Amendments to the Florida Family Law Rules and Forms Appendix B
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APPENDIX B IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, 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. The Court has jurisdiction of the parties and the subject matter under the laws of Florida. 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 , at appear and testify at a hearing regarding this matter on {date} 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, support and who should pay the filing fees and costs. 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 (O Florida Family Law Rules of Procedure Form 12.902(b) or (c)), tax return, pay stubs, and Florida Supreme Court Approved Family Law Form 12.980(d)(1), Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren) (9/00) B-1 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. 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. 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. 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 Florida Supreme Court Approved Family Law Form 12.980(d)(1), Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren) (9/00) B-2 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 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 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 who are residing in the same single dwelling unit with Petitioner. 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: Florida Supreme Court Approved Family Law Form 12.980(d)(1), Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren) (9/00) B-3 Firearms. 3. [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 ten (10) days of the change. All further papers (excluding the final injunction, if entered without Respondent s 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 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: . Florida Supreme Court Approved Family Law Form 12.980(d)(1), Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren) (9/00) B-4 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 Respondent in possession of the home. place ( ) Petitioner ( ) 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. 10. ( )Petitioner ( ) Respondent shall not damage or remove any furnishings or fixtures from the parties' former shared premises. 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 Act (UCCJA). 12. Temporary Custody of Minor Child(ren). ( ) Petitioner ( ) Respondent shall have temporary custody of the parties minor child(ren) listed below: Name Birth date Florida Supreme Court Approved Family Law Form 12.980(d)(1), Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren) (9/00) B-5 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.) Florida Supreme Court Approved Family Law Form 12.980(d)(1), Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren) (9/00) B-6 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: Florida Supreme Court Approved Family Law Form 12.980(d)(1), Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren) (9/00) B-7 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 Florida Supreme Court Approved Family Law Form 12.980(d)(1), Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren) (9/00) B-8 IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, 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. The Court has jurisdiction of the parties and the subject matter under the laws of Florida. 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 , at a.m./p.m., when and testify at a hearing regarding this matter on {date} 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 who should pay the filing fees and costs, 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 (O 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. Florida Supreme Court Approved Family Law Form 12.980(d)(2), Temporary Injunction for Protection Against Domestic Violence without Minor Child(ren) (9/00) B-9 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. 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. 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 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 domestic violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one Florida Supreme Court Approved Family Law Form 12.980(d)(2), Temporary Injunction for Protection Against Domestic Violence without Minor Child(ren) (9/00) B-10 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 who are residing in the same single dwelling unit with Petitioner. 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: Firearms. 3. [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: Florida Supreme Court Approved Family Law Form 12.980(d)(2), Temporary Injunction for Protection Against Domestic Violence without Minor Child(ren) (9/00) B-11 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 ten (10) days of the change. All further papers (excluding the final injunction, if entered without Respondent s 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 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 ( and possession of the dwelling located at: ) Respondent shall have temporary exclusive use . 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 Florida Supreme Court Approved Family Law Form 12.980(d)(2), Temporary Injunction for Protection Against Domestic Violence without Minor Child(ren) (9/00) B-12 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. 10. ( )Petitioner ( ) Respondent shall not damage or remove any furnishings or fixtures from the parties' former shared premises. 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 Florida Supreme Court Approved Family Law Form 12.980(d)(2), Temporary Injunction for Protection Against Domestic Violence without Minor Child(ren) (9/00) B-13 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 Florida Supreme Court Approved Family Law Form 12.980(d)(2), Temporary Injunction for Protection Against Domestic Violence without Minor Child(ren) (9/00) B-14 IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, 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 ) Petitioner s Counsel ( ( ) Respondent ) 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. Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (9/00) B-15 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 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 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 who is residing in the same single dwelling unit with Petitioner. 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: Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (9/00) B-16 . 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). Evaluation/Counseling. 