondent.

NOTICE OF PRODUCTION FROM NONPARTY

TO: ________________________________________________________________ {all parties}

YOU ARE NOTIFIED that, after 10 days from the date of service of this notice, the undersigned will apply to the clerk of this Court for issuance of the attached subpoena directed to {name of person, organization, or agency} _____________________________, who is not a party, to produce the items listed at the time and place specified in the subpoena. Objections to the issuance of this subpoena must be filed with the clerk of the circuit court within 10 days.

I certify that a copy of this document was [ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} __________________________.

Other party or his/her attorney (if represented) Other

__________________________________ ____________________________________ Printed Name Printed Name __________________________________ ____________________________________ Address Address __________________________________ ____________________________________ City State Zip City State Zip ___________________________________ ____________________________________ Telephone (area code and number) Telephone (area code and number) ___________________________________ ____________________________________ Fax (area code and number) Fax (area code and number)

Dated: ____________________________

____________________________________ Signature of Party

Printed Name: ______________________ Address: ___________________________ City, State, Zip: __________________ Telephone Number: __________________ Fax Number: ________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks]

I, {full legal name and trade name of nonlawyer} _____________________, a nonlawyer, located at {street} ___________________, {city}_______________, {state} ______________, {phone} ______________, helped {name} __________, who is the [ one only] ___ petitioner or ___ respondent, fill out this form.

IN THE CIRCUIT COURT OF THE ___________________________ JUDICIAL CIRCUIT, IN AND FOR ____________________________ COUNTY, FLORIDA

Case No.: _____________________________ Division: _____________________________

_____________________________, Petitioner,

and

_____________________________, Respondent.

SUBPOENA FOR PRODUCTION OF DOCUMENTS FROM NONPARTY

THE STATE OF FLORIDA TO: ______________________________________________________________________

YOU MUST go to {place}________________________________________, on {date} ______________, at {time} _________________, a.m./p.m. and bring with you at that time and place the following: ___________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

These items will be inspected and may be copied at that time. You will not have to leave the original items.

You may obey this subpoena by providing readable copies of the items to be produced to the party or his/her attorney whose name appears on this subpoena on or before the scheduled date of production. You may condition the preparation of the copies upon payment in advance of the reasonable cost of preparation. If you mail or deliver the copies to the attorney whose name appears on this subpoena before the date indicated above, you do not have to appear in person.

You may be in contempt of court if you fail to: (1) appear as specified; (2) furnish the records instead of appearing as provided above; or (3) object to this subpoena.

You can only be excused by the person whose name appears on this subpoena and, unless excused by that person or the Court, you shall respond as directed.

Dated: _______________

CLERK OF THE CIRCUIT COURT (SEAL)

By:_______________________________________ Deputy Clerk

This part to be filled out by the court or filled in with information you have obtained from the court:

If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {name} ________________________________________________, {address} _________________________________________________ {telephone} ___________________, within 2 working days of your receipt of this subpoena. If you are hearing or voice impaired, call TDD 1-800-955-8771.

I CERTIFY that I gave notice to every other party to this action of my intent to serve a subpoena upon a person who is not a party to this action directing that person to produce documents or things without deposition. I also certify that no objection under Florida Rule of Civil Procedure 1.351 has been received by the undersigned within 10 days of service of this notice, if service was by hand delivery or appropriate facsimile transmission, and within 15 days if service was by mail.

Dated: _______________

____________________________________ Signature of Party Printed Name: ______________________ Address: ___________________________ City, State, Zip: __________________ Telephone Number: __________________ Fax Number: ________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks]

I, {full legal name and trade name of nonlawyer}___________________________, a nonlawyer, located at {street}____________________________________, {city} ___________, {state}___________________, {phone} ______________________, helped {name} ____________, who is the [ one only] ___ petitioner or ___ respondent, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(a), PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE When should this form be used?

If you are a victim of any act of domestic violence or have reasonable cause to believe that you are in imminent danger of becoming a victim of domestic violence, you can use this form to ask the court for a protective order prohibiting domestic violence. Because you are making a request to the court, you are called the petitioner . The person whom you are asking the court to protect you from is called the respondent . Domestic violence includes: assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnaping, false imprisonment, or any other criminal offense resulting in physical injury or death to petitioner by any of petitioner's family or household members. In determining whether you have reasonable cause to believe you are in imminent danger of becoming a victim of domestic violence, the court must consider all relevant factors alleged in the petition, including, but not limited to the following:

1. The history between the petitioner and the respondent, including threats, harassment, stalking, and physical abuse.

2. Whether the respondent has attempted to harm the petitioner or family members or individuals closely associated with the petitioner.

3. Whether the respondent has threatened to conceal, kidnap, or harm the petitioner's child or children.

4. Whether the respondent has intentionally injured or killed a family pet.

5. Whether the respondent has used, or has threatened to use, against the petitioner any weapons such as guns or knives.

6. Whether the respondent has physically restrained the petitioner from leaving the home or calling law enforcement.

7. Whether the respondent has a criminal history involving violence or the threat of violence.

8. The existence of a verifiable order of protection issued previously or from another jurisdiction.

9. Whether the respondent has destroyed personal property, including, but not limited to, telephones or other communications equipment, clothing, or other items belonging to the petitioner.

10. Whether the respondent engaged in any other behavior or conduct that leads the petitioner to have reasonable cause to believe that he or she is in imminent danger of becoming a victim of domestic violence.

The domestic violence laws only apply to your situation if the respondent is your spouse , former spouse, related to you by blood or marriage, living with you now or has lived with you in the past (if you are or were living as a family), or the other parent of your child(ren) whether or not you have ever been married or ever lived together. With the exception of persons who have a child in common, the family or household members must be currently residing together or have in the past resided together in the same single dwelling unit. If the respondent is not one of the above, you should look at Petition for Injunction for Protection Against Repeat Violence, Florida Supreme Court Approved Family Law Form 12.980(f), to determine if your situation will qualify for an injunction for protection against repeat violence, or Petition for Injunction for Protection Against Dating Violence, Florida Supreme Court Approved Family Law Form 12.980(n), to determine if your situation will qualify for an injunction for protection against dating violence, or Petition for Injunction for Protection Against Sexual Violence, Florida Supreme Court Approved Family Law Form 12.980(q), to determine if your situation will qualify for an injunction for protection against sexual violence.

If you are under the age of eighteen and you have never been married or had the disabilities of nonage removed by a court, then one of your parents or your legal guardian must sign this petition with you.

This form should be typed or printed in black ink. You should complete this form (giving as much detail as possible) and sign it in front of a notary public or the clerk of the circuit court in the county where you live. The clerk will take your completed petition to a judge . You should keep a copy for your records. If you have any questions or need assistance completing this form, the clerk or family law intake staff will help you.

What should I do if the judge grants my petition?

If the facts contained in your petition convince the judge that you are a victim of domestic violence or that an imminent danger of domestic violence exists, the judge will sign an immediate Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.980(c)(1). A temporary injunction is issued without notice to the respondent. The clerk will give your petition, the temporary injunction, and any other papers filed with your petition to the sheriff or other law enforcement officer for personal service on the respondent. The temporary injunction will take effect immediately after the respondent is served with a copy of it. It lasts until a full hearing can be held or for a period of 15 days, whichever comes first. The court may extend the temporary injunction beyond 15 days for a good reason, which may include failure to obtain service on the respondent.

The temporary injunction is issued " ex parte ." This means that the judge has considered only the information presented by one side — YOU. The temporary injunction gives a date that you should appear in court for a hearing. At that hearing, you will be expected to testify about the facts in your petition. The respondent will be given the opportunity to testify at this hearing, also. At the hearing, the judge will decide whether to issue a Final Judgment of Injunction for Protection Against Domestic Violence with Minor Child(ren) (After Notice), Florida Supreme Court Approved Family Law Form 12.980(d)(1), which will remain in effect for a specific time period or until modified or dissolved by the court. If you and/or the respondent do not appear, the temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including the imposition of court costs.

If the judge signs a temporary or final injunction, the clerk will provide you with the necessary copies. Make sure that you keep one certified copy of the injunction with you at all times!

What can I do if the judge denies my petition?

If your petition is denied on the grounds that it appears to the court that no imminent danger of domestic violence exists, the court will set a full hearing, at the earliest possible time, on your petition. The respondent will be notified by personal service of your petition and the hearing. If your petition is denied, you may: amend your petition by filing a Supplemental Affidavit in Support of Petition for Injunction for Protection Against Domestic Violence, Repeat or Dating Violence, Florida Family Law Form 12.980 (g); attend the hearing and present facts that support your petition; and/or dismiss your petition.

Where can I look for more information?

Before proceeding, you should read "General Information for Self-Represented Litigants" found at the beginning of these forms. The words that are in " bold underline " are defined in that section. The clerk of the circuit court or family law intake staff will help you complete any necessary domestic violence forms and can give you information about local domestic violence victim assistance programs, shelters, and other related services. You may also call the Domestic Violence Hotline at 1-800-500-1119. For further information, see chapter 741, Florida Statutes, and rule 12.610, Florida Family Law Rules of Procedure.

Special notes . . .

With this form you may also need to file the following:

• Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), must be completed and filed if you are asking the court to determine issues of temporary custody or visitation with regards to a minor child(ren).

• Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), must be completed and filed if you are asking the court to determine issues of temporary child support.

• Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), must be completed and filed if you are seeking temporary alimony or temporary child support.

• Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), MUST be filed with the court at or prior to a hearing to establish or modify child support.

Additionally, if you fear that disclosing your address to the respondent would put you in danger, you should complete Petitioner's Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), and file it with the clerk of the circuit court and write "confidential" in the space provided on the petition.

IN THE CIRCUIT COURT OF THE ____________________________ JUDICIAL CIRCUIT, IN AND FOR ______________________________ COUNTY, FLORIDA

Case No.: _____________________________ Division: _____________________________

_____________________________, Petitioner,

and

_____________________________, Respondent.

PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE

I, {full legal name} ___________________, being sworn, certify that the following statements are true:

SECTION I. PETITIONER (This section is about you. It must be completed. However, if you fear that disclosing your address to the respondent would put you in danger, you should complete and file Petitioner's Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), and write "confidential" in the space provided on this form for your address and telephone number.)

1. Petitioner currently lives at: {street address} _______________________ {city, state and zip code} ____________________________________________ Telephone Number: {area code and number} ______________________________ Physical description of Petitioner: Race: ____ Sex: Male ___ Female ___ Date of Birth: _________________

2. Petitioner's attorney's name, address, and telephone number is: __________________________________________________________________. (If you do not have an attorney, write "none.")

SECTION II. RESPONDENT (This section is about the person you want to be protected from. It must be completed.)

1. Respondent currently lives at: {street address, city, state, and zip code} ________________________________________________________________. Respondent's Driver's License number is: {if known} _______________________________.

2. Respondent is: [ all that apply]

___ a. the spouse of Petitioner. Date of Marriage: _______________________ ___ b. the former spouse of Petitioner. Date of Marriage: _____________________________ Date of Divorce: ______________________________ ___ c. related by blood or marriage to Petitioner. Specify relationship: _____________________________________________ ___ d. a person who is or was living in one home with Petitioner, as if a family. ___ e. a person with whom Petitioner has a child in common, even if Petitioner and Respondent never were married or living together.

3. Petitioner has known Respondent since {date} ________________________.

4. Respondent's last known place of employment: __________________________ Employment address: ___________________________________________________ Working hours: ________________________________________________________

5. Physical description of Respondent:

Race: ____ Sex: Male ____ Female ____ Date of Birth: __________________ Height: ____ Weight: ____ Eye Color: ____ Hair Color: _________________ Distinguishing marks or scars: ________________________________________ Vehicle: (make/model) _____________ Color: _________ Tag Number: ______

6. Other names Respondent goes by (aliases or nicknames): _________________

7. Respondent's attorney's name, address, and telephone number is: ________ _______________________________________________________________________ (If you do not know whether Respondent has an attorney, write" unknown." If Respondent does not have an attorney, write" none.")

SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION (This section must be completed.)

1. Has Petitioner ever received or tried to get an injunction for protection against domestic violence against Respondent in this or any other court?

____ Yes ____ No If yes, what happened in that case? (include case number, if known) _____________________________________________________ _______________________________________________________________________

2. Has Respondent ever received or tried to get an injunction for protection against domestic violence against Petitioner in this or any other court?

____ Yes ____ No If yes, what happened in that case? (include case number, if known) _______________________________________________________________________ _______________________________________________________________________

3. Describe any other court case that is either going on now or that happened in the past, including a dissolution of marriage, paternity action, or child support enforcement action, between Petitioner and Respondent {include city, state, and case number, if known}: _______ _______________________________________________________________________

4. Petitioner is the victim of an act of domestic violence or has reasonable cause to believe that he or she is in imminent danger of becoming the victim of an act of domestic violence. Below is a brief description of the latest act of violence or threat of violence that causes Petitioner to honestly fear imminent domestic violence by Respondent. (Use additional sheets if necessary.)

On {date} ______________, at {location} _____________________________, the Respondent __________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

Check here if you are attaching additional pages to continue these facts.

5. Additional Information

[ all that apply]

___ a. Other acts or threats of domestic violence as described on attached sheet. ___ b. This or other acts of domestic violence have been previously reported to {person or agency}: ______________________________. ___ c. Respondent owns, has, and/or is known to have guns or other weapons. Describe weapon(s): ______________________________________________ ___ d. Respondent has a drug problem. ___ e. Respondent has an alcohol problem. ___ f. Respondent has a history of mental health problems. If checked, answer the following, if known.

Has Respondent ever been the subject of a Baker Act proceeding? ( ) Yes ( ) No

Is Respondent supposed to take medication for mental health problems? ( ) Yes ( ) No

If yes, is Respondent currently taking his/her medication? ( ) Yes ( ) No

SECTION IV. TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME (Complete this section only if you want the Court to grant you temporary exclusive use and possession of the home that you share with the Respondent.)

1. Petitioner claims the following about the home that Petitioner and Respondent share or that Petitioner left because of domestic violence:

[ all that apply]

___ a. Petitioner needs the exclusive use and possession of the home that the parties share at {street address} ________________________, {city, state, zip code} ___________________________________________.

___ b. Petitioner cannot get another safe place to live because: __________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ ______________________________________________________________________.

___ c. If kept out of the home, Respondent has the money to get other housing or may live without money at {street address} ________________, {city, state, zip code} ______________________________________________.

2. The home is:

[ one only]

___ a. owned or rented by Petitioner and Respondent jointly.

___ b. solely owned or rented by Petitioner.

___ c. solely owned or rented by Respondent.

SECTION V. TEMPORARY CUSTODY OF MINOR CHILD(REN) (Complete this section only if you are seeking temporary custody of any minor child. You must be the natural parent, adoptive parent, or guardian by court order of the minor child(ren). If you are asking the court to determine issues of temporary custody with regards to a minor child, you must also complete and file a Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d). Note: If the paternity of the minor child(ren) listed below has not been established through either marriage or court order, the Court may deny temporary custody, visitation, and/or support.

1. Petitioner is the natural parent, adoptive parent, or guardian by court order of the minor child(ren) whose name(s) and age(s) is (are) listed below.

Name Place of Birth Birth date Sex _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

2. The minor child(ren) whom Petitioner is seeking temporary custody of: [ one only]

___ a. saw the domestic violence described in this petition happen. ___ b. were at the place where the domestic violence happened but did not see it. ___ c. were not there when the domestic violence happened this time but have seen previous acts of domestic violence by Respondent. ___ d. have not witnessed domestic violence by Respondent.

3. Name any other minor child(ren) who were there when the domestic violence happened. Include child(ren)'s name, age, sex, and parents' names. _____________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

4. Visitation

[ all that apply]

___ a. Petitioner requests that the Court order reasonable visitation by Respondent with the minor child(ren), as follows: _____________________ _______________________________________________________________________ _______________________________________________________________________

___ b. Petitioner requests that the Court order supervised exchange of the minor child(ren) or exchange through a responsible person designated by the Court. The following person is suggested as a responsible person for purposes of such exchange. Explain: ____________ _______________________________________________________________________ _______________________________________________________________________

___ c. Petitioner requests that the Court limit visitation by Respondent with the minor child(ren). Explain: ______________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

___ d. Petitioner requests that the Court prohibit visitation by Respondent with the minor child(ren) because Petitioner genuinely fears that Respondent imminently will abuse, remove, or hide the minor child(ren) from Petitioner. Explain: ____________________________ _______________________________________________________________________ _______________________________________________________________________

SECTION VI. TEMPORARY SUPPORT (Complete this section only if you are seeking financial support from the Respondent. You must also complete and file a Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), and Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902 (j), if you are seeking child support. A Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), must be filed with the court at or prior to a hearing to establish or modify child support.)

[ all that apply]

___ 1. Petitioner claims a need for the money he or she is asking the Court to make Respondent pay, and that Respondent has the ability to pay that money.

___ 2. Petitioner requests that the Court order Respondent to pay the following temporary alimony to Petitioner. (Petitioner must be married to Respondent to ask for temporary alimony.) Temporary Alimony Requested $ __________ every ( ) week ( ) other week ( ) month.

___ 3. Petitioner requests that the Court order Respondent to pay the following temporary child support to Petitioner. (The respondent must be the natural parent, adoptive parent, or guardian by court order of the minor child(ren) for the court to order the respondent to pay child support.) Temporary child support is requested in the amount of $ ___________ every ( ) week ( ) other week ( ) month.

SECTION VII. INJUNCTION (This section summarizes what you are asking the Court to include in the injunction. This section must be completed.)

1. Petitioner asks the Court to enter a TEMPORARY INJUNCTION for protection against domestic violence that will be in place from now until the scheduled hearing in this matter.

2. Petitioner asks the Court to enter, after a hearing has been held on this petition, a final judgment on injunction prohibiting Respondent from committing any acts of domestic violence against Petitioner and:

a. prohibiting Respondent from going to or within 500 feet of any place the Petitioner lives;

b. prohibiting Respondent from going to or within 500 feet of the Petitioner's place(s) of employment or school; the address of Petitioner's place(s) of employment or school is: _____________________

c. prohibiting Respondent from contacting Petitioner by mail, by telephone, through another person, or in any other manner;

d. prohibiting Respondent from knowingly and intentionally going to or within 100 feet of Petitioner's motor vehicle.

e. prohibiting Respondent from defacing or destroying Petitioner's personal property.

[ all that apply]

___ f. prohibiting Respondent from going to or within 500 feet of the following place(s) Petitioner or Petitioner's minor child(ren) must go often {include address}: ___________________________________________ _______________________________________________________________________

___ g. granting Petitioner temporary exclusive use and possession of the home Petitioner and Respondent share;

___ h. granting Petitioner temporary exclusive custody of the parties' minor child(ren);

___ i. establishing visitation rights with the parties' minor child(ren);

___ j. granting temporary alimony for Petitioner;

___ k. granting temporary child support for the minor child(ren);

___ l. ordering Respondent to participate in treatment, intervention, and/or counseling services;

___ m. referring Petitioner to a certified domestic violence center; and any other terms the Court deems necessary for the protection of Petitioner and/or Petitioner's child(ren), including injunctions or directives to law enforcement agencies, as provided in section 741.30, Florida Statutes.

I UNDERSTAND THAT BY FILING THIS PETITION, I AM ASKING THE COURT TO HOLD A HEARING ON THIS PETITION, THAT BOTH RESPONDENT AND I WILL BE NOTIFIED OF THE HEARING, AND THAT I MUST APPEAR AT THE HEARING. I HAVE READ EVERY STATEMENT MADE IN THIS PETITION, AND EACH STATEMENT IS TRUE AND CORRECT. I UNDERSTAND THAT THE STATEMENTS MADE IN THIS PETITION ARE BEING MADE UNDER PENALTY OF PERJURY, PUNISHABLE AS PROVIDED IN SECTION 837.02, FLORIDA STATUTES.

______________ (initials)

Dated: ______________________

_____________________________ Signature of Petitioner

STATE OF FLORIDA COUNTY OF ___________________

Sworn to or affirmed and signed before me on ____________________ by _______________________________.

_____________________________________ NOTARY PUBLIC or DEPUTY CLERK

_____________________________________ ___ Personally known [Print, type, or stamp commissioned name of notary or clerk.]

___ Produced identification Type of identification produced ______________________________

IN THE CIRCUIT COURT OF THE _____________________________ JUDICIAL CIRCUIT, IN AND FOR ____________________________ COUNTY, FLORIDA

Case No.: _________________________ Division: _________________________

______________________________, Petitioner,

and

______________________________, Respondent.

ORDER SETTING HEARING ON PETITION FOR INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE ( ) DATING VIOLENCE ( ) SEXUAL VIOLENCE WITHOUT ISSUANCE OF AN INTERIM TEMPORARY INJUNCTION

The Petition for Injunction for Protection Against Domestic Violence filed under section 741.30, Florida Statutes, or Repeat Violence, Dating Violence, or Sexual Violence under section 784.046, Florida Statutes, has been reviewed. This Court has jurisdiction of the parties and of the subject matter. A Temporary Injunction for Protection Against Repeat, Dating, or Sexual Violence, pending the hearing scheduled below, is NOT being entered at this time but an injunction may be entered after the hearing, depending on the findings made by the Court at that time.

