In Re: Amendments To The Florida Supreme Court Approved Family Law Forms
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Supreme Court of Florida ____________ No. SC12-510 ____________ IN RE: AMENDMENTS TO THE FLORIDA SUPREME COURT APPROVED FAMILY LAW FORMS. [June 7, 2012] PER CURIAM. Pursuant to the procedures approved by this Court in Amendments to the Florida Family Law Rules of Procedure & Family Law Forms, 810 So. 2d 1, 14 (Fla. 2000), this Court has internally reviewed the Florida Supreme Court Approved Family Law Forms and has determined that amendments to twenty-four forms regarding domestic, repeat, dating, and sexual violence are needed. In general, the amendments do the following: (1) revise language in notices of hearing to comply with Florida Rule of Judicial Administration 2.540 (Requests for Accommodations by Persons with Disabilities); (2) remove unnecessary or unauthorized requests for personal information, such as place of marriage, and place of birth or gender of a minor; (3) add language to forms used in proceedings for temporary injunctions to expressly advise litigants that failure to appear at the final hearing may result in the issuance of a permanent injunction; (4) add language in the petition for temporary injunction forms making a specific prayer for entry of a temporary injunction; (5) update language relating to health and dental insurance, where applicable, to reflect current statutory requirements; and (6) revise the method of payment sections, where applicable, to add the central depository within each circuit as an entity able to accept court-ordered payments. Input on these issues was received from the Advisory Workgroup on the Florida Supreme Court Approved Family Law Forms, which provided valuable assistance. We have jurisdiction. See art. V, § 2(a), Fla. Const. The new and amended forms are adopted as set forth in the appendix to this opinion, fully engrossed, and ready for use. The forms shall become effective immediately upon release of this opinion. The forms may also be accessed and downloaded from the Florida State Court s website at www.flcourts.org/gen_public/family/forms_rules/index.shtml. By adoption of the new and amended forms, we express no opinion as to their correctness or applicability. We also direct that the new and amended forms be published for comment. Interested persons shall have sixty days from the date of this opinion to file comments with the Court.1 1. An original and nine paper copies of all comments must be filed with the Court on or before August 6, 2012, as well as a separate request for oral argument if the person filing the comment wishes to participate in oral argument, which may -2- It is so ordered. CANADY, C.J., and PARIENTE, LEWIS, QUINCE, POLSTON, LABARGA, and PERRY, JJ., concur. THE FILING OF A MOTION FOR REHEARING SHALL NOT ALTER THE EFFECTIVE DATE OF THESE AMENDMENTS. Original Proceedings Florida Supreme Court Approved Family Law Forms be scheduled in this case. Electronic copies of all comments also must be filed in accordance with the Court's administrative order In re Mandatory Submission of Electronic Copies of Documents, Fla. Admin. Order No. AOSC04-84 (Sept. 13, 2004). -3- APPENDIX INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(a), PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE (06/12) When should this form be used? If you are a victim of any act of domestic violence or have reasonable cause to believe that you are in imminent danger of becoming a victim of domestic violence, you can use this form to ask the court for a protective order prohibiting domestic violence. Because you are making a request to the court, you are called the petitioner. The person whom you are asking the court to protect you from is called the respondent. Domestic violence includes: assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any other criminal offense resulting in physical injury or death to petitioner by any of petitioner s family or household members. In determining whether you have reasonable cause to believe you are in imminent danger of becoming a victim of domestic violence, the court must consider all relevant factors alleged in the petition, including, but not limited to the following: 1. The history between the petitioner and the respondent, including threats, harassment, stalking, and physical abuse. 2. Whether the respondent has attempted to harm the petitioner or family members or individuals closely associated with the petitioner. 3. Whether the respondent has threatened to conceal, kidnap, or harm the petitioner s child or children. 4. Whether the respondent has intentionally injured or killed a family pet. 5. Whether the respondent has used, or has threatened to use, against the petitioner any weapons such as guns or knives. 6. Whether the respondent has physically restrained the petitioner from leaving the home or calling law enforcement. 7. Whether the respondent has a criminal history involving violence or the threat of violence. 8. The existence of a verifiable order of protection issued previously or from another jurisdiction. 9. Whether the respondent has destroyed personal property, including, but not limited to, telephones or other communications equipment, clothing, or other items belonging to the petitioner. 10. Whether the respondent engaged in any other behavior or conduct that leads the petitioner to have reasonable cause to believe that he or she is in imminent danger of becoming a victim of domestic violence. The domestic violence laws only apply to your situation if the respondent is your spouse, former spouse, Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (06/12) -4- related to you by blood or marriage, living with you now or has lived with you in the past (if you are or were living as a family), or the other parent of your child(ren) whether or not you have ever been married or ever lived together. With the exception of persons who have a child in common, the family or household members must be currently residing together or have in the past resided together in the same single dwelling unit. If the respondent is not one of the above, you should look at Petition for Injunction for Protection Against Repeat Violence, Florida Supreme Court Approved Family Law Form 12.980(f), to determine if your situation will qualify for an injunction for protection against repeat violence, or Petition for Injunction for Protection Against Dating Violence, Florida Supreme Court Approved Family Law Form 12.980(n), to determine if your situation will qualify for an injunction for protection against dating violence, or Petition for Injunction for Protection Against Sexual Violence, Florida Supreme Court Approved Family Law Form 12.980(q), to determine if your situation will qualify for an injunction for protection against sexual violence. If you are under the age of eighteen and you have never been married or had the disabilities of nonage removed by a court, then one of your parents, custodians, or your legal guardian must sign this petition with you. This form should be typed or printed in black ink. You should complete this form (giving as much detail as possible) and sign it in front of a notary public or the clerk of the circuit court in the county where you live. The clerk will take your completed petition to a judge. You should keep a copy for your records. If you have any questions or need assistance completing this form, the clerk or family law intake staff will help you. What should I do if the judge grants my petition? If the facts contained in your petition convince the judge that you are a victim of domestic violence or that an imminent danger of domestic violence exists, the judge will sign either an immediate Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.980(c)(1) or an immediate Temporary Injunction for Protection Against Domestic Violence without Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.980(c)(2). A temporary injunction is issued without notice to the respondent. The clerk will give your petition, the temporary injunction, and any other papers filed with your petition to the sheriff or other law enforcement officer for personal service on the respondent. The temporary injunction will take effect immediately after the respondent is served with a copy of it. It lasts until a full hearing can be held or for a period of 15 days, whichever comes first. The court may extend the temporary injunction beyond 15 days for a good reason, which may include failure to obtain service on the respondent. The temporary injunction is issued ex parte. This means that the judge has considered only the Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (06/12) -5- information presented by one side--YOU. The temporary injunction gives a date that you must appear in court for a hearing. At that hearing, you will be expected to testify about the facts in your petition. The respondent will be given the opportunity to testify at this hearing, also. At the hearing, the judge will decide whether to issue either a Final Judgment of Injunction for Protection Against Domestic Violence with Minor Child(ren)(After Notice), Florida Supreme Court Approved Family Law Form 12.980(d)(1), or a Final Judgment of Injunction for Protection Against Domestic Violence without Minor Child(ren)(After Notice), Florida Supreme Court Approved Family Law Form 12.980(d)(2). Either of these final judgments will remain in effect for a specific time period or until modified or dissolved by the court. If either you or the respondent does not appear at the final hearing, the temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including entry of a permanent injunction and the imposition of court costs. You and respondent will be bound by the terms of any injunction issued at the final hearing. IF EITHER YOU OR RESPONDENT DOES NOT APPEAR AT THE FINAL HEARING, YOU WILL BOTH BE BOUND BY THE TERMS OF ANY INJUNCTION ISSUED IN THIS MATTER. If the judge signs a temporary or final injunction, the clerk will provide you with the necessary copies. Make sure that you keep one certified copy of the injunction with you at all times! What can I do if the judge denies my petition? If your petition is denied solely on the grounds that it appears to the court that no imminent danger of domestic violence exists, the court will set a full hearing, at the earliest possible time, on your petition, unless you request that no hearing be set. The respondent will be notified by personal service of your petition and the hearing. If your petition is denied, you may: amend your petition by filing a Supplemental Affidavit in Support of Petition for Injunction for Protection Against Domestic Violence, Repeat or Dating Violence, Florida Family Law Form 12.980 (g); attend the hearing and present facts that support your petition; and/or dismiss your petition. Where can I look for more information? Before proceeding, you should read General Information for Self-Represented Litigants found at the beginning of these forms. The words that are in bold underline are defined in that section. The clerk of the circuit court or family law intake staff will help you complete any necessary domestic violence forms and can give you information about local domestic violence victim assistance programs, shelters, and other related services. You may also call the Domestic Violence Hotline at 1-800-500-1119. For further information, see Chapter 741, Florida Statutes, and Rule 12.610, Florida Family Law Rules of Procedure. Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (06/12) -6- Special notes... With this form you may also need to file the following: ï · Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), must be completed and filed if you are asking the court to determine issues with regard to your parenting plan or time-sharing for a minor child(ren). ï · Parenting plan means a document created to govern the relationship between the parents relating to the decisions that must be made regarding the minor child(ren) and must contain a time-sharing schedule for the parents and child(ren). The issues concerning the minor child(ren) may include, but are not limited to, the child(ren) s education, health care, and physical, social, and emotional well-being. In creating the plan, all circumstances between the parents, including their historic relationship, domestic violence, and other factors must be taken into consideration. The Parenting Plan shall be developed and agreed to by the parents and either approved by a court or established by the court, with or without the use of a court-ordered parenting plan recommendation. If the parents cannot agree, or if the parents agreed to a plan that is not approved by the court, a Parenting Plan shall established by the court. Time-sharing schedule means a timetable that must be included in the Parenting Plan that specifies the time, including overnights and holidays, that a minor child will spend with each parent. If developed and agreed to by the parents of a minor child, it must be approved by the court. If the parents cannot agree, of if their agreed-upon schedule is not approved by the court, the schedule shall be established by the court. ï · Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), must be completed and filed if you are asking the court to determine issues of temporary child support. ï · Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), must be completed and filed if you are seeking temporary alimony or temporary child support. ï · Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), MUST be filed with the court at or prior to a hearing to establish or modify child support. Additionally, if you fear that disclosing your address to the respondent would put you in danger, you should complete a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), and file it with the clerk of the circuit court and write confidential in the space provided on the petition. Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (06/12) -7- IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: , Petitioner, and , Respondent. PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE I, {full legal name} following statements are true: , being sworn, certify that the SECTION I. PETITIONER (This section is about you. It must be completed. However, if you fear that disclosing your address to the respondent would put you in danger, you should complete and file a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), and write confidential in the space provided on this form for your address and telephone number.) 1. Petitioner s current address is: {street address} {city, state and zip code} Telephone Number: {area code and number} Physical description of Petitioner: Race: ____ Sex: Male ___ Female ___ Date of Birth: ____________________________ 2. Petitioner s attorney s name, address, and telephone number is: . (If you do not have an attorney, write none.) SECTION II. RESPONDENT (This section is about the person you want to be protected from. It must be completed.) 1. Respondent s current address is: {street address, city, state, and zip code} Respondent s Driver s License number is: {if known} . . Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (06/12) -8- 2. Respondent is: [Choose all that apply] a. ____the spouse of Petitioner. Date of Marriage: b. ____the former spouse of Petitioner. Date of Marriage: Date of Dissolution of Marriage: c. ____ related by blood or marriage to Petitioner. Specify relationship: d. ____a person who is or was living in one home with Petitioner, as if a family. e. ____a person with whom Petitioner has a child in common, even if Petitioner and Respondent never were married or living together. 3. Petitioner has known Respondent since {date} . 4. Respondent s last known place of employment: Employment address: Working hours: 5. Physical description of Respondent: Race: Sex: Male Female Date of Birth: Height: Weight: Eye Color: Hair Color: Distinguishing marks or scars: Vehicle: (make/model) Color: Tag Number: 6. Other names Respondent goes by (aliases or nicknames): 7. Respondent s attorney s name, address, and telephone number is: (If you do not know whether Respondent has an attorney, write unknown. If Respondent does not have an attorney, write none.) SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION (This section must be completed.) 1. Has Petitioner ever received or tried to get an injunction for protection against domestic violence against Respondent in this or any other court? Yes No If yes, what happened in that case? (Include case number, if known) Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (06/12) -9- 2. Has Respondent ever received or tried to get an injunction for protection against domestic violence against Petitioner in this or any other court? Yes No If yes, what happened in that case? (Include case number, if known) 3. Describe any other court case that is either going on now or that happened in the past, including a dissolution of marriage, paternity action, or child support enforcement action, between Petitioner and Respondent {include city, state, and case number, if known}: ____________________________________________________________________________ 4. Petitioner is either a victim of domestic violence or has reasonable cause to believe he or she is in imminent danger of becoming a victim of domestic violence because respondent has {mark all sections that apply and describe in the spaces below the incidents of violence or threats of violence, specifying when and where they occurred, including, but not limited to, locations such as a home, school, place of employment, or time-sharing exchange}: a. ___committed or threatened to commit domestic violence defined in s. 741.28, Florida Statutes, as any assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any criminal offense resulting in physical injury or death of one family or household member by another. With the exception of persons who are parents of a child in common, the family or household members must be currently residing or have in the past resided together in the same single dwelling unit. b. ___previously threatened, harassed, stalked, or physically abused the petitioner. c. ___attempted to harm the petitioner or family members or individuals closely associated with the petitioner. d. ___threatened to conceal, kidnap, or harm the petitioner's child or children. e. ___intentionally injured or killed a family pet. f. ___used, or has threatened to use, against the petitioner any weapons such as guns or knives. g. ___physically restrained the petitioner from leaving the home or calling law enforcement. h. ___a criminal history involving violence or the threat of violence (if known). i. ___another order of protection issued against him or her previously or from another jurisdiction (if known). j. ___destroyed personal property, including, but not limited to, telephones or other communication equipment, clothing, or other items belonging to the petitioner. k. ___engaged in any other behavior or conduct that leads the petitioner to have reasonable cause to believe he or she is in imminent danger of becoming a victim of domestic violence. Below is a brief description of the latest act of violence or threat of violence that causes Petitioner to Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (06/12) - 10 - honestly fear imminent domestic violence by Respondent. (Use additional sheets if necessary.) On {date} , at {location} , Respondent: . _______Please indicate here if you are attaching additional pages to continue these facts. 5. Additional Information [Choose all that apply] a.___ Other acts or threats of domestic violence as described on attached sheet. b.___This or other acts of domestic violence have been previously reported to {person or agency}:_____________________________________________________________ c.___ Respondent owns, has, and/or is known to have guns or other weapons. Describe weapon(s): d.___Respondent has a drug problem. e.___ Respondent has an alcohol problem. f.___ Respondent has a history of mental health problems. If checked, answer the following, if known: Has Respondent ever been the subject of a Baker Act proceeding? ( ) Yes ( ) No Is Respondent supposed to take medication for mental health problems? ( ) Yes ( ) No Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (06/12) - 11 - If yes, is Respondent currently taking his/her medication? ( ) Yes ( ) No SECTION IV. TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME (Complete this section only if you want the Court to grant you temporary exclusive use and possession of the home that you share with the Respondent.) 1. Petitioner claims the following about the home that Petitioner and Respondent share or that Petitioner left because of domestic violence: [Choose all that apply] a.___ Petitioner needs the exclusive use and possession of the home that the parties share at {street address} , {city, state, zip code} . b.__ _Petitioner cannot get another safe place to live because: . c. ___If kept out of the home, Respondent has the money to get other housing or may live without money at {street address} , {city, state, zip code} . 2. The home is: [Choose one only] a. ___owned or rented by Petitioner and Respondent jointly. b. ___solely owned or rented by Petitioner. c. ___solely owned or rented by Respondent. SECTION V. TEMPORARY PARENTING PLAN WITH TEMPORARY TIME-SHARING SCHEDULE FOR MINOR CHILD(REN) (Complete this section only if you are asking the court to provide a temporary parenting plan, including a temporary time-sharing schedule, with regard to, the minor child or children of the parties which might involve prohibiting or limiting time-sharing or requiring that it be supervised by a third party. You must be the natural parent, adoptive parent, or guardian by court order of the minor child(ren). If you are asking the court to provide a temporary parenting plan, including a temporary time-sharing schedule, with regard to the minor child or children of the parties which might involve prohibiting or limiting time-sharing or requiring that it be supervised by a third party, you must also complete and file a Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d).) Note: If the paternity of the minor child(ren) listed below has not been established through either marriage or court order, the Court may deny a request to provide a temporary parenting plan, Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (06/12) - 12 - including a temporary time-sharing schedule with regard to, the minor child or children, and/or a request for child support. Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (06/12) - 13 - 1. Petitioner is the natural parent, adoptive parent, or guardian by court order of the minor child(ren) whose name(s) and age(s) is (are) listed below. Name Birth date 2. The minor child(ren) for whom Petitioner is asking the court to provide a temporary parenting plan, including a temporary time-sharing schedule, with regard to: [Choose one only] a.