4. [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)(d), 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 Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (9/00) B-17 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. Court Costs. Pursuant to section 741.30(2)(a), Florida Statutes, filing fees to the Clerk of the Circuit Court and service fees to the sheriff are waived, subject to subsequent order of the Court; OR costs in the amount of $ for the filing fee, plus $ for the sheriff s fee, for a total of $ are taxed against ( ) Petitioner ( ) Respondent ( ) Other (explain) , for which sum let execution issue. This amount shall be paid to the {county} Clerk of the Circuit Court, within 30 days of the date of this injunction. If Respondent is directed to pay filing fees or service fees and Petitioner has previously paid said fees, the clerk shall refund same to Petitioner, upon payment by Respondent. 6. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within ten (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. 7. Other provisions necessary to protect Petitioner from domestic violence: Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (9/00) B-18 TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME [Initial if applies; Write N/A if not applicable] 8. Possession of the Home. ( ) Petitioner ( and possession of the dwelling located at: ) Respondent shall have temporary exclusive use . 9. 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. 10. 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 11 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. 11. The following other personal possessions may also be removed from the premises at this time: 12. Other: TEMPORARY CUSTODY OF AND VISITATION WITH MINOR CHILD(REN) 13. 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 Act (UCCJA). 14. Temporary Custody of Minor Child(ren). ( ) Petitioner ( ) Respondent shall have temporary custody of the parties minor child(ren) listed below: Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (9/00) B-19 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). Type of Contact/Visitation with Minor Child(ren). The noncustodial parent shall have: 15. [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} Limitations on Visitation. The above specified visitation shall be: 16. [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: . Arrangements for Contact/Visitation with Minor Child(ren). 17. [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: Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (9/00) B-20 Exchange of Minor Child(ren). 18. [Initial all that apply; write N/A if does not apply] a. The parties shall exchange the child(ren) at ( location(s): ) school or daycare, or ( ) at the following 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: 19. Other Additional Provisions Relating to the Minor Child(ren). TEMPORARY SUPPORT 20. 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 , whichever occurs first. until {date} 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: Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (9/00) B-21 Temporary Child Support. 21. [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,O Florida Family Law Form12.902(e), filed by ( ) Petitioner ( ) Respondent are correct OR the Court makes the following findings: The Petitioner s net monthly , (Child Support Guidelines %). The Respondent s net monthly income income is $ , (Child Support Guidelines %). Monthly child care costs are $ . is $ 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. O 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: 22. 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 County Clerk of Circuit Court. Obligor shall also pay the the {name of county} applicable state disbursement unit service charge. Income deduction is not in the best interests of the child(ren) because: Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (9/00) B-22 . 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. Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (9/00) B-23 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.) 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.) Respondent (or his or her attorney): 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} certified copy of this Injunction for Protection. ,acknowledge receipt of a Petitioner ACKNOWLEDGMENT I, {Name of Respondent} ,acknowledge receipt of a Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (9/00) B-24 certified copy of this Injunction for Protection. Respondent Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (9/00) B-25 IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, 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 ) Petitioner s Counsel ( ( ) Respondent ) 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. Florida Supreme Court Approved Family Law Form 12.980(e)(2), Final Judgment of Injunction for Protection Against Domestic Violence without Minor Child(ren) (After Notice) (9/00) B-26 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 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 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 who is residing in the same single dwelling unit with Petitioner. 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: Florida Supreme Court Approved Family Law Form 12.980(e)(2), Final Judgment of Injunction for Protection Against Domestic Violence without Minor Child(ren) (After Notice) (9/00) B-27 . 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). Evaluation/Counseling. 4. [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)(d), 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 Florida Supreme Court Approved Family Law Form 12.980(e)(2), Final Judgment of Injunction for Protection Against Domestic Violence without Minor Child(ren) (After Notice) (9/00) B-28 provide proof of such enrollment to the Clerk of Circuit Court within ( )30 days ( ) no more than 30 days) of the date of this injunction: days, (but 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. Court Costs. Pursuant to section 741.30(2)(a), Florida Statutes, filing fees to the Clerk of the Circuit Court and service fees to the sheriff are waived, subject to subsequent order of the Court; OR costs in the amount of $ for the filing fee, plus $ for the sheriff s fee, for a total of $ are taxed against ( ) Petitioner ( ) Respondent ( ) Other (explain) , for which sum let execution issue. This amount shall be paid to the {county} Clerk of the Circuit Court, within 30 days of the date of this injunction. If Respondent is directed to pay filing fees or service fees and Petitioner has previously paid said fees, the clerk shall refund same to Petitioner, upon payment by Respondent. 6. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within ten (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. 7. Other provisions necessary to protect Petitioner from domestic violence: Florida Supreme Court Approved Family Law Form 12.980(e)(2), Final Judgment of Injunction for Protection Against Domestic Violence without Minor Child(ren) (After Notice) (9/00) B-29 TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME [Initial if applies; Write N/A if not applicable] 8. Possession of the Home. ( ) Petitioner ( and possession of the dwelling located at: ) Respondent shall have temporary exclusive use . 9. 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. 10. 