FINDINGS

The Court finds that the facts, as stated in the Petition alone and without a hearing on the matter, do not demonstrate that Petitioner is a victim of domestic, repeat, dating, or sexual violence or that Petitioner has reasonable cause to believe that he or she is in imminent danger of becoming a victim of domestic or dating violence. Therefore, there is not a sufficient factual basis upon which the court can enter a Temporary Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence prior to a hearing. A hearing is scheduled on the Petition for Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence in section II of this Order. Petitioner may amend or supplement the Petition at any time to state further reasons why a Temporary Injunction should be ordered which would be in effect until the hearing scheduled below.

NOTICE OF HEARING

Petitioner and Respondent are ordered to appear and testify at a hearing on the Petition for Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence on {date} ____, at ____ a.m./p.m. at {location} ____, at which time the Court will consider whether a Final Judgment of Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence should be entered. If entered, the injunction will remain in effect until a fixed date set by the Court or until modified or dissolved by the Court. At the hearing, the Court will determine whether other things should be ordered, including, for example, such matters as visitation and support.

If Petitioner and/or Respondent do not appear, orders may be entered, including the imposition of court costs or an injunction.

All witnesses and evidence, if any, must be presented at this time. In cases where temporary support issues have been alleged in the pleadings, each party is ordered to bring his or her financial affidavit ( Florida Family Law Rules of Procedure Form 12.902(b) or (c)), tax return, pay stubs, and other evidence of financial income to the hearing.

NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at public expense.

YOU ARE ADVISED THAT IN THIS COURT:

___ a. a court reporter is provided by the court.

___ b. electronic audio tape recording only is provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense.

___ c. in repeat, dating, and sexual violence cases, no electronic audio tape recording or court reporting services are provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense.

A RECORD, WHICH INCLUDES A TRANSCRIPT, MAY BE REQUIRED TO SUPPORT AN APPEAL. THE PARTY SEEKING THE APPEAL IS RESPONSIBLE FOR HAVING THE TRANSCRIPT PREPARED BY A COURT REPORTER. THE TRANSCRIPT MUST BE FILED WITH THE REVIEWING COURT OR THE APPEAL MAY BE DENIED.

If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {name} __________________________________________________________________________, {address} ____________________________________, {telephone} _____________________, within 2 working days of your receipt of this order. If you are hearing or voice impaired, call TDD 1-800-955-8771.

Nothing in this order limits Petitioner's rights to dismiss the petition.

ORDERED on ___________________________________.

_____________________________________ CIRCUIT JUDGE

COPIES TO:

Petitioner: ___ by hand delivery in open Court

___ by U.S. mail

Respondent: ___ forwarded to sheriff for service

Other: ___________________________________________________

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of _______________ County, Florida, and that I have furnished copies of this order as indicated above.

CLERK OF THE CIRCUIT COURT

(SEAL) By: _________________________________ Deputy Clerk

IN THE CIRCUIT COURT OF THE ____________________________ JUDICIAL CIRCUIT, IN AND FOR __________________________________ COUNTY, FLORIDA

Case No.: ___________________________ Division: ___________________________

_________________________________, Petitioner,

and

_________________________________, Respondent.

ORDER DENYING PETITION FOR INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE ( ) DATING VIOLENCE ( ) SEXUAL VIOLENCE

The Court has reviewed the Petition for Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence filed in this cause and finds that Petitioner has failed to comply with one or more statutory requirements applicable to that petition including the following:

___ 1. Petitioner has failed to allege in a petition for domestic violence that Respondent is a family or household member as that term is defined by Chapter 741, Florida Statutes.

___ 2. Petitioner has used a petition form other than that which is approved by the Court and the form used lacks the statutorily required components.

___ 3. Petitioner has failed to complete a mandatory portion of the petition.

___ 4. Petitioner has failed to sign the petition.

___ 5. Petitioner has failed to allege facts sufficient to support the entry of an injunction for protection against domestic, repeat, dating, or sexual violence because: ___________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ ______________________________________________________________________.

___ 6. Other: _____________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ ______________________________________________________________________.

It is therefore, ORDERED AND ADJUDGED that the Petition is denied without prejudice to amend or supplement the petition to cure the above stated defects.

ORDERED ON ______________.

____________________________________________ CIRCUIT JUDGE

COPIES TO:

Petitioner: ___ by hand delivery in open Court ___ by U.S. mail

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of _________ County, Florida, and that I have furnished copies of this order as indicated above.

CLERK OF THE CIRCUIT COURT

(SEAL) By: _________________________________ Deputy Clerk

IN THE CIRCUIT COURT OF THE ___________________________ JUDICIAL CIRCUIT, IN AND FOR ________________________________ COUNTY, FLORIDA

Case No.: ___________________________ Division: ___________________________

_________________________________, Petitioner,

and

_________________________________, Respondent.

TEMPORARY INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE WITH MINOR CHILD(REN)

The Petition for Injunction for Protection Against Domestic Violence under section 741.30, Florida Statutes, and other papers filed in this Court have been reviewed. Under the laws of Florida, the Court has jurisdiction of the petitioner and the subject matter and has jurisdiction of the respondent upon service of the temporary injunction.

It is intended that this protection order meet the requirements of 18 U.S.C. § 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe.

NOTICE OF HEARING

Because this Temporary Injunction for Protection Against Domestic Violence has been issued without prior notice to Respondent, Petitioner and Respondent are instructed that they are scheduled to appear and testify at a hearing regarding this matter on {date} __________, at _________________________ a.m./p.m., when the Court will consider whether the Court should issue a Final Judgment of Injunction for Protection Against Domestic Violence, which would remain in effect until modified or dissolved by the Court, and whether other things should be ordered, including, for example, such matters as visitation and support. The hearing will be before The Honorable {name} _______________, at {room name/number, location, address, city} ____________________________________________________ ________________________________________________________________, Florida. If Petitioner and/or Respondent do not appear, this temporary injunction may be continued in force, extended, dismissed, and/or additional orders may be granted, including the imposition of court costs.

All witnesses and evidence, if any, must be presented at this time. In cases where temporary support issues have been alleged in the pleadings, each party is ordered to bring his or her financial affidavit ( Florida Family Law Rules of Procedure Form 12.902(b) or (c)), tax return, pay stubs, and other evidence of financial income to the hearing.

NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at public expense.

YOU ARE ADVISED THAT IN THIS COURT:

___ a. a court reporter is provided by the court.

___ b. electronic audio tape recording only is provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense.

A RECORD, WHICH INCLUDES A TRANSCRIPT, MAY BE REQUIRED TO SUPPORT AN APPEAL. THE PARTY SEEKING THE APPEAL IS RESPONSIBLE FOR HAVING THE TRANSCRIPT PREPARED BY A COURT REPORTER. THE TRANSCRIPT MUST BE FILED WITH THE REVIEWING COURT OR THE APPEAL MAY BE DENIED.

If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {name} __________________________________________________________________________, {address} ________________________________________, {telephone} ___________________________, within 2 working days of your receipt of this temporary injunction. If you are hearing or voice impaired, call TDD 1-800-955-8771.

FINDINGS

The statements made under oath by Petitioner make it appear that section 741.30, Florida Statutes, applies to the parties. It also appears that Petitioner is a victim of domestic violence by Respondent, and/or Petitioner has reasonable cause to believe he/she is in imminent danger of becoming a victim of domestic violence by Respondent, and that there is an immediate and present danger of domestic violence to Petitioner or persons lawfully with Petitioner.

TEMPORARY INJUNCTION AND TERMS

This injunction shall be effective until the hearing set above and in no event for longer than 15 days, unless extended by court order. If a final order of injunction is issued, the terms of this temporary injunction will be extended until service of the final injunction is effected upon Respondent. This injunction is valid and enforceable in all counties of the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction. Any violation of this injunction, whether or not at the invitation of Petitioner or anyone else, may subject Respondent to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment. Certain willful violations of the terms of this injunction, such as: refusing to vacate the dwelling that the parties share; going to or being within 500 feet of Petitioner's residence, going to Petitioner's place of employment, school, or other place prohibited in this injunction; telephoning, contacting or communicating with Petitioner if prohibited by this injunction; knowingly or intentionally coming within 100 feet of Petitioner's motor vehicle, whether or not it is occupied; defacing or destroying Petitioner's personal property; refusing to surrender firearms or ammunition if ordered to do so by the court; or committing an act of domestic violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes. In addition, it is a federal criminal felony offense, punishable by up to life imprisonment, depending on the nature of the violation, to cross state lines or enter Indian country for the purpose of engaging in conduct that is prohibited in this injunction. 18 U.S.C. § 2262.

ORDERED and ADJUDGED:

1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of domestic violence against Petitioner. Domestic violence includes: assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnaping, false imprisonment, or any other criminal offense resulting in physical injury or death to Petitioner or any of Petitioner's family or household members. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner.

2. No Contact. Respondent shall have no contact with Petitioner unless otherwise provided in this Section, or unless paragraph 14 below provides for contact connected with the temporary custody of and visitation with minor child(ren).

___ a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner's current residence {list address} ___________________________________________ _______________________________________________________________________ or any residence to which Petitioner may move; Petitioner's current or any subsequent place of employment {list address of current employment} _______________________________________________________________________ or place where Petitioner attends school {list address of school} _________________________________________________________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner's minor child(ren) go often: _______________________________ _______________________________________________________________________ ______________________________________________________________________. Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time.

___ b. Other provisions regarding contact: ________________________________ _______________________________________________________________________ _______________________________________________________________________

3. Firearms.

[Initial all that apply; write N/A if does not apply]

___ a. Respondent shall not use or possess a firearm or ammunition. ___ b. Respondent shall surrender any firearms and ammunition in the Respondent's possession to the ___________________ County Sheriff's Department until further order of the court.

___ c. Other directives relating to firearms and ammunition: ______________ _______________________________________________________________________ _______________________________________________________________________

NOTE: RESPONDENT IS ADVISED THAT, IF A PERMANENT INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE IS ISSUED FOLLOWING A HEARING REGARDING THIS MATTER, IN MOST CASES IT WILL BE A VIOLATION OF § 790.233, FLORIDA STATUTES, AND A FIRST DEGREE MISDEMEANOR, FOR RESPONDENT TO HAVE IN HIS OR HER CARE, CUSTODY, POSSESSION OR CONTROL ANY FIREARM OR AMMUNITION. ADDITIONALLY, IT WILL BE A FEDERAL CRIMINAL FELONY OFFENSE TO SHIP OR TRANSPORT IN INTERSTATE OR FOREIGN COMMERCE, OR POSSESS IN OR AFFECTING COMMERCE, ANY FIREARM OR AMMUNITION; OR TO RECEIVE ANY FIREARM OR AMMUNITION WHICH HAS BEEN SHIPPED OR TRANSPORTED IN INTERSTATE OR FOREIGN COMMERCE WHILE SUBJECT TO SUCH AN INJUNCTION. 18 U.S.C. § 922(g)(8).

4. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding the final injunction, if entered without Respondent being present at the hearing, and pleadings requiring personal service) shall be served by mail to Respondent's last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Fla.Fam.L.R.P., section 741.30, Florida Statutes.

5. Additional order(s) necessary to protect Petitioner from domestic violence: _____________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME

[Initial all that apply; write N/A if does not apply]

6. ___ Possession of the Home. () Petitioner () Respondent shall have temporary exclusive use and possession of the dwelling located at: __________________________________________________________________.

7. ___ Transfer of Possession of the Home. A law enforcement officer with jurisdiction over the home shall accompany ( ) Petitioner ( ) Respondent to the home, and shall place ( ) Petitioner ( ) Respondent in possession of the home.

8. ___ Personal Items. ( ) Petitioner ( ) Respondent, in the presence of a law enforcement officer, may return to the premises described above ( ) on _____________, _____________, at _________ a.m./p.m., or ( ) at a time arranged with the law enforcement department with jurisdiction over the home, for the purpose of obtaining his or her clothing and items of personal health and hygiene and tools of the trade. A law enforcement officer with jurisdiction over the home from which these items are to be retrieved shall accompany ( ) Petitioner ( ) Respondent to the home and stand by to insure that he/she vacates the premises with only his/her personal clothing, toiletries, tools of the trade, and any items listed in paragraph 10 below. The law enforcement agency shall not be responsible for storing or transporting any property. IF THE RESPONDENT IS NOT AWARDED POSSESSION OF THE HOME AND GOES TO THE HOME WITHOUT A LAW ENFORCEMENT OFFICER, IT IS A VIOLATION OF THIS INJUNCTION.

9. ___ ( ) Petitioner ( ) Respondent shall not damage or remove any furnishings or fixtures from the parties' former shared premises.

10. ___ Other: ____________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________

TEMPORARY SUPPORT

Temporary support, if requested by Petitioner in the Petition for Injunction for Protection Against Domestic Violence, will be addressed by the Court after notice to Respondent and hearing on the matter.

TEMPORARY CUSTODY OF MINOR CHILD(REN)

11. Jurisdiction. Jurisdiction to determine custody of any minor child(ren) listed in paragraph 12 below is proper under the Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA).

12. Temporary Custody of Minor Child(ren). ( ) Petitioner ( ) Respondent shall have temporary custody of the parties' minor child(ren) listed below:

Name Birth date _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

When requested by the custodial parent, law enforcement officers shall use any and all reasonable and necessary force to physically deliver the minor child(ren) listed above to custodial parent. The noncustodial parent shall not take the child(ren) from the custody of custodial parent or any child care provider or other person entrusted by the custodial parent with the care of the child(ren).

[Initial if applies; write N/A if does not apply]

___ Neither party shall remove the minor child(ren) from the State of Florida, which is the jurisdiction of this Court, prior to the hearing on this temporary injunction. Violation of this custody order may constitute a felony of the third degree under sections 787.03 and 787.04, Florida Statutes.

13. Contact with Minor Child(ren). Unless otherwise provided in paragraph 14 below, the noncustodial parent shall have no contact with the parties' minor child(ren) until further order of the Court.

14. Other Additional Provisions Relating to the Minor Child(ren). _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

OTHER SPECIAL PROVISIONS (This section to be used for inclusion of local provisions approved by the chief judge as provided in Florida Family Law Rule 12.610.) DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION (Provisions in this injunction that do not include a line for the judge to either initial or write N/A are considered mandatory provisions and should be interpreted to be part of this injunction.)

1. The Sheriff of _____________ County, or any other authorized law enforcement officer, is ordered to serve this temporary injunction upon Respondent as soon as possible after its issuance.

2. This injunction is valid in all counties of the State of Florida. Violation of this injunction should be reported to the appropriate law enforcement agency. Law enforcement officers of the jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this injunction and are authorized to arrest without warrant pursuant to section 901.15, Florida Statutes, for any violation of its provisions which constitutes a criminal act under section 741.31, Florida Statutes.

3. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES. The arresting agent shall notify the State Attorney's Office immediately after arrest.

4. Reporting alleged violations. If Respondent violates the terms of this injunction and there has not been an arrest, Petitioner may contact the Clerk of the Circuit Court of the county in which the violation occurred and complete an affidavit in support of the violation, or Petitioner may contact the State Attorney's office for assistance in filing an action for indirect civil contempt or indirect criminal contempt. Upon receiving such a report, the State Attorney is hereby appointed to prosecute such violations by indirect criminal contempt proceedings, or the State Attorney may decide to file a criminal charge, if warranted by the evidence.

ORDERED on ________________.

______________________________________ CIRCUIT JUDGE

COPIES TO: Sheriff of ____________ County Petitioner (or his or her attorney): ____ by U.S. Mail ____ by hand delivery in open court

Respondent: ____ forwarded to sheriff for service ____ State Attorney's Office ____ Other: ______________________________________________

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of _________ County, Florida, and that I have furnished copies of this order as indicated above.

CLERK OF THE CIRCUIT COURT

(SEAL) By:____________________________________ Deputy Clerk

IN THE CIRCUIT COURT OF THE _________________ JUDICIAL CIRCUIT, IN AND FOR ___________________ COUNTY, FLORIDA

Case No.: _________________________ Division: _________________________

______________________________, Petitioner,

and

______________________________, Respondent.

TEMPORARY INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE WITHOUT MINOR CHILD(REN)

The Petition for Injunction for Protection Against Domestic Violence under section 741.30, Florida Statutes, and other papers filed in this Court have been reviewed. Under the laws of Florida, the Court has jurisdiction of the petitioner and the subject matter and has jurisdiction of the respondent upon service of the temporary injunction.

It is intended that this protection order meet the requirements of 18 U.S.C. § 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe.

NOTICE OF HEARING

Because this Temporary Injunction for Protection Against Domestic Violence has been issued without prior notice to Respondent, Petitioner and Respondent are instructed that they are scheduled to appear and testify at a hearing regarding this matter on {date} ______________, at _____________ a.m./p.m., when the Court will consider whether the Court should issue a Final Judgment of Injunction for Protection Against Domestic Violence, which would remain in effect until modified or dissolved by the Court, and whether other things should be ordered, including, for example, such matters as support. The hearing will be before The Honorable {name} _____________, at {room name/number, location, address, city} ____________________________________________, Florida. If Petitioner and/or Respondent do not appear, this temporary injunction may be continued in force, extended, dismissed, and/or additional orders may be granted, including the imposition of court costs.

All witnesses and evidence, if any, must be presented at this time. In cases where temporary support issues have been alleged in the pleadings, each party is ordered to bring his or her financial affidavit ( Florida Family Law Rules of Procedure Form 12.902(b) or (c)), tax return, pay stubs, and other evidence of financial income to the hearing.

NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at public expense.

YOU ARE ADVISED THAT IN THIS COURT:

____ a. a court reporter is provided by the court.

____ b. electronic audio tape recording only is provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense.

A RECORD, WHICH INCLUDES A TRANSCRIPT, MAY BE REQUIRED TO SUPPORT AN APPEAL. THE PARTY SEEKING THE APPEAL IS RESPONSIBLE FOR HAVING THE TRANSCRIPT PREPARED BY A COURT REPORTER. THE TRANSCRIPT MUST BE FILED WITH THE REVIEWING COURT OR THE APPEAL MAY BE DENIED.

If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {name} ___________________________________________, {address} _________________________________, {telephone} _________, within 2 working days of your receipt of this temporary injunction. If you are hearing or voice impaired, call TDD 1-800-955-8771.

FINDINGS

The statements made under oath by Petitioner make it appear that section 741.30, Florida Statutes, applies to the parties. It also appears that Petitioner is a victim of domestic violence by Respondent, and/or Petitioner has reasonable cause to believe he/she is in imminent danger of becoming a victim of domestic violence by Respondent, and that there is an immediate and present danger of domestic violence to Petitioner or persons lawfully with Petitioner.

TEMPORARY INJUNCTION AND TERMS

This injunction shall be effective until the hearing set above and in no event for longer than 15 days, unless extended by court order. If a final order of injunction is issued, the terms of this temporary injunction will be extended until service of the final injunction is effected upon Respondent. This injunction is valid and enforceable in all counties of the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction. Any violation of this injunction, whether or not at the invitation of Petitioner or anyone else, may subject Respondent to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment. Certain willful violations of the terms of this injunction, such as: refusing to vacate the dwelling that the parties share; going to or being within 500 feet of Petitioner's residence, going to Petitioner's place of employment, school, or other place prohibited in this injunction; telephoning, contacting or communicating with Petitioner if prohibited by this injunction; knowingly or intentionally coming within 100 feet of Petitioner's motor vehicle, whether or not it is occupied; defacing or destroying Petitioner's personal property; refusing to surrender firearms or ammunition if ordered to do so by the court; or committing an act of domestic violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes. In addition, it is a federal criminal felony offense, punishable by up to life imprisonment, depending on the nature of the violation, to cross state lines or enter Indian country for the purpose of engaging in conduct that is prohibited in this injunction. 18 U.S.C. § 2262.

ORDERED and ADJUDGED:

1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of domestic violence against Petitioner. Domestic violence includes: assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnaping, false imprisonment, or any other criminal offense resulting in physical injury or death to Petitioner or any of Petitioner's family or household members. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner.

2. No Contact. Respondent shall have no contact with Petitioner unless otherwise provided in this section.

a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner's current residence {list address} _________________ ___________________________________________________________ or any residence to which Petitioner may move; Petitioner's current or any subsequent place of employment {list address of current employment} _________________________ _______________________________ or place where Petitioner attends school {list address of school} ___________________________________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner's minor child(ren) go often: ___________________________________________ ______________________________________________________________________ _____________________________________________________________________. Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time.