___saw the domestic violence described in this petition happen. b.___were at the place where the domestic violence happened but did not see it. c.___were not there when the domestic violence happened this time but have seen previous acts of domestic violence by Respondent. d.___have not witnessed domestic violence by Respondent. 3. Name any other minor child(ren) who were there when the domestic violence happened. Include child(ren) s name, age, and parents names. 4. Temporary Parenting Plan and Temporary Time-Sharing Schedule [Choose all that apply] a.___Petitioner requests that the Court provide a temporary parenting plan, including a temporary timesharing schedule, with regard to the minor child or children of the parties, as follows: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ b.___Petitioner requests that the Court order supervised exchange of the minor child(ren) or exchange through a responsible person designated by the Court. The following person is suggested as a responsible person for purposes of such exchange. Explain: ____________________________________________________________________________ _____________________________________________________________________________ ____________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (06/12) - 14 - c.___Petitioner requests that the Court limit time-sharing by Respondent with the minor child(ren). Explain: ________________________________________________________________________ d.___Petitioner requests that the Court prohibit time-sharing by Respondent with the minor child(ren) because Petitioner genuinely fears that Respondent imminently will abuse, remove, or hide the minor child(ren) from Petitioner. Explain: _____________________________________________________________________________ ____________________________________________________________________________ e.___Petitioner requests that the Court allow only supervised time-sharing by Respondent with the minor child(ren). Explain: ______________________________________________________________ ___________________________________________________________________________________ ____________________________________________________________________________________ Supervision should be provided by a Family Visitation Center, or other (specify):_______________________________________________________________________ SECTION VI. TEMPORARY SUPPORT (Complete this section only if you are seeking financial support from the Respondent. You must also complete and file a Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), and Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), if you are seeking child support. A Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), must be filed with the court at or prior to a hearing to establish or modify child support.) [Choose all that apply] 1. ___Petitioner claims a need for the money he or she is asking the Court to make Respondent pay, and that Respondent has the ability to pay that money. 2. ___Petitioner requests that the Court order Respondent to pay the following temporary alimony to Petitioner. (Petitioner must be married to Respondent to ask for temporary alimony.) Temporary Alimony Requested $ every ( ) week ( ) other week ( ) month. 3. ___Petitioner requests that the Court order Respondent to pay the following temporary child support to Petitioner. (The Respondent must be the natural parent, adoptive parent, or guardian by court order of the minor child(ren) for the court to order the Respondent to pay child support.) Temporary child support is requested in the amount of $ every ( ) week ( ) other week ( ) month. SECTION VII. INJUNCTION (This section summarizes what you are asking the Court to include in the injunction. This section must be completed.) Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (06/12) - 15 - 1. Petitioner asks the Court to enter a TEMPORARY INJUNCTION for protection against domestic violence that will be in place from now until the scheduled hearing in this matter. 2. Petitioner asks the Court to enter, after a hearing has been held on this petition, a final judgment on injunction prohibiting Respondent from committing any acts of domestic violence against Petitioner and: a. prohibiting Respondent from going to or within 500 feet of any place the Petitioner lives; b. prohibiting Respondent from going to or within 500 feet of the Petitioner s place(s) of employment or school; the address of Petitioner s place(s) of employment or school is: _____________________________________________________________________________________ _____________________________________________________________________ c. prohibiting Respondent from contacting Petitioner by mail, by telephone, through another person, or in any other manner; d. prohibiting Respondent from knowingly and intentionally going to or within 100 feet of Petitioner s motor vehicle. e. prohibiting Respondent from defacing or destroying Petitioner s personal property. [Choose all that apply] f.___prohibiting Respondent from going to or within 500 feet of the following place(s) Petitioner or Petitioner s minor child(ren) must go often {include address}: g.___granting Petitioner temporary exclusive use and possession of the home Petitioner and Respondent share; h.___granting Petitioner on a temporary basis 100% of the time sharing with the parties minor child(ren); i.___establishing a temporary parenting plan including a temporary time-sharing schedule for the parties minor child(ren); j.___ granting temporary alimony for Petitioner; k.___granting temporary child support for the minor child(ren); l.___ ordering Respondent to participate in treatment, intervention, and/or counseling services; m.___referring Petitioner to a certified domestic violence center; and any other terms the Court deems necessary for the protection of Petitioner and/or Petitioner s child(ren), including injunctions or directives to law enforcement agencies, as provided in Section 741.30, Florida Statutes. I UNDERSTAND THAT BY FILING THIS PETITION, I AM ASKING THE COURT TO HOLD A HEARING ON THIS PETITION, THAT BOTH RESPONDENT AND I WILL BE NOTIFIED OF THE HEARING, AND THAT I Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (06/12) - 16 - MUST APPEAR AT THE HEARING. I UNDERSTAND THAT IF EITHER RESPONDENT OR I FAIL TO APPEAR AT THE HEARING, WE WILL BE BOUND BY THE TERMS OF ANY INJUNCTION ISSUED AT THAT HEARING. Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (06/12) - 17 - I HAVE READ EVERY STATEMENT MADE IN THIS PETITION, AND EACH STATEMENT IS TRUE AND CORRECT. I UNDERSTAND THAT THE STATEMENTS MADE IN THIS PETITION ARE BEING MADE UNDER PENALTY OF PERJURY, PUNISHABLE AS PROVIDED IN SECTION 837.02, FLORIDA STATUTES. _____________ (initials) _______________________________ Signature of Petitioner Dated: STATE OF FLORIDA COUNTY OF _________________________ Sworn to or affirmed and signed before me on by . NOTARY PUBLIC or DEPUTY CLERK [Print, type, or stamp commissioned name of notary or clerk.] Personally known Produced identification _________________________Type of identification produced Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (06/12) - 18 - IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: _____________________ Division: ______________________ __________________, Petitioner, and __________________, Respondent. ORDER SETTING HEARING ON PETITION FOR INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE ( ) DATING VIOLENCE ( ) SEXUAL VIOLENCE WITHOUT ISSUANCE OF AN INTERIM TEMPORARY INJUNCTION The Petition for Injunction for Protection Against Domestic Violence filed under section 741.30, Florida Statutes, or Repeat Violence, Dating Violence, or Sexual Violence under section 784.046, Florida Statutes, has been reviewed. This Court has jurisdiction of the parties and of the subject matter. A Temporary Injunction for Protection Against Repeat, Dating, or Sexual Violence, pending the hearing scheduled below, is NOT being entered at this time but an injunction may be entered after the hearing, depending on the findings made by the Court at that time. FINDINGS The Court finds that the facts, as stated in the Petition alone and without a hearing on the matter, do not demonstrate that Petitioner is a victim of domestic, repeat, dating, or sexual violence or that Petitioner has reasonable cause to believe that he or she is in imminent danger of becoming a victim of domestic or dating violence. Therefore, there is not a sufficient factual basis upon which the court can enter a Temporary Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence prior to a hearing. A hearing is scheduled on the Petition for Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence in section II of this Order. Petitioner may amend or supplement the Petition at any time to state further reasons why a Temporary Injunction should be ordered which would be in effect until the hearing scheduled below. NOTICE OF HEARING Petitioner and Respondent are ordered to appear and testify at a hearing on the Petition for Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence on {date} , at _ a.m./p.m. at {location}_________________________________________ at which time the Court will consider whether a Final Judgment of Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence should be entered. If entered, the injunction will remain in Florida Supreme Court Approved Family Law Form 12.980(b(1),Order Setting Hearing on Petition for Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence without Issuance of an Interim Temporary Injunction (06/12) - 19 - effect until a fixed date set by the Court or until modified or dissolved by the Court. At the hearing, the Court will determine whether other things should be ordered, including, for example, such matters as time-sharing and support. If Petitioner and/or Respondent do not appear, orders may be entered, including entry of a permanent injunction and the imposition of court costs. Petitioner and Respondent will be bound by the terms of any injunction or order issued at the final hearing. IF EITHER PETITIONER OR RESPONDENT DOES NOT APPEAR AT THE FINAL HEARING, HE OR SHE WILL BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED IN THIS MATTER. All witnesses and evidence, if any, must be presented at this time. In cases where temporary support issues have been alleged in the pleadings, each party is ordered to bring his or her financial affidavit (Florida Family Law Rules of Procedure Form 12.902(b) or (c)), tax return, pay stubs, and other evidence of financial income to the hearing. NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at public expense. YOU ARE ADVISED THAT IN THIS COURT: a. ____a court reporter is provided by the court. b. ____electronic recording only is provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party s expense. c. ____in repeat, dating, and sexual violence cases, no electronic 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 provisions of certain assistance. Please contact: __________________________________________________________________ __________________________________________________________________ {identify applicable court personnel by name, address, and telephone number} at least 7 days before your scheduled court appearance, or immediately upon receiving this notification if the time before the scheduled appearance is less than 7 days; if you are hearing or voice impaired, call 711. Florida Supreme Court Approved Family Law Form 12.980(b)(1),Order Setting Hearing on Petition for Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence without Issuance of an Interim Temporary Injunction (06/12) - 20 - Nothing in this order limits Petitioner s right to dismiss the petition. DONE AND ORDERED in _______________________, Florida on . _______________________________ CIRCUIT JUDGE COPIES TO: Petitioner: ____ by hand delivery in open Court _by U.S. mail Respondent: _ forwarded to sheriff for service Other: I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of __ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By: Deputy Clerk Florida Supreme Court Approved Family Law Form 12.980(b)(1),Order Setting Hearing on Petition for Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence without Issuance of an Interim Temporary Injunction (06/12) - 21 - THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: _________________, Petitioner, and ___________________ Respondent. ORDER DENYING PETITION FOR INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE ( ) DATING VIOLENCE ( ) SEXUAL VIOLENCE The Court has reviewed the Petition for Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence filed in this cause and finds that Petitioner has failed to comply with one or more statutory requirements applicable to that petition including the following: 1. ____ Petitioner has failed to allege in a petition for domestic violence that Respondent is a family or household member as that term is defined by Chapter 741, Florida Statutes. 2. ____ Petitioner has used a petition form other than that which is approved by the Court and the form used lacks the statutorily required components. 3. ____ Petitioner has failed to complete a mandatory portion of the petition. 4. ____ Petitioner has failed to sign the petition. 5. ____ Petitioner has failed to allege facts sufficient to support the entry of an injunction for protection against domestic, repeat, dating, or sexual violence because: . 6. ____ Other: . It is therefore, ORDERED AND ADJUDGED that the Petition is denied without prejudice to amend or supplement the petition to cure the above stated defects. DONE AND ORDERED in ______________________________, Florida, on ____________. Florida Supreme Court Approved Family Law Form 12.980(b)(2),Order Denying, Petition for Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 22 - CIRCUIT JUDGE COPIES TO: Petitioner: by hand delivery in open Court by U.S. mail I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of _ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By: Deputy Clerk Florida Supreme Court Approved Family Law Form 12.980(b)(2),Order Denying Hearing on Petition for Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 23 - 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. Under the laws of Florida, the Court has jurisdiction of the Petitioner and the subject matter and has jurisdiction of the Respondent upon service of the temporary injunction. It is intended that this protection order meet the requirements of 18 U.S.C. Section 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 Domestic Violence has been issued without prior notice to Respondent, Petitioner and Respondent are instructed that they are scheduled to appear and testify at a hearing regarding this matter on {date} __________________, at ______ a.m./p.m., when the Court will consider whether the Court should issue a Final Judgment of Injunction for Protection Against Domestic Violence, which would remain in effect until modified or dissolved by the Court, and whether other things should be ordered, including, for example, such matters as time-sharing 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 entry of a permanent injunction and the imposition of court costs. Petitioner and Respondent will be bound by the terms of any injunction or order issued at the final hearing. IF EITHER PETITIONER OR RESPONDENT DOES NOT APPEAR AT THE FINAL HEARING, HE OR SHE WILL BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED IN THIS MATTER. All witnesses and evidence, if any, must be presented at this time. In cases where temporary support issues have been alleged in the pleadings, each party is ordered to bring his or her financial affidavit, Florida Supreme Court Approved Family Law Form 12.980(c)(1) Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren) (06/12) - 24 - (Florida Family Law Rules of Procedure Form 12.902(b) or (c)), tax return, pay stubs, and other evidence of financial income to the hearing. NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at public expense. YOU ARE ADVISED THAT IN THIS COURT: a.____ a court reporter is provided by the court. b.____ an electronic recording only is provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party s expense. A RECORD, WHICH INCLUDES A TRANSCRIPT, MAY BE REQUIRED TO SUPPORT AN APPEAL. THE PARTY SEEKING THE APPEAL IS RESPONSIBLE FOR HAVING THE TRANSCRIPT PREPARED BY A COURT REPORTER. THE TRANSCRIPT MUST BE FILED WITH THE REVIEWING COURT OR THE APPEAL MAY BE DENIED. If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact _______________________ _______________________________________________________________ {identify applicable court personnel by name, address, and phone number} at least 7 days before your scheduled court appearance, or immediately upon receiving this notification if the time before the scheduled appearance is less than 7 days; if you are hearing impaired, call 711. SECTION II. 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. SECTION III. TEMPORARY INJUNCTION AND TERMS This injunction shall be effective until the hearing set above and in no event for longer than 15 days, unless extended by court order. If a final order of injunction is issued, the terms of this temporary injunction will be extended until service of the final injunction is effected upon Respondent. This injunction is valid and enforceable in all counties of the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction. Any violation of this injunction, whether or not at the invitation of Petitioner or anyone else, may Florida Supreme Court Approved Family Law Form 12.980(c)(1),Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren) (06/12) - 25 - subject Respondent to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment. Certain willful violations of the terms of this injunction, such as: refusing to vacate the dwelling that the parties share; going to or being within 500 feet of Petitioner's residence, going to Petitioner s place of employment, school, or other place prohibited in this injunction; telephoning, contacting or communicating with Petitioner if prohibited by this injunction; knowingly or intentionally coming within 100 feet of Petitioner s motor vehicle, whether or not it is occupied; defacing or destroying Petitioner s personal property; refusing to surrender firearms or ammunition if ordered to do so by the court; or committing an act of domestic violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes. In addition, it is a federal criminal felony offense, punishable by up to life imprisonment, depending on the nature of the violation, to cross state lines or enter Indian country for the purpose of engaging in conduct that is prohibited in this injunction. 18 U.S.C. Section 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, kidnapping, false imprisonment, or any other criminal offense resulting in physical injury or death to Petitioner or any of Petitioner's family or household members. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner. 2. No Contact. Respondent shall have no contact with Petitioner unless otherwise provided in this Section, or unless paragraph 14 below provides for contact connected with the temporary parenting plan and temporary time-sharing with respect to the 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(c)(1),Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren) (06/12) - 26 - ______ 3. Firearms. [Initial all that apply; write N/A if does not apply] a. ____Respondent shall not use or possess a firearm or ammunition. b. ____Respondent shall surrender any firearms and ammunition in the Respondent's possession to the County Sheriff's Department until further order of the court. c. ___Other directives relating to firearms and ammunition: ___________________________________________________________________________ NOTE: RESPONDENT IS ADVISED THAT, IF A PERMANENT INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE IS ISSUED FOLLOWING A HEARING REGARDING THIS MATTER, IN MOST CASES IT WILL BE A VIOLATION OF SECTION 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. SECTION 922(g)(8). 4. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding the final injunction, if entered without Respondent being present at the hearing, and pleadings requiring personal service) shall be served by mail to Respondent s last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Florida Family Law Rules of Procedure; section 741.30, Florida Statutes. 5. Additional order(s) necessary to protect Petitioner from domestic violence: TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME [Initial all that apply; write N/A if does not apply] 6. ___Possession of the Home. ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the dwelling located at: ______________________________________ Florida Supreme Court Approved Family Law Form 12.980(c)(1),Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren) (06/12) - 27 - . 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 {date} , at ______a.m./p.m., or ( ) at a time arranged with the law enforcement department with jurisdiction over the home, for the purpose of obtaining his or her clothing and items of personal health and hygiene and tools of the trade. A law enforcement officer with jurisdiction over the home from which these items are to be retrieved shall accompany ( ) Petitioner ( ) Respondent to the home and stand by to insure that he/she vacates the premises with only his/her personal clothing, toiletries, tools of the trade, and any items listed in paragraph 10 below. The law enforcement agency shall not be responsible for storing or transporting any property. IF THE RESPONDENT IS NOT AWARDED POSSESSION OF THE HOME AND GOES TO THE HOME WITHOUT A LAW ENFORCEMENT OFFICER, IT IS A VIOLATION OF THIS INJUNCTION. 9. ___( ) Petitioner ( ) Respondent shall not damage or remove any furnishings or fixtures from the parties' former shared premises. 10. ___Other:______________________________________________________________________ TEMPORARY SUPPORT Temporary support, if requested by Petitioner in the Petition for Injunction for Protection Against Domestic Violence, will be addressed by the Court after notice to Respondent and hearing on the matter. TEMPORARY PARENTING PLAN WITH TIME-SHARING WITH MINOR CHILD(REN) 11. Jurisdiction. [Initial one only] ______ Jurisdiction to determine issues relating to parenting plan and time-sharing with respect to any minor child(ren) listed in paragraph 12 below is proper under the Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA). ______ Jurisdiction is exclusive to the dependency court, and accordingly no order is made herein. (Case Number ____________________________.) 