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 12 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. 11. The following other personal possessions may also be removed from the premises at this time: 12. Other: TEMPORARY SUPPORT Temporary Alimony. 13. [Initial all that apply; write N/A if does not apply] Florida Supreme Court Approved Family Law Form 12.980(e)(2), Final Judgment of Injunction for Protection Against Domestic Violence without Minor Child(ren) (After Notice) (9/00) B-30 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: 14. Method of Payment. [Initial one only] a. Obligor shall pay any temporary alimony ordered through income deduction, and such support shall County. Obligor is be paid to the Central Government Depository in 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 County Clerk of Circuit Court. Obligor shall also pay the {name of county} 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.) Florida Supreme Court Approved Family Law Form 12.980(e)(2), Final Judgment of Injunction for Protection Against Domestic Violence without Minor Child(ren) (After Notice) (9/00) B-31 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): Respondent (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.) 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 acknowledge the receipt of a fails or refuses to injunction.) certified copy of this Florida Supreme Court Approved Family Law Form 12.980(e)(2), Final Judgment of Injunction for Protection Against Domestic Violence without Minor Child(ren) (After Notice) (9/00) B-32 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} certified copy of this Injunction for Protection. , acknowledge receipt of a Petitioner ACKNOWLEDGMENT I, {Name of Respondent} certified copy of this Injunction for Protection. ,acknowledge receipt of a Respondent Florida Supreme Court Approved Family Law Form 12.980(e)(2), Final Judgment of Injunction for Protection Against Domestic Violence without Minor Child(ren) (After Notice) (9/00) B-33 IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, 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. The Court has jurisdiction of the parties and the subject matter under the laws of Florida. 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, including, for example, such matters as who should pay the filing fees and costs. 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. Florida Supreme Court Approved Family Law Form 12.980(l), Temporary Injunction for Protection Against Repeat Violence (9/00) B-34 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. 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 Florida Supreme Court Approved Family Law Form 12.980(l), Temporary Injunction for Protection Against Repeat Violence (9/00) B-35 acts of violence against Petitioner, including assault, battery, sexual battery, or stalking. 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 ten (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. Florida Supreme Court Approved Family Law Form 12.980(l), Temporary Injunction for Protection Against Repeat Violence (9/00) B-36 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. Florida Supreme Court Approved Family Law Form 12.980(l), Temporary Injunction for Protection Against Repeat Violence (9/00) B-37 ORDERED on . CIRCUIT JUDGE COPIES TO: Sheriff of Petitioner Respondent: Other: County by U. S. Mail by hand delivery forwarded to sheriff for service 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 Florida Supreme Court Approved Family Law Form 12.980(l), Temporary Injunction for Protection Against Repeat Violence (9/00) B-38 IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: , Petitioner, and , Respondent. 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 ) Petitioner s Counsel ( ( ) Respondent ) 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 Florida Supreme Court Approved Family Law Form 12.980(m), Final Judgment of Injunction for Protection Against Repeat Violence (After Notice) (9/00) B-39 This injunction shall be in full force and effect until ( ) further order of the Court ( ) . This injunction is valid and enforceable throughout all counties {date} 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, battery, sexual battery, or stalking. 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: . Florida Supreme Court Approved Family Law Form 12.980(m), Final Judgment of Injunction for Protection Against Repeat Violence (After Notice) (9/00) B-40 [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. Court Costs. Pursuant to section 784.046(3)(b), Florida Statutes, filing fees to the Clerk of the Circuit Court and service fees to the sheriff are waived, subject to subsequent order of the court; for the filing fee, plus $ for the sheriff s fee, for OR costs in the amount of $ a total of $ are taxed against ( ) Petitioner ( ) Respondent ( ) Other {explain} , for which sum let execution issue. This amount shall be paid to the office of the {name of county} Clerk of the Circuit Court, within 30 days of the date of this injunction. If Respondent is directed to pay filing fees or service fees and Petitioner has previously paid said fees, the clerk shall refund same to Petitioner, upon payment by Respondent. 5. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within ten (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. 6. 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.) Florida Supreme Court Approved Family Law Form 12.980(m), Final Judgment of Injunction for Protection Against Repeat Violence (After Notice) (9/00) B-41 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) Florida Supreme Court Approved Family Law Form 12.980(m), Final Judgment of Injunction for Protection Against Repeat Violence (After Notice) (9/00) B-42 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} certified copy of this Injunction for Protection. , acknowledge receipt of a Petitioner ACKNOWLEDGMENT I, {Name of Respondent} certified copy of this Injunction for Protection. ,acknowledge receipt of a Respondent Florida Supreme Court Approved Family Law Form 12.980(m), Final Judgment of Injunction for Protection Against Repeat Violence (After Notice) (9/00) B-43 NOTICE APPENDIX C IS OVER 500 PAGES LONG AND, FOR PURPOSES OF ECONOMY, IS NOT PRINTED OUT AND ATTACHED HERE. A HARD COPY IS LOCATED IN THE CLERK S OFFICE FOR INSPECTION AND COPYING IF DESIRED. ADDITIONALLY, APPENDIX C (ALONG WITH THE REST OF THE OPINION) MAY BE ACCESSED AND DOWNLOADED IN ITS ENTIRETY FROM THIS COURT S WEB SITE AT WWW.FLCOURTS.ORG (CLICK ON OPINIONS AND RULES OPTION, THEN, UNDER THE HEADING COURT RULES, CLICK ON EITHER FAMILY LAW RULES OPINIONS OR FAMILY LAW FORMS ). FINALLY, APPENDIX C (ALONG WITH THE REST OF THE OPINION) WILL ULTIMATELY BE PUBLISHED IN ITS ENTIRETY IN THE SOUTHERN SECOND REPORTER. PLEASE CONTACT THE CLERK S OFFICE FOR FURTHER ASSISTANCE IF NEEDED. Florida Supreme Court Approved Family Law Form 12.980(m), Final Judgment of Injunction for Protection Against Repeat Violence (After Notice) (9/00) B-44
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