___ b. Other provisions regarding contact: _______________________________ ______________________________________________________________________ ______________________________________________________________________

3. Firearms. [Initial all that apply; write N/A if does not apply] ____ a. Respondent shall not use or possess a firearm or ammunition. ____ b. Respondent shall surrender any firearms and ammunition in the Respondent's possession to the _____________ County Sheriff's Department until further order of the court. ____ c. Other directives relating to firearms and ammunition: _____________ ______________________________________________________________________ ______________________________________________________________________

NOTE: RESPONDENT IS ADVISED THAT, IF A PERMANENT INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE IS ISSUED FOLLOWING A HEARING REGARDING THIS MATTER, IN MOST CASES IT WILL BE A VIOLATION OF § 790.233, FLORIDA STATUTES, AND A FIRST DEGREE MISDEMEANOR, FOR RESPONDENT TO HAVE IN HIS OR HER CARE, CUSTODY, POSSESSION OR CONTROL ANY FIREARM OR AMMUNITION. ADDITIONALLY, IT WILL BE A FEDERAL CRIMINAL FELONY OFFENSE TO SHIP OR TRANSPORT IN INTERSTATE OR FOREIGN COMMERCE, OR POSSESS IN OR AFFECTING COMMERCE, ANY FIREARM OR AMMUNITION; OR TO RECEIVE ANY FIREARM OR AMMUNITION WHICH HAS BEEN SHIPPED OR TRANSPORTED IN INTERSTATE OR FOREIGN COMMERCE WHILE SUBJECT TO SUCH AN INJUNCTION. 18 U.S.C. § 922(g)(8).

4. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding the final injunction, if entered without Respondent being present at the hearing, and pleadings requiring personal service) shall be served by mail to Respondent's last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Fla.Fam.L.R.P., section 741.30, Florida Statutes.

5. Additional order(s) necessary to protect Petitioner from domestic violence: _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________

TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME

[Initial all that apply; write N/A if does not apply]

6. ____ Possession of the Home. ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the dwelling located at: ___________________________________ ______________________________________________________________.

7. ____ Transfer of Possession of the Home. A law enforcement officer with jurisdiction over the home shall accompany ( ) Petitioner ( ) Respondent to the home, and shall place ( ) Petitioner ( ) Respondent in possession of the home.

8. ____ Personal Items. ( ) Petitioner ( ) Respondent, in the presence of a law enforcement officer, may return to the premises described above () on ______________, at ___ a.m./p.m., or ( ) at a time arranged with the law enforcement department with jurisdiction over the home, for the purpose of obtaining his or her clothing and items of personal health and hygiene and tools of the trade. A law enforcement officer with jurisdiction over the home from which these items are to be retrieved shall accompany ( ) Petitioner ( ) Respondent to the home and stand by to insure that he/she vacates the premises with only his/her personal clothing, toiletries, tools of the trade, and any items listed in paragraph 10 below. The law enforcement agency shall not be responsible for storing or transporting any property. IF THE RESPONDENT IS NOT AWARDED POSSESSION OF THE HOME AND GOES TO THE HOME WITHOUT A LAW ENFORCEMENT OFFICER, IT IS A VIOLATION OF THIS INJUNCTION.

9. ___ ( ) Petitioner ( ) Respondent shall not damage or remove any furnishings or fixtures from the parties' former shared premises.

10. ___ Other: ___________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

TEMPORARY SUPPORT

Temporary support, if requested by Petitioner in the Petition for Injunction for Protection Against Domestic Violence, will be addressed by the Court after notice to Respondent and hearing on the matter.

OTHER SPECIAL PROVISIONS (This section to be used for inclusion of local provisions approved by the chief judge as provided in Florida Family Law Rule 12.610.)

DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION

(Provisions in this injunction that do not include a line for the judge to either initial or write N/A are considered mandatory provisions and should be interpreted to be part of this injunction.)

1. The Sheriff of _____________ County, or any other authorized law enforcement officer, is ordered to serve this temporary injunction upon Respondent as soon as possible after its issuance.

2. This injunction is valid in all counties of the State of Florida. Violation of this injunction should be reported to the appropriate law enforcement agency. Law enforcement officers of the jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this injunction and are authorized to arrest without warrant pursuant to section 901.15, Florida Statutes, for any violation of its provisions which constitutes a criminal act under section 741.31, Florida Statutes.

3. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES. The arresting agent shall notify the State Attorney's Office immediately after arrest.

4. Reporting alleged violations. If Respondent violates the terms of this injunction and there has not been an arrest, Petitioner may contact the Clerk of the Circuit Court of the county in which the violation occurred and complete an affidavit in support of the violation, or Petitioner may contact the State Attorney's office for assistance in filing an action for indirect civil contempt or indirect criminal contempt. Upon receiving such a report, the State Attorney is hereby appointed to prosecute such violations by indirect criminal contempt proceedings, or the State Attorney may decide to file a criminal charge, if warranted by the evidence.

ORDERED on ________________.

______________________________________ CIRCUIT JUDGE

COPIES TO: Sheriff of ____________ County Petitioner (or his or her attorney): ____ by U.S. Mail ____ by hand delivery in open court

Respondent: ____ forwarded to sheriff for service ____ State Attorney's Office ____ Other: ______________________________________________

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of _________ County, Florida, and that I have furnished copies of this order as indicated above.

CLERK OF THE CIRCUIT COURT

(SEAL) By:__________________________________ Deputy Clerk

IN THE CIRCUIT COURT OF THE _________________ JUDICIAL CIRCUIT, IN AND FOR ___________________ COUNTY, FLORIDA

Case No.: _________________________ Division: _________________________

______________________________, Petitioner,

and

______________________________, Respondent.

FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE WITH MINOR CHILD(REN) (AFTER NOTICE)

The Petition for Injunction for Protection Against Domestic Violence under section 741.30, Florida Statutes, and other papers filed in this Court have been reviewed. The Court has jurisdiction of the parties and the subject matter.

It is intended that this protection order meet the requirements of 18 U.S.C. § 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe.

HEARING

This cause came before the Court for a hearing to determine whether an Injunction for Protection Against Domestic Violence in this case should be () issued () modified () extended.

The hearing was attended by ( ) Petitioner ( ) Respondent ( ) Petitioner's Counsel ( ) Respondent's Counsel

FINDINGS

On {date} ______________, a notice of this hearing was served on Respondent together with a copy of Petitioner's petition to this Court and the temporary injunction, if issued. Service was within the time required by Florida law, and Respondent was afforded an opportunity to be heard.

After hearing the testimony of each party present and of any witnesses, or upon consent of Respondent, the Court finds, based on the specific facts of this case, that Petitioner is a victim of domestic violence or has reasonable cause to believe that he/she is in imminent danger of becoming a victim of domestic violence by Respondent.

INJUNCTION AND TERMS

This injunction shall be in full force and effect until ( ) further order of the Court or ( ) ____________. This injunction is valid and enforceable in all counties of the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction at any time. Any violation of this injunction, whether or not at the invitation of Petitioner or anyone else, may subject Respondent to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment. Certain willful violations of the terms of this injunction, such as: refusing to vacate the dwelling that the parties share; going to or being within 500 feet of Petitioner's residence, going to Petitioner's place of employment, school, or other place prohibited in this injunction; telephoning, contacting or communicating with Petitioner if prohibited by this injunction; knowingly or intentionally coming within 100 feet of Petitioner's motor vehicle, whether or not it is occupied; defacing or destroying Petitioner's personal property; refusing to surrender firearms or ammunition if ordered to do so by the court; or committing an act of domestic violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes. In addition, it is a federal criminal felony offense, punishable by up to life imprisonment, depending on the nature of the violation, to cross state lines or enter Indian country for the purpose of engaging in conduct that is prohibited in this injunction. 18 U.S.C. § 2262.

ORDERED and ADJUDGED:

1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of domestic violence against Petitioner. Domestic violence includes: assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnaping, false imprisonment, or any other criminal offense resulting in physical injury or death to Petitioner or any of Petitioner's family or household members. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner.

2. No Contact. Respondent shall have no contact with the Petitioner unless otherwise provided in this section, or unless paragraphs 13 through 19 below provide for contact connected with the temporary custody of and visitation with minor child(ren).

a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner's current residence {list address} _____________________ _______________________________________________________________ or any residence to which Petitioner may move; Petitioner's current or any subsequent place of employment {list address of current employment} ____________________________ ________________ or place where Petitioner attends school {list address of school} ________________________________________________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner's minor child(ren) go often: ___________________________________________________________ __________________________________________________________________ __________________________________________________________________. Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time.

____ b. Other provisions regarding contact: _______________________ ______________________________________________________________ ______________________________________________________________

3. Firearms. Unless paragraph a. is initialed below, Respondent shall not have in his or her care, custody, possession or control any firearm or ammunition. It is a violation of section 790.233, Florida Statutes, and a first degree misdemeanor, for the respondent to have in his or her care, custody, possession or control any firearm or ammunition.

[Initial if applies; write N/A if not applicable]

____ a. Respondent is a state or local officer as defined in section 943.10(14), Florida Statutes, who holds an active certification, who receives or possesses a firearm or ammunition for use in performing official duties on behalf of the officer's employing agency and is not prohibited by the court from having in his or her care, custody, possession or control a firearm or ammunition. The officer's employing agency may prohibit the officer from having in his or her care, custody, possession or control a firearm or ammunition.

____ b. Respondent shall surrender any firearms and ammunition in the Respondent's possession to the _____________ County Sheriff's Department.

____ c. Other directives relating to firearms and ammunition: __________________________________________________ ______________________________________________________________ ______________________________________________________________

NOTE: RESPONDENT IS ADVISED THAT IT IS A FEDERAL CRIMINAL FELONY OFFENSE TO SHIP OR TRANSPORT IN INTERSTATE OR FOREIGN COMMERCE, OR POSSESS IN OR AFFECTING COMMERCE, ANY FIREARM OR AMMUNITION; OR TO RECEIVE ANY FIREARM OR AMMUNITION WHICH HAS BEEN SHIPPED OR TRANSPORTED IN INTERSTATE OR FOREIGN COMMERCE WHILE SUBJECT TO SUCH AN INJUNCTION. 18 U.S.C. § 922(g)(8).

4. Evaluation/Counseling. [Initial all that apply; write N/A if does not apply]

a. The Court finds that Respondent has:

____ i. willfully violated the ex parte injunction;

____ ii. been convicted of, had adjudication withheld on, or pled nolo contendere to a crime involving violence or a threat of violence; and/or

____ iii. in this state or any other state, had at any time a prior injunction for protection entered against the respondent after a hearing with notice.

Note: If respondent meets any of the above enumerated criteria, the Court must order the Respondent to attend a batterers' intervention program unless it makes written factual findings stating why such a program would not be appropriate. See § 741.30(6)(e), Florida Statutes.

b. Within ()10 days () days, (but no more than 10 days) of the date of this injunction, Respondent shall enroll in and thereafter without delay complete the following, and Respondent shall provide proof of such enrollment to the Clerk of Circuit Court within ()30 days ()____days, (but no more than 30 days) of the date of this injunction:

____ i. A certified batterers' intervention program from a list of programs to be provided by the Court or any entity designated by the Court. Respondent shall also successfully complete any substance abuse or mental health evaluation that the assessing program counselor deems necessary as a predicate to completion of the batterers' intervention program.

____ ii. A substance abuse evaluation at: ______________________ _______________ or a similarly qualified facility and any substance abuse treatment recommended by that evaluation.

____ iii. A mental health evaluation by a licensed mental health professional at:___________________________________________ _____________ or any other similarly qualified facility and any mental health treatment recommended by that evaluation.

____ iv. Other:

____ c. Although Respondent meets the statutory mandate of attendance at a batterers' intervention program, the Court makes the following written findings as to why the condition of batterers' intervention program would be inappropriate: ______________________________________ ______________________________________________________________________ ______________________________________________________________________

____ d. Petitioner is referred to a certified domestic violence center and is provided with a list of certified domestic violence centers in this circuit, which Petitioner may contact.

5. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent's last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Fla.Fam.L.R.P., section 741.30, Florida Statutes.

6. Other provisions necessary to protect Petitioner from domestic violence: ____________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME

[Initial if applies; write N/A if not applicable]

7. ____ Possession of the Home. ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the dwelling located at: ____________________________________ _____________________________________________________________.

8. ____ Transfer of Possession of the Home. A law enforcement officer with jurisdiction over the home shall accompany ( ) Petitioner ( ) Respondent to the home, and shall place ( ) Petitioner ( ) Respondent in possession of the home.

9. ____ Personal Items. ( ) Petitioner ( ) Respondent, in the presence of a law enforcement officer, may return to the premises described above ( ) on _______________, at ______ a.m./p.m., or ( ) at a time arranged with the law enforcement department with jurisdiction over the home, accompanied by a law enforcement officer only, for the purpose of obtaining his or her clothing and items of personal health and hygiene and tools of the trade. A law enforcement officer with jurisdiction over the premises shall go with ( ) Petitioner ( ) Respondent to the home and stand by to insure that he/she vacates the premises with only his/her personal clothing, toiletries, tools of the trade, and any items listed in paragraph 10 below. The law enforcement agency shall not be responsible for storing or transporting any property. IF THE RESPONDENT IS NOT AWARDED POSSESSION OF THE HOME AND GOES TO THE HOME WITHOUT A LAW ENFORCEMENT OFFICER, IT IS A VIOLATION OF THIS INJUNCTION.

10. ____ The following other personal possessions may also be removed from the premises at this time: ______________________________ ______________________________________________________________

11. ____ Other: ___________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

TEMPORARY CUSTODY OF AND VISITATION WITH MINOR CHILD(REN)

12. Jurisdiction. Jurisdiction to determine custody of and visitation with any minor child(ren) listed in paragraph 2 below is proper under the Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA).

13. Temporary Custody of Minor Child(ren). ( ) Petitioner ( ) Respondent shall have temporary custody of the parties' minor child(ren) listed below:

Name Birth date ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

When requested by the custodial parent, law enforcement officers shall use any and all reasonable and necessary force to physically deliver the minor child(ren) listed above to custodial parent. The noncustodial parent shall not take the child(ren) from the custody of custodial parent or any child care provider or other person entrusted by the custodial parent with the care of the child(ren).

14. Type of Contact/Visitation with Minor Child(ren). The noncustodial parent shall have: [Initial one only]

____ a. no contact with the parties minor child(ren) until further order of the Court.

____ b. the following specified visitation with the parties' minor child(ren), subject to any limitations set out below: {specify days and times} ______________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

15. Limitations on Visitation. The above specified visitation shall be: [Initial all that apply; write N/A if does not apply]

____ a. unsupervised.

____ b. supervised by the following specified responsible adult: ________.

____ c. at a supervised visitation center located at: ____________________ _____________________________________________________________________. and shall be subject to the available times and rules of the supervised visitation center. The cost of such visits shall be paid by ( ) custodial parent ( ) noncustodial parent ( ) both: ________________________________________________________________ ________________________________________________________________.

16. Arrangements for Contact/Visitation with Minor Child(ren).

[Initial all that apply; write N/A if does not apply]

____ a. A responsible person shall coordinate the visitation arrangements of the minor child(ren). If specified, the responsible person shall be: {name} ___ ____ b. Other conditions for visitation arrangements as follows: ________ ____________________________________________________________________ ____________________________________________________________________

17. Exchange of Minor Child(ren).

[Initial all that apply; write N/A if does not apply]

____ a. The parties shall exchange the child(ren) at ( ) school or daycare, or ( ) at the following location(s): __________________ ________________________________________________________________ ________________________________________________________________

____ b. A responsible person shall conduct all exchanges of the child(ren). The noncustodial parent shall not be present during the exchange. If specified, the responsible person shall be: {name} ________________________________________ __________________________________________________________________

____ c. Other conditions for visitation exchange as follows: __________ __________________________________________________________________ __________________________________________________________________

18. Other Additional Provisions Relating to the Minor Child(ren). ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

TEMPORARY SUPPORT

19. Temporary Alimony.

[Initial all that apply; write N/A if does not apply]

____ a. The court finds that there is a need for temporary alimony and that ( ) Petitioner ( ) Respondent (hereinafter Obligor) has the present ability to pay alimony and shall pay temporary alimony to ( ) Petitioner ( ) Respondent (hereinafter Obligee) in the amount of $____________________________________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} ______________________________________________________________________ beginning {date} ______________. This alimony shall continue until modified by court order, until a final judgment of dissolution of marriage is entered, until Obligee dies, until this injunction expires, or until {date} ______________, whichever occurs first. ____ b. ( ) Petitioner ( ) Respondent shall be required to maintain health insurance coverage for the other party. Any uncovered medical costs for the party awarded alimony shall be assessed as follows: ___________________________________________ ________________________________________________________________. ____ c. Other provisions relating to alimony: _______________________ ________________________________________________________________ ________________________________________________________________

20. Temporary Child Support. [Initial all that apply; write N/A if does not apply]

____ a. The Court finds that there is a need for temporary child support and that the noncustodial parent (hereinafter Obligor) has the present ability to pay child support. The amounts in the Child Support Guidelines Worksheet, Florida Family Law Form 12.902(e), filed by ( ) Petitioner ( ) Respondent are correct OR the Court makes the following findings: The Petitioner's net monthly income is $_______________, (Child Support Guidelines ___%). The Respondent's net monthly income is $______________, (Child Support Guidelines ___%). Monthly child care costs are $ _____________________________________________________. Monthly health/dental insurance costs are $ _______.

____ b. Amount. Obligor shall pay temporary child support in the amount of $_________, per month payable () in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain}: ___________________ _______________________________________________________________, beginning {date} ______________, and continuing until further order of the court, or until {date/event} ___________________________, {explain} _____________________________________________________. If the child support ordered deviates from the guidelines by more than 5%, the factual findings which support that deviation are: _______________________________________________________ ______________________________________________________________________

____ c. ( ) Petitioner ( ) Respondent shall be required to maintain ( ) health ( ) dental insurance coverage for the parties' minor child(ren) so long as reasonably available. OR ( ) Health ( ) dental insurance is not reasonably available at this time. ____ d. Any reasonable and necessary uninsured medical/dental/prescription drug costs for the minor child(ren) shall be assessed as follows: ____________________________________________________ _______________________________________________________________. ____ e. Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security Number, is incorporated herein by reference. ____ f. Other provisions relating to child support: _________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

21. Method of Payment. [Initial one only] ____ a. Obligor shall pay any temporary child support/alimony ordered through income deduction, and such support shall be paid to the state disbursement unit. Obligor is individually responsible for paying this support obligation in the event that all or any portion of said support is not deducted from Obligor's income. Obligor shall also pay the applicable state disbursement unit service charge. Until child support/alimony payments are deducted from Obligor's paycheck pursuant to the Income Deduction Order, Obligor is responsible for making timely payments directly to the state disbursement unit. ____ b. Temporary child support/alimony shall be paid through the state disbursement unit in the office of the {name of county} _____________ County Clerk of Circuit Court. Obligor shall also pay the applicable state disbursement unit service charge. Income deduction is not in the best interests of the child(ren) because: __________________ ________________________________________________________________ ________________________________________________________________. ____ c. Other provisions relating to method of payment: _____________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

OTHER SPECIAL PROVISIONS (This section to be used for inclusion of local provisions approved by the chief judge as provided in Florida Family Law Rule 12.610.) DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION (Provisions in this injunction that do not include a line for the judge to either initial or write N/A are considered mandatory provisions and should be interpreted to be part of this injunction.)

1. This injunction is valid in all counties of the State of Florida. Violation of this injunction should be reported to the appropriate law enforcement agency. Law enforcement officers of the jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this injunction and are authorized to arrest without warrant pursuant to section 901.15, Florida Statutes, for any violation of its provisions, except those regarding child support and/or alimony, which constitutes a criminal act under section 741.31, Florida Statutes. When inconsistent with this order, any subsequent court order issued under Chapter 61, Florida Statutes, shall take precedence over this order on all matters relating to property division, alimony, child custody, or child support.

2. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA, AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES. The arresting agent shall notify the State Attorney's Office immediately after arrest.

3. Reporting alleged violations. If Respondent violates the terms of this injunction and there has not been an arrest, Petitioner may contact the Clerk of the Circuit Court of the county in which the violation occurred and complete an affidavit in support of the violation, or Petitioner may contact the State Attorney's office for assistance in filing an action for indirect civil contempt or indirect criminal contempt. Upon receiving such a report, the State Attorney is hereby appointed to prosecute such violations by indirect criminal contempt proceedings, or the State Attorney may decide to file a criminal charge, if warranted by the evidence.

4. Respondent, upon service of this injunction, shall be deemed to have knowledge of and to be bound by all matters occurring at the hearing and on the face of this injunction.

5. The temporary injunction, if any, entered in this case is extended until such time as service of this injunction is effected upon Respondent.

ORDERED on ________________.

______________________________________ CIRCUIT JUDGE

COPIES TO: Sheriff of ____________ County Petitioner (or his or her attorney): ____ by U.S. Mail ____ by hand delivery in open court (Petitioner must acknowledge receipt in writing on the face of the original order — see below.) Respondent (or his or her attorney): ____ forwarded to sheriff for service ____ by hand delivery in open court (Respondent must acknowledge receipt in writing on the face of the original order — see below.) ____ by certified mail (may only be used when Respondent is present at the hearing and Respondent fails or refuses to acknowledge the receipt of a certified copy of this injunction.) ____ State Attorney's Office ____ Batterer's intervention program (if ordered) ____ Central Governmental Depository (if ordered) ____ Department of Revenue ____ Other: _______________________________________________

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of __________ County, Florida, and that I have furnished copies of this order as indicated above.