12. Temporary Order for 100% Time-Sharing With Respect to Minor Child(ren). ( ) Petitioner ( ) Respondent shall, on a temporary basis, have 100% time sharing with respect to the parties Florida Supreme Court Approved Family Law Form 12.980(c)(1),Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren) (06/12) - 28 - minor child(ren) listed below: Name Birth date When requested by the parent to whom 100% time-sharing is awarded on a temporary basis herein, law enforcement officers shall use any and all reasonable and necessary force to physically deliver the minor child(ren) listed above to the parent to whom 100% time-sharing is awarded on a temporary basis herein. The other parent shall not take the child(ren) from: the parent to whom 100% time-sharing is awarded on a temporary basis herein or any child care provider or other person entrusted by the parent to whom 100% time-sharing is awarded on a temporary basis herein 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 ( ) Petitioner ( ) Respondent (i.e., the parent to whom 100% time-sharing is not awarded on a temporary basis herein) 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). SECTION IV. OTHER SPECIAL PROVISIONS Florida Supreme Court Approved Family Law Form 12.980(c)(1),Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren) (06/12) - 29 - {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 Florida Supreme Court Approved Family Law Form 12.980(c)(1),Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren) (06/12) - 30 - {Unless ordered otherwise by the judge, all provisions in this injunction are considered mandatory provisions and should be interpreted as part of this injunction.) 1. The Sheriff of County, or any other authorized law enforcement officer, is ordered to serve this temporary injunction upon Respondent as soon as possible after its issuance. 2. This injunction is valid in all counties of the State of Florida. Violation of this injunction should be reported to the appropriate law enforcement agency. Law enforcement officers of the jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this injunction and are authorized to arrest without warrant pursuant to section 901.15, Florida Statutes, for any violation of its provisions which constitutes a criminal act under section 741.31, Florida Statutes. 3. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES. The arresting agent shall notify the State Attorney's Office immediately after arrest. 4. THIS IS A CUSTODY ORDER FOR PURPOSES OF THE UCCJEA AND ALL STATUTES MAKING IT A CRIME TO INTERFERE WITH CUSTODY UNDER CHAPTER 787 OF FLORIDA STATUTES AND OTHER SIMILAR STATUTES. 5. 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. DONE AND ORDERED at ___________________________, Florida on . ___________________________ CIRCUIT JUDGE COPIES TO: Sheriff of County Petitioner (or his or her attorney): __by U. S. Mail Florida Supreme Court Approved Family Law Form 12.980(c)(1),Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren) (06/12) - 31 - _ 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(c)(1),Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren) (06/12) - 32 - 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. Under the laws of Florida, the Court has jurisdiction of the Petitioner and the subject matter and has jurisdiction of the Respondent upon service of the temporary injunction. It is intended that this protection order meet the requirements of 18 U.S.C. Section 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 Domestic Violence has been issued without prior notice to Respondent, Petitioner and Respondent are instructed that they are scheduled to appear and testify at a hearing regarding this matter on {date} _________, at a.m./p.m., when the Court will consider whether the Court should issue a Final Judgment of Injunction for Protection Against Domestic Violence, which would remain in effect until modified or dissolved by the Court, and whether other things should be ordered, including, for example, such matters as support. The hearing will be before The Honorable {name} ______________________________________, at {room name/number, location, address, city} ___________________________________, Florida. If Petitioner and/or Respondent do not appear, this temporary injunction may be continued in force, extended, dismissed, and/or additional orders may be granted, including entry of a permanent injunction and the imposition of court costs. Petitioner and Respondent will be bound by the terms of any injunction or order issued at the final hearing. IF EITHER PETITIONER OR RESPONDENT DOES NOT APPEAR AT THE FINAL HEARING, HE OR SHE WILL BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED IN THIS MATTER. Florida Supreme Court Approved Family Law Form 12.980(c)(2), Temporary Injunction for Protection Against Domestic Violence without Minor Child(ren) (06/12) - 33 - All witnesses and evidence, if any, must be presented at this time. In cases where temporary support issues have been alleged in the pleadings, each party is ordered to bring his or her financial affidavit (Florida Family Law Rules of Procedure Form 12.902(b) or (c)), tax return, pay stubs, and other evidence of financial income to the hearing. NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at public expense. YOU ARE ADVISED THAT IN THIS COURT: a.____ a court reporter is provided by the court. b.____an electronic recording only is provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party s expense. A RECORD, WHICH INCLUDES A TRANSCRIPT, MAY BE REQUIRED TO SUPPORT AN APPEAL. THE PARTY SEEKING THE APPEAL IS RESPONSIBLE FOR HAVING THE TRANSCRIPT PREPARED BY A COURT REPORTER. THE TRANSCRIPT MUST BE FILED WITH THE REVIEWING COURT OR THE APPEAL MAY BE DENIED. If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact__________________________ __________________________________________________________________ {identify applicable court personnel by name, address and telephone number} at least 7 days before your scheduled court appearance, or immediately upon receiving this notification if the time before the scheduled appearance is less than 7 days; if you are hearing impaired, call 711. SECTION II. 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. SECTION III. TEMPORARY INJUNCTION AND TERMS This injunction shall be effective until the hearing set above and in no event for longer than 15 days, unless extended by court order. If a final order of injunction is issued, the terms of this temporary Florida Supreme Court Approved Family Law Form 12.980(c)(2), Temporary Injunction for Protection Against Domestic Violence without Minor Child(ren) (06/12) - 34 - injunction will be extended until service of the final injunction is effected upon Respondent. This injunction is valid and enforceable in all counties of the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction. Any violation of this injunction, whether or not at the invitation of Petitioner or anyone else, may subject Respondent to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment. Certain willful violations of the terms of this injunction, such as: refusing to vacate the dwelling that the parties share; going to or being within 500 feet of Petitioner's residence, going to Petitioner s place of employment, school, or other place prohibited in this injunction; telephoning, contacting or communicating with Petitioner if prohibited by this injunction; knowingly or intentionally coming within 100 feet of Petitioner s motor vehicle, whether or not it is occupied; defacing or destroying Petitioner s personal property; refusing to surrender firearms or ammunition if ordered to do so by the court; or committing an act of domestic violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes. In addition, it is a federal criminal felony offense, punishable by up to life imprisonment, depending on the nature of the violation, to cross state lines or enter Indian country for the purpose of engaging in conduct that is prohibited in this injunction. 18 U.S.C. Section 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, kidnapping, false imprisonment, or any other criminal offense resulting in physical injury or death to Petitioner or any of Petitioner's family or household members. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner. 2. No Contact. Respondent shall have no contact with Petitioner unless otherwise provided in this section. a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner s current residence {list address} or any residence to which Petitioner may move; Petitioner s current or any subsequent place of employment {list address of current employment} or place where Petitioner attends school {list address of school} ; or the following other places (if requested by Petitioner) where Petitioner or Petitioner s minor child(ren) go often: . Florida Supreme Court Approved Family Law Form 12.980(c)(2), Temporary Injunction for Protection Against Domestic Violence without Minor Child(ren) (06/12) - 35 - Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time. b._____ Other provisions regarding contact: ______________________________________________________________________________ _______________________________________________________________________________. 3. Firearms. [Initial all that apply; write N/A if does not apply] a. Respondent shall not use or possess a firearm or ammunition. b. Respondent shall surrender any firearms and ammunition in the Respondent's possession to the _________ County Sheriff's Department until further order of the court. c. Other directives relating to firearms and ammunition: NOTE: RESPONDENT IS ADVISED THAT, IF A PERMANENT INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE IS ISSUED FOLLOWING A HEARING REGARDING THIS MATTER, IN MOST CASES IT WILL BE A VIOLATION OF SECTION 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. SECTION 922(g)(8). 4. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding the final injunction, if entered without Respondent being present at the hearing, and pleadings requiring personal service) shall be served by mail to Respondent s last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Florida Family Law Rules of Procedure; section 741.30, Florida Statutes. 5. Additional order(s) necessary to protect Petitioner from domestic violence: TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME [Initial all that apply; write N/A if does not apply] 6. ____Possession of the Home. ( ) Petitioner ( ) Respondent shall have temporary exclusive use and Florida Supreme Court Approved Family Law Form 12.980(c)(2), Temporary Injunction for Protection Against Domestic Violence without Minor Child(ren) (06/12) - 36 - possession of the dwelling located at: . 7. ____ Transfer of Possession of the Home. A law enforcement officer with jurisdiction over the home shall accompany ( ) Petitioner ( ) Respondent to the home, and shall place ( ) Petitioner ( ) Respondent in possession of the home. 8. ____Personal Items. ( ) Petitioner ( ) Respondent, in the presence of a law enforcement officer, may return to the premises described above ( ) on ________________, at ___________, a.m./p.m., or ( ) at a time arranged with the law enforcement department with jurisdiction over the home, for the purpose of obtaining his or her clothing and items of personal health and hygiene and tools of the trade. A law enforcement officer with jurisdiction over the home from which these items are to be retrieved shall accompany ( ) Petitioner ( ) Respondent to the home and stand by to insure that he/she vacates the premises with only his/her personal clothing, toiletries, tools of the trade, and any items listed in paragraph 10 below. The law enforcement agency shall not be responsible for storing or transporting any property. IF THE RESPONDENT IS NOT AWARDED POSSESSION OF THE HOME AND GOES TO THE HOME WITHOUT A LAW ENFORCEMENT OFFICER, IT IS A VIOLATION OF THIS INJUNCTION. 9. ____ ( ) Petitioner ( ) Respondent shall not damage or remove any furnishings or fixtures from the parties' former shared premises. 10.____ Other: TEMPORARY SUPPORT Temporary support, if requested by Petitioner in the Petition for Injunction for Protection Against Domestic Violence, will be addressed by the Court after notice to Respondent and hearing on the matter. 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 {Unless ordered otherwise by the judge, all provisions in this injunction are considered mandatory and Florida Supreme Court Approved Family Law Form 12.980(c)(2), Temporary Injunction for Protection Against Domestic Violence without Minor Child(ren) (06/12) - 37 - should be interpreted as part of this injunction.} 1. The Sheriff of County, or any other authorized law enforcement officer, is ordered to serve this temporary injunction upon Respondent as soon as possible after its issuance. 2. This injunction is valid in all counties of the State of Florida. Violation of this injunction should be reported to the appropriate law enforcement agency. Law enforcement officers of the jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this injunction and are authorized to arrest without warrant pursuant to section 901.15, Florida Statutes, for any violation of its provisions which constitutes a criminal act under section 741.31, Florida Statutes. 3. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES. The arresting agent shall notify the State Attorney's Office immediately after arrest. 4. Reporting alleged violations. If Respondent violates the terms of this injunction and there has not been an arrest, Petitioner may contact the Clerk of the Circuit Court of the county in which the violation occurred and complete an affidavit in support of the violation, or Petitioner may contact the State Attorney s office for assistance in filing an action for indirect civil contempt or indirect criminal contempt. Upon receiving such a report, the State Attorney is hereby appointed to prosecute such violations by indirect criminal contempt proceedings, or the State Attorney may decide to file a criminal charge, if warranted by the evidence. DONE AND ORDERED in_________________, Florida 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. Florida Supreme Court Approved Family Law Form 12.980(c)(2), Temporary Injunction for Protection Against Domestic Violence without Minor Child(ren) (06/12) - 38 - CLERK OF THE CIRCUIT COURT (SEAL) By: Deputy Clerk Florida Supreme Court Approved Family Law Form 12.980(c)(2), Temporary Injunction for Protection Against Domestic Violence without Minor Child(ren) (06/12) - 39 - 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. Section 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 Domestic Violence in this case should be: [ ] issued [ ] modified [ ] extended. The hearing was attended by [ ] Petitioner [ ] Respondent * + Petitioner s Counsel * + Respondent s Counsel SECTION II. FINDINGS On {date} , a notice of this hearing was served on Respondent together with a copy of Petitioner s petition to this Court and the temporary injunction, if issued. Service was within the time required by Florida law, and Respondent was afforded an opportunity to be heard. After hearing the testimony of each party present and of any witnesses, or upon consent of Respondent, the Court finds, based on the specific facts of this case, that Petitioner is a victim of Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction of Protection Against Domestic Violence with Minor Child(ren) (After Notice) (06/12) - 40 - domestic violence or has reasonable cause to believe that he/she is in imminent danger of becoming a victim of domestic violence by Respondent. SECTION III. INJUNCTION AND TERMS This injunction shall be in full force and effect until either [ ] further order of the Court or [ ] . This injunction is valid and enforceable in all counties of the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction at any time. Any violation of this injunction, whether or not at the invitation of Petitioner or anyone else, may subject Respondent to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment. Certain willful violations of the terms of this injunction, such as: refusing to vacate the dwelling that the parties share; going to or being within 500 feet of Petitioner's residence, going to Petitioner s place of employment, school, or other place prohibited in this injunction; telephoning, contacting or communicating with Petitioner if prohibited by this injunction; knowingly or intentionally coming within 100 feet of Petitioner s motor vehicle, whether or not it is occupied; defacing or destroying Petitioner s personal property; refusing to surrender firearms or ammunition if ordered to do so by the court; or committing an act of domestic violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes. In addition, it is a federal criminal felony offense, punishable by up to life imprisonment, depending on the nature of the violation, to cross state lines or enter Indian country for the purpose of engaging in conduct that is prohibited in this injunction. 18 U.S.C. Section 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, kidnapping, false imprisonment, or any other criminal offense resulting in physical injury or death to Petitioner or any of Petitioner's family or household members. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner. 2. No Contact. Respondent shall have no contact with the Petitioner unless otherwise provided in this section, or unless paragraphs 13 through 19 below provide for contact connected with the temporary parenting plan and temporary time-sharing with respect to the 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 Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction of Protection Against Domestic Violence with Minor Child(ren) (After Notice) (06/12) - 41 - any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner s current residence {list address} or any residence to which Petitioner may move; Petitioner s current or any subsequent place of employment {list address of current employment} ___________________________ ______________________________________or place where Petitioner attends school {list address of school} ; or the following other places (if requested by Petitioner) where Petitioner or Petitioner s minor child(ren) go often:______________________________________________________ ___________________________________________________________________________ Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time. b. ___Other provisions regarding contact: 3. Firearms. Unless paragraph a. is initialed below, Respondent shall not have in his or her care, custody, possession or control any firearm or ammunition. It is a violation of section 790.233, Florida Statutes, and a first degree misdemeanor, for the respondent to have in his or her care, custody, possession or control any firearm or ammunition. [Initial if applies; write N/A if not applicable] a. ____Respondent is a state or local officer as defined in section 943.10(14), Florida Statutes, who holds an active certification, who receives or possesses a firearm or ammunition for use in performing official duties on behalf of the officer s employing agency and is not prohibited by the court from having in his or her care, custody, possession or control a firearm or ammunition. The officer s employing agency may prohibit the officer from having in his or her care, custody, possession or control a firearm or ammunition. b. ____Respondent shall surrender any firearms and ammunition in the Respondent's possession to the __________ County Sheriff's Department. c. ____Other directives relating to firearms and ammunition: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ NOTE: RESPONDENT IS ADVISED THAT IT IS A FEDERAL CRIMINAL FELONY OFFENSE TO SHIP OR TRANSPORT IN INTERSTATE OR FOREIGN COMMERCE, OR POSSESS IN OR AFFECTING COMMERCE, ANY FIREARM OR AMMUNITION; OR TO RECEIVE ANY FIREARM OR AMMUNITION WHICH HAS BEEN SHIPPED OR TRANSPORTED IN INTERSTATE OR FOREIGN COMMERCE WHILE SUBJECT TO SUCH AN INJUNCTION. 18 U.S.C. SECTION 922(g)(8). 4. Evaluation/Counseling Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction of Protection Against Domestic Violence with Minor Child(ren) (After Notice) (06/12) - 42 - [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 Section 741.30(6)(e), Florida Statutes. b. Within [ ] 10 days [ ] days, (but no more than 10 days) of the date of this injunction, Respondent shall enroll in and thereafter without delay complete the following, and Respondent shall provide proof of such enrollment to the Clerk of Circuit Court within [ ] 30 days or [ ] days, (but no more than 30 days) of the date of this injunction: i. ___A certified batterers intervention program from a list of programs to be provided by the Court or any entity designated by the Court. Respondent shall also successfully complete any substance abuse or mental health evaluation that the assessing program counselor deems necessary as a predicate to completion of the batterers intervention program. ii. ___A substance abuse evaluation at:__________________________________________ or a similarly qualified facility and any substance abuse treatment recommended by that evaluation. iii. ___A mental health evaluation by a licensed mental health professional at: ________________________________or any other similarly qualified facility and any mental health treatment recommended by that evaluation. iv. ___Other:_______________________________________________________________ c. ___Although Respondent meets the statutory mandate of attendance at a batterers intervention program, the Court makes the following written findings as to why the condition of batterers intervention program would be inappropriate: ___________________________________________________________________________ d. ___Petitioner is referred to a certified domestic violence center and is provided with a list of certified domestic violence centers in this circuit, which Petitioner may contact. 5. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent s last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Florida Family Law Rules of Procedure; Section 741.30, Florida Statutes. Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction of Protection Against Domestic Violence with Minor Child(ren) (After Notice) (06/12) - 43 - 6. Other provisions necessary to protect Petitioner from domestic violence: _________________ TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME [Initial if applies; write N/A if not applicable] 7. ____Possession of the Home. ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the dwelling located at: ________________________________ ____________________________________________________________________________________ ___________________________________________________________________________________. 8. ____Transfer of Possession of the Home. A law enforcement officer with jurisdiction over the home shall accompany ( ) Petitioner ( ) Respondent to the home, and shall place ( ) Petitioner ( ) Respondent in possession of the home. 9. ____Personal Items. ( ) Petitioner ( ) Respondent, in the presence of a law enforcement officer, may return to the premises described above on ( ) ___, at a.m./p.m., or ( ) at a time arranged with the law enforcement department with jurisdiction over the home, accompanied by a law enforcement officer only, for the purpose of obtaining his or her clothing and items of personal health and hygiene and tools of the trade. A law enforcement officer with jurisdiction over the premises shall go with ( ) Petitioner ( ) Respondent to the home and stand by to insure that he/she vacates the premises with only his/her personal clothing, toiletries, tools of the trade, and any items listed in paragraph 10 below. The law enforcement agency shall not be responsible for storing or transporting any property. IF THE RESPONDENT IS NOT AWARDED POSSESSION OF THE HOME AND GOES TO THE HOME WITHOUT A LAW ENFORCEMENT OFFICER, IT IS A VIOLATION OF THIS INJUNCTION. 10.____The following other personal possessions may also be removed from the premises at this time:________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 11.____Other:_________________________________________________________________ _____________________________________________________________________________ _______________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction of Protection Against Domestic Violence with Minor Child(ren) (After Notice) (06/12) - 44 - TEMPORARY PARENTING PLAN AND TIME-SHARING WITH MINOR CHILD(REN) 12. Jurisdiction. [Initial one only.] _____ Jurisdiction to determine issues relating to parenting plan and time-sharing with respect to any minor child(ren) listed in paragraph 13 below is proper under the Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA). _____ Jurisdiction is exclusive to the dependency court, and accordingly no order is made herein. (Case Number ____________________________.) 13. Temporary Parenting Plan for Minor Child(ren). Except for that time-sharing (if any) specified for the other parent in paragraph 14, below, ( ) Petitioner ( ) Respondent shall on a temporary basis have 100% of the time-sharing with the parties minor child(ren) listed below and shall have sole decision-making responsibility until further court order: Name Birth date When requested by the parent to whom the majority of overnight time-sharing with the child(ren) is awarded on a temporary basis herein, in this case the ( ) Petitioner ( ) Respondent, law enforcement officers shall use any and all reasonable and necessary force to physically deliver the minor child(ren) listed above to the parent to whom the majority of overnight time-sharing with the child(ren) is awarded on a temporary basis herein. The other parent shall not take the child(ren) from the parent to whom the majority of overnight time-sharing with the child(ren) is awarded on a temporary basis herein or any child care provider or other person entrusted by the parent to whom the majority of overnight time-sharing with the child(ren) is awarded on a temporary basis herein with the care of the child(ren). 14. Temporary Parenting Plan with Time-Sharing for Minor Child(ren). The Petitioner and Respondent shall have time-sharing with the minor child(ren) on the following schedule: [Initial one only] a. ____( ) Petitioner ( ) Respondent shall have 100% of time-sharing and ( ) Petitioner ( ) Respondent shall have 0% of time sharing with the child(ren) until further order of the Court. Until further order of the Court, all parenting decisions shall be made by the parent with 100% of the timesharing. b.___( ) Petitioner ( ) Respondent shall have time-sharing from ___________ a.m./p.m. to __________a.m./p.m on the following day(s)_________________________________. The other parent will have the remaining time-sharing. _____________________________ ___________________________________________________________________________ ___________________________________________________________________________ c.___Other:_________________________________________________________________ ___________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction of Protection Against Domestic Violence with Minor Child(ren) (After Notice) (06/12) - 45 - ___________________________________________________________________________ 15. Limitations on Time-Sharing The time-sharing specified in paragraph 14, above, for ) Petitioner ( ) Respondent with the child(ren) shall be: [Initial all that apply; write N/A if does not apply] a.______ unsupervised. b.______ supervised by the following specified responsible adult:____________________. c.______ at a supervised visitation center located at_________________________________ ( . and shall be subject to the available times and rules of the supervised visitation center. The cost associated with the services of the supervised visitation center shall be paid by ( ) parent to whom the majority of overnight time-sharing with the child(ren) is awarded on a temporary basis herein ( ) other parent ( ) both: . If specified, the level of supervision shall be:__________________________________________. 16. Arrangements for Time-Sharing with Minor Child(ren). [Initial all that apply; write N/A if does not apply] a.___A responsible person shall coordinate the time-sharing arrangements with respect to the minor child(ren). If specified, the responsible person shall be: {name} ________________________________ b.___Other conditions for time-sharing arrangements as follows: ___________________ 17. Exchange of Minor Child(ren). [Initial all that apply; write N/A if does not apply] a. ____the parties shall exchange the child(ren) at ( ) school or daycare, or ( ) at the following location(s): b.___A responsible person shall conduct all exchanges of the child(ren). The ( ) Petitioner ( ) Respondent shall not be present during the exchange. If specified, the responsible person shall be: {name} ___________________________________________________________________________ c.___Other conditions for exchange as follows: 18. Other Additional Provisions Relating to the Minor Child(ren). Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction of Protection Against Domestic Violence with Minor Child(ren) (After Notice) (06/12) - 46 - TEMPORARY SUPPORT 19. Temporary Alimony. [Initial all that apply; write N/A if does not apply] a. ___The court finds that there is a need for temporary alimony and that ( ) Petitioner ( ) Respondent (hereinafter Obligor) has the present ability to pay alimony and shall pay temporary alimony to ( ) Petitioner ( ) Respondent (hereinafter Obligee) in the amount of $_______ per month, payable ( ) in accordance with Obligor s employer s payroll cycle, and in any event, at least once a month ( ) other {explain} ________________________________ beginning {date} _________. This alimony shall continue until modified by court order, until a final judgment of dissolution of marriage is entered, until Obligee dies, until this injunction expires, or until {date} __________, whichever occurs first. b.___( ) Petitioner ( ) Respondent shall be required to maintain health insurance coverage for the other party. Any uncovered medical costs for the party awarded alimony shall be assessed as follows: ______________ . c.___Other provisions relating to alimony: 20. Temporary Child Support. [Initial all that apply; write N/A if does not apply] a. ___The Court finds that there is a need for temporary child support and that ( ) Petitioner ( ) Respondent (hereinafter Obligor) has the present ability to pay child support. The amounts in the Child Support Guidelines Worksheet, Florida Family Law Form 12.902(e), filed by ( ) Petitioner ( ) Respondent are correct OR the Court makes the following findings: The Petitioner s net monthly income is $ , (Child Support Guidelines %). The Respondent s net monthly income is $ , (Child Support Guidelines %). Monthly child care costs are $ ____. Monthly health/dental insurance costs are $ . b. ___Amount. Obligor shall pay temporary child support in the amount of $ ___, per month payable ( ) in accordance with Obligor s employer s payroll cycle, and in any event at least once a month ( )other {explain}:________________________________________ Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction of Protection Against Domestic Violence with Minor Child(ren) (After Notice) (06/12) - 47 - , 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 it is reasonable in cost and accessible to the child(ren) OR ( ) Health ( ) dental insurance is either not reasonable in cost or accessible to the child(ren) at this time. d. ___Any reasonable and necessary uninsured medical/dental/prescription drug costs for the minor child(ren) shall be assessed as follows: ___________________________________ . e. ___Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security Number, is incorporated herein by reference. f. ___Other provisions relating to child support: 21. Method of Payment. [Initial one only] a._____ Obligor shall pay any temporary court-ordered child support/alimony through income deduction, and such support shall be paid to either the State Disbursement Unit or the central depository. 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 any service charge required by statute. 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 either the State Disbursement Unit or the central depository. b._____ Temporary child support/alimony shall be paid through either the State Disbursement Unit or the central depository. Obligor shall also pay any service charge required by statute. Income deduction is not in the best interests of the child(ren) because: {explain} c._____ Other provisions relating to method of payment: _______________________________________________________________________ . Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction of Protection Against Domestic Violence with Minor Child(ren) (After Notice) (06/12) - 48 - 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 {Unless ordered otherwise by the judge, all provisions in this injunction are considered mandatory provisions and should be interpreted as 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 or Chapter 39, Florida Statutes, shall take precedence over this order on all matters relating to property division, alimony, parental responsibility, parenting plan, time-sharing, 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. 6. THIS IS A CUSTODY ORDER FOR PURPOSES OF THE UCCJEA AND ALL STATUTES MAKING IT A CRIME TO INTERFERE WITH CUSTODY UNDER CHAPTER 787, FLORIDA STATUTES AND OTHER SIMILAR STATUTES. Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction of Protection Against Domestic Violence with Minor Child(ren) (After Notice) (06/12) - 49 - DONE AND ORDERED at __________________________, Florida on . ____________________________ CIRCUIT JUDGE COPIES TO: Sheriff of County Petitioner (or his or her attorney): ____ by U. S. Mail ____ by hand delivery in open court (Petitioner must acknowledge receipt in writing on the face of the original order--see below.) Respondent (or his or her attorney): ___ _forwarded to sheriff for service ____ by hand delivery in open court (Respondent must acknowledge receipt in writing on the face of the original order--see below.) ____ by certified mail (may only be used when Respondent is present at the hearing and Respondent fails or refuses to acknowledge the receipt of a certified copy of this injunction.) ____ State Attorney s Office ____ Batterer s intervention program (if ordered) ___ _State Disbursement Unit (if ordered) ____Central 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 Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction of Protection Against Domestic Violence with Minor Child(ren) (After Notice) (06/12) - 50 - ACKNOWLEDGMENT I, {Name of Petitioner} Injunction for Protection. , acknowledge receipt of a certified copy of this Petitioner__________________________________________ ACKNOWLEDGMENT I, {Name of Respondent} copy of this Injunction for Protection. , acknowledge receipt of a certified Respondent_________________________________________ Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction of Protection Against Domestic Violence with Minor Child(ren) (After Notice) (06/12) - 51 - 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. Section 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 Domestic 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 domestic violence or has reasonable cause to believe that he/she is in imminent danger of becoming a victim of domestic Florida Supreme Court Approved Family Law Form 12.980(d)(2), Final Judgment of Injunction of Protection Against Domestic Violence without Minor Child(ren) (After Notice) (06/12) - 52 - violence by Respondent. SECTION III. INJUNCTION AND TERMS This injunction shall be in full force and effect until ( ) further order of the Court or ( ) ___________. This injunction is valid and enforceable in all counties of the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction at any time. Any violation of this injunction, whether or not at the invitation of Petitioner or anyone else, may subject Respondent to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment. Certain willful violations of the terms of this injunction, such as: refusing to vacate the dwelling that the parties share; going to or being within 500 feet of Petitioner's residence, going to Petitioner s place of employment, school, or other place prohibited in this injunction; telephoning, contacting or communicating with Petitioner if prohibited by this injunction; knowingly or intentionally coming within 100 feet of Petitioner s motor vehicle, whether or not it is occupied; defacing or destroying Petitioner s personal property; refusing to surrender firearms or ammunition if ordered to do so by the court; or committing an act of domestic violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes. In addition, it is a federal criminal felony offense, punishable by up to life imprisonment, depending on the nature of the violation, to cross state lines or enter Indian country for the purpose of engaging in conduct that is prohibited in this injunction. 18 U.S.C. Section 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, kidnapping, false imprisonment, or any other criminal offense resulting in physical injury or death to Petitioner or any of Petitioner's family or household members. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner. 2. No Contact. Respondent shall have no contact with the Petitioner unless otherwise provided in this section. a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner s current residence {list address} Florida Supreme Court Approved Family Law Form 12.980(d)(2), Final Judgment of Injunction of Protection Against Domestic Violence without Minor Child(ren) (After Notice) (06/12) - 53 - or any residence to which Petitioner may move; Petitioner s current or any subsequent place of employment {list address of current employment} or place where Petitioner attends school {list address of school} ; or the following other places (if requested by Petitioner) where Petitioner or Petitioner s minor child(ren) go often: . Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time. b. Other provisions regarding contact: _______________________________________________ 3. Firearms. Unless paragraph a. is initialed below, Respondent shall not have in his or her care, custody, possession or control any firearm or ammunition. It is a violation of Section 790.233, Florida Statutes, and a first degree misdemeanor, for the Respondent to have in his or her care, custody, possession, or control any firearm or ammunition. [Initial if applies; write N/A if not applicable] a. ____Respondent is a state or local officer as defined in section 943.10(14), Florida Statutes, who holds an active certification, who receives or possesses a firearm or ammunition for use in performing official duties on behalf of the officer s employing agency and is not prohibited by the court from having in his or her care, custody, possession or control a firearm or ammunition. The officer s employing agency may prohibit the officer from having in his or her care, custody, possession or control a firearm or ammunition. b.____Respondent shall surrender any firearms and ammunition in the Respondent's possession to the County Sheriff's Department. c. ____Other directives relating to firearms and ammunition: NOTE: RESPONDENT IS ADVISED THAT IT IS A FEDERAL CRIMINAL FELONY OFFENSE TO SHIP OR TRANSPORT IN INTERSTATE OR FOREIGN COMMERCE, OR POSSESS IN OR AFFECTING COMMERCE, ANY FIREARM OR AMMUNITION; OR TO RECEIVE ANY FIREARM OR AMMUNITION WHICH HAS BEEN SHIPPED OR TRANSPORTED IN INTERSTATE OR FOREIGN COMMERCE WHILE SUBJECT TO SUCH AN INJUNCTION. 18 U.S.C. SECTION 922(g)(8). 4. Evaluation/Counseling. [Initial all that apply; write N/A if does not apply] a. The Court finds that Respondent has: i. ____willfully violated the ex parte injunction; ii. ____been convicted of, had adjudication withheld on, or pled nolo contendere to a crime Florida Supreme Court Approved Family Law Form 12.980(d)(2), Final Judgment of Injunction for Protection Against Domestic Violence without Minor Child(ren) (After Notice) (06/12) - 54 - 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 Section 741.30(6)(e), Florida Statutes. b. Within ( ) 10 days ( )____ days, (but no more than 10 days) of the date of this injunction, Respondent shall enroll in and thereafter without delay complete the following, and Respondent shall provide proof of such enrollment to the Clerk of Circuit Court within ( ) 30 days ( ) ___ days, (but no more than 30 days) of the date of this injunction: i. ____A certified batterers intervention program from a list of programs to be provided by the Court or any entity designated by the Court. Respondent shall also successfully complete any substance abuse or mental health evaluation that the assessing program counselor deems necessary as a predicate to completion of the batterers intervention program. ii. ____A substance abuse evaluation at: or a similarly qualified facility and any substance abuse treatment recommended by that evaluation. iii. ____A mental health evaluation by a licensed mental health professional at: _______________________or any other similarly qualified facility and any mental health treatment recommended by that evaluation. iv. ____Other: c. ____Although Respondent meets the statutory mandate of attendance at a batterers intervention program, the Court makes the following written findings as to why the condition of batterers intervention program would be inappropriate: d. ____Petitioner is referred to a certified domestic violence center and is provided with a list of certified domestic violence centers in this circuit, which Petitioner may contact. 5. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent s last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Florida Family Law Rules of Procedure; section 741.30, Florida Statutes. 6. Other provisions necessary to protect Petitioner from domestic violence: Florida Supreme Court Approved Family Law Form 12.980(d)(2), Final Judgment of Injunction for Protection Against Domestic Violence without Minor Child(ren) (After Notice) (06/12) - 55 - TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME [Initial if applies; write N/A if not applicable] 7. ____Possession of the Home. ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the dwelling located at: . 8. ____Transfer of Possession of the Home. A law enforcement officer with jurisdiction over the home shall accompany ( ) Petitioner ( ) Respondent to the home, and shall place ( ) Petitioner ( ) Respondent in possession of the home. 9.____Personal Items. ( ) Petitioner ( ) Respondent, in the presence of a law enforcement officer, may return to the premises described above ( ) on , at ______a.m./p.m., or ( ) at a time arranged with the law enforcement department with jurisdiction over the home, accompanied by a law enforcement officer only, for the purpose of obtaining his or her clothing and items of personal health and hygiene and tools of the trade. A law enforcement officer with jurisdiction over the premises shall go with ( ) Petitioner ( ) Respondent to the home and stand by to insure that he/she vacates the premises with only his/her personal clothing, toiletries, tools of the trade, and any items listed in paragraph 10 below. The law enforcement agency shall not be responsible for storing or transporting any property. IF THE RESPONDENT IS NOT AWARDED POSSESSION OF THE HOME AND GOES TO THE HOME WITHOUT A LAW ENFORCEMENT OFFICER, IT IS A VIOLATION OF THIS INJUNCTION. 10. ____The following other personal possessions may also be removed from the premises at this time: 11. ____Other:________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(d)(2), Final Judgment of Injunction for Protection Against Domestic Violence without Minor Child(ren) (After Notice) (06/12) - 56 - TEMPORARY SUPPORT 12. Temporary Alimony. [Initial all that apply; write N/A if does not apply] a. ____The court finds that there is a need for temporary alimony and that ( ) Petitioner ( ) Respondent (hereinafter Obligor) has the present ability to pay alimony and shall pay temporary alimony to ( ) Petitioner ( ) Respondent (hereinafter Obligee) in the amount of $___________ per month, payable ( ) in accordance with Obligor s employer s payroll cycle, and in any event, at least once a month ( ) other {explain} beginning {date} . This alimony shall continue until modified by court order, until a final judgment of dissolution of marriage is entered, until Obligee dies, until this injunction expires, or until {date} , whichever occurs first. b. ____( ) Petitioner ( ) Respondent shall be required to maintain health insurance coverage for the other party. Any uncovered medical costs for the party awarded alimony shall be assessed as follows: . c. ____Other provisions relating to alimony: 13. Method of Payment. [Initial one only] a. ____Obligor shall pay any temporary court-ordered alimony through income deduction, and such support shall be paid to either the State Disbursement Unit or the central depository. 