CLERK OF THE CIRCUIT COURT

(SEAL) By:____________________________________ Deputy Clerk

ACKNOWLEDGMENT

I, {Name of Petitioner} _____________, acknowledge receipt of a certified copy of this Injunction for Protection.

____________________________________ Petitioner

ACKNOWLEDGMENT

I, {Name of Respondent} ____________, acknowledge receipt of a certified copy of this Injunction for Protection.

____________________________________ Respondent

IN THE CIRCUIT COURT OF THE ____________________ JUDICIAL CIRCUIT, IN AND FOR ______________________ COUNTY, FLORIDA

Case No.: _________________________ Division: _________________________ ___________________________, Petitioner,

and

___________________________, Respondent.

FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE WITHOUT MINOR CHILD(REN) (AFTER NOTICE)

The Petition for Injunction for Protection Against Domestic Violence under section 741.30, Florida Statutes, and other papers filed in this Court have been reviewed. The Court has jurisdiction of the parties and the subject matter.

It is intended that this protection order meet the requirements of 18 U.S.C. § 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe.

HEARING

This cause came before the Court for a hearing to determine whether an Injunction for Protection Against Domestic Violence in this case should be ( ) issued ( ) modified ( ) extended.

The hearing was attended by ( ) Petitioner ( ) Respondent ( ) Petitioner's Counsel ( ) Respondent's Counsel

FINDINGS

On {date} _________________, a notice of this hearing was served on Respondent together with a copy of Petitioner's petition to this Court and the temporary injunction, if issued. Service was within the time required by Florida law, and Respondent was afforded an opportunity to be heard.

After hearing the testimony of each party present and of any witnesses, or upon consent of Respondent, the Court finds, based on the specific facts of this case, that Petitioner is a victim of domestic violence or has reasonable cause to believe that he/she is in imminent danger of becoming a victim of domestic violence by Respondent.

INJUNCTION AND TERMS

This injunction shall be in full force and effect until () further order of the Court () __________________. This injunction is valid and enforceable in all counties of the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction at any time. Any violation of this injunction, whether or not at the invitation of Petitioner or anyone else, may subject Respondent to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment. Certain willful violations of the terms of this injunction, such as: refusing to vacate the dwelling that the parties share; going to or being within 500 feet of Petitioner's residence, going to Petitioner's place of employment, school, or other place prohibited in this injunction; telephoning, contacting or communicating with Petitioner if prohibited by this injunction; knowingly or intentionally coming within 100 feet of Petitioner's motor vehicle, whether or not it is occupied; defacing or destroying Petitioner's personal property; refusing to surrender firearms or ammunition if ordered to do so by the court; or committing an act of domestic violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes. In addition, it is a federal criminal felony offense, punishable by up to life imprisonment, depending on the nature of the violation, to cross state lines or enter Indian country for the purpose of engaging in conduct that is prohibited in this injunction. 18 U.S.C. § 2262.

ORDERED and ADJUDGED:

1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of domestic violence against Petitioner. Domestic violence includes: assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnaping, false imprisonment, or any other criminal offense resulting in physical injury or death to Petitioner or any of Petitioner's family or household members. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner.

2. No Contact. Respondent shall have no contact with the Petitioner unless otherwise provided in this section.

a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner's current residence {list address} _______________________________ ________________________________________________________________ or any residence to which Petitioner may move; Petitioner's current or any subsequent place of employment {list address of current employment} _________________________________ ___________________________ or place where Petitioner attends school {list address of school} _____________________________________________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner's minor child(ren) go often: _________________________________________________________ ________________________________________________________________ ________________________________________________________________. Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time.

___ b. Other provisions regarding contact: __________________________ _________________________________________________________________ _________________________________________________________________

3. Firearms. Unless paragraph a. is initialed below, Respondent shall not have in his or her care, custody, possession or control any firearm or ammunition. It is a violation of section 790.233, Florida Statutes, and a first degree misdemeanor, for the respondent to have in his or her care, custody, possession or control any firearm or ammunition.

[Initial if applies; write N/A if not applicable]

___ a. Respondent is a state or local officer as defined in section 943.10(14), Florida Statutes, who holds an active certification, who receives or possesses a firearm or ammunition for use in performing official duties on behalf of the officer's employing agency and is not prohibited by the court from having in his or her care, custody, possession or control a firearm or ammunition. The officer's employing agency may prohibit the officer from having in his or her care, custody, possession or control a firearm or ammunition.

___ b. Respondent shall surrender any firearms and ammunition in the Respondent's possession to the _____________ County Sheriff's Department.

___ c. Other directives relating to firearms and ammunition: _________ __________________________________________________________________ __________________________________________________________________

NOTE: RESPONDENT IS ADVISED THAT IT IS A FEDERAL CRIMINAL FELONY OFFENSE TO SHIP OR TRANSPORT IN INTERSTATE OR FOREIGN COMMERCE, OR POSSESS IN OR AFFECTING COMMERCE, ANY FIREARM OR AMMUNITION; OR TO RECEIVE ANY FIREARM OR AMMUNITION WHICH HAS BEEN SHIPPED OR TRANSPORTED IN INTERSTATE OR FOREIGN COMMERCE WHILE SUBJECT TO SUCH AN INJUNCTION. 18 U.S.C. § 922(g)(8).

4. Evaluation/Counseling.

[Initial all that apply; write N/A if does not apply]

a. The Court finds that Respondent has:

____ i. willfully violated the ex parte injunction; ____ ii. been convicted of, had adjudication withheld on, or pled nolo contendere to a crime involving violence or a threat of violence; and/or ____ iii. in this state or any other state, had at any time a prior injunction for protection entered against the respondent after a hearing with notice.

Note: If respondent meets any of the above enumerated criteria, the Court must order the Respondent to attend a batterers' intervention program unless it makes written factual findings stating why such a program would not be appropriate. See § 741.30(6)(e), Florida Statutes.

b. Within ( ) 10 days ( ) _____ days, (but no more than 10 days) of the date of this injunction, Respondent shall enroll in and thereafter without delay complete the following, and Respondent shall provide proof of such enrollment to the Clerk of Circuit Court within ( ) 30 days ( ) _____ days, (but no more than 30 days) of the date of this injunction:

____ i. A certified batterers' intervention program from a list of programs to be provided by the Court or any entity designated by the Court. Respondent shall also successfully complete any substance abuse or mental health evaluation that the assessing program counselor deems necessary as a predicate to completion of the batterers' intervention program.

____ ii. A substance abuse evaluation at: _______________________ _______________ or a similarly qualified facility and any substance abuse treatment recommended by that evaluation.

____ iii. A mental health evaluation by a licensed mental health professional at: __________________________________________ __________________ or any other similarly qualified facility and any mental health treatment recommended by that evaluation.

____ iv. Other: ________________________________________________ ___________________________________________________________

___ c. Although Respondent meets the statutory mandate of attendance at a batterers' intervention program, the Court makes the following written findings as to why the condition of batterers' intervention program would be inappropriate: ______ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________

___ d. Petitioner is referred to a certified domestic violence center and is provided with a list of certified domestic violence centers in this circuit, which Petitioner may contact.

5. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent's last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Fla.Fam.L.R.P., section 741.30, Florida Statutes.

6. Other provisions necessary to protect Petitioner from domestic violence: ___________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________

TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME

[Initial if applies; write N/A if not applicable]

7. ____ Possession of the Home. () Petitioner () Respondent shall have temporary exclusive use and possession of the dwelling located at: _______________________________________ ________________________________________________________________.

8. ____ Transfer of Possession of the Home. A law enforcement officer with jurisdiction over the home shall accompany ( ) Petitioner ( ) Respondent to the home, and shall place ( ) Petitioner ( ) Respondent in possession of the home.

9. ____ Personal Items. ( ) Petitioner ( ) Respondent, in the presence of a law enforcement officer, may return to the premises described above ( ) on ___________, at ______ a.m./p.m., or ( ) at a time arranged with the law enforcement department with jurisdiction over the home, accompanied by a law enforcement officer only, for the purpose of obtaining his or her clothing and items of personal health and hygiene and tools of the trade. A law enforcement officer with jurisdiction over the premises shall go with ( ) Petitioner ( ) Respondent to the home and stand by to insure that he/she vacates the premises with only his/her personal clothing, toiletries, tools of the trade, and any items listed in paragraph 10 below. The law enforcement agency shall not be responsible for storing or transporting any property. IF THE RESPONDENT IS NOT AWARDED POSSESSION OF THE HOME AND GOES TO THE HOME WITHOUT A LAW ENFORCEMENT OFFICER, IT IS A VIOLATION OF THIS INJUNCTION.

10. ___ The following other personal possessions may also be removed from the premises at this time:_______________________________ ______________________________________________________________ ______________________________________________________________

11. Other: _______________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

TEMPORARY SUPPORT

12. Temporary Alimony.

[Initial all that apply; write N/A if does not apply]

____ a. The court finds that there is a need for temporary alimony and that ( ) Petitioner ( ) Respondent (hereinafter Obligor) has the present ability to pay alimony and shall pay temporary alimony to ( ) Petitioner ( ) Respondent (hereinafter Obligee) in the amount of $_________________________________________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} ______________________________________________________________ _______________________________________________________________ beginning {date} _________________. This alimony shall continue until modified by court order, until a final judgment of dissolution of marriage is entered, until Obligee dies, until this injunction expires, or until {date} ___________________, whichever occurs first.

____ b. ( ) Petitioner ( ) Respondent shall be required to maintain health insurance coverage for the other party. Any uncovered medical costs for the party awarded alimony shall be assessed as follows: _________________________________________________________ __________________________________________________________________.

____ c. Other provisions relating to alimony: _________________________ __________________________________________________________________ __________________________________________________________________

13. Method of Payment.

[Initial one only]

____ a. Obligor shall pay any temporary alimony ordered through income deduction, and such support shall be paid to the Central Government Depository in ________________ County. Obligor is individually responsible for paying this support obligation in the event that all or any portion of said support is not deducted from Obligor's income. Obligor shall also pay the applicable Central Government Depository service charge. Until alimony payments are deducted from Obligor's paycheck pursuant to the Income Deduction Order, Obligor is responsible for making timely payments directly to the Central Government Depository.

____ b. Temporary alimony shall be paid through the Central Government Depository in the office of the {name of county} __________ County Clerk of Circuit Court. Obligor shall also pay the applicable Central Government Depository service charge.

____ c. Other provisions relating to method of payment: _________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

OTHER SPECIAL PROVISIONS (This section to be used for inclusion of local provisions approved by the chief judge as provided in Florida Family Law Rule 12.610.)

DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION

(Provisions in this injunction that do not include a line for the judge to either initial or write N/A are considered mandatory provisions and should be interpreted to be part of this injunction.)

1. This injunction is valid in all counties of the State of Florida. Violation of this injunction should be reported to the appropriate law enforcement agency. Law enforcement officers of the jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this injunction and are authorized to arrest without warrant pursuant to section 901.15, Florida Statutes, for any violation of its provisions, except those regarding child support and/or alimony, which constitutes a criminal act under section 741.31, Florida Statutes. When inconsistent with this order, any subsequent court order issued under Chapter 61, Florida Statutes, shall take precedence over this order on all matters relating to property division, alimony, child custody, or child support.

2. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA, AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES. The arresting agent shall notify the State Attorney's Office immediately after arrest.

3. Reporting alleged violations. If Respondent violates the terms of this injunction and there has not been an arrest, Petitioner may contact the Clerk of the Circuit Court of the county in which the violation occurred and complete an affidavit in support of the violation, or Petitioner may contact the State Attorney's office for assistance in filing an action for indirect civil contempt or indirect criminal contempt. Upon receiving such a report, the State Attorney is hereby appointed to prosecute such violations by indirect criminal contempt proceedings, or the State Attorney may decide to file a criminal charge, if warranted by the evidence.

4. Respondent, upon service of this injunction, shall be deemed to have knowledge of and to be bound by all matters occurring at the hearing and on the face of this injunction.

5. The temporary injunction, if any, entered in this case is extended until such time as service of this injunction is effected upon Respondent.

ORDERED on _______________.

__________________________________________ CIRCUIT JUDGE

COPIES TO:

Sheriff of _______________ County Petitioner (or his or her attorney): ____ by U.S. Mail

____ by hand delivery in open court (Petitioner must acknowledge receipt in writing on the face of the original order — see below.)

Respondent (or his or her attorney): ____ forwarded to sheriff for service ____ by hand delivery in open court (Respondent must acknowledge receipt in writing on the face of the original order — see below.)

____ by certified mail (may only be used when Respondent is present at the hearing and Respondent fails or refuses to acknowledge the receipt of a certified copy of this injunction.)

____ State Attorney's Office ____ Batterer's intervention program (if ordered) ____ Central Governmental Depository (if ordered) ____ Department of Revenue ____ Other: ____________________________________________________________

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of _____________ County, Florida, and that I have furnished copies of this order as indicated above.

CLERK OF THE CIRCUIT COURT

(SEAL) By: _____________________________________ Deputy Clerk

ACKNOWLEDGMENT

I, {Name of Petitioner} ________________, acknowledge receipt of a certified copy of this Injunction for Protection.

______________________________________ Petitioner

ACKNOWLEDGMENT

I, {Name of Respondent} _____________________, acknowledge receipt of a certified copy of this Injunction for Protection.

_____________________________________ Respondent

IN THE CIRCUIT COURT OF THE ____________________________ JUDICIAL CIRCUIT, IN AND FOR ________________________________ COUNTY, FLORIDA

Case No.: ______________________ Division: ______________________ ________________________________, Petitioner,

and

________________________________, Respondent.

ORDER OF DISMISSAL OF TEMPORARY INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE ( ) DATING VIOLENCE ( ) SEXUAL VIOLENCE

THIS CAUSE came before the Court on {date} ______________, upon Petitioner's action for an injunction for protection against domestic violence, repeat, dating, or sexual violence, and it appearing to the Court as follows:

[ all that apply]

____ Petitioner failed to appear at the hearing scheduled in this cause. ____ Petitioner appeared at the hearing but desires to voluntarily dismiss this action. ____ The evidence presented is insufficient under Florida law (section 741.30 or 784.046, Florida Statutes) to allow the Court to issue an injunction for protection against domestic, repeat, dating, or sexual violence.

Accordingly, the case is dismissed without prejudice.

ORDERED on _________________.

_____________________________________________ CIRCUIT JUDGE

COPIES TO:

Sheriff of _____________ County Petitioner ___ by U.S. Mail ___ by hand delivery in open court Respondent ___ by U.S. Mail ___ by hand delivery in open court ____ State Attorney's Office ____ Other: ____________________________________________________

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of _____________ County, Florida, and that I have furnished copies of this order as indicated above.

CLERK OF THE CIRCUIT COURT

(SEAL) By: ____________________________________ Deputy Clerk

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(f), PETITION FOR INJUNCTION FOR PROTECTION AGAINST REPEAT VIOLENCE When should this form be used?

If you or a member of your immediate family are a victim of repeat violence, you can use this form to ask the court for a protective order prohibiting repeat violence. Repeat violence means that two incidents of violence have been committed against you or a member of your immediate family by another person, one of which must have been within 6 months of filing this petition. Repeat violence includes assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnaping, or false imprisonment, or any criminal offense resulting in physical injury or death. Because you are making a request to the court, you are called the petitioner . The person whom you are asking the court to protect you from is called the respondent . If you are under the age of eighteen and have never been married or had the disabilities of nonage removed by a court, one of your parents or your legal guardian must sign this petition on your behalf.

The parent or legal guardian of any minor child who is living at home may seek an injunction for protection against repeat violence on behalf of the minor child. With respect to a minor child who is living at home, the parent or legal guardian must have been an eye-witness to, or have direct physical evidence or affidavits from eye-witnesses of, the specific facts and circumstances that form the basis of the petition.

If the respondent is your spouse , former spouse, related to you by blood or marriage, living with you now or has lived with you in the past (if you are or were living as a family), or the other parent of your child(ren), whether or not you have ever been married or ever lived together, you should use Petition for Injunction for Protection Against Domestic Violence, Florida Supreme Court Approved Family Law Form 12.980(a), rather than this form.

This form should be typed or printed in black ink. You should complete this form (giving as much detail as possible) and sign it the presence of a notary or in front of the clerk of the circuit court in the county were you live. The clerk will take your completed petition to a judge . You should keep a copy for your records. If have any questions or need assistance completing this form, the clerk or family law intake staff will help you.

What should I do if the judge grants my petition?

If the facts contained in your petition convince the judge that you or a member of your immediate family are a victim of repeat violence and that an immediate and present danger of repeat violence to you or that family exists, the judge will sign a Temporary Injunction for Protection Against Repeat Violence, Florida Supreme Court Approved Family Law Form 12.980(k). A temporary injunction is issued without notice to the respondent. The clerk will give your petition , the temporary injunction, and any other papers filed with your petition to the sheriff or other law enforcement officer for personal service on the respondent. The temporary injunction will take effect immediately after the respondent is served with a copy of it. It lasts until a full hearing can be held or for a period of 15 days, whichever comes first. The court may extend the temporary injunction beyond 15 days for a good reason, which may include failure to obtain service on the respondent.

The temporary injunction is issued " ex parte ." This means that the judge has considered only the information presented by one side — YOU. Section I of the temporary injunction gives a date that you should appear in court for a hearing. You will be expected to testify about the facts in your petition. The respondent will be given the opportunity to testify at this hearing, also. At the hearing, the judge will decide whether to issue a Final Judgment of Injunction for Protection Against Repeat Violence (After Notice), Florida Supreme Court Approved Family Law Form 12.980( l), which will remain in effect for a specific time period or until modified or dissolved by the court. If you and/or the respondent do not appear, the temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including the imposition of court costs.

If the judge signs a temporary or final injunction, the clerk will provide you with the necessary copies. Make sure that you keep one certified copy of the injunction with you at all times!

What can I do if the judge denies my petition?

If your petition is denied on the grounds that it appears to the court that no immediate and present danger of repeat violence exists, the court will set a full hearing on your petition. The respondent will be notified by personal service of your petition and the hearing. If your petition is denied, you may: amend your petition by filing a Supplemental Affidavit in Support of Petition for Injunction for Protection, Florida Supreme Court Approved Family Law Form 12.980 (g); attend the hearing and present facts that support your petition; and/or dismiss your petition.

Where can I look for more information?

Before proceeding, you should read "General Information for Self-Represented Litigants" found at the beginning of these forms. The words that are in " bold underline " are defined in that section. The clerk of the circuit court or family law intake staff will help you complete any necessary forms. For further information, see section 784.046, Florida Statutes, and rule 12.610, Florida Family Law Rules of Procedure.

IN THE CIRCUIT COURT OF THE ___________________________ JUDICIAL CIRCUIT, IN AND FOR ____________________________ COUNTY, FLORIDA

Case No.: ______________________ Division: ______________________

_________________________________, Petitioner,

and

_________________________________, Respondent.

PETITION FOR INJUNCTION FOR PROTECTION AGAINST REPEAT VIOLENCE

I, {full legal name} _____________________, being sworn, certify that the following statements are true:

SECTION I. PETITIONER (This section is about you. It must be completed.)

1. Petitioner currently lives at: {address, city, state, zip code} ___________________________________________ __________________________________________________________. [ if applies]

____ Petitioner seeks an injunction for protection on behalf of a minor child. Petitioner is the parent or legal guardian of {full legal name} _____________, a minor child who is living at home.

2. Petitioner's attorney's name, address, and telephone number is: __________________________________________________________ ______________________________________________________________. (If you do not have an attorney, write "none.")

SECTION II. RESPONDENT (This section is about the person you want to be protected from. It must be completed.)

1. Respondent currently lives at: {address, city, state, and zip code} ______________________________________ _________________________________________________________. Respondent's Driver's License number is: {if known} ______________.

2. Petitioner has known Respondent since: {date} ______________.

3. Respondent's last known place of employment: ________________________ Employment address: _________________________________________________ Working hours: ______________________________________________________

4. Physical description of Respondent: Race: ______ Sex: Male ____ Female _____ Date of Birth: ____________ Height: ____ Weight: ______ Eye Color: ______ Hair Color: __________ Distinguishing marks and/or scars: __________________________________ Vehicle: (make/model) _______ Color: _________ Tag Number: __________

5. Other names Respondent goes by (aliases or nicknames): ______________

6. Respondent's attorney's name, address, and telephone number is: _________________________________________________________________ _____________________________________________________________________. (If you do not know whether Respondent has an attorney, write" unknown." If Respondent does not have an attorney, write" none.")

SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION

(This section must be completed.)

1. Has Petitioner ever received or tried to get an injunction for protection against domestic violence, repeat violence, dating violence, or sexual violence against Respondent in this or any other court?

_____ Yes ____ No If yes, what happened in that case? {include case number, if known} ____________________________________________________________________ ____________________________________________________________________

2. Has Respondent ever received or tried to get an injunction for protection against domestic violence, repeat violence, dating violence, or sexual violence against Petitioner in this or any other court?

_____ Yes ____ No If yes, what happened in that case? {include case number, if known} ____________________________________________________________________ ____________________________________________________________________

3. Describe any other court case that is either going on now or that happened in the past between Petitioner and Respondent {include case number, if known}: ____________________________________________________________________ ____________________________________________________________________

4. Respondent has directed at least two incidents of "violence," meaning assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnaping, or false imprisonment, or any criminal offense resulting in physical injury or death against Petitioner or a member of Petitioner's immediate family. One of these two incidents of "violence" has occurred within 6 months of the date of filing of this petition. The most recent incident (including date and location) is described below.

On {date} ______________, at {location} _____________, Respondent ___________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Check here if you are attaching additional pages to continue these facts.

5. Other prior incidents (including dates and location) are described below:

On {date} _______________, at {location} _____________, Respondent ___________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Check here if you are attaching additional pages to continue these facts.

6. Petitioner genuinely fears repeat violence by Respondent. Explain: _____________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

7. Additional Information [ all that apply]

___ a. Respondent owns, has, and/or is known to have guns or other weapons. Describe weapon(s): __________________________________________________ ______________________________________________________________________ ___ b. This or prior acts of repeat violence have been previously reported to: {person or agency} _______________________________ _____________________________________________________________________.

SECTION IV. INJUNCTION (This section must be completed.)

1. Petitioner asks the Court to enter an injunction prohibiting Respondent from committing any acts of violence against Petitioner and:

a. prohibiting Respondent from going to or within 500 feet of any place Petitioner lives;

b. prohibiting Respondent from going to or within 500 feet of Petitioner's place(s) of employment or the school that Petitioner attends; the address of Petitioner's place(s) of employment and/or school is:______________________________ _____________________________________________________________________;

c. prohibiting Respondent from contacting Petitioner by telephone, mail, by e-mail, in writing, through another person, or in any other manner;

d. ordering Respondent not to use or possess any guns or firearms;

[ all that apply]

___ e. prohibiting Respondent from going to or within 500 feet of the following place(s) Petitioner or Petitioner's immediate family must go to often: ___________________________________ ______________________________________________________________________

___ f. prohibiting Respondent from knowingly and intentionally going to or within 100 feet of Petitioner's motor vehicle; and any other terms the Court deems necessary for the safety of Petitioner and Petitioner's immediate family.

I UNDERSTAND THAT BY FILING THIS PETITION, I AM ASKING THE COURT TO HOLD A HEARING ON THIS PETITION, THAT BOTH THE RESPONDENT AND I WILL BE NOTIFIED OF THE HEARING, AND THAT I MUST APPEAR AT THE HEARING. I UNDERSTAND THAT I AM SWEARING OR AFFIRMING UNDER OATH TO THE TRUTHFULNESS OF THE CLAIMS MADE IN THIS PETITION AND THAT THE PUNISHMENT FOR KNOWINGLY MAKING A FALSE STATEMENT INCLUDES FINES AND/OR IMPRISONMENT.

Dated: ____________________________

___________________________________ Signature of Party Printed Name: _____________________ Address: __________________________ City, State, Zip: _________________ Telephone Number: _________________ Fax Number: _______________________

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 ________________________________

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(g), SUPPLEMENTAL AFFIDAVIT IN SUPPORT OF PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE, REPEAT VIOLENCE, DATING VIOLENCE, OR SEXUAL VIOLENCE When should this form be used?

You may use this form if your Petition for Injunction for Protection Against Domestic Violence, Florida Supreme Court Approved Family Law Form 12.980(a), or your Petition for Injunction for Protection Against Repeat Violence, Florida Supreme Court Approved Family Law Form 12.980(f), or your Petition for Injunction for Protection Against Dating Violence, Florida Supreme Court Approved Family Law Form 12.980(n), or your Petition for Injunction for Protection Against Sexual Violence, Florida Supreme Court Approved Family Law Form 12.890(q), was denied by the judge . You should use this supplemental affidavit to add facts or clarify the facts you wrote in your original petition . For a domestic violence case, you should include FACTS that establish that you have been a victim of violence or are in imminent danger of becoming a victim of violence from the respondent . For a repeat violence case, you should include FACTS that establish that you or a member of your immediate family have or has been a victim of at least two prior incidents of violence, that one of those incidents occurred within the last six months and that there is an immediate and present risk of danger to you or a member of your immediate family. For a dating violence case, you should include FACTS that establish that you have been a victim of violence or are in imminent danger of becoming a victim of violence from the respondent who is an individual with whom you have or have had a continuing and significant relationship of a romantic or intimate nature, to be determined by consideration of such facts as the dating relationship existed within the past six months, the nature of the relationship included an expectation of affection or sexual involvement and the frequency and type of interaction between you and the individual included involvement over time and on a continued basis. Dating violence does not include violence in a casual acquaintanceship or violence between individuals who only have engaged in ordinary fraternization in a business or social context. For a sexual violence case, you should include FACTS that establish that you are a victim of sexual violence or the parent of a minor child living at home who is a victim of sexual violence, that you have reported the sexual violence to law enforcement and are cooperating in the criminal proceeding if there is one. You should attach the law enforcement agency incident report. If the respondent was in state prison for sexual violence against you or the minor child and respondent is out of prison or is getting out within 90 days of the petition, include that information in your supplemental affidavit, along with a copy of the notice of inmate release.

This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or the clerk of the circuit court . You should then file the original with the clerk in the county where the petition was filed and keep a copy for your records.

What should I do next?

After you complete this supplemental affidavit, the clerk will attach it to your original petition and all the documents will be submitted to the judge as your "Amended Petition."

IN THE CIRCUIT COURT OF THE ________________ JUDICIAL CIRCUIT, IN AND FOR ________________________ COUNTY, FLORIDA

Case No.: _____________________________ Division: _____________________________

_______________________________, Petitioner,

and

_______________________________, Respondent.

SUPPLEMENTAL AFFIDAVIT IN SUPPORT OF PETITION FOR INJUNCTION FOR PROTECTION AGAINST () DOMESTIC VIOLENCE () REPEAT VIOLENCE () DATING VIOLENCE () SEXUAL VIOLENCE

I, {full legal name} ______________, being sworn, certify that the following statements are true:

1. On {date} ______________, at {place and address} __________________________________________________________________, Respondent said or did the following things that hurt me or a member of my immediate family and made me afraid for my or my family member's safety: ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Check here if you are attaching additional pages to continue these facts.

2. On {date} ______________, at {place and address} ____________________________________________________________________ ____________________________________________________________________, the following event(s) took place: _________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

Check here if you are attaching additional pages to continue these facts.

3. ___ Check here if you are attaching copies of medical records for treatment you may have received for injuries referred to in your petition or in this supplemental affidavit, copies of any police or sheriff reports concerning incidents of violence involving you and Respondent, or any notice of inmate release.

I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this supplemental affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment.

Dated: ________________________

__________________________________ Signature of Petitioner

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 _________________________

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(h), PETITIONER'S REQUEST FOR CONFIDENTIAL FILING OF ADDRESS When should this form be used?

If you are the petitioner in a petition for injunction for protection against domestic violence action and you fear that disclosing your address to the respondent would put you in danger, you should complete this form and file it with the clerk of the circuit court .

You cannot use this form in a petition for injunction for protection against repeat, dating, sexual violence action.

This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your petition was filed and keep a copy for your records.

IN THE CIRCUIT COURT OF THE __________________________ JUDICIAL CIRCUIT, IN AND FOR ___________________________ COUNTY, FLORIDA

Case No.: ___________________________ Division: ___________________________ ____________________________, Petitioner,

and

____________________________, Respondent.

PETITIONER'S REQUEST FOR CONFIDENTIAL FILING OF ADDRESS

I, {full legal name} ___________________________, Petitioner in the above injunction for protection against domestic violence action, request that the Court maintain and hold as confidential, the following address:

Address ___________________________________________________________________ ___________________________________________________________________________ City__________________________ State _______________________ Zip __________ Telephone (area code and number) __________________________________________

This request is being made for the purpose of keeping the location of my residence unknown to Respondent for safety reasons pursuant to section 741.30, Florida Statutes.

Dated: ______________________

___________________________________ Signature of Petitioner

CLERK'S CERTIFICATE AS TO PETITIONER'S REQUEST FOR CONFIDENTIAL FILING OF ADDRESS

I, __________________, as Clerk of the Circuit Court, do hereby certify that I received and filed the above and will keep the above address confidential, subsequent to further order of the Court relative to such confidentiality.

CLERK OF THE CIRCUIT COURT

(SEAL)

By: ___________________________________ Deputy Clerk

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(i), MOTION FOR EXTENSION OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE, REPEAT VIOLENCE, DATING VIOLENCE, OR SEXUAL VIOLENCE When should this form be used?

If you are the petitioner on a previously entered injunction for protection against domestic violence, repeat violence, dating violence, or sexual violence and that injunction will soon expire, you may use this form to request that the court extend the injunction. You must file a motion for extension BEFORE the previously entered order expires.

This form should be typed or printed in black ink. After completing this form, you should sign it before a notary public or the clerk of the circuit court . You should then file the original with the clerk in the county where the petition was filed and keep a copy for your records. If you have any questions or need assistance completing this form, the clerk or family law intake staff will help you.

What should I do next?

For your case to proceed, you will need to set a hearing on your motion. You must properly notify the other party of the motion and hearing. You should check with the clerk of court for information on the local procedure for scheduling a hearing. When you know the date and time of your hearing, you should file Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form. You will need to serve a copy of your motion and Notice of Hearing to the other party. Service of your motion must be in a manner that is reasonably calculated to apprise the other party of your motion and the hearing. * Please note that if notice is mailed, the court in certain circumstances may not consider mailing to be adequate notice. If you want to be sure, you should consider using certified mail, return receipt requested, or having the motion personally served. This is a technical area of the law; if you have any questions about it, you should consult a lawyer. For more information on personal service, see the instructions for Summons: Personal Service on an Individual, Florida Family Law Rules of Procedure Form 12.910(a).

You will need to appear at the hearing on your motion. After the hearing, if the judge grants your motion, he or she will prepare an Order Extending Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence, Florida Supreme Court Approved Family Law Form 12.980(m). After the judge signs the order, the clerk will provide you with the necessary copies. Make sure that you keep a certified copy of the previously entered injunction AND a certified copy of the order extending that injunction with you at all times.

Where can I look for more information?

Before proceeding, you should read "General Information for Self-Represented Litigants" found at the beginning of these forms. The words that are in " bold underline " are defined in that section. The clerk of the circuit court or family law intake staff will help you complete any necessary domestic, repeat, dating, or sexual violence forms and will answer any question that you may have.

Special notes . . .

With this form you may also file the following:

• Petitioner's Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), if your petition is for protection against domestic violence and you wish to keep your address confidential.

• When completing this form, you should make sure that your reasons for requesting that the injunction be extended are stated clearly and that you include all relevant facts.

IN THE CIRCUIT COURT OF THE ___________________________ JUDICIAL CIRCUIT, IN AND FOR _________________________________ COUNTY, FLORIDA

Case No.: ___________________________ Division: ___________________________

________________________________________, Petitioner,

and

________________________________________, Respondent.

MOTION FOR EXTENSION OF INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE ( ) DATING VIOLENCE ( ) SEXUAL VIOLENCE

I, {full legal name} ____________________, being sworn, certify that the following statements are true:

SECTION I. PETITIONER (This section is about you. It must be completed. However, if this is a domestic violence case and you fear that disclosing your address to the respondent would put you in danger, you should complete and file Petitioner's Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), and write "confidential" in the space provided on this form for your address and telephone number.)

1. Petitioner currently lives at: {street address} ______________________ {city, state and zip code} ___________________________________________ Telephone Number: {area code and number} _____________________________

2. Petitioner's attorney's name, address and telephone number is: _____________________________________________________________________. (If you do not have an attorney, write "none.")

SECTION II. RESPONDENT (This section is about the person you want to be protected from. It must be completed.)

New information about Respondent, since the current injunction was issued: (If known, write Respondent's new address, place of employment, physical description, vehicle, aliases or nicknames, or attorney's name.)

___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________

SECTION III. CASE HISTORY AND REASON FOR SEEKING EXTENSION OF INJUNCTION

1. Describe any attempts since the date of the current injunction by either Petitioner or Respondent to get an injunction for protection in this or any other court (other than the injunction you are asking to extend in this motion). _____________ ______________________________________________________________________ ______________________________________________________________________

2. Describe any other court cases (including city, state, and case numbers, if known) since the date of the current injunction between Petitioner and Respondent, including any cases involving the parties' minor child(ren), divorce, juvenile dependency, guardianship, or other civil or criminal cases. ______________________________________________________ ______________________________________________________________________ ______________________________________________________________________

3. Petitioner requests that the previously entered injunction for protection against domestic violence, repeat violence, dating, or sexual violence be extended for the following specific reasons: {State in detail why you wish the injunction to remain in effect.} __________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Check here if you are attaching additional pages to continue these facts.

4. Petitioner genuinely fears the continued threat of violence by Respondent.

SECTION IV. REQUESTED RELIEF

1. Petitioner understands that the Court will hold a hearing on this motion and that he or she must appear at the hearing.

2. Petitioner asks the Court to enter an order in this case that extends the previously entered injunction for a period of () ____________________ or () until modified or dissolved by the court.

I certify that a copy of this document was [ one only] () mailed () faxed and mailed () mailed by certified mail, return receipt requested, () furnished to a law enforcement officer for personal service to the person(s) listed below on {date} __________________.

Other party or his/her attorney:

Name: _________________________________ Address: ______________________________ City, State, Zip: _____________________ Fax Number: ___________________________

I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this motion and that the punishment for knowingly making a false statement includes fines and/or imprisonment.

Dated: _______________________

______________________________________ Signature of Petitioner

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 ____________________

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(j), MOTION FOR MODIFICATION OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE, REPEAT VIOLENCE, DATING VIOLENCE, OR SEXUAL VIOLENCE When should this form be used?

This form may be used if you are a party to a previously entered injunction for protection against domestic violence, repeat violence, dating violence, or sexual violence and you want the court to modify the terms of the injunction. If you use this form, you are called the moving party.

This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or the clerk of the circuit court . You should then file the original with the clerk in the county where the original petition was filed and keep a copy for your records. You must file a motion for modification before the previously entered order expires. If you have any questions or need assistance completing this form, the clerk or family law intake staff will help you.

What should I do next?

For your case to proceed, you will need to set a hearing on your motion. You must properly notify the other party of the motion and hearing. You should check with the clerk of court for information on the local procedure for scheduling a hearing. When you know the date and time of your hearing, you should file Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form. You will need to serve a copy of your motion and Notice of Hearing to the other party. Service of your motion must be in a manner that is reasonably calculated to apprise the other party of your motion and the hearing. * Please note that if notice is mailed, the court in certain circumstances may not consider mailing to be adequate notice. If you want to be sure, you should consider using certified mail, return receipt requested, or having the motion personally served. If you are not represented by an attorney in this action, you must file proof that the other party personally received notice of your motion. This is a technical area of the law; if you have any questions about it, you should consult a lawyer. For more information on personal service, see the instructions for Summons: Personal Service on an Individual, Florida Family Law Rules of Procedure Form 12.910(a).

You will need to appear at a hearing on your motion for modification of injunction. After the hearing, if the judge grants your motion, he or she will prepare a new injunction for protection that contains the modifications. After the judge signs the new injunction, the clerk will provide you with the necessary copies. Make sure that you keep a certified copy of the new injunction with you at all times!

Where can I look for more information?

Before proceeding, you should read "General Information for Self-Represented Litigants" found at the beginning of these forms. The words that are in " bold underline " are defined in that section. The clerk of the circuit court or family law intake staff will help you complete any necessary domestic, repeat, dating, or sexual violence forms and will answer any question that you may have.

Special notes . . .

If the injunction you are seeking to modify is for domestic violence and you want the court to modify alimony , custody of a minor child(ren), or child support , you must establish that there has been a change in circumstance(s), as required by chapters 61 Florida Statutes, or 741 Florida Statutes, as applicable, that requires this (these) modification(s). Be sure that you make these change(s) clear in your motion.

With this form you may also file the following:

• Petitioner's Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), if your petition is for domestic violence and you wish to keep your address confidential.

• Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), must be completed and attached if the modification(s) you are seeking involves temporary custody of any minor child(ren).

• Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), must be completed and attached if the modification(s) you are seeking involves temporary alimony or temporary child support.

• When completing this form, you should make sure that your reasons for requesting that the injunction be modified are stated clearly and that you include all relevant facts.

MOTION FOR MODIFICATION OF INJUNCTION FOR PROTECTION AGAINST () DOMESTIC VIOLENCE () REPEAT VIOLENCE () DATING VIOLENCE () SEXUAL VIOLENCE

I, {full legal name} ______________, being sworn, certify that the following statements are true:

SECTION I. MOVING PARTY (This section is about you. It must be completed. However, if you are the Petitioner and this is a domestic violence case and you fear that disclosing your address to the respondent would put you in danger, you should complete and file Petitioner's Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), and write "confidential" in the space provided on this form for your address and telephone number.)

1. Moving Party is the ( ) Petitioner ( ) Respondent in this case.

2. Moving Party currently lives at: {street address} _________________ {city, state and zip code} ______________________________________ Telephone Number: {area code and number} ________________________

3. Moving Party's attorney's name, address and telephone number is: _________________________________________________________________. __________________________________________________________ (If you do not have an attorney, write "none.")

SECTION II. NEW INFORMATION

New information since the previous injunction was issued: (If known, write the other party's new address, place of employment, physical description, vehicle, aliases or nicknames, or attorney's name.) ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________

SECTION III. CASE HISTORY AND REASON FOR SEEKING MODIFICATION OF INJUNCTION

1. Describe any attempts since the date of the current injunction by either Petitioner or Respondent to get an injunction for protection in this or any other court (other than the injunction you are asking to modify in this motion). ______________ _______________________________________________________________________ _______________________________________________________________________

2. Describe any other court cases (including case numbers, if known) since the date of the current injunction between Petitioner and Respondent, including any cases involving the parties' minor child(ren), divorce, juvenile dependency, guardianship, or other civil or criminal cases. _______________________ _______________________________________________________________________ _______________________________________________________________________

3. Moving Party requests that the previously entered injunction for protection against domestic violence, repeat violence, dating, or sexual violence be modified for the following specific reasons: {State why you wish the injunction to be changed.} _____________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

Check here if you are attaching additional pages to continue these facts.

SECTION IV. REQUESTED RELIEF

1. Moving Party understands that the court will hold a hearing on this motion and that he or she must appear at the hearing.

2. Moving Party asks the Court to enter an order in this case, that modifies the previously entered injunction in the following ways: {State how you wish the injunction to be changed.} ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

I certify that a copy of this document was [ one only] () mailed () faxed and mailed () mailed by certified mail, return receipt requested, () furnished to a law enforcement officer for personal service to the person(s) listed below on {date} _________________________________________________________.

Other party or his/her attorney:

Name: _________________________________________ Address: ______________________________________ City, State, Zip: _________________________ Fax Number: ___________________________________

I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this motion and that the punishment for knowingly making a false statement includes fines and/or imprisonment.

Dated: ___________________________ _____________________________________ 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 ________________________

IN THE CIRCUIT OF THE __________________________________ JUDICIAL CIRCUIT, IN AND FOR _____________________________ COUNTY, FLORIDA

Case No.: ___________________________ Division: ___________________________

________________________________, Petitioner,

and

________________________________, Respondent.

TEMPORARY INJUNCTION FOR PROTECTION AGAINST REPEAT VIOLENCE

The Petition for Injunction for Protection Against Repeat Violence under section 784.046, Florida Statutes, and other papers filed in this Court have been reviewed. Under the laws of Florida, the Court has jurisdiction of the petitioner and the subject matter and has jurisdiction of the respondent upon service of the temporary injunction. The term "Petitioner" as used in this injunction includes the person on whose behalf this injunction is entered.

It is intended that this protection order meet the requirements of 18 U.S.C. § 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe.

SECTION I. NOTICE OF HEARING

Because this Temporary Injunction for Protection Against Repeat Violence has been issued without notice to Respondent, Petitioner and Respondent are instructed that they are scheduled to appear and testify at a hearing regarding this matter on {date} _________________________________, at __________ a.m./p.m., when the Court will consider whether the Court should issue a Final Judgment of Injunction for Protection Against Repeat Violence, which shall remain in effect until modified or dissolved by the Court, and whether other things should be ordered. The hearing will be before The Honorable {name} ____________________________________________ _______________, at {room name/number, location, address, city} __________________________________________________ __________________________________________, Florida. If Petitioner and/or Respondent do not appear, this temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including the imposition of court costs. All witnesses and evidence, if any, must be presented at this time.

NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at public expense.

YOU ARE ADVISED THAT IN THIS COURT:

_______ a. a court reporter is provided by the court.

_______ b. electronic audio tape recording only is provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense.

_______ c. no electronic audio tape recording or court reporting services are provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense.

A RECORD, WHICH INCLUDES A TRANSCRIPT, MAY BE REQUIRED TO SUPPORT AN APPEAL. THE PARTY SEEKING THE APPEAL IS RESPONSIBLE FOR HAVING THE TRANSCRIPT PREPARED BY A COURT REPORTER. THE TRANSCRIPT MUST BE FILED WITH THE REVIEWING COURT OR THE APPEAL MAY BE DENIED.