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 any service charge required by statute. Until alimony payments are deducted from Obligor s paycheck pursuant to the Income Deduction Order, Obligor is responsible for making timely payments directly to either the State Disbursement Unit or the central depository. b. ____Temporary alimony shall be paid through either the State Disbursement Unit or the central depository. Obligor shall also pay any service charge required by statute. c. ____Other provisions relating to method of payment: 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(d)(2), Final Judgment of Injunction for Protection Against Domestic Violence without Minor Child(ren) (06/12) - 57 - ___________________________________________________________________________________ ___________________________________________________________________________________ SECTION V. DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION {Unless ordered otherwise by the judge, all provisions in this injunction are considered mandatory provisions and should be interpreted as 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. DONE AND ORDERED in ______________________________, Florida on . ______________________________ CIRCUIT JUDGE COPIES TO: Sheriff of County Petitioner (or his or her attorney): Florida Supreme Court Approved Family Law Form 12.980(d)(2), Final Judgment of Injunction for Protection Against Domestic Violence without Minor Child(ren) (06/12) - 58 - __ by U. S. __ by hand delivery in open court (Petitioner must acknowledge receipt in writing on the face of the original order--see below.) Respondent (or his or her attorney): __ forwarded to sheriff for service __ by hand delivery in open court (Respondent must acknowledge receipt in writing on the face of the original order--see below.) __ by certified mail (may only be used when Respondent is present at the hearing and Respondent fails or refuses to acknowledge the receipt of a certified copy of this injunction.) _ State Attorney s Office _ Batterer s intervention program (if ordered) _ Central Depository (if ordered) ____ State Disbursement Unit (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} Injunction for Protection. , acknowledge receipt of a certified copy of this __________________________________ Petitioner ACKNOWLEDGMENT I, {Name of Respondent} copy of this Injunction for Protection. , acknowledge receipt of a certified ____________________________________ Respondent Florida Supreme Court Approved Family Law Form 12.980(d)(2), Final Judgment of Injunction for Protection Against Domestic Violence without Minor Child(ren) (06/12) - 59 - IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR COUNTY, FLORIDA Case No.: Division: __________________, Petitioner, and ___________________, Respondent. ORDER OF DISMISSAL OF TEMPORARY INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE ( ) DATING VIOLENCE ( ) SEXUAL VIOLENCE THIS CAUSE came before the Court on {date} , upon Petitioner s action for an injunction for protection against domestic violence, repeat, dating, or sexual violence, and it appearing to the Court as follows: [Choose all that apply] a. Petitioner failed to appear at the hearing scheduled in this cause. b. Petitioner appeared at the hearing but desires to voluntarily dismiss this action. c. _ The evidence presented is insufficient under Florida law (section 741.30 or 784.046, Florida Statutes) to allow the Court to issue an injunction for protection against domestic, repeat, dating, or sexual violence. Accordingly, the case is dismissed without prejudice. DONE AND ORDERED in___________________________, Florida on . ___________________________ CIRCUIT JUDGE COPIES TO: Sheriff of County Florida Supreme Court Approved Family Law Form 12.980(e), Order of Dismissal of Temporary Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 60 - Petitioner by U.S. Mail by hand delivery in open court Respondent by U.S. Mail by hand delivery in open court State Attorney s Office Other:_________________________________ I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of __________ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By: Deputy Clerk Florida Supreme Court Approved Family Law Form 12.980(e), Order of Dismissal of Temporary Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 61 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(f), PETITION FOR INJUNCTION FOR PROTECTION AGAINST REPEAT VIOLENCE (06/12) When should this form be used? If you, or a member of your immediate family, are a victim of repeat violence, you can use this form to ask the court for a protective order prohibiting repeat violence. Repeat violence means that two incidents of violence have been committed against you or a member of your immediate family by another person, one of which must have been within 6 months of filing this petition. Repeat violence includes assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, or false imprisonment, or any criminal offense resulting in physical injury or death. Because you are making a request to the court, you are called the petitioner. The person whom you are asking the court to protect you from is called the respondent. If you are under the age of eighteen and have never been married or had the disabilities of nonage removed by a court, one of your parents or your legal guardian must sign this petition on your behalf. The parent or legal guardian of any minor child who is living at home may seek an injunction for protection against repeat violence on behalf of the minor child. With respect to a minor child who is living at home, the parent or legal guardian must have been an eyewitness to, or have direct physical evidence or affidavits from eyewitnesses of, the specific facts and circumstances that form the basis of the petition. If the respondent is your spouse, former spouse, related to you by blood or marriage, living with you now or has lived with you in the past (if you are or were living as a family), or the other parent of your child(ren), whether or not you have ever been married or ever lived together, you should use Petition for Injunction for Protection Against Domestic Violence, Florida Supreme Court Approved Family Law Form 12.980(a), rather than this form. This form should be typed or printed in black ink. You should complete this form (giving as much detail as possible) and sign it the presence of a notary or in front of the clerk of the circuit court in the county where you live. The clerk will take your completed petition to a judge. You should keep a copy for your records. If you have any questions or need assistance completing this form, the clerk or family law intake staff will help you. What should I do if the judge grants my petition? If the facts contained in your petition convince the judge that you or a member of your immediate family are a victim of repeat violence and that an immediate and present danger of repeat violence to you or your family exists, the judge will sign a Temporary Injunction for Protection Against Repeat Violence, Florida Supreme Court Approved Family Law Form 12.980(k). A temporary injunction is issued without notice to the respondent. The clerk will give your petition, the temporary injunction, and any Instructions for Florida Supreme Court Approved Family Law Form 12.980(f), Petition for Injunction for Protection Against Repeat Violence, (06/12) - 62 - other papers filed with your petition to the sheriff or other law enforcement officer for personal service on the respondent. The temporary injunction will take effect immediately after the respondent is served with a copy of it. It lasts until a full hearing can be held or for a period of 15 days, whichever comes first. The court may extend the temporary injunction beyond 15 days for a good reason, which may include failure to obtain service on the respondent. The temporary injunction is issued ex parte. This means that the judge has considered only the information presented by one side--YOU. Section I of the temporary injunction gives a date that you should appear in court for a hearing. You will be expected to testify about the facts in your petition. The respondent will be given the opportunity to testify at this hearing, also. At the hearing, the judge will decide whether to issue a Final Judgment of Injunction for Protection Against Repeat Violence (After Notice), Florida Supreme Court Approved Family Law Form 12.980(l), which will remain in effect for a specific time period or until modified or dissolved by the court. If you and/or the respondent do not appear, the temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including entry of a permanent injunction and the imposition of court costs. You and respondent will be bound by the terms of any injunction or order issued at the final hearing. IF EITHER YOU OR RESPONDENT DOES NOT APPEAR AT THE FINAL HEARING, YOU WILL BOTH BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED IN THIS MATTER. If the judge signs a temporary or final injunction, the clerk will provide you with the necessary copies. Make sure that you keep one certified copy of the injunction with you at all times! What can I do if the judge denies my petition? If your petition is denied on the grounds that it appears to the court that no immediate and present danger of repeat violence exists, the court will set a full hearing on your petition. The respondent will be notified by personal service of your petition and the hearing. If your petition is denied, you may: amend your petition by filing a Supplemental Affidavit in Support of Petition for Injunction for Protection, Florida Supreme Court Approved Family Law Form 12.980 (g); attend the hearing and present facts that support your petition; and/or dismiss your petition. Where can I look for more information? Before proceeding, you should read General Information for Self-Represented Litigants found at the beginning of these forms. The words that are in bold underline are defined in that section. The clerk of the circuit court or family law intake staff will help you complete any necessary forms. For further information, see Section 784.046, Florida Statutes, and Rule 12.610, Florida Family Law Rules of Procedure. Instructions for Florida Supreme Court Approved Family Law Form 12.980(f), Petition for Injunction for Protection Against Repeat Violence, (06/12) - 63 - IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: __________________, Petitioner, and __________________, Respondent. PETITION FOR INJUNCTION FOR PROTECTION AGAINST REPEAT VIOLENCE I, {full legal name} following statements are true: , being sworn, certify that the SECTION I. PETITIONER (This section is about you. It must be completed.) 1. Petitioner currently lives at the following address: {address, city, state, zip code} . [Indicate if applicable] Petitioner seeks an injunction for protection on behalf of a minor child. Petitioner is the parent or legal guardian of {full legal name} ___________________, a minor child who is living at home. 2. Petitioner's attorney's name, address, and telephone number is: . (If you do not have an attorney, write "none.") SECTION II. RESPONDENT (This section is about the person you want to be protected from. It must be completed.) 1. Respondent currently lives at the following address: {address, city, state, and zip code} Respondent s Driver s License number is: {if known} . . 2. . Petitioner has known Respondent since: {date} Florida Supreme Court Approved Family Law Form 12.980(f), Petition for Injunction for Protection Against Repeat Violence (06/12) - 64 - 3. Respondent's last known place of employment: Employment address: Working hours: 4. Physical description of Respondent: Race: Sex: Male _ Female Height: Weight: Eye Color: Distinguishing marks and/or scars: Vehicle: (make/model) Color: Date of Birth: _________________________ Hair Color: Tag Number: ___________________ 5. Other names Respondent goes by (aliases or nicknames): 6. Respondent's attorney s name, address, and telephone number is: . (If you do not know whether Respondent has an attorney, write "unknown." If Respondent does not have an attorney, write "none.") SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION (This section must be completed.) 1. Has Petitioner ever received or tried to get an injunction for protection against domestic violence, repeat violence, dating violence, or sexual violence against Respondent in this or any other court? Yes No If yes, what happened in that case? {include case number, if known} 2. Has Respondent ever received or tried to get an injunction for protection against domestic violence, repeat violence, dating violence, or sexual violence against Petitioner in this or any other court? Yes No If yes, what happened in that case? {include case number, if known} 3. Describe any other court case that is either going on now or that happened in the past between Petitioner and Respondent {include case number, if known}: 4. Respondent has directed at least two incidents of violence, meaning assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, or false imprisonment, or any criminal offense resulting in physical injury or death against Petitioner or a member of Petitioner s immediate family. One of these two incidents of violence has occurred within 6 months of the date of filing of this petition. The most recent incident (including date and location) is described below. On {date} , at {location} , Florida Supreme Court Approved Family Law Form 12.980(f), Petition for Injunction for Protection Against Repeat Violence (06/12) - 65 - Respondent ______Please indicate here if you are attaching additional pages to continue these facts. 5. Other prior incidents (including dates and location) are described below: On {date} , at {location} , Respondent _____Please indicate here if you are attaching additional pages to continue these facts. 6. Petitioner genuinely fears repeat violence by Respondent. Explain: 7. Additional Information [Choose all that apply] a. ____Respondent owns, has, and/or is known to have guns or other weapons. Describe weapon(s): b. ____This or prior acts of repeat violence have been previously reported to: {person or agency} . Florida Supreme Court Approved Family Law Form 12.980(f), Petition for Injunction for Protection Against Repeat Violence (06/12) - 66 - SECTION IV. INJUNCTION (This section must be completed.) 1. ____Petitioner asks the Court to enter a TEMPORARY INJUNCTION for protection against repeat violence that will be in place from now until the scheduled hearing in this matter. 2. ____Petitioner asks the Court to enter, after a hearing has been held on this petition, a final judgment of injunction prohibiting Respondent from committing any acts of violence against Petitioner and: a. prohibiting Respondent from going to or within 500 feet of any place Petitioner lives; b. prohibiting Respondent from going to or within 500 feet of Petitioner s place(s) of employment or the school that Petitioner attends; the address of Petitioner's place(s) of employment and/or school is: ; c. prohibiting Respondent from contacting Petitioner by telephone, mail, by e-mail, in writing, through another person, or in any other manner; d. ordering Respondent not to use or possess any guns or firearms; [Choose all that apply] e. ____prohibiting Respondent from going to or within 500 feet of the following place(s) Petitioner or Petitioner s immediate family must go often:__________________________ ________________________________________________________________________ f. ____prohibiting Respondent from knowingly and intentionally going to or within 100 feet of Petitioner s motor vehicle; and any other terms the Court deems necessary for the safety of Petitioner and Petitioner s immediate family. I UNDERSTAND THAT BY FILING THIS PETITION, I AM ASKING THE COURT TO HOLD A HEARING ON THIS PETITION, THAT BOTH THE RESPONDENT AND I WILL BE NOTIFIED OF THE HEARING, AND THAT I MUST APPEAR AT THE HEARING. I UNDERSTAND THAT IF EITHER RESPONDENT OR I FAIL TO APPEAR AT THE FINAL HEARING, WE WILL BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED AT THAT HEARING. I UNDERSTAND THAT I AM SWEARING OR AFFIRMING UNDER OATH TO THE TRUTHFULNESS OF THE CLAIMS MADE IN THIS PETITION AND THAT THE PUNISHMENT FOR KNOWINGLY MAKING A FALSE STATEMENT INCLUDES FINES AND/OR IMPRISONMENT. Dated:_____________________ ________________________________ Signature of Petitioner Printed Name: Address: City, State, Zip: Telephone Number: Fax Number: Florida Supreme Court Approved Family Law Form 12.980(f), Petition for Injunction for Protection Against Repeat Violence (06/12) - 67 - STATE OF FLORIDA COUNTY OF ___________________ Sworn to or affirmed and signed before me on by . __________________________________________ NOTARY PUBLIC or DEPUTY CLERK __________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] Personally known Produced identification _________________________Type of identification produced Florida Supreme Court Approved Family Law Form 12.980(f), Petition for Injunction for Protection Against Repeat Violence (06/12) - 68 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(g), SUPPLEMENTAL AFFIDAVIT IN SUPPORT OF PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE, REPEAT VIOLENCE, DATING VIOLENCE, OR SEXUAL VIOLENCE (06/12) When should this form be used? You may use this form if your Petition for Injunction for Protection Against Domestic Violence, Florida Supreme Court Approved Family Law Form 12.980(a), or your Petition for Injunction for Protection Against Repeat Violence, Florida Supreme Court Approved Family Law Form 12.980(f), or your Petition for Injunction for Protection Against Dating Violence, Florida Supreme Court Approved Family Law Form 12.980(n), or your Petition for Injunction for Protection Against Sexual Violence, Florida Supreme Court Approved Family Law Form 12.890(q), was denied by the judge. You should use this supplemental affidavit to add facts or clarify the facts you wrote in your original petition. For a domestic violence case, you should include facts that establish that you have been a victim of violence or are in imminent danger of becoming a victim of violence from the respondent. For a repeat violence case, you should include facts that establish that you or a member of your immediate family have or has been a victim of at least two prior incidents of violence, that one of those incidents occurred within the last six months and that there is an immediate and present risk of danger to you or a member of your immediate family. For a dating violence case, you should include fact that establish that you have been a victim of violence or are in imminent danger of becoming a victim of violence from the respondent who is an individual with whom you have or have had a continuing and significant relationship of a romantic or intimate nature, to be determined by consideration of such facts as: whether the dating relationship existed within the past six months; whether the nature of the relationship included an expectation of affection or sexual involvement; and whether the frequency and type of interaction between you and the individual included involvement over time and on a continued basis. Dating violence does not include violence in a casual acquaintanceship or violence between individuals who only have engaged in ordinary fraternization in a business or social context. For a sexual violence case, you should include facts that establish that you are a victim of sexual violence or the parent of a minor child living at home who is a victim of sexual violence, that you have reported the sexual violence to law enforcement and are cooperating in the criminal proceeding if there is one. If the respondent was in state prison for sexual violence against you or the minor child and respondent is out of prison or is getting out within 90 days of the petition, include that information in your supplemental affidavit, along with a copy of the notice of inmate release. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or the clerk of the circuit court. You should then file the original with the clerk in Instructions for Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental Affidavit in Support of Petition for Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 69 - the county where the petition was filed and keep a copy for your records. What should I do next? After you complete this supplemental affidavit, the clerk will attach it to your original petition and all the documents will be submitted to the judge as your Amended Petition. Instructions for Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental Affidavit in Support of Petition for Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 70 - IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: __________________, Petitioner, and ____________________, Respondent. SUPPLEMENTAL AFFIDAVIT IN SUPPORT OF PETITION FOR INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE ( ) DATING VIOLENCE ( ) SEXUAL VIOLENCE I, {full legal name} following statements are true: 1. On {date} , being sworn, certify that the , at {place and address} , Respondent said or did the following things that hurt me or a member of my immediate family and made me afraid for my or my family member s safety: _____Please indicate here if you are attaching additional pages to continue these facts. Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental Affidavit in Support of Petition for Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 71 - 2. On {date} , at {place and address} , the following event(s) took place: ____ Please indicate here if you are attaching additional pages to continue these facts. 3. __Please indicate here if you are attaching copies of medical records for treatment you may have received for injuries referred to in your petition or in this supplemental affidavit, copies of any police or sheriff reports concerning incidents of violence involving you and Respondent, or any notice of inmate release. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this supplemental affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: ______________________ _________________________________ Signature of Petitioner STATE OF FLORIDA COUNTY OF ____________________ Sworn to or affirmed and signed before me on by . NOTARY PUBLIC or DEPUTY CLERK Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental Affidavit in Support of Petition for Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 72 - [Print, type, or stamp commissioned name of notary or clerk.] Personally known Produced identification __________________________Type of identification produced Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental Affidavit in Support of Petition for Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 73 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(h), REQUEST FOR CONFIDENTIAL FILING OF ADDRESS (06/12) When should this form be used? If you fear that disclosing your address would put you in danger because you are the victim of sexual battery, aggravated child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence, you should complete this form and file it with the clerk of the circuit court. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your petition was filed and keep a copy for your records. Instructions for Florida Supreme Court Approved Family Law Form 12.980(h), Request for Confidential Filing of Address (06/12) - 74 - IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: __________________, Petitioner, and __________________, Respondent. REQUEST FOR CONFIDENTIAL FILING OF ADDRESS I, {full legal name} maintain and hold as confidential, the following address: , request that the Court Address City Telephone (area code and number) State Zip This request is being made for the purpose of keeping the location of my residence unknown for safety reasons pursuant to section 119.071(2)(j)1, Florida Statutes. Dated: ________________________________ Signature CLERK S CERTIFICATE AS TO REQUEST FOR CONFIDENTIAL FILING OF ADDRESS I, , as Clerk of the Circuit Court, do hereby certify that I received and filed the above and will keep the above address confidential, subsequent to further order of the Court relative to such confidentiality. CLERK OF THE CIRCUIT COURT (SEAL) By: Deputy Clerk Florida Supreme Court Approved Family Law Form 12.980(h), Request for Confidential Filing of Address (06/12) - 75 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(i), MOTION FOR EXTENSION OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE, REPEAT VIOLENCE, DATING VIOLENCE, OR SEXUAL VIOLENCE (06/12) When should this form be used? If you are the petitioner on a previously entered injunction for protection against domestic violence, repeat violence, dating violence, or sexual violence and that injunction will soon expire, you may use this form to request that the court extend the injunction. You must file a motion for extension BEFORE the previously entered order expires. This form should be typed or printed in black ink. After completing this form, you should sign it before a notary public or the clerk of the circuit court. You should then file the original with the clerk in the county where the petition was filed and keep a copy for your records. If you have any questions or need assistance completing this form, the clerk or family law intake staff will help you. What should I do next? For your case to proceed, you will need to set a hearing on your motion. You must properly notify the other party of the motion and hearing. You should check with the clerk of court for information on the local procedure for scheduling a hearing. When you know the date and time of your hearing, you should file Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form. You will need to serve a copy of your motion and Notice of Hearing on the other party. Service of your motion must be in a manner that is reasonably calculated to apprise the other party of your motion and the hearing. Please note that if notice is mailed, the court in certain circumstances may not consider mailing to be adequate notice. If you want to be sure, you should consider using certified mail, return receipt requested, or having the motion personally served. This is a technical area of the law; if you have any questions about it, you should consult a lawyer. For more information on personal service, see the instructions for Summons: Personal Service on an Individual, Florida Family Law Rules of Procedure Form 12.910(a). You will need to appear at the hearing on your motion. After the hearing, if the judge grants your motion, he or she will prepare an Order Extending Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence, Florida Supreme Court Approved Family Law Form 12.980(m). After the judge signs the order, the clerk will provide you with the necessary copies. Make sure that you keep a certified copy of the previously entered injunction AND a certified copy of the order extending that injunction with you at all times. Where can I look for more information? Instructions for Florida Supreme Court Approved Family Law Form 12.980(i) Motion for Extension of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 76 - Before proceeding, you should read General Information for Self-Represented Litigants found at the beginning of these forms. The words that are in bold underline are defined in that section. The clerk of the circuit court or family law intake staff will help you complete any necessary domestic, repeat, dating, or sexual violence forms and will answer any question that you may have. Special notes... With this form you may also file a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), if you fear that disclosing your address would put you in danger because you are the victim of sexual battery, aggravated child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence, and you wish to keep your address confidential. When completing this form, you should make sure that your reasons for requesting that the injunction be extended are stated clearly and that you include all relevant facts. Instructions for Florida Supreme Court Approved Family Law Form 12.980(i) Motion for Extension of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 77 - IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: _________________, Petitioner, and ___________________, Respondent. MOTION FOR EXTENSION OF INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE ( ) DATING VIOLENCE ( ) SEXUAL VIOLENCE I, {full legal name} statements are true: , being sworn, certify that the following SECTION I. PETITIONER (This section is about you. It must be completed; however, if you fear that disclosing your address would put you in danger because you are the victim of sexual battery, aggravated child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence, you should complete and file a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), and write "confidential" in the space provided on this form for your address and telephone number.) 1. Petitioner currently lives at the following address: {street address} {city, state, and zip code} Telephone Number: {area code and number} 2. Petitioner's attorney's name, address and telephone number is: . (If you do not have an attorney, write "none.") SECTION II. RESPONDENT (This section is about the person you want to be protected from. It must be completed.) New information about Respondent, since the current injunction was issued: (If known, write Respondent s new address, place of employment, physical description, vehicle, aliases or nicknames, or Florida Supreme Court Approved Family Law Form 12.980(i), Motion for Extension of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 78 - attorney s name.) _________ _____________________________________________________________________________________ SECTION III. CASE HISTORY AND REASON FOR SEEKING EXTENSION OF INJUNCTION 1. Describe any attempts since the date of the current injunction by either Petitioner or Respondent to get an injunction for protection in this or any other court (other than the injunction you are asking to extend in this motion). 2. Describe any other court cases (including city, state, and case numbers, if known) since the date of the current injunction between Petitioner and Respondent, including any cases involving the parties' minor child(ren), divorce, juvenile dependency, guardianship, or other civil or criminal cases. 3. Petitioner requests that the previously entered injunction for protection against domestic violence, repeat violence, dating violence, or sexual violence be extended for the following specific reasons: {State in detail why you wish the injunction to remain in effect.} ______Please indicate here if you are attaching additional pages to continue these facts. 4. Petitioner genuinely fears the continued threat of violence by Respondent. SECTION IV. REQUESTED RELIEF 1. Petitioner understands that the Court will hold a hearing on this motion and that he or she must appear at the hearing. Florida Supreme Court Approved Family Law Form 12.980(i), Motion for Extension of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 79 - 2. Petitioner asks the Court to enter an order in this case that extends the previously entered injunction for a period of ( ) or ( ) until modified or dissolved by the court. I certify that a copy of this document was [Choose one only] ( ) mailed ( ) faxed and mailed ( ) mailed by certified mail, return receipt requested, ( ) furnished to a law enforcement officer for personal service to the person(s) listed below on {date} . Other party or his/her attorney: Name: Address: City, State, Zip: Fax Number: I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this motion and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: ___________________ ________________________ Signature of Petitioner STATE OF FLORIDA COUNTY OF ________________ Sworn to or affirmed and signed before me on by . NOTARY PUBLIC or DEPUTY CLERK [Print, type, or stamp commissioned name of notary or clerk] Personally known Produced identification __________________________Type of identification produced Florida Supreme Court Approved Family Law Form 12.980(i), Motion for Extension of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 80 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(j), MOTION FOR MODIFICATION OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE, REPEAT VIOLENCE, DATING VIOLENCE, OR SEXUAL VIOLENCE (06/12) When should this form be used? This form may be used if you are a party to a previously entered injunction for protection against domestic violence, repeat violence, dating violence, or sexual violence and you want the court to modify the terms of the injunction. If you use this form, you are called the moving party. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or the clerk of the circuit court. You should then file the original with the clerk in the county where the original petition was filed and keep a copy for your records. You must file a motion for modification before the previously entered order expires. If you have any questions or need assistance completing this form, the clerk or family law intake staff will help you. What should I do next? For your case to proceed, you will need to set a hearing on your motion. You must properly notify the other party of the motion and hearing. You should check with the clerk of court for information on the local procedure for scheduling a hearing. When you know the date and time of your hearing, you should file Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form. You will need to serve a copy of your motion and Notice of Hearing on the other party. Service of your motion must be in a manner that is reasonably calculated to apprise the other party of your motion and the hearing. Please note that if notice is mailed, the court in certain circumstances may not consider mailing to be adequate notice. If you want to be sure, you should consider using certified mail, return receipt requested, or having the motion personally served. If you are not represented by an attorney in this action, you must file proof that the other party personally received notice of your motion. This is a technical area of the law; if you have any questions about it, you should consult a lawyer. For more information on personal service, see the instructions for Summons: Personal Service on an Individual, Florida Family Law Rules of Procedure Form 12.910(a). You will need to appear at a hearing on your motion for modification of injunction. After the hearing, if the judge grants your motion, he or she will prepare a new injunction for protection that contains the modifications. After the judge signs the new injunction, the clerk will provide you with the necessary copies. Make sure that you keep a certified copy of the new injunction with you at all times! Where can I look for more information? Before proceeding, you should read General Information for Self-Represented Litigants found at the Instructions for Florida Supreme Court Approved Family Law Form 12.980(j), Motion for Modification of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 81 - beginning of these forms. The words that are in bold underline are defined in that section. The clerk of the circuit court or family law intake staff will help you complete any necessary domestic, repeat, dating, or sexual violence forms and will answer any question that you may have. Special notes... If the injunction you are seeking to modify is for domestic violence and you want the court to modify alimony, child support, or time-sharing of minor child(ren), you must establish that there has been a change in circumstance(s), as required by chapter 61, Florida Statutes, or chapter 741, Florida Statutes, as applicable, that requires this (these) modification(s). Be sure that you make these change(s) clear in your motion. With this form you may also file the following: Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), if you fear that disclosing your address would put you in danger because you are the victim of sexual battery, aggravated child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence, and you wish to keep your address confidential. Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), must be completed and attached if the modification(s) you are seeking involves temporary custody of any minor child(ren). Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), must be completed and attached if the modification(s) you are seeking involves temporary alimony or temporary child support. When completing this form, you should make sure that your reasons for requesting that the injunction be modified are stated clearly and that you include all relevant facts. Instructions for Florida Supreme Court Approved Family Law Form 12.980(j), Motion for Modification of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 82 - IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: _________________, Petitioner, and __________________, Respondent. MOTION FOR MODIFICATION OF INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE ( ) DATING VIOLENCE ( ) SEXUAL VIOLENCE I, {full legal name} statements are true: , being sworn, certify that the following SECTION I. MOVING PARTY (This section is about you. It must be completed. However, if you fear that disclosing your address would put you in danger because you are the victim of sexual battery, aggravated child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence, you should complete and file a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), and write "confidential" in the space provided on this form for your address and telephone number.) 1. Moving Party is the ( ) petitioner ( ) respondent in this case. 2. Moving Party currently lives at the following address: {street address} {city, state and zip code} Telephone Number: {area code and number} 3. Moving Party's attorney's name, address and telephone number is: . (If you do not have an attorney, write "none.") SECTION II. NEW INFORMATION New information since the previous injunction was issued: (If known, write the other party's new address, place of employment, physical description, vehicle, aliases or nicknames, or attorney s name.) Florida Supreme Court Approved Family Law Form 12.980(j), Motion for Modification of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 83 - SECTION III. CASE HISTORY AND REASON FOR SEEKING MODIFICATION OF INJUNCTION 1. Describe any attempts since the date of the current injunction by either Petitioner or Respondent to get an injunction for protection in this or any other court (other than the injunction you are asking to modify in this motion). 2. Describe any other court cases (including case numbers, if known) since the date of the current injunction between Petitioner and Respondent, including any cases involving the parties' minor child(ren), divorce, juvenile dependency, guardianship, or other civil or criminal cases. 3. Moving Party requests that the previously entered injunction for protection against domestic violence, repeat violence, dating violence, or sexual violence be modified for the following specific reasons: {State why you wish the injunction to be changed.} _____Please indicate here if you are attaching additional pages to continue these facts. SECTION IV. REQUESTED RELIEF 1. Moving Party understands that the court will hold a hearing on this motion and that he or she must appear at the hearing. Florida Supreme Court Approved Family Law Form 12.980(j), Motion for Modification of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 84 - 2. Moving Party asks the Court to enter an order in this case that modifies the previously entered injunction in the following ways: {State how you wish the injunction to be changed.} I certify that a copy of this document was [Choose one only] ( ) mailed ( ) faxed and mailed ( ) mailed by certified mail, return receipt requested, ( ) furnished to a law enforcement officer for personal service to the person(s) listed below on {date} . Other party or his/her attorney: Name: Address: City, State, Zip: Fax Number: I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this motion and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _____________________ Signature of Party STATE OF FLORIDA COUNTY OF _________________ Sworn to or affirmed and signed before me on by . NOTARY PUBLIC or DEPUTY CLERK [Print, type, or stamp commissioned name of notary or clerk.] _ Personally known _ Produced identification _________________________Type of identification produced Florida Supreme Court Approved Family Law Form 12.980(j), Motion for Modification of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 85 - 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. Under the laws of Florida, the Court has jurisdiction of the petitioner and the subject matter and has jurisdiction of the respondent upon service of the temporary injunction. The term Petitioner as used in this injunction includes the person on whose behalf this injunction is entered. It is intended that this protection order meet the requirements of 18 U.S.C. Section 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe. SECTION I. NOTICE OF HEARING Because this Temporary Injunction for Protection Against Repeat Violence has been issued without notice to Respondent, Petitioner and Respondent are instructed that they are scheduled to appear and testify at a hearing regarding this matter on {date} , at a.m./p.m., when the Court will consider whether the Court should issue a Final Judgment of Injunction for Protection Against Repeat Violence, which shall remain in effect until modified or dissolved by the Court, and whether other things should be ordered. The hearing will be before The Honorable {name} , at {room name/number, location, address, city} ______________________________________________________________________________, Florida. If Petitioner and/or Respondent do not appear, this temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including entry of a permanent injunction and the imposition of court costs. All witnesses and evidence, if any, must be presented at this time. Petitioner and Respondent will be bound by the terms of any injunction or order issued at the final hearing. IF EITHER PETITIONER OR RESPONDENT DOES NOT APPEAR AT THE FINAL HEARING, HE OR SHE WILL Florida Supreme Court Approved Family Law Form 12.980(k), Temporary Injunction for Protection Against Repeat Violence (06/12) - 86 - BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED IN THIS MATTER. 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 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. ____ neither electronic recording nor 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 _________________________ __________________________________________________________________ {identify applicable court personnel by name, address, and telephone number} at least 7 days before your scheduled court appearance, or immediately upon receiving this notification if the time before the scheduled appearance is less than 7 days; if you are hearing or voice impaired, call 711. SECTION II. FINDINGS The statements made under oath by Petitioner make it appear that Section 784.046, Florida Statutes, applies to the parties, that Petitioner is a victim of repeat violence and that an immediate and present danger of repeat violence exists to Petitioner or to a member of Petitioner's immediate family. SECTION III. TEMPORARY INJUNCTION AND TERMS This injunction shall be effective until the hearing set above and in no event for longer than 15 days, unless extended by court order. If a final order of injunction is issued, the terms of this temporary injunction will be extended until service of the final injunction is effected upon Respondent. This injunction is valid and enforceable in all counties of the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the Florida Supreme Court Approved Family Law Form 12.980(k), Temporary Injunction for Protection Against Repeat Violence (06/12) - 87 - terms of this injunction. Either party may ask the Court to change or end this injunction. Willful violation of the terms of this injunction, such as refusing to vacate the dwelling which the parties share, going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction, telephoning, contacting or communicating with Petitioner, if prohibited by this injunction, or committing an act of repeat violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by Sections 775.082 and 775.083, Florida Statutes. Any party violating this injunction may be subject to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment, and also may be charged with a crime punishable by a fine, jail, or both, as provided by Florida Statutes. ORDERED and ADJUDGED: 1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of violence against Petitioner, including assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, or false imprisonment or any criminal offense resulting in physical injury or death. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word, or act to do violence to the Petitioner. 2. No Contact. Respondent shall have no contact with Petitioner unless otherwise provided in this section. a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner s current residence {list address} or any residence to which Petitioner may move; Petitioner s current or any subsequent place of employment {list address of current employment} or place where Petitioner attends school {list address of school}__________________________ [Initial if applies; write N/A if not applicable] b. ____Respondent may not knowingly come within 100 feet of Petitioner s automobile at anytime. c. ____Other provisions regarding contact: 3. Firearms. [Initial all that apply; write N/A if does not apply] Florida Supreme Court Approved Family Law Form 12.980(k), Temporary Injunction for Protection Against Repeat Violence (06/12) - 88 - the a. ____Respondent shall not use or possess a firearm or ammunition. b. ____Respondent shall surrender any firearms and ammunition in Respondent's possession to _______ County Sheriff's Department. c. ____Other directives relating to firearms and ammunition: 4. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent s last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Florida Family Law Rules of Procedure; Section 784.046, Florida Statutes. 5. Additional order(s) necessary to protect Petitioner from repeat violence: SECTION IV. OTHER SPECIAL PROVISIONS {This section to be used for inclusion of local provisions approved by the chief judge as provided in Florida Family Law Rule 12.610.} ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ SECTION V. DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION {Unless ordered otherwise by the judge, all provisions in this injunction are considered mandatory provisions and should be interpreted as 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 Florida Supreme Court Approved Family Law Form 12.980(k), Temporary Injunction for Protection Against Repeat Violence (06/12) - 89 - 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. DONE AND ORDERED in ____________________, Florida on __________. CIRCUIT JUDGE COPIES TO: Sheriff of Petitioner by U. S. Mail by hand delivery County Respondent: forwarded to sheriff for service Other: I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of ______ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By: Deputy Clerk Florida Supreme Court Approved Family Law Form 12.980(k), Temporary Injunction for Protection Against Repeat Violence (06/12) - 90 - 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. Section 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: SECTION II. ( ) 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 repeat violence. Florida Supreme Court Approved Family Law Form 12.980(l), Final Judgment of Injunction for Protection Against Repeat Violence (After Notice) (06/12) - 91 - SECTION III. INJUNCTION AND TERMS This injunction shall be in full force and effect until either ( ) further order of the Court or ( ){date} . This injunction is valid and enforceable throughout all counties in the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction. Willful violation of the terms of this injunction, such as refusing to vacate the dwelling which the parties share, going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction, telephoning, contacting or communicating with Petitioner, if prohibited by this injunction, or committing an act of repeat violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by Sections 775.082 and 775.083, Florida Statutes. Any party violating this injunction shall be subject to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment, and also may be charged with a crime punishable by a fine, jail, or both, as provided by Florida Statutes. ORDERED and ADJUDGED: 1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of violence against Petitioner, including assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, or false imprisonment, or any criminal offense resulting in physical injury or death. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner. 2. No Contact. Respondent shall have no contact with Petitioner unless otherwise provided in this section. a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner s current residence {list address}__________________________________________________________ or any residence to which Petitioner may move; Petitioner s current or any subsequent place of employment {list address of current employment}_____________________________________ or place where Petitioner attends school {list address of school}_________________________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner s minor child(ren) go often:________________________________________________________ _____________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(l), Final Judgment of Injunction for Protection Against Repeat Violence (After Notice) (06/12) - 92 - ______________________________________________________________________________. [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 not applicable] a._____ Respondent shall not use or possess a firearm or ammunition. b. _____Respondent shall surrender any firearms and ammunition in the Respondent's possession to the __________________County Sheriff's Department. c. _____Other directives relating to firearms and ammunition: 4. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent s last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Florida Family Law Rules of Procedure; Section 784.046, Florida Statutes. 5. Additional order(s) necessary to protect Petitioner from repeat violence: SECTION IV. OTHER SPECIAL PROVISIONS (This section to be used for inclusion of local provisions approved by the chief judge as provided in Florida Family Law Rule 12.610.) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(l), Final Judgment of Injunction for Protection Against Repeat Violence (After Notice) (06/12) - 93 - SECTION V. DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION {Unless ordered otherwise by the judge, all provisions in this injunction are considered mandatory provisions and should be interpreted as 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. DONE AND ORDERED in __________________________, Florida on ____. CIRCUIT JUDGE Florida Supreme Court Approved Family Law Form 12.980(l), Final Judgment of Injunction for Protection Against Repeat Violence (After Notice) (06/12) - 94 - COPIES TO: Sheriff of _____ County Petitioner (or his or her attorney): ______by U. S. Mail ______by hand delivery in open court (Petitioner must acknowledge receipt in writing on the face of the original order--see below) Respondent (or his or her attorney): forwarded to sheriff for service by hand delivery in open court (Respondent must acknowledge receipt in writing on the face of the original order--see below) by certified mail (may only be used when Respondent is present at the hearing and Respondent fails or refuses to acknowledge the receipt of certified copy of this injunction) ____ State Attorney s Office ____ Other:____________________________________ I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of _________ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By: Deputy Clerk ACKNOWLEDGMENT I, {Name of Petitioner} this Injunction for Protection. , acknowledge receipt of a certified copy of _______________________________________ Petitioner ACKNOWLEDGMENT I, {Name of Respondent} copy of this Injunction for Protection. , acknowledge receipt of a certified ________________________________________ Respondent Florida Supreme Court Approved Family Law Form 12.980(l), Final Judgment of Injunction for Protection Against Repeat Violence (After Notice) (06/12) - 95 - IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: __________________, Petitioner and ___________________, Respondent. ORDER EXTENDING INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE ( ) DATING VIOLENCE ( ) SEXUAL VIOLENCE THIS CAUSE came before the Court on {date} , upon Petitioner s motion for an extension of injunction for protection and it appearing to the Court as follows: 1.____Ex parte. The claims in the motion for extension of injunction for protection make it appear to the Court that there is an immediate and present danger of domestic, repeat, dating, or sexual violence, as required under section 741.30 or section 784.046, Florida Statutes. The previously entered injunction is extended until {date} ________________________________. A full hearing on the petition is scheduled for {date} at___a.m./p.m. in _____________________________________ __________________________________________________________________________________. NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at public expense. YOU ARE ADVISED THAT IN THIS COURT: a. ____a court reporter is provided by the court. b. ____electronic recording only is provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party s expense. c. ____If this is a repeat violence, dating violence, or sexual violence action, no electronic 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. Florida Supreme Court Approved Family Law Form 12.980(m), Order Extending Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 96 - 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 _____________________________________________________________ {identify applicable court personnel by name, address, and telephone number} at least 7 days before your scheduled court appearance, or immediately upon receiving this notification if the time before the scheduled appearance is less than 7 days; if you are hearing or voice impaired, call 711. 2._____After notice and hearing. Respondent was served with a copy of the temporary injunction, if applicable, and a notice of this hearing within the time required by Florida law and was afforded an opportunity to be heard. The notice and opportunity to be heard were sufficient to protect Respondent s right to due process. The following persons attended the hearing: ( ) Petitioner ( ) Respondent. After hearing the testimony of each party present and of any witnesses, or upon consent of Respondent, the Court finds that Petitioner is a victim of domestic violence, repeat violence, dating violence, or sexual violence, or reasonably fears that he/she will become a victim of domestic, repeat dating, or sexual violence from Respondent. The previously entered injunction is extended until {date}_____________________________ or until further order of the Court. DONE AND ORDERED in __________________, Florida on __________. CIRCUIT JUDGE COPIES TO: Sheriff of County Petitioner (or his or her attorney): ____by U.S. Mail ____ by hand delivery in open court (Petitioner must acknowledge receipt in writing on the face of the original order see below) Respondent (or his or her attorney): _forwarded to sheriff for service Florida Supreme Court Approved Family Law Form 12.980(m),Order Extending Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 97 - ___ 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),Order Extending Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 98 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(n), PETITION FOR INJUNCTION FOR PROTECTION AGAINST DATING VIOLENCE (06/12) When should this form be used? If you, or a member of your immediate family, are a victim of dating violence, you can use this form to ask the court for a protective order prohibiting dating violence. Dating violence means violence between individuals who have or have had a continuing and significant relationship of a romantic or intimate nature. The dating relationship must have existed within the past six months, the nature of the relationship must have been characterized by the expectation of affection or sexual involvement between the parties, and the frequency and type of interaction must have included that the persons have been involved over time and on a continuous basis during the course of the relationship. Dating violence does not include violence in a casual acquaintanceship or violence between individuals who only have engaged in ordinary fraternization in a business or social context. Dating violence includes assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, or false imprisonment, or any criminal offense resulting in physical injury or death. Because you are making a request to the court, you are called the petitioner. The person whom you are asking the court to protect you from is called the respondent. If you are under the age of eighteen and have never been married or had the disabilities of nonage removed by a court, one of your parents or your legal guardian must sign this petition on your behalf. The parent or legal guardian of any minor child who is living at home may seek an injunction for protection against dating violence on behalf of the minor child. With respect to a minor child who is living at home, the parent or legal guardian must have been an eyewitness to, or have direct physical evidence or affidavits from eyewitnesses of, the specific facts and circumstances that form the basis of the petition. If the respondent is your spouse, former spouse, related to you by blood or marriage, living with you now or has lived with you in the past (if you are or were living as a family), or the other parent of your child(ren), whether or not you have ever been married or ever lived together, you should use Petition for Injunction for Protection Against Domestic Violence, Florida Supreme Court Approved Family Law Form 12.980(a), rather than this form. This form should be typed or printed in black ink. You should complete this form (giving as much detail as possible) and sign it the presence of a notary or in front of the clerk of the circuit court in the county where you live. The clerk will take your completed petition to a judge. You should keep a copy for your records. If you have any questions or need assistance completing this form, the clerk or family law intake staff will help you. What should I do if the judge grants my petition? Instructions for Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for Protection Against Dating Violence (06/12) - 99 - If the facts contained in your petition convince the judge that you or a member of your immediate family are a victim of dating violence and that an immediate and present danger of dating violence to you or your family exists, the judge will sign a Temporary Injunction for Protection Against Dating Violence, Florida Supreme Court Approved Family Law Form 12.980(o). A temporary injunction is issued without notice to the respondent. The clerk will give your petition, the temporary injunction, and any other papers filed with your petition to the sheriff or other law enforcement officer for personal service on the respondent. The temporary injunction will take effect immediately after the respondent is served with a copy of it. It lasts until a full hearing can be held or for a period of 15 days, whichever comes first. The court may extend the temporary injunction beyond 15 days for a good reason, which may include failure to obtain service on the respondent. The temporary injunction is issued ex parte. This means that the judge has considered only the information presented by one side--YOU. Section I of the temporary injunction gives a date that you should appear in court for a hearing. You will be expected to testify about the facts in your petition. The respondent will be given the opportunity to testify at this hearing, also. At the hearing, the judge will decide whether to issue a Final Judgment of Injunction for Protection Against Dating Violence (After Notice), Florida Supreme Court Approved Family Law Form 12.980(p), which will remain in effect for a specific time period or until modified or dissolved by the court. If you and/or the respondent do not appear, the temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including entry of a permanent injunction and the imposition of court costs. You and respondent will be bound by the terms of any injunction or order issued at the final hearing. IF EITHER YOU OR RESPONDENT DOES NOT APPEAR AT THE FINAL HEARING, YOU WILL BOTH BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED IN THIS MATTER. If the judge signs a temporary or final injunction, the clerk will provide you with the necessary copies. Make sure that you keep one certified copy of the injunction with you at all times! What can I do if the judge denies my petition? If your petition is denied on the grounds that it appears to the court that no immediate and present danger of dating violence exists, the court will set a full hearing on your petition. The respondent will be notified by personal service of your petition and the hearing. If your petition is denied, you may: amend your petition by filing a Supplemental Affidavit in Support of Petition for Injunction for Protection, Florida Supreme Court Approved Family Law Form 12.980(g); attend the hearing and present facts that support your petition; and/or dismiss your petition. Where can I look for more information? Before proceeding, you should read General Information for Self-Represented Litigants found at the beginning of these forms. The words that are in bold underline are defined in that section. The clerk of the circuit court or family law intake staff will help you complete any necessary forms. For further Instructions for Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for Protection Against Dating Violence (06/12) - 100 - information, see Section 784.046, Florida Statutes, and Rule 12.610, Florida Family Law Rules of Procedure. Instructions for Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for Protection Against Dating Violence (06/12) - 101 - IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: __________________, Petitioner, and __________________, Respondent. PETITION FOR INJUNCTION FOR PROTECTION AGAINST DATING VIOLENCE I, {full legal name} following statements are true: , being sworn, certify that the SECTION I. PETITIONER (This section is about you. It must be completed.) 1. Petitioner currently lives at the following address: {address, city, state, zip code}_____________ . Date of Birth of Petitioner: ___________________________. [Indicate if applicable] _____ Petitioner seeks an injunction for protection on behalf of a minor child. Petitioner is the parent or legal guardian of {full legal name} __________________, a minor child who is living at home. 2. Petitioner's attorney's name, address, and telephone number is: _________________________ (If you do not have an attorney, write "none.") SECTION II. RESPONDENT (This section is about the person you want to be protected from. It must be completed.) 1. Respondent currently lives at the following address: {address, city, state, and zip code}________ Respondent s Driver s License number is: {if known} _______________________________ Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for Protection Against Dating Violence (06/12) - 102 - 2. Petitioner has known Respondent since {date}_____________________________________. 3. Respondent's last known place of employment:_____________________________________ Employment address:_________________________________________________________ Working hours: ___________________________ 4. Physical description of Respondent: Race: _____ Sex: Male ___ Female ___ Date of Birth: Height: _____ Weight: _____ Eye Color: _____ Hair Color:_________________ Distinguishing marks and/or scars: Vehicle: (make/model) _______________ Color: __________ Tag Number: ________________ 5. Other names Respondent goes by (aliases or nicknames):_____________________________ 6. Respondent's attorney s name, address, and telephone number is: ____________________ (If you do not know whether Respondent has an attorney, write "unknown." If Respondent does not have an attorney, write "none.") 7. If Respondent is a minor, the address of Respondent s parent or legal guardian is: SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION (This section must be completed.) 1. Describe the nature of the relationship between the Petitioner and Respondent {Include the length of time of the relationship, the romantic or intimate nature of the relationship, the frequency or type of interaction, and any other facts that characterize the relationship} _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ___________________ _____Please indicate here if you are attaching additional pages to continue these facts. 2. Have the Petitioner and Respondent been involved in a dating relationship within the past six months? Yes No 3. Has Petitioner ever received or tried to get an injunction for protection against domestic violence, dating violence, repeat violence, or sexual violence against Respondent in this or any other court? Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for Protection Against Dating Violence (06/12) - 103 - ( ) Yes ( ) No If yes, what happened in that case? {include case number, if known} 4. Has Respondent ever received or tried to get an injunction for protection against domestic violence, dating violence, repeat violence, or sexual violence against Petitioner in this or any other court? ( ) Yes ( ) No If yes, what happened in that case? {include case number, if known} 5. Describe any other court case that is either going on now or that happened in the past between Petitioner and Respondent {include case number, if known}: 6. Respondent has directed an incident of violence, meaning assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, or false imprisonment, or any criminal offense resulting in physical injury or death against Petitioner or a member of Petitioner s immediate family. The incident (including date and location) is described below: On {date} , at {location} ___________________________, Respondent ______________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _____Please indicate here if you are attaching additional pages to continue these facts. 7. Other prior incidents (including dates and location) are described below: On {date} , at {location} ________________________________, Respondent__________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ _____________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for Protection Against Dating Violence (06/12) - 104 - _____Please indicate here if you are attaching additional pages to continue these facts. 8. Petitioner genuinely fears dating violence by Respondent. Explain:____________________ ____________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ 9. Additional Information [Choose all that apply] a.____ Respondent owns, has, and/or is known to have guns or other weapons. Describe weapon(s):__________________________________________________________ __________________________________________________________________________ b.____ This or prior acts of dating violence have been previously reported to: {person or agency} _______________________________________________________________________ _______________________________________________________________________. SECTION IV. INJUNCTION (This section must be completed.) 1. Petitioner asks the Court to enter a TEMPORARY INJUNCTION for protection against dating violence that will be in place from now until the scheduled hearing in this matter. 