If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {name} __________________________________________________, {address} __________________________, {telephone} ______________, within 2 working days of your receipt of this temporary injunction. If you are hearing or voice impaired, call TDD 1-800-955-8771.

SECTION II. FINDINGS

The statements made under oath by Petitioner make it appear that section 784.046, Florida Statutes, applies to the parties, that Petitioner is a victim of repeat violence and that an immediate and present danger of repeat violence exists to Petitioner or to a member of Petitioner's immediate family.

SECTION III. TEMPORARY INJUNCTION AND TERMS

This injunction shall be effective until the hearing set above and in no event for longer than 15 days, unless extended by court order. If a final order of injunction is issued, the terms of this temporary injunction will be extended until service of the final injunction is effected upon Respondent. This injunction is valid and enforceable in all counties of the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction. Willful violation of the terms of this injunction, such as refusing to vacate the dwelling which the parties share, going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction, telephoning, contacting or communicating with Petitioner, if prohibited by this injunction, or committing an act of repeat violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes. Any party violating this injunction may be subject to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment, and also may be charged with a crime punishable by a fine, jail, or both, as provided by Florida Statutes.

ORDERED and ADJUDGED:

1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of violence against Petitioner, including assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnaping, or false imprisonment or any criminal offense resulting in physical injury or death. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word, or act to do violence to the Petitioner.

2. No Contact. Respondent shall have no contact with Petitioner unless otherwise provided in this section.

a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner's current residence {list address} ______________________ ________________________________________________________________ or any residence to which Petitioner may move; Petitioner's current or any subsequent place of employment {list address of current employment} ____________________________ ________________________ or place where Petitioner attends school {list address of school} ______________________________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner's minor child(ren) go often: __________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

[Initial if applies; write N/A if not applicable]

____ b. Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time.

____ c. Other provisions regarding contact: ________________________ _______________________________________________________________ _______________________________________________________________

3. Firearms.

[Initial all that apply; write N/A if does not apply]

____ a. Respondent shall not use or possess a firearm or ammunition.

____ b. Respondent shall surrender any firearms and ammunition in Respondent's possession to the _____________ County Sheriff's Department.

____ c. Other directives relating to firearms and ammunition: ______ _______________________________________________________________ _______________________________________________________________

4. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent's last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Fla.Fam.L.R.P., section 784.046, Florida Statutes.

5. Additional order(s) necessary to protect Petitioner from repeat violence: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________

SECTION IV. OTHER SPECIAL PROVISIONS

(This section to be used for inclusion of local provisions approved by the chief judge as provided in Florida Family Law Rule 12.610.)

SECTION V. DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION

(Provisions in this injunction that do not include a line for the judge to either initial or write N/A are considered mandatory provisions and should be interpreted to be part of this injunction.)

1. The Sheriff of _____________ County, or any other authorized law enforcement officer, is ordered to serve this temporary injunction upon Respondent as soon as possible after its issuance.

2. This injunction is valid and enforceable in all counties of the State of Florida. Violation of this injunction should be reported to the appropriate law enforcement agency. Law enforcement officers of the jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this injunction and are authorized to arrest without a warrant pursuant to section 901.15, Florida Statutes, for any violation of its provisions, which constitutes a criminal act under section 784.047, Florida Statutes.

3. Should any Florida law enforcement officer having jurisdiction have probable cause to believe that Respondent has knowingly violated this injunction, the officer may arrest Respondent, confine him/her in the county jail without bail, and shall bring him/her before the Initial Appearance Judge on the next regular court day so that Respondent can be dealt with according to law. The arresting agent shall notify the State Attorney's Office immediately after arrest. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES.

4. Reporting alleged violations. If Respondent violates the terms of this injunction and there has not been an arrest, Petitioner may contact the Clerk of the Circuit Court of the county in which the violation occurred and complete an affidavit in support of the violation or Petitioner may contact the State Attorney's office for assistance in filing an action for indirect civil contempt or indirect criminal contempt. Upon receiving such a report, the State Attorney is hereby appointed to prosecute such violations by indirect criminal contempt proceedings, or the State Attorney may decide to file a criminal charge, if warranted by the evidence.

ORDERED on ___________________.

______________________________________ CIRCUIT JUDGE

COPIES TO: Sheriff of _____________ County Petitioner ____ by U.S. Mail ____ by hand delivery Respondent: ____ forwarded to sheriff for service ____ Other: _______________________________________

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of ____________ County, Florida, and that I have furnished copies of this order as indicated above.

CLERK OF THE CIRCUIT COURT

(SEAL) By: ___________________________________________ Deputy Clerk

FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST REPEAT VIOLENCE (AFTER NOTICE)

The Petition for Injunction for Protection Against Repeat Violence under section 784.046, Florida Statutes, and other papers filed in this Court have been reviewed. The Court has jurisdiction of the parties and the subject matter. The term "Petitioner" as used in this injunction includes the person on whose behalf this injunction is entered.

It is intended that this protection order meet the requirements of 18 U.S.C. § 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe.

SECTION I. HEARING

This cause came before the Court for a hearing to determine whether an Injunction for Protection Against Repeat Violence in this case should be () issued () modified () extended.

The hearing was attended by () Petitioner () Respondent () Petitioner's Counsel () Respondent's Counsel

SECTION II. FINDINGS

On {date} ______________, a notice of this hearing was served on Respondent together with a copy of Petitioner's petition to this Court and the temporary injunction, if issued. Service was within the time required by Florida law, and Respondent was afforded an opportunity to be heard.

After hearing the testimony of each party present and of any witnesses, or upon consent of Respondent, the Court finds, based on the specific facts of this case, that Petitioner is a victim of repeat violence.

SECTION III. INJUNCTION AND TERMS

This injunction shall be in full force and effect until () further order of the Court () {date} ______________. This injunction is valid and enforceable throughout all counties in the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction. Willful violation of the terms of this injunction, such as refusing to vacate the dwelling which the parties share, going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction, telephoning, contacting or communicating with Petitioner, if prohibited by this injunction, or committing an act of repeat violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes. Any party violating this injunction shall be subject to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment, and also may be charged with a crime punishable by a fine, jail, or both, as provided by Florida Statutes.

ORDERED and ADJUDGED:

1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of violence against Petitioner, including assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnaping, or false imprisonment, or any criminal offense resulting in physical injury or death. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner.

2. No Contact. Respondent shall have no contact with Petitioner unless otherwise provided in this section.

a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner's current residence {list address} ______________________ ________________________ or any residence to which Petitioner may move; Petitioner's current or any subsequent place of employment {list address of current employment} ____________________________ or place where Petitioner attends school {list address of school} ________________________________________________ _______________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner's minor child(ren) go often: _________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________.

[Initial if applies; write N/A if not applicable]

____ b. Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time.

____ c. Other provisions regarding contact: ________________________ _______________________________________________________________ _______________________________________________________________

3. Firearms.

[Initial all that apply; write N/A if does not apply]

____ a. Respondent shall not use or possess a firearm or ammunition.

____ b. Respondent shall surrender any firearms and ammunition in the Respondent's possession to the _____________ County Sheriff's Department.

____ c. Other directives relating to firearms and ammunition: ____________ _____________________________________________________________________ _____________________________________________________________________

4. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent's last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Fla.Fam.L.R.P., section 784.046, Florida Statutes.

5. Additional order(s) necessary to protect Petitioner from repeat violence: ____________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

SECTION IV. OTHER SPECIAL PROVISIONS

(This section to be used for inclusion of local provisions approved by the chief judge as provided in Florida Family Law Rule 12.610.) SECTION V. DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION

(Provisions in this injunction that do not include a line for the judge to either initial or write N/A are considered mandatory provisions and should be interpreted to be part of this injunction.)

1. This injunction is valid and enforceable in all counties of the State of Florida. Violation of this injunction should be reported to the appropriate law enforcement agency. Law enforcement officers of the jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this injunction and are authorized to arrest without a warrant pursuant to section 901.15, Florida Statutes, for any violation of its provision, which constitutes a criminal act under section 784.047, Florida Statutes.

2. Should any Florida law enforcement officer having jurisdiction have probable cause to believe that Respondent has knowingly violated this injunction, the officer may arrest Respondent, confine him/her in the county jail without bail, and shall bring him/her before the Initial Appearance Judge on the next regular court day so that Respondent can be dealt with according to law. The arresting agent shall notify the State Attorney's Office immediately after arrest. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES.

3. Reporting alleged violations. If Respondent violates the terms of this injunction and there has not been an arrest, Petitioner may contact the Clerk of the Circuit Court of the county in which the violation occurred and complete an affidavit in support of the violation or Petitioner may contact the State Attorney's office for assistance in filing an action for indirect civil contempt or indirect criminal contempt. Upon receiving such a report, the State Attorney is hereby appointed to prosecute such violations by indirect criminal contempt proceedings, or the State Attorney may decide to file a criminal charge, if warranted by the evidence.

4. Respondent, upon service of this injunction, shall be deemed to have knowledge of and to be bound by all matters occurring at the hearing and on the face of this injunction.

5. The temporary injunction, if any, entered in this case is extended until such time as service of this injunction is effected upon Respondent.

ORDERED on _______________________.

___________________________________ CIRCUIT JUDGE

COPIES TO: Sheriff of ________________ County Petitioner (or his or her attorney): ____ by U.S. Mail ____ by hand delivery in open court (Petitioner must acknowledge receipt in writing on the face of the original order — see below)

Respondent (or his or her attorney): ____ forwarded to sheriff for service ____ by hand delivery in open court (Respondent must acknowledge receipt in writing on the face of the original order — see below)

____ by certified mail (may only be used when Respondent is present at the hearing and Respondent fails or refuses to acknowledge the receipt of certified copy of this injunction)

____ State Attorney's Office ____ Other: ____________________________________

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of __________ County, Florida, and that I have furnished copies of this order as indicated above.

CLERK OF THE CIRCUIT COURT

(SEAL)

By: __________________________ Deputy Clerk

ACKNOWLEDGMENT

I, {Name of Respondent} _________________________, acknowledge receipt of a certified copy of this Injunction for Protection.

______________________________ Petitioner

ACKNOWLEDGMENT

I, {Name of Respondent} _____________________, acknowledge receipt of a certified copy of this Injunction for Protection.

______________________________ Respondent

IN THE CIRCUIT COURT OF THE ____________ JUDICIAL CIRCUIT, IN AND FOR _____________ COUNTY, FLORIDA

Case No.: ___________________________ Division: ___________________________

________________________, Petitioner

and

________________________, Respondent.

ORDER EXTENDING INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE ( ) DATING VIOLENCE ( ) SEXUAL VIOLENCE

THIS CAUSE came before the Court on { date} ________, upon Petitioner's motion for an extension of injunction for protection and it appearing to the Court as follows:

_____ Ex parte. The claims in the motion for extension of injunction for protection make it appear to the Court that there is an immediate and present danger of domestic, repeat, dating, or sexual violence, as required under section 741.30 or section 784.046, Florida Statutes. The previously entered injunction is extended until { date} ________________. A full hearing on the petition is scheduled for { date} ________________ at _____ a.m./p.m. in _________________________.

NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at public expense.

YOU ARE ADVISED THAT IN THIS COURT:

_____ a. a court reporter is provided by the court.

_____ b. electronic audio tape recording only is provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense.

_____ c. If this is a repeat violence, dating violence, or sexual violence action, no electronic audio tape recording or court reporting services are provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense.

A RECORD, WHICH INCLUDES A TRANSCRIPT, MAY BE REQUIRED TO SUPPORT AN APPEAL. THE PARTY SEEKING THE APPEAL IS RESPONSIBLE FOR HAVING THE TRANSCRIPT PREPARED BY A COURT REPORTER. THE TRANSCRIPT MUST BE FILED WITH THE REVIEWING COURT OR THE APPEAL MAY BE DENIED.

If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact { name} ________________________________________, { address} ______________________________________________________, { telephone} _______________________, within 2 working days of your receipt of this order. If you are hearing or voice impaired, call TDD 1-800-955-8771.

After notice and hearing. Respondent was served with a copy of the temporary injunction, if applicable, and a notice of this hearing within the time required by Florida law and was afforded an opportunity to be heard. The notice and opportunity to be heard were sufficient to protect Respondent's right to due process. The following persons attended the hearing: ( ) Petitioner ( ) Respondent.

After hearing the testimony of each party present and of any witnesses, or upon consent of Respondent, the Court finds that Petitioner is a victim of domestic, repeat violence, dating violence, or sexual violence or reasonably fears that he/she will become a victim of domestic or dating violence from Respondent. The previously entered injunction is extended until { date} ___________, or until further order of the Court.

ORDERED on _________________.

___________________________________ CIRCUIT JUDGE

COPIES TO: Sheriff of County Petitioner (or his or her attorney): _____ by U.S. Mail _____ by hand delivery in open court (Petitioner must acknowledge receipt in writing on the face of the original order — see below) Respondent (or his or her attorney): _____ forwarded to sheriff for service by hand delivery in open court (Respondent must acknowledge receipt in writing on the face of the original order — see below)

_____ by certified mail (may only be used when Respondent is present at the hearing and Respondent fails or refuses to acknowledge the receipt of certified copy of this injunction)

_____ State Attorney's Office

_____ Other: _______________________________________________________

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of ________________ County, Florida, and that I have furnished copies of this order as indicated above.

CLERK OF THE CIRCUIT COURT

(SEAL) By: ________________________ Deputy Clerk

ACKNOWLEDGMENT

I, { Name of Petitioner} ___________________________, acknowledge receipt of a certified copy of this Injunction for Protection.

____________________________ Petitioner

ACKNOWLEDGMENT

I, { Name of Respondent} ________________________, acknowledge receipt of a certified copy of this Injunction for Protection.

_____________________________ Respondent

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(n), PETITION FOR INJUNCTION FOR PROTECTION AGAINST DATING VIOLENCE

When should this form be used?

If you or a member of your immediate family are a victim of dating violence, you can use this form to ask the court for a protective order prohibiting dating violence. Dating violence means violence between individuals who have or have had a continuing and significant relationship of a romantic or intimate nature. The dating relationship must have existed within the past six months, the nature of the relationship must have been characterized by the expectation of affection or sexual involvement between the parties, and the frequency and type of interaction must have included that the persons have been involved over time and on a continuous basis during the course of the relationship. Dating violence does not include violence in a casual acquaintanceship or violence between individuals who only have engaged in ordinary fraternization in a business or social context. Dating violence includes assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnaping, or false imprisonment, or any criminal offense resulting in physical injury or death. Because you are making a request to the court, you are called the petitioner . The person whom you are asking the court to protect you from is called the respondent. If you are under the age of eighteen and have never been married or had the disabilities of nonage removed by a court, one of your parents or your legal guardian must sign this petition on your behalf.

The parent or legal guardian of any minor child who is living at home may seek an injunction for protection against dating violence on behalf of the minor child. With respect to a minor child who is living at home, the parent or legal guardian must have been an eye-witness to, or have direct physical evidence or affidavits from eye-witnesses of, the specific facts and circumstances that form the basis of the petition.

If the respondent is your spouse , former spouse, related to you by blood or marriage, living with you now or has lived with you in the past (if you are or were living as a family), or the other parent of your child(ren), whether or not you have ever been married or ever lived together, you should use Petition for Injunction for Protection Against Domestic Violence, Florida Supreme Court Approved Family Law Form 12.980(a), rather than this form.

This form should be typed or printed in black ink. You should complete this form (giving as much detail as possible) and sign it the presence of a notary or in front of the clerk of the circuit court in the county were you live. The clerk will take your completed petition to a judge. You should keep a copy for your records. If you have any questions or need assistance completing this form, the clerk or family law intake staff will help you.

What should I do if the judge grants my petition?

If the facts contained in your petition convince the judge that you or a member of your immediate family are a victim of dating violence and that an immediate and present danger of dating violence to you or that family exists, the judge will sign a Temporary Injunction for Protection Against Dating Violence, Florida Supreme Court Approved Family Law Form 12.980(o). A temporary injunction is issued without notice to the respondent. The clerk will give your petition, the temporary injunction, and any other papers filed with your petition to the sheriff or other law enforcement officer for personal service on the respondent. The temporary injunction will take effect immediately after the respondent is served with a copy of it. It lasts until a full hearing can be held or for a period of 15 days, whichever comes first. The court may extend the temporary injunction beyond 15 days for a good reason, which may include failure to obtain service on the respondent.

The temporary injunction is issued " ex parte. " This means that the judge has considered only the information presented by one side — YOU. Section I of the temporary injunction gives a date that you should appear in court for a hearing. You will be expected to testify about the facts in your petition. The respondent will be given the opportunity to testify at this hearing, also. At the hearing, the judge will decide whether to issue a Final Judgment of Injunction for Protection Against Dating Violence (After Notice), Florida Supreme Court Approved Family Law Form 12.980(p), which will remain in effect for a specific time period or until modified or dissolved by the court. If you and/or the respondent do not appear, the temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including the imposition of court costs.

If the judge signs a temporary or final injunction, the clerk will provide you with the necessary copies. Make sure that you keep one certified copy of the injunction with you at all times!

What can I do if the judge denies my petition?

If your petition is denied on the grounds that it appears to the court that no immediate and present danger of dating violence exists, the court will set a full hearing on your petition. The respondent will be notified by personal service of your petition and the hearing. If your petition is denied, you may: amend your petition by filing a Supplemental Affidavit in Support of Petition for Injunction for Protection, Florida Supreme Court Approved Family Law Form 12.980(g); attend the hearing and present facts that support your petition; and/or dismiss your petition.

Where can I look for more information?

Before proceeding, you should read "General Information for Self-Represented Litigants" found at the beginning of these forms. The words that are in "bold underline" are defined in that section. The clerk of the circuit court or family law intake staff will help you complete any necessary forms. For further information, see section 784.046, Florida Statutes, and rule 12.610, Florida Family Law Rules of Procedure.

IN THE CIRCUIT COURT OF THE _________ JUDICIAL CIRCUIT, IN AND FOR _____________ COUNTY, FLORIDA

Case No.: ______________________ Division: ______________________

______________________________, Petitioner,

and

______________________________, Respondent.

PETITION FOR INJUNCTION FOR PROTECTION AGAINST DATING VIOLENCE

I, { full legal name} __________________, being sworn, certify that the following statements are true:

SECTION I. PETITIONER (This section is about you. It must be completed.)

1. Petitioner currently lives at: { address, city, state, zip code} ________________________________________________________________. Date of Birth of Petitioner: _____________________________

[ if applies]

_____ Petitioner seeks an injunction for protection on behalf of a minor child.

Petitioner is the parent or legal guardian of { full legal name} ___________________________, a minor child who is living at home.

2. Petitioner's attorney's name, address, and telephone number is: ____________________________________________________________ (If you do not have an attorney, write "none.")

SECTION II. RESPONDENT (This section is about the person you want to be protected from. It must be completed.)

1. Respondent currently lives at: { address, city, state, and zip code} ________________________________________________________________ Respondent's Driver's License number is: { if known} ____________

2. Petitioner has known Respondent since { date} __________________.

3. Respondent's last known place of employment: ___________________ Employment address: ____________________________________________ Working hours: ___________________________

Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for Protection Against Dating Violence (03/04)

4. Physical description of Respondent: Race: _____ Sex: Male ___ Female ___ Date of Birth: ____________ Height: _____ Weight: _____ Eye Color: _____ Hair Color:________ Distinguishing marks and/or scars: _____________________________ Vehicle: (make/model) ________ Color: ______ Tag Number: _______

5. Other names Respondent goes by (aliases or nicknames): _________

6. Respondent's attorney's name, address, and telephone number is: ____________________________________________________________ (If you do not know whether Respondent has an attorney, write "unknown." If Respondent does not have an attorney, write "none.")

7. If Respondent is a minor, the address of Respondent's parent or legal guardian is: _____________________________________________ ________________________________________________________________

SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION (This section must be completed.)

1. Describe the nature of the relationship between the Petitioner and Respondent (include the length of time of the relationship, the romantic or intimate nature of the relationship, the frequency or type of interaction, and any other facts that characterize the relationship) ______________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

Check here if you are attaching additional pages to continue these facts.

2. Have the Petitioner and Respondent been involved in a dating relationship within the past six months? ____ Yes ____ No

3. Has Petitioner ever received or tried to get an injunction for protection against domestic violence, dating violence, repeat violence, or sexual violence against Respondent in this or any other court?

( ) Yes ( ) No If yes, what happened in that case? {include case number, if known} ______________________________________________ ________________________________________________________________

4. Has Respondent ever received or tried to get an injunction for protection against domestic violence, dating violence, repeat violence, or sexual violence against Petitioner in this or any other court?

( ) Yes ( ) No If yes, what happened in that case? {include case number, if known} ______________________________________________ ________________________________________________________________

5. Describe any other court case that is either going on now or that happened in the past between Petitioner and Respondent (include case number, if known): ________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

6. Respondent has directed an incident of "violence," meaning assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnaping, or false imprisonment, or any criminal offense resulting in physical injury or death against Petitioner or a member of Petitioner's immediate family. The incident (including date and location) is described below.

On {date} ______________, at {location} __________________________,

Respondent ________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

Check here if you are attaching additional pages to continue these facts.

7. Other prior incidents (including dates and location) are described below:

On {date} _________, at {location} _______________________________,

Respondent ________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

Check here if you are attaching additional pages to continue these facts.

8. Petitioner genuinely fears dating violence by Respondent. Explain: __________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

9. Additional Information

[ all that apply]

___ a. Respondent owns, has, and/or is known to have guns or other weapons. Describe weapon(s): ___________________________________________________ _______________________________________________________________________

___ b. This or prior acts of dating violence have been previously reported to: {person or agency} ________________________________________________ _______________________________________________________________________.

SECTION IV. INJUNCTION (This section must be completed.)

1. Petitioner asks the Court to enter an injunction prohibiting Respondent from committing any acts of violence against Petitioner and:

a. prohibiting Respondent from going to or within 500 feet of any place Petitioner lives;

b. prohibiting Respondent from going to or within 500 feet of Petitioner's place(s) of employment or the school that Petitioner attends; the address of Petitioner's place(s) of employment and/or school is: ______________________________________________________________ __________________________________________________________________;

c. prohibiting Respondent from contacting Petitioner by telephone, mail, by e-mail, in writing, through another person, or in any other manner;

d. ordering Respondent not to use or possess any guns or firearms;

[ all that apply]

___ e. prohibiting Respondent from going to or within 500 feet of the following place(s) Petitioner or Petitioner's immediate family must go to often: ______________________________________________________ ___________________________________________________________________;

___ f. prohibiting Respondent from knowingly and intentionally going to or within 100 feet of Petitioner's motor vehicle;

and any other terms the Court deems necessary for the safety of Petitioner and Petitioner's immediate family.

I UNDERSTAND THAT BY FILING THIS PETITION, I AM ASKING THE COURT TO HOLD A HEARING ON THIS PETITION, THAT BOTH THE RESPONDENT AND I WILL BE NOTIFIED OF THE HEARING, AND THAT I MUST APPEAR AT THE HEARING.

I UNDERSTAND THAT I AM SWEARING OR AFFIRMING UNDER OATH TO THE TRUTHFULNESS OF THE CLAIMS MADE IN THIS PETITION AND THAT THE PUNISHMENT FOR KNOWINGLY MAKING A FALSE STATEMENT INCLUDES FINES AND/OR IMPRISONMENT.

Dated: ____________________________

____________________________________ Signature of Petitioner

Printed Name: Address: City, State, Zip: Telephone Number: Fax Number:

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 ____________ Form 12.980(o)

IN THE CIRCUIT COURT OF THE _____________ JUDICIAL CIRCUIT, IN AND FOR ________________ COUNTY, FLORIDA

Case No.: _________________ Division: _________________

_____________________________, Petitioner, and _____________________________, Respondent.

TEMPORARY INJUNCTION FOR PROTECTION AGAINST DATING VIOLENCE

The Petition for Injunction for Protection Against Dating Violence under section 784.046, Florida Statutes, and other papers filed in this Court have been reviewed. Under the laws of Florida, the Court has jurisdiction of the petitioner and the subject matter and has jurisdiction of the respondent upon service of the temporary injunction. The term "Petitioner" as used in this injunction includes the person on whose behalf this injunction is entered.

It is intended that this protection order meet the requirements of 18 U.S.C. § 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe.

SECTION I. NOTICE OF HEARING

Because this Temporary Injunction for Protection Against Dating Violence has been issued without notice to Respondent, Petitioner and Respondent are instructed that they are scheduled to appear and testify at a hearing regarding this matter on {date} __________________, at __________ a.m./p.m., when the Court will consider whether the Court should issue a Final Judgment of Injunction for Protection Against Dating Violence, which shall remain in effect until modified or dissolved by the Court, and whether other things should be ordered. The hearing will be before The Honorable {name} ____________________, at {room name/number, location, address, city} _____________________ __________________________________________________ , Florida. If Petitioner and/or Respondent do not appear, this temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including the imposition of court costs. All witnesses and evidence, if any, must be presented at this time.

NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at public expense.

YOU ARE ADVISED THAT IN THIS COURT:

___ a. a court reporter is provided by the court.

___ b. electronic audio tape recording only is provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense.

___ c. no electronic audio tape recording or court reporting services are provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense.

A RECORD, WHICH INCLUDES A TRANSCRIPT, MAY BE REQUIRED TO SUPPORT AN APPEAL. THE PARTY SEEKING THE APPEAL IS RESPONSIBLE FOR HAVING THE TRANSCRIPT PREPARED BY A COURT REPORTER. THE TRANSCRIPT MUST BE FILED WITH THE REVIEWING COURT OR THE APPEAL MAY BE DENIED.

If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {name} _____________________, {address} ___________________________, {telephone} ________________, within 2 working days of your receipt of this temporary injunction. If you are hearing or voice impaired, call TDD 1-800-955-8771.

SECTION II. FINDINGS

The statements made under oath by Petitioner make it appear that section 784.046, Florida Statutes, applies to the parties, that Petitioner is a victim of dating violence and/or Petitioner has reasonable cause to believe he or she is in imminent danger of becoming a victim of an act of dating violence by Respondent, and that an immediate and present danger of dating violence exists to Petitioner or to a member of Petitioner's immediate family.

SECTION III. TEMPORARY INJUNCTION AND TERMS

This injunction shall be effective until the hearing set above and in no event for longer than 15 days, unless extended by court order. If a final order of injunction is issued, the terms of this temporary injunction will be extended until service of the final injunction is effected upon Respondent. This injunction is valid and enforceable in all counties of the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction.

Willful violation of the terms of this injunction, such as refusing to vacate the dwelling which the parties share, going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction, telephoning, contacting or communicating with Petitioner, if prohibited by this injunction, or committing an act of dating violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes.

Any party violating this injunction may be subject to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment, and also may be charged with a crime punishable by a fine, jail, or both, as provided by Florida Statutes.

ORDERED and ADJUDGED:

1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of violence against Petitioner, including assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnaping, or false imprisonment, or any criminal offense resulting in physical injury or death. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word, or act to do violence to the Petitioner.

2. No Contact. Respondent shall have no contact with the Petitioner unless otherwise provided in this section.

a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner's current residence {list address} __________________________________________ or any residence to which Petitioner may move; Petitioner's current or any subsequent place of employment {list address of current employment} ________________________________ or place where Petitioner attends school {list address of school} __________________________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner's minor child(ren) go often: ____________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

[Initial if applies; write N/A if not applicable]

___ b. Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time.

___ c. Other provisions regarding contact: ____________________________ ___________________________________________________________________ ___________________________________________________________________

3. Firearms.

[Initial all that apply; write N/A if does not apply]

___ a. Respondent shall not use or possess a firearm or ammunition.

___ b. Respondent shall surrender any firearms and ammunition in Respondent's possession to the County Sheriff's Department.

___ c. Other directives relating to firearms and ammunition: _________ __________________________________________________________________ __________________________________________________________________

4. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent's last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Fla.Fam.L.R.P., section 784.046, Florida Statutes.

5. Additional order(s) necessary to protect Petitioner from dating violence: ________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

SECTION IV. OTHER SPECIAL PROVISIONS

(This section to be used for inclusion of local provisions approved by the chief judge as provided in Florida Family Law Rule 12.610.)

SECTION V. DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION

(Provisions in this injunction that do not include a line for the judge to either initial or write N/A are considered mandatory provisions and should be interpreted to be part of this injunction.)

1. The Sheriff of ______________ County, or any other authorized law enforcement officer, is ordered to serve this temporary injunction upon Respondent as soon as possible after its issuance.

2. This injunction is valid and enforceable in all counties of the State of Florida. Violation of this injunction should be reported to the appropriate law enforcement agency. Law enforcement officers of the jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this injunction and are authorized to arrest without a warrant pursuant to section 901.15, Florida Statutes, for any violation of its provisions, which constitutes a criminal act under section 784.047, Florida Statutes.

3. Should any Florida law enforcement officer having jurisdiction have probable cause to believe that Respondent has knowingly violated this injunction, the officer may arrest Respondent, confine him/her in the county jail without bail, and shall bring him/her before the Initial Appearance Judge on the next regular court day so that Respondent can be dealt with according to law. The arresting agent shall notify the State Attorney's Office immediately after arrest. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES.

4. Reporting alleged violations. If Respondent violates the terms of this injunction and there has not been an arrest, Petitioner may contact the Clerk of the Circuit Court of the county in which the violation occurred and complete an affidavit in support of the violation or Petitioner may contact the State Attorney's office for assistance in filing an action for indirect civil contempt or indirect criminal contempt. Upon receiving such a report, the State Attorney is hereby appointed to prosecute such violations by indirect criminal contempt proceedings, or the State Attorney may decide to file a criminal charge, if warranted by the evidence.

ORDERED on ___________.

____________________________ CIRCUIT JUDGE

COPIES TO:

Sheriff of _____________ County Petitioner: ___ by U.S. Mail ___ by hand delivery Respondent: ___ forwarded to sheriff for service ___ Other: ________________________________________

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of _________ County, Florida, and that I have furnished copies of this order as indicated above.

CLERK OF THE CIRCUIT COURT

(SEAL)

By: ________________________ Deputy Clerk

Form 12.980(p)

IN THE CIRCUIT COURT OF THE __________ JUDICIAL CIRCUIT, IN AND FOR _______________ COUNTY, FLORIDA

Case No.: _________________ Division: _________________

_____________________________, Petitioner, and _____________________________, Respondent.

FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST DATING VIOLENCE (AFTER NOTICE)

The Petition for Injunction for Protection Against Dating Violence under section 784.046, Florida Statutes, and other papers filed in this Court have been reviewed. The Court has jurisdiction of the parties and the subject matter. The term "Petitioner" as used in this injunction includes the person on whose behalf this injunction is entered.

It is intended that this protection order meet the requirements of 18 U.S.C. § 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe.

SECTION I. HEARING

This cause came before the Court for a hearing to determine whether an Injunction for Protection Against Dating Violence in this case should be ( ) issued ( ) modified ( ) extended.

The hearing was attended by ( ) Petitioner ( ) Respondent ( ) Petitioner's Counsel ( ) Respondent's Counsel

SECTION II. FINDINGS

On {date} _____________________, a notice of this hearing was served on Respondent together with a copy of Petitioner's petition to this Court and the temporary injunction, if issued. Service was within the time required by Florida law, and Respondent was afforded an opportunity to be heard.

After hearing the testimony of each party present and of any witnesses, or upon consent of Respondent, the Court finds, based on the specific facts of this case, that Petitioner is a victim of dating violence and/or Petitioner has reasonable cause to believe he or she is in imminent danger of becoming a victim of an act of dating violence by Respondent, and that an immediate and present danger of dating violence exists to Petitioner or to a member of Petitioner's immediate family.

SECTION III. INJUNCTION AND TERMS

This injunction shall be in full force and effect until ( ) further order of the Court ( ){date} __________________________. This injunction is valid and enforceable throughout all counties in the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction. Willful violation of the terms of this injunction, such as refusing to vacate the dwelling which the parties share, going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction, telephoning, contacting or communicating with Petitioner, if prohibited by this injunction, or committing an act of dating violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes.

Any party violating this injunction shall be subject to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment, and also may be charged with a crime punishable by a fine, jail, or both, as provided by Florida Statutes.

ORDERED and ADJUDGED:

1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of violence against Petitioner, including assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnaping, or false imprisonment, or any criminal offense resulting in physical injury or death. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner.

2. No Contact. Respondent shall have no contact with Petitioner unless otherwise provided in this section.

a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner's current residence {list address} _____________________________________ or any residence to which Petitioner may move; Petitioner's current or any subsequent place of employment {list address of current employment} ________________________________ or place where Petitioner attends school {list address of school} _____________________ _______________________________________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner's minor child(ren) go often: ________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________.

[Initial if applies; write N/A if not applicable]

___ b. Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time.

___ c. Other provisions regarding contact: _____________________________ ____________________________________________________________________ ____________________________________________________________________

3. Firearms.

[Initial all that apply; write N/A if does not apply]

___ a. Respondent shall not use or possess a firearm or ammunition.

___ b. Respondent shall surrender any firearms and ammunition in the Respondent's possession to the ___________________ County Sheriff's Department.

___ c. Other directives relating to firearms and ammunition: _________ ______________________________________________________________________

4. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent's last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Fla.Fam.L.R.P., section 784.046, Florida Statutes.

5. Additional order(s) necessary to protect Petitioner from dating violence: ________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

SECTION IV. OTHER SPECIAL PROVISIONS

(This section to be used for inclusion of local provisions approved by the chief judge as provided in Florida Family Law Rule 12.610.)

SECTION V. DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION

(Provisions in this injunction that do not include a line for the judge to either initial or write N/A are considered mandatory provisions and should be interpreted to be part of this injunction.)

1. This injunction is valid and enforceable in all counties of the State of Florida. Violation of this injunction should be reported to the appropriate law enforcement agency. Law enforcement officers of the jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this injunction and are authorized to arrest without a warrant pursuant to section 901.15, Florida Statutes, for any violation of its provision, which constitutes a criminal act under section 784.047, Florida Statutes.

2. Should any Florida law enforcement officer having jurisdiction have probable cause to believe that Respondent has knowingly violated this injunction, the officer may arrest Respondent, confine him/her in the county jail without bail, and shall bring him/her before the Initial Appearance Judge on the next regular court day so that Respondent can be dealt with according to law. The arresting agent shall notify the State Attorney's Office immediately after arrest. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES.

3. Reporting alleged violations. If Respondent violates the terms of this injunction and there has not been an arrest, Petitioner may contact the Clerk of the Circuit Court of the county in which the violation occurred and complete an affidavit in support of the violation or Petitioner may contact the State Attorney's office for assistance in filing an action for indirect civil contempt or indirect criminal contempt. Upon receiving such a report, the State Attorney is hereby appointed to prosecute such violations by indirect criminal contempt proceedings, or the State Attorney may decide to file a criminal charge, if warranted by the evidence.

4. Respondent, upon service of this injunction, shall be deemed to have knowledge of and to be bound by all matters occurring at the hearing and on the face of this injunction.

5. The temporary injunction, if any, entered in this case is extended until such time as service of this injunction is effected upon Respondent.

ORDERED on ____________________.

______________________________ CIRCUIT JUDGE

COPIES TO:

Sheriff of _________________ County Petitioner (or his or her attorney): ___ by U.S. Mail ___ by hand delivery in open court (Petitioner must acknowledge receipt in writing on the face of the original order — see below)

Respondent (or his or her attorney): ___ forwarded to sheriff for service ___ by hand delivery in open court (Respondent must acknowledge receipt in writing on the face of the original order — see below) ___ by certified mail (may only be used when Respondent is present at the hearing and Respondent fails or refuses to acknowledge the receipt of certified copy of this injunction)

___ State Attorney's Office ___ Other: ______________________________

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of ___________ County, Florida, and that I have furnished copies of this order as indicated above.

CLERK OF THE CIRCUIT COURT (SEAL) By: _________________________ Deputy Clerk

ACKNOWLEDGMENT

I, {Name of Petitioner} ___________________________, acknowledge receipt of a certified copy of this Injunction for Protection.

____________________________ Petitioner

ACKNOWLEDGMENT

I, {Name of Respondent} ___________________________, acknowledge receipt of a certified copy of this Injunction for Protection.

____________________________ Respondent

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(q), PETITION FOR INJUNCTION FOR PROTECTION AGAINST SEXUAL VIOLENCE

When should this form be used?

If you are a victim of sexual violence or the parent or legal guardian of a minor child who is living at home and is a victim of sexual violence, you can use this form to ask the court for a protective order prohibiting sexual violence. Sexual violence means any one incident of:

• sexual battery, as defined in chapter 794, Florida Statutes;

• a lewd or lascivious act, as defined in chapter 800, Florida Statutes, committed upon or in the presence of a person younger than 16 years of age;

• luring or enticing a child, as described in chapter 787, Florida Statutes;

• sexual performance by a child, as described in chapter 827, Florida Statutes; or

• any other forcible felony wherein a sexual act is committed or attempted

regardless of whether criminal charges based on the incident were filed, reduced, or dismissed by the state attorney. In order to get an injunction you must have reported the sexual violence to a law enforcement agency and be cooperating in the criminal proceeding if there is one. Attach the incident report by the law enforcement agency to your petition. It does not matter whether criminal charges based on the sexual violence have been filed, reduced, or dismissed by the state attorney's office. You may also seek an injunction for protection against sexual violence if the respondent was sent to prison for committing one of the sexual violence crimes listed above against you or your minor child living at home and respondent is out of prison or is getting our of prison within 90 days of your petition. Attach the notice of inmate release to your petition.

Because you are making a request to the court, you are called the petitioner . The person whom you are asking the court to protect you from is called the respondent . If you are seeking an injunction for protection against sexual violence on behalf of a minor child who is living at home, the parent or legal guardian must have been an eyewitness to, or have direct physical evidence or affidavits from eyewitnesses of, the specific facts and circumstances that form the basis of the petition. If you are under the age of eighteen and have never been married or had the disabilities of nonage removed by a court, one of your parents or your legal guardian must sign this petition on your behalf.

If the respondent is your spouse , former spouse, related to you by blood or marriage, living with you now or has lived with you in the past (if you are or were living as a family), or is the other parent of your child(ren) whether or not you have ever been married or ever lived together, you should use Petition for Injunction for Protection Against Domestic Violence, Florida Supreme Court Approved Family Law Form 12.980(a), rather than this form.

This form should be typed or printed in black ink. You should complete this form (giving as much detail as possible) and sign it the presence of a notary or in front of the clerk of the circuit court in the county were you live. The clerk will take your completed petition to a judge . You should keep a copy for your records. If have any questions or need assistance completing this form, the clerk or family law intake staff will help you.

What should I do if the judge grants my petition?

If the facts contained in your petition convince the judge that an immediate and present danger of violence exists, the judge will sign a Temporary Injunction for Protection Against Sexual Violence, Florida Supreme Court Approved Family Law Form 12.980(r). A temporary injunction is issued without notice to the respondent. The clerk will give your petition , the temporary injunction, and any other papers filed with your petition to the sheriff or other law enforcement officer for personal service on the respondent. The temporary injunction will take effect immediately after the respondent is served with a copy of it. It lasts until a full hearing can be held or for a period of 15 days, whichever comes first, unless the respondent is incarcerated, and in such instance the temporary injunction is effective for 15 days following the date the respondent is released from incarceration. The court may extend the temporary injunction beyond 15 days for a good reason, which may include failure to obtain service on the respondent.

The temporary injunction is issued " ex parte ." This means that the judge has considered only the information presented by one side — YOU. Section I of the temporary injunction gives a date that you should appear in court for a hearing. You will be expected to testify about the facts in your petition. The respondent will be given the opportunity to testify at this hearing, also. At the hearing, the judge will decide whether to issue a Final Judgment of Injunction for Protection Against Sexual Violence (After Notice), Florida Supreme Court Approved Family Law Form 12.980(s), which will remain in effect for a specific time period or until modified or dissolved by the court. If you and/or the respondent do not appear, the temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including the imposition of court costs.

If the judge signs a temporary or final injunction, the clerk will provide you with the necessary copies. Make sure that you keep one certified copy of the injunction with you at all times!

What can I do if the judge denies my petition?

If your petition is denied on the grounds that it appears to the court that no immediate and present danger of sexual violence exists, the court will set a full hearing on your petition. The respondent will be notified by personal service of your petition and the hearing. If your petition is denied, you may: amend your petition by filing a Supplemental Affidavit in Support of Petition for Injunction for Protection, Florida Supreme Court Approved Family Law Form 12.980 (g); attend the hearing and present facts that support your petition; and/or dismiss your petition.

Where can I look for more information?

Before proceeding, you should read "General Information for Self-Represented Litigants" found at the beginning of these forms. The words that are in "bold underline" are defined in that section. The clerk of the circuit court or family law intake staff will provide you with necessary forms. For further information, see section 784.046, Florida Statutes.

Form 12.980(q)

IN THE CIRCUIT COURT OF THE __________ JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA

Case No.: _______________ Division: _______________

____________________________, Petitioner, and ____________________________, Respondent.

PETITION FOR INJUNCTION FOR PROTECTION AGAINST SEXUAL VIOLENCE

I, {full legal name} ____________________________________ being sworn, certify that the following statements are true:

SECTION I. PETITIONER (This section is about you. It must be completed.)

1. Petitioner currently lives at: {address, city, state, zip code} _______ _______________________________________________________________________.

Date of Birth of Petitioner: ______________________________________________

[ if applies]

___ Petitioner seeks an injunction for protection on behalf of a minor child.

Petitioner is the parent or legal guardian of {full legal name} _________________, a minor child who is living at home.

2. Petitioner's attorney's name, address, and telephone number is: _______ ___________________________________________________________________________ (If you do not have an attorney, write "none.")