2. Petitioner asks the Court to enter an injunction prohibiting Respondent from committing any acts of violence against Petitioner and: a. prohibiting Respondent from going to or within 500 feet of any place Petitioner lives; b. prohibiting Respondent from going to or within 500 feet of Petitioner s place(s) of employment or the school that Petitioner attends; the address of Petitioner's place(s) of employment and/or school is:______________________________________________________ ; c. prohibiting Respondent from contacting Petitioner by telephone, mail, by e-mail, in writing, through another person, or in any other manner; d. ordering Respondent not to use or possess any guns or firearms; [Choose all that apply] e. ____prohibiting Respondent from going to or within 500 feet of the following place(s) Petitioner or Petitioner s immed ; Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for Protection Against Dating Violence (06/12) - 105 - f. ____ prohibiting Respondent from knowingly and intentionally going to or within 100 feet of Petitioner s motor vehicle; and any other terms the Court deems necessary for the safety of Petitioner and Petitioner s immediate family. I UNDERSTAND THAT BY FILING THIS PETITION, I AM ASKING THE COURT TO HOLD A HEARING ON THIS PETITION, THAT BOTH THE RESPONDENT AND I WILL BE NOTIFIED OF THE HEARING, AND THAT I MUST APPEAR AT THE HEARING. I UNDERSTAND THAT IF EITHER RESPONDENT OR I FAIL TO APPEAR AT THE FINAL HEARING, WE WILL BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED AT THAT HEARING. I UNDERSTAND THAT I AM SWEARING OR AFFIRMING UNDER OATH TO THE TRUTHFULNESS OF THE CLAIMS MADE IN THIS PETITION AND THAT THE PUNISHMENT FOR KNOWINGLY MAKING A FALSE STATEMENT INCLUDES FINES AND/OR IMPRISONMENT. Dated: ____________________________ _______________________________________ Signature of Petitioner Printed Name: Address: City, State, Zip: Telephone Number: Fax Number: STATE OF FLORIDA COUNTY OF _____________________ Sworn to or affirmed and signed before me on by NOTARY PUBLIC or DEPUTY CLERK [Print, type, or stamp commissioned name of notary or clerk.] Personally known Produced identification __________________________Type of identification produced Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for Protection Against Dating Violence (06/12) - 106 - . IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: _________________, Petitioner, and __________________, Respondent. TEMPORARY INJUNCTION FOR PROTECTION AGAINST DATING VIOLENCE The Petition for Injunction for Protection Against Dating Violence under Section 784.046, Florida Statutes, and other papers filed in this Court have been reviewed. Under the laws of Florida, the Court has jurisdiction of the petitioner and the subject matter and has jurisdiction of the respondent upon service of the temporary injunction. The term Petitioner as used in this injunction includes the person on whose behalf this injunction is entered. It is intended that this protection order meet the requirements of 18 U.S.C. Section 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe. SECTION I. NOTICE OF HEARING Because this Temporary Injunction for Protection Against Dating Violence has been issued without notice to Respondent, Petitioner and Respondent are instructed that they are scheduled to appear and testify at a hearing regarding this matter on {date} _______________________, at ________ a.m./p.m., when the Court will consider whether the Court should issue a Final Judgment of Injunction for Protection Against Dating Violence, which shall remain in effect until modified or dissolved by the Court, and whether other things should be ordered. The hearing will be before The Honorable {name} ____________________________________, at {room name/number, location, address, city} ____________________________________________________ _______________________, Florida. If Petitioner and/or Respondent do not appear, this temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including entry of a permanent injunction and the imposition of court costs. All witnesses and evidence, if any, must be presented at this time. Petitioner and Respondent will be bound by the terms of any injunction or order issued at the final hearing. IF EITHER PETITIONER OR RESPONDENT DOES NOT APPEAR AT THE FINAL HEARING, HE OR SHE WILL Florida Supreme Court Approved Family Law Form 12.980(o), Temporary Injunction for Protection Against Dating Violence (06/12) - 107 - BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED IN THIS MATTER. 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 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.____ neither electronic recording nor 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 __________________________ __________________________________________________________________ {identify applicable court personnel by name, address, and telephone number} at least 7 days before your scheduled court appearance, or immediately upon receiving this notification if the time before the scheduled appearance is less than 7 days; if you are hearing or voice impaired, call 711. SECTION II. FINDINGS The statements made under oath by Petitioner make it appear that Section 784.046, Florida Statutes, applies to the parties, that Petitioner is a victim of dating violence and/or Petitioner has reasonable cause to believe he or she is in imminent danger of becoming a victim of an act of dating violence by Respondent, and that an immediate and present danger of dating violence exists to Petitioner or to a member of Petitioner's immediate family. SECTION III. TEMPORARY INJUNCTION AND TERMS This injunction shall be effective until the hearing set above and in no event for longer than 15 days, unless extended by court order. If a final order of injunction is issued, the terms of this temporary injunction will be extended until service of the final injunction is effected upon Respondent. This Florida Supreme Court Approved Family Law Form 12.980(o), Temporary Injunction for Protection Against Dating Violence (06/12) - 108 - injunction is valid and enforceable in all counties of the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction. Willful violation of the terms of this injunction, such as refusing to vacate the dwelling which the parties share, going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction, telephoning, contacting or communicating with Petitioner, if prohibited by this injunction, or committing an act of dating violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by Sections 775.082 and 775.083, Florida Statutes. Any party violating this injunction may be subject to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment, and also may be charged with a crime punishable by a fine, jail, or both, as provided by Florida Statutes. ORDERED and ADJUDGED: 1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of violence against Petitioner, including assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, or false imprisonment, or any criminal offense resulting in physical injury or death. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word, or act to do violence to the Petitioner. 2. No Contact. Respondent shall have no contact with the Petitioner unless otherwise provided in this section. a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner s current residence {list address} ________________________________________________________________________ or any residence to which Petitioner may move; Petitioner s current or any subsequent place of employment {list address of current employment} ________________________________ or place where Petitioner attends school {list address of school} ; or the following other places (if requested by Petitioner) where Petitioner or Petitioner s minor child(ren) go often: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ [Initial if applies; write N/A if not applicable] b. ____Respondent may not knowingly come within 100 feet of Petitioner s automobile at any Florida Supreme Court Approved Family Law Form 12.980(o), Temporary Injunction for Protection Against Dating Violence (06/12) - 109 - time. c. ____Other provisions regarding contact:________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. Firearms. [Initial all that apply; write N/A if does not apply] a. ____Respondent shall not use or possess a firearm or ammunition. b. ____Respondent shall surrender any firearms and ammunition in Respondent's possession to the County Sheriff's Department. c. ____Other directives relating to firearms and ammunition:___________________________ ____________________________________________________________________________ ____________________________________________________________________________ 4. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent s last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Florida Family Law Rules of Procedure; Section 784.046, Florida Statutes. 5. Additional order(s) necessary to protect Petitioner from dating violence: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ SECTION IV. OTHER SPECIAL PROVISIONS {This section to be used for inclusion of local provisions approved by the chief judge as provided in Florida Family Law Rule 12.610. __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ SECTION V. DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION {Unless ordered otherwise by the judge, all provisions in this injunction are considered mandatory provisions and should be interpreted as 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 Florida Supreme Court Approved Family Law Form 12.980(o), Temporary Injunction for Protection Against Dating Violence (06/12) - 110 - 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. DONE AND ORDERED in ___________________________, Florida on . CIRCUIT JUDGE COPIES TO: Sheriff of Petitioner: _ by U. S. Mail _ by hand delivery County Respondent: _ forwarded to sheriff for service _ Other:________________________________ I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of __________________ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By:_______________________________________ Deputy Clerk Florida Supreme Court Approved Family Law Form 12.980(o), Temporary Injunction for Protection Against Dating Violence (06/12) - 111 - IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR COUNTY, FLORIDA Case No.: Division: __________________, Petitioner, and __________________, Respondent. FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST DATING VIOLENCE (AFTER NOTICE) The Petition for Injunction for Protection Against Dating Violence under Section 784.046, Florida Statutes, and other papers filed in this Court have been reviewed. The Court has jurisdiction of the parties and the subject matter. The term Petitioner as used in this injunction includes the person on whose behalf this injunction is entered. It is intended that this protection order meet the requirements of 18 U.S.C. Section 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe. SECTION I. HEARING This cause came before the Court for a hearing to determine whether an Injunction for Protection Against Dating Violence in this case should be ( ) issued ( ) modified ( ) extended. The hearing was attended by ( ) Petitioner ( ) Respondent ( ) Petitioner s Counsel ( ) Respondent s Counsel SECTION II. FINDINGS On {date} _____________________, a notice of this hearing was served on Respondent together with a copy of Petitioner s petition to this Court and the temporary injunction, if issued. Service was within the time required by Florida law, and Respondent was afforded an opportunity to be heard. Florida Supreme Court Approved Family Law Form 12.980(p), Final Judgment of Injunction for Protection Against Dating Violence (After Notice) (06/12) - 112 - After hearing the testimony of each party present and of any witnesses, or upon consent of Respondent, the Court finds, based on the specific facts of this case, that Petitioner is a victim of dating violence and/or Petitioner has reasonable cause to believe he or she is in imminent danger of becoming a victim of an act of dating violence by Respondent, and that an immediate and present danger of dating violence exists to Petitioner or to a member of Petitioner's immediate family. SECTION III. INJUNCTION AND TERMS This injunction shall be in full force and effect until ( ) further order of the Court or ( ) {date} __________________________. This injunction is valid and enforceable throughout all counties in the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction Willful violation of the terms of this injunction, such as refusing to vacate the dwelling which the parties share, going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction, telephoning, contacting or communicating with Petitioner, if prohibited by this injunction, or committing an act of dating violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by Sections 775.082 and 775.083, Florida Statutes. Any party violating this injunction shall be subject to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment, and also may be charged with a crime punishable by a fine, jail, or both, as provided by Florida Statutes. ORDERED and ADJUDGED: 1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of violence against Petitioner, including assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, or false imprisonment, or any criminal offense resulting in physical injury or death. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner. 2. No Contact. Respondent shall have no contact with Petitioner unless otherwise provided in this section. a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner s current residence {list address}___________________________________________________________ or any residence Florida Supreme Court Approved Family Law Form 12.980(p), Final Judgment of Injunction for Protection Against Dating Violence (After Notice) (06/12) - 113 - to which Petitioner may move; Petitioner s current or any subsequent place of employment {list address of current employment}________________________________________________ or place where Petitioner attends school {list address of school}_________________________ _______________________________________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner s minor child(ren) go often: ___________________ _____________________________________________________________________________ _____________________________________________________________________________ . [Initial if applies; write N/A if not applicable] b.____Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time. c. ____Other provisions regarding contact:__________________________________________ ____________________________________________________________________________ _____________________________________________________________________________ 3. Firearms. [Initial all that apply; write N/A if does not apply] a. ____Respondent shall not use or possess a firearm or ammunition. b. ____Respondent shall surrender any firearms and ammunition in the Respondent's possession to the___________________ County Sheriff's Department. c. ____Other directives relating to firearms and ammunition:___________________________ _____________________________________________________________________________ 4. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent s last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Florida Family Law Rules of Procedure; Section 784.046, Florida Statutes. 5. Additional order(s) necessary to protect Petitioner from dating violence: ______________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(p), Final Judgment of Injunction for Protection Against Dating Violence (After Notice) (06/12) - 114 - 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 {Unless ordered otherwise by the judge, all provisions in this injunction are considered mandatory provisions and should be interpreted as 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. DONE AND ORDERED in____________________________, Florida on ___________________ __________________________________________ Circuit Judge Florida Supreme Court Approved Family Law Form 12.980(p), Final Judgment of Injunction for Protection Against Dating Violence (After Notice) (06/12) - 115 - COPIES TO: Sheriff of ____________________ County Petitioner (or his or her attorney): ____ by U. S. Mail ____ by hand delivery in open court (Petitioner must acknowledge receipt in writing on the face of the original order see below) Respondent (or his or her attorney): ____ forwarded to sheriff for service ____ by hand delivery in open court (Respondent must acknowledge receipt in writing on the face the of the original order--see below) ____ by certified mail (may only be used when Respondent is present at the hearing and Respondent fails or refuses to acknowledge the receipt of certified copy of this injunction) ____ State Attorney s Office ____ Other: ______________________________ I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of ___________ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By:_______________________________________ Deputy Clerk ACKNOWLEDGMENT I, {Name of Petitioner} ___________________________, acknowledge receipt of a certified copy of this Injunction for Protection. Petitioner ACKNOWLEDGMENT I, {Name of Respondent} ________________________________, acknowledge receipt of a certified copy of this Injunction for Protection. Respondent Florida Supreme Court Approved Family Law Form 12.980(p), Final Judgment of Injunction for Protection Against Dating Violence (After Notice) (06/12) - 116 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(q), PETITION FOR INJUNCTION FOR PROTECTION AGAINST SEXUAL VIOLENCE (06/12) When should this form be used? If you are a victim of sexual violence or the parent or legal guardian of a minor child who is living at home and is a victim of sexual violence, you can use this form to ask the court for a protective order prohibiting sexual violence. Sexual violence means any one incident of: ï · sexual battery, as defined in Chapter 794, Florida Statutes; ï · a lewd or lascivious act, as defined in Chapter 800, Florida Statutes, committed upon or in the presence of a person younger than 16 years of age; ï · luring or enticing a child, as described in Chapter 787, Florida Statutes; ï · sexual performance by a child, as described in Chapter 827, Florida Statutes; or ï · any other forcible felony wherein a sexual act is committed or attempted In order to get an injunction you must have reported the sexual violence to a law enforcement agency and be cooperating in the criminal proceeding if there is one. It does not matter whether criminal charges based on the sexual violence have been filed, reduced, or dismissed by the state attorney s office. You may also seek an injunction for protection against sexual violence if the respondent was sent to prison for committing one of the sexual violence crimes listed above against you or your minor child living at home and respondent is out of prison or is getting out of prison within 90 days of your petition. Attach the notice of inmate release to your petition. Because you are making a request to the court, you are called the petitioner. The person whom you are asking the court to protect you from is called the respondent. If you are seeking an injunction for protection against sexual violence on behalf of a minor child who is living at home, the parent or legal guardian must have been an eyewitness to, or have direct physical evidence or affidavits from eyewitnesses of, the specific facts and circumstances that form the basis of the petition. If you are under the age of eighteen and have never been married or had the disabilities of nonage removed by a court, one of your parents or your legal guardian must sign this petition on your behalf. If the respondent is your spouse, former spouse, related to you by blood or marriage, living with you now or has lived with you in the past (if you are or were living as a family), or is the other parent of your child(ren) whether or not you have ever been married or ever lived together, you should use Petition for Injunction for Protection Against Domestic Violence, Florida Supreme Court Approved Family Law Form 12.980(a), rather than this form. Instructions for Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (06/12) - 117 - This form should be typed or printed in black ink. You should complete this form (giving as much detail as possible) and sign it the presence of a notary or in front of the clerk of the circuit court in the county where you live. The clerk will take your completed petition to a judge. You should keep a copy for your records. If you have any questions or need assistance completing this form, the clerk or family law intake staff will help you. What should I do if the judge grants my petition? If the facts contained in your petition convince the judge that an immediate and present danger of violence exists, the judge will sign a Temporary Injunction for Protection Against Sexual Violence, Florida Supreme Court Approved Family Law Form 12.980(r). A temporary injunction is issued without notice to the respondent. The clerk will give your petition, the temporary injunction, and any other papers filed with your petition to the sheriff or other law enforcement officer for personal service on the respondent. The temporary injunction will take effect immediately after the respondent is served with a copy of it. It lasts until a full hearing can be held or for a period of 15 days, whichever comes first, unless the respondent is incarcerated, and in such instance the temporary injunction is effective for 15 days following the date the respondent is released from incarceration. The court may extend the temporary injunction beyond 15 days for a good reason, which may include failure to obtain service on the respondent. The temporary injunction is issued ex parte. This means that the judge has considered only the information presented by one side--YOU. Section I of the temporary injunction gives a date that you should appear in court for a hearing. You will be expected to testify about the facts in your petition. The respondent will be given the opportunity to testify at this hearing, also. At the hearing, the judge will decide whether to issue a Final Judgment of Injunction for Protection Against Sexual Violence (After Notice), Florida Supreme Court Approved Family Law Form 12.980(s), which will remain in effect for a specific time period or until modified or dissolved by the court. If you and/or the respondent do not appear, the temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including entry of a permanent injunction and the imposition of court costs. You and respondent will be bound by the terms of any injunction or order issued at the final hearing. IF EITHER YOU OR RESPONDENT DOES NOT APPEAR AT THE FINAL HEARING, YOU WILL BOTH BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED IN THIS MATTER. If the judge signs a temporary or final injunction, the clerk will provide you with the necessary copies. Make sure that you keep one certified copy of the injunction with you at all times! Instructions for Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (06/12) - 118 - What can I do if the judge denies my petition? If your petition is denied on the grounds that it appears to the court that no immediate and present danger of sexual violence exists, the court will set a full hearing on your petition. The respondent will be notified by personal service of your petition and the hearing. If your petition is denied, you may: amend your petition by filing a Supplemental Affidavit in Support of Petition for Injunction for Protection, Florida Supreme Court Approved Family Law Form 12.980 (g); attend the hearing and present facts that support your petition; and/or dismiss your petition. Where can I look for more information? Before proceeding, you should read General Information for Self-Represented Litigants found at