SECTION II. RESPONDENT (This section is about the person you want to be protected from. It must be completed.)

1. Respondent currently lives at: {address, city, state, and zip code} ___ _______________________________________________________________________

Respondent's Driver's License number is: {if known} ___________________

2. Respondent's last known place of employment: __________________________

Employment address: ___________________________________________________

Working hours: ___________________________

3. Physical description of Respondent:

Race: _______ Sex: Male ___ Female _________ Date of Birth: ________ Height: _____ Weight: _____ Eye Color: _____ Hair Color: ___________ Distinguishing marks and/or scars: _________________________________ Vehicle: (make/model) __________ Color: _________ Tag Number: ______

4. Other names Respondent goes by (aliases or nicknames): _____________

5. Respondent's attorney's name, address, and telephone number is: ____ ____________________________________________________________________

(If you do not know whether Respondent has an attorney, write "unknown." If Respondent does not have an attorney, write "none.")

6. If Respondent is a minor, the address of Respondent's parent or legal guardian is: _________________________________________________

SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION (This section must be completed.)

1. Petitioner has suffered sexual violence as shown by the fact that the Respondent has: {describe the facts of violence} ____________________ _____________________________________________________________________ _____________________________________________________________________

Check here if you are attaching additional pages to continue these facts.

[ all that apply]

___ a. Petitioner reported the sexual violence to law enforcement and is cooperating in any criminal proceeding. The incident report by law enforcement is attached. {If there is a criminal case, include case number, if known} __________________.

___ b. Respondent was sent to prison for committing sexual violence against Petitioner or Petitioner's minor child living at home and Respondent is out of prison or is getting out of prison within 90 days. The notice of inmate release is attached.

2. Has Petitioner ever received or tried to get an injunction for protection against domestic violence, dating violence, repeat violence, or sexual violence against Respondent in this or any other court?

( ) Yes ( ) No If yes, what happened in that case? {include case number, if known} _________________________________________________ ___________________________________________________________________

3. Has Respondent ever received or tried to get an injunction for protection against domestic violence, dating violence, repeat violence, or sexual violence against Petitioner in this or any other court?

( ) Yes ( ) No If yes, what happened in that case? {include case number, if known} ___________________________________________________ _____________________________________________________________________

4. Describe any other court case that is either going on now or that happened in the past between Petitioner and Respondent {include case number, if known}: ___________________________________________________ ______________________________________________________________________

5. Additional Information

[ all that apply]

___ a. Respondent owns, has, and/or is known to have guns or other weapons. Describe weapon(s): ______________________________________

___ b. This or prior acts of violence have been previously reported to: {person or agency} ________________________________________________.

SECTION IV. INJUNCTION (This section must be completed.)

1. Petitioner asks the Court to enter an injunction prohibiting Respondent from committing any acts of violence against Petitioner and:

a. prohibiting Respondent from going to or within 500 feet of any place Petitioner lives;

b. prohibiting Respondent from going to or within 500 feet of Petitioner's place(s) of employment or the school that Petitioner attends; the address of Petitioner's place(s) of employment and/or school is: ________________________________________________;

c. prohibiting Respondent from contacting Petitioner by telephone, mail, by e-mail, in writing, through another person, or in any other manner;

d. ordering Respondent not to use or possess any guns or firearms;

[ all that apply]

___ e. prohibiting Respondent from going to or within 500 feet of the following place(s) Petitioner or Petitioner's immediate family must go to often: ______________________________________________________ ___________________________________________________________________;

___ f. prohibiting Respondent from knowingly and intentionally going to or within 100 feet of Petitioner's motor vehicle;

and any other terms the Court deems necessary for the safety of Petitioner and Petitioner's immediate family.

I UNDERSTAND THAT BY FILING THIS PETITION, I AM ASKING THE COURT TO HOLD A HEARING ON THIS PETITION, THAT BOTH THE RESPONDENT AND I WILL BE NOTIFIED OF THE HEARING, AND THAT I MUST APPEAR AT THE HEARING.

I UNDERSTAND THAT I AM SWEARING OR AFFIRMING UNDER OATH TO THE TRUTHFULNESS OF THE CLAIMS MADE IN THIS PETITION AND THAT THE PUNISHMENT FOR KNOWINGLY MAKING A FALSE STATEMENT INCLUDES FINES AND/OR IMPRISONMENT.

Dated: ________________________

_____________________________ Signature of Petitioner Printed Name: _________________________ Address: ______________________________ City, State, Zip: _____________________ Telephone Number: _____________________ Fax Number: ___________________________

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 ___________

Form 12.980(r)

IN THE CIRCUIT COURT OF THE __________ JUDICIAL CIRCUIT, IN AND FOR ______________ COUNTY, FLORIDA

Case No.: ______________ Division: ______________

________________________, Petitioner,

and

________________________, Respondent.

TEMPORARY INJUNCTION FOR PROTECTION AGAINST SEXUAL VIOLENCE

The Petition for Injunction for Protection Against Sexual Violence under section 784.046, Florida Statutes, and other papers filed in this Court have been reviewed. Under the laws of Florida, the Court has jurisdiction of the petitioner and the subject matter and has jurisdiction of the respondent upon service of the temporary injunction. The term "Petitioner" as used in this injunction includes the person on whose behalf this injunction is entered.

It is intended that this protection order meet the requirements of 18 U.S.C. § 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe.

SECTION I. NOTICE OF HEARING

Because this Temporary Injunction for Protection Against Sexual Violence has been issued without notice to Respondent, Petitioner and Respondent are instructed that they are scheduled to appear and testify at a hearing regarding this matter on {date} ___________, at ______ a.m./p.m., when the Court will consider whether the Court should issue a Final Judgment of Injunction for Protection Against Sexual Violence, which shall remain in effect until modified or dissolved by the Court, and whether other things should be ordered. The hearing will be before The Honorable {name} _____________________, at {room name/number, location, address, city} _________________________________, Florida. If Petitioner and/or Respondent do not appear, this temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including the imposition of court costs. All witnesses and evidence, if any, must be presented at this time.

NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at public expense.

YOU ARE ADVISED THAT IN THIS COURT:

___ a. a court reporter is provided by the court.

___ b. electronic audio tape recording only is provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense.

___ c. no electronic audio tape recording or court reporting services are provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense.

A RECORD, WHICH INCLUDES A TRANSCRIPT, MAY BE REQUIRED TO SUPPORT AN APPEAL. THE PARTY SEEKING THE APPEAL IS RESPONSIBLE FOR HAVING THE TRANSCRIPT PREPARED BY A COURT REPORTER. THE TRANSCRIPT MUST BE FILED WITH THE REVIEWING COURT OR THE APPEAL MAY BE DENIED.

If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {name} _______________________________________________________________, {address} _____________________________________, {telephone} _________, within 2 working days of your receipt of this temporary injunction. If you are hearing or voice impaired, call TDD 1-800-955-8771.

SECTION II. FINDINGS

The statements made under oath by Petitioner make it appear that section 784.046, Florida Statutes, applies to the parties, that Petitioner is a victim of sexual violence by Respondent and meets the requirements for an injunction established by law.

SECTION III. TEMPORARY INJUNCTION AND TERMS

This injunction shall be effective until the hearing set above and in no event for longer than 15 days, unless extended by court order or unless the Respondent is incarcerated, and if incarcerated, shall be effective for 15 days following the date Respondent is released from incarceration. If a final order of injunction is issued, the terms of this temporary injunction will be extended until service of the final injunction is effected upon Respondent. This injunction is valid and enforceable in all counties of the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction. Willful violation of the terms of this injunction, such as refusing to vacate the dwelling which the parties share, going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction, telephoning, contacting or communicating with Petitioner, if prohibited by this injunction, or committing an act of sexual violence against Petitioner constitutes a contemptuous act. Any party violating this injunction may be subject to civil or criminal contempt proceedings, including the imposition of a fine or imprisonment.

ORDERED and ADJUDGED:

1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of violence against Petitioner, including assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnaping, or false imprisonment, or any criminal offense resulting in physical injury or death. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word, or act to do violence to Petitioner.

2. No Contact. Respondent shall have no contact with the Petitioner unless otherwise provided in this section.

a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner's current residence {list address} _________________________________ or any residence to which Petitioner may move; Petitioner's current or any subsequent place of employment {list address of current employment} ________________________________ or place where Petitioner attends school {list address of school} _____________________________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner's minor child(ren) go often: _______________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________

[Initial if applies; write N/A if not applicable]

___ b. Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time.

___ c. Other provisions regarding contact: _______________________________ ______________________________________________________________________ ______________________________________________________________________

3. Firearms.

[Initial all that apply; write N/A if does not apply]

___ a. Respondent shall not use or possess a firearm or ammunition.

___ b. Respondent shall surrender any firearms and ammunition in Respondent's possession to the County Sheriff's Department.

___ c. Other directives relating to firearms and ammunition: __________ ___________________________________________________________________ ___________________________________________________________________

4. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent's last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Fla.Fam.L.R.P., section 784.046, Florida Statutes.

5. Additional order(s) necessary to protect Petitioner from sexual violence: _________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

SECTION IV. OTHER SPECIAL PROVISIONS

(This section to be used for inclusion of local provisions approved by the chief judge.)

SECTION V. DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION

(Provisions in this injunction that do not include a line for the judge to either initial or write N/A are considered mandatory provisions and should be interpreted to be part of this injunction.)

1. The Sheriff of ______________ County, or any other authorized officer, is ordered to serve this temporary injunction upon Respondent as soon as possible after its issuance.

2. This injunction is valid and enforceable in all counties of the State of Florida. Violation of this injunction should be reported to the appropriate law enforcement agency. Law enforcement officers of the jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this injunction.

3. Reporting alleged violations. If Respondent violates the terms of this injunction, Petitioner may contact the Clerk of the Circuit Court of the county in which the violation occurred and complete an affidavit in support of the violation.

ORDERED on ___________________.

__________________________________________ CIRCUIT JUDGE

COPIES TO: Sheriff of ________ County Petitioner: ___ by U.S. Mail ___ by hand delivery Respondent: ___ forwarded to sheriff for service ___ Other: __________________________________

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of _________ County, Florida, and that I have furnished copies of this order as indicated above.

CLERK OF THE CIRCUIT COURT

(SEAL)

By: ________________________ Deputy Clerk

Form 12.980(s)

IN THE CIRCUIT COURT OF THE __________ JUDICIAL CIRCUIT, IN AND FOR _________ COUNTY, FLORIDA

Case No.: _________________ Division: _________________

___________________________, Petitioner,

and

___________________________, Respondent.

FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST SEXUAL VIOLENCE (AFTER NOTICE)

The Petition for Injunction for Protection Against Sexual Violence under section 784.046, Florida Statutes, and other papers filed in this Court have been reviewed. The Court has jurisdiction of the parties and the subject matter. The term "Petitioner" as used in this injunction includes the person on whose behalf this injunction is entered.

It is intended that this protection order meet the requirements of 18 U.S.C. § 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe.

SECTION I. HEARING

This cause came before the Court for a hearing to determine whether an Injunction for Protection Against Sexual Violence in this case should be ( ) issued ( ) modified ( ) extended.

The hearing was attended by ( ) Petitioner ( ) Respondent ( ) Petitioner's Counsel ( ) Respondent's Counsel

SECTION II. FINDINGS

On {date} _____________________, a notice of this hearing was served on Respondent together with a copy of Petitioner's petition to this Court and the temporary injunction, if issued. Service was within the time required by Florida law, and Respondent was afforded an opportunity to be heard.

After hearing the testimony of each party present and of any witnesses, or upon consent of Respondent, the Court finds, based on the specific facts of this case, that Petitioner is a victim of sexual violence by Respondent and meets the requirements for an injunction established by law.

SECTION III. INJUNCTION AND TERMS

This injunction shall be in full force and effect until ( ) further order of the Court ( ){date} __________________________. This injunction is valid and enforceable throughout all counties in the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction. Willful violation of the terms of this injunction, such as refusing to vacate the dwelling which the parties share, going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction, telephoning, contacting or communicating with Petitioner, if prohibited by this injunction, or committing an act of sexual violence against Petitioner constitutes a contemptuous act. Any party violating this injunction shall be subject to civil or criminal contempt proceedings, including the imposition of a fine or imprisonment.

ORDERED and ADJUDGED:

1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of violence against Petitioner, including assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnaping, or false imprisonment, or any criminal offense resulting in physical injury or death. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner.

2. No Contact. Respondent shall have no contact with Petitioner unless otherwise provided in this section.

a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner's current residence {list address} _________________________________________ or any residence to which Petitioner may move; Petitioner's current or any subsequent place of employment {list address of current employment} ________________________________ or place where Petitioner attends school {list address of school} ________________ _______________________________________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner's minor child(ren) go often: _________________________________________ ____________________________________________________________________ ____________________________________________________________________.

[Initial if applies; write N/A if not applicable]

___ b. Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time.

___ c. Other provisions regarding contact: ____________________________ ___________________________________________________________________ ___________________________________________________________________

3. Firearms.

[Initial all that apply; write N/A if does not apply]

___ a. Respondent shall not use or possess a firearm or ammunition.

___ b. Respondent shall surrender any firearms and ammunition in the Respondent's possession to the __________ County Sheriff's Department.

___ c. Other directives relating to firearms and ammunition: ___________ ____________________________________________________________________

4. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent's last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Fla.Fam.L.R.P., section 784.046, Florida Statutes.

5. Additional order(s) necessary to protect Petitioner from sexual violence: __________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

SECTION IV. OTHER SPECIAL PROVISIONS

(This section to be used for inclusion of local provisions approved by the chief judge.)

SECTION V. DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION

(Provisions in this injunction that do not include a line for the judge to either initial or write N/A are considered mandatory provisions and should be interpreted to be part of this injunction.)

1. This injunction is valid and enforceable in all counties of the State of Florida. Violation of this injunction should be reported to the appropriate law enforcement agency. Law enforcement officers of the jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this injunction.

2. Reporting alleged violations. If Respondent violates the terms of this injunction, Petitioner may contact the Clerk of the Circuit Court of the county in which the violation occurred and complete an affidavit in support of the violation.

3. Respondent, upon service of this injunction, shall be deemed to have knowledge of and to be bound by all matters occurring at the hearing and on the face of this injunction.

4. The temporary injunction, if any, entered in this case is extended until such time as service of this injunction is effected upon Respondent.

ORDERED on _________________________________.

_____________________________________________ CIRCUIT JUDGE

COPIES TO: Sheriff of ____________________ County

Petitioner (or his or her attorney): ___ by U.S. Mail ___ by hand delivery in open court (Petitioner must acknowledge receipt in writing on the face of the original order — see below)

Respondent (or his or her attorney): ___ forwarded to sheriff for service ___ by hand delivery in open court (Respondent must acknowledge receipt in writing on the face of the original order — see below) ___ by certified mail (may only be used when Respondent is present at the hearing and Respondent fails or refuses to acknowledge the receipt of certified copy of this injunction)

___ State Attorney's Office ___ Other: ______________________________

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of ___________ County, Florida, and that I have furnished copies of this order as indicated above.

CLERK OF THE CIRCUIT COURT (SEAL)

By: ___________________________ Deputy Clerk

ACKNOWLEDGMENT

I, {Name of Petitioner} ___________________________, acknowledge receipt of a certified copy of this Injunction for Protection.

____________________________________ Petitioner

ACKNOWLEDGMENT

I, {Name of Respondent} ________________________________, acknowledge receipt of a certified copy of this Injunction for Protection.

_____________________________________ Respondent

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(t), PETITION BY AFFIDAVIT FOR ORDER TO SHOW CAUSE FOR A VIOLATION OF FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE, REPEAT VIOLENCE, DATING VIOLENCE, OR SEXUAL VIOLENCE

When should this form be used?

You may use this form if you have a valid Final Judgment of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence in force which has been violated. You should use this affidavit to state the essential facts which establish a violation of the Final Judgment of Injunction.

This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or the clerk of the circuit court . You should then file the original with such clerk or judge as determined by the chief judge of your circuit to be the recipient of affidavits of violation, provide a copy to the state attorney of that circuit and keep a copy for your records.

Form 12.980(t)

IN THE CIRCUIT COURT OF THE _____________ JUDICIAL CIRCUIT, IN AND FOR ___________ COUNTY, FLORIDA

Case No.: ________________ Division: ________________

_____________________________, Petitioner,

and

_____________________________, Respondent.

PETITION BY AFFIDAVIT FOR ORDER TO SHOW CAUSE FOR A VIOLATION OF FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE ( ) DATING VIOLENCE ( ) SEXUAL VIOLENCE

I, {full legal name} ___________________________________________, being sworn, certify that I have actual knowledge of the following facts as set forth and the following statements are true:

1. The Court has previously issued [ one only]

___ a. Final Judgment of Injunction for Protection Against Domestic Violence ___ b. Final Judgment of Injunction for Protection Against Repeat Violence ___ c. Final Judgment of Injunction for Protection Against Dating Violence ___ d. Final Judgment of Injunction for Protection Against Sexual Violence

in this case on the ___ day of ____________________, _____.

2. The Final Judgment of Injunction for Protection was served on Respondent on the ___ day of ____________________, _____.

3. On {date} _____________________, at {place and address} _____________ _____________________________________________________________________, the following event(s) took place: __________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________

Check here if you are attaching additional pages to continue these facts.

4. Respondent has willfully violated the Injunction by (explain what Respondent did that violated the Order of Protection.) ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

Check here if you are attaching additional pages to continue these facts.

5. ___ Check here if you are attaching copies of medical records for treatment you may have received for injuries referred to in your affidavit, or copies of any police or sheriff reports concerning incidents of violence involving you and Respondent.

6. Respondent acted to impair, interfere with, delay, hinder, lessen the authority of, dignity of, and embarrass the cause of justice in a manner contemptuous of this court.

WHEREFORE, I respectfully request that the Court issue an Order to Show Cause, requiring Respondent to appear before the Court to show cause why Respondent should not be held in contempt of court for failure to abide by the terms and conditions of the Final Judgment of Injunction for Protection.

I understand that by filing this affidavit, I am asking the court to hold a hearing, that both Respondent and I will be notified of the hearing, and that I must appear at the hearing. In addition to my own testimony, I understand that I can bring other proof of the violation such as, for example, people who saw Respondent violate the order, pictures, medical records, police reports, or anything that might help show the judge how Respondent violated the Final Judgment of Injunction for Protection.

I have read every statement made in this affidavit and each statement is true and correct. I understand that the statements made in this affidavit are being made under penalty of perjury, punishable as provided in Section 837.02, Florida Statutes and that the punishment for knowingly making a false statement includes fines and/or imprisonment.

Dated: _____________________

_______________________________________ Signature of Petitioner

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 _____________

I certify that a copy of this document was [ one only] ( ) 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: ________________________

Form 12.980(u)

IN THE CIRCUIT COURT OF THE ______________ JUDICIAL CIRCUIT, IN AND FOR ___________ COUNTY, FLORIDA

Case No.: ________________ Division: ________________

________________________, Petitioner, and

________________________, Respondent.

Description of Respondent:

Sex: _________________ Eye color: __________ Race: ________________ Hair color: __________ Height: ______________ Last known address: __________________________ Weight: ______________ ______________________________________________ DOB: _________________

ORDER TO SHOW CAUSE

This cause comes before the court for review based upon the alleged conduct of Respondent for the issuance of an Order to Show Cause directed to {name} ______________________________ for violation of the Final Judgment of Injunction for Protection as is more specifically set forth in the Petition By Affidavit For Order To Show Cause For a Violation Of Final Judgment Of Injunction For Protection, a copy of which is attached hereto and made a part hereof.

NOW, THEREFORE, you, {name} ________________, are hereby ORDERED to appear before this court before Judge {name} ____________________, on {date} __________________, at {time} _______.m., in Room _______ of the ____________ Courthouse, located at ___________________________, to be arraigned. A subsequent hearing will be scheduled requiring Respondent to show cause why he/she should not be held in contempt of this court for violation of the Final Judgment of Injunction for Protection as is stated in the attached Petition By Affidavit For Order To Show Cause For a Violation of Final Judgment of Injunction For Protection. Punishment, if imposed, may include a fine and incarceration.

Should the court determine, based on the evidence presented at the hearing, that Respondent's conduct warrants sanctions for civil contempt in addition to or instead of indirect criminal contempt, the court reserves the right to find Respondent guilty of civil contempt and impose appropriate civil sanctions.

The court hereby appoints the State Attorney's Office to prosecute the case.

Respondent is advised that he/she is entitled to be represented by counsel.

IT IS FURTHER ORDERED that the Sheriff of this county serve this Order to Show Cause by delivering copies to Respondent, with proof of Sheriff's service.

ORDERED in ______________ County, Florida, on {date} ______________.

______________________________ Judge

Copies to: ___ State Attorney ___ Petitioner or Counsel for Petitioner ___ Respondent or Counsel for Respondent

If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {name} _____ ________, {address} ______________, {telephone} ___________, within 2 working days of your receipt of this order. If you are hearing or voice impaired, call TDD 1-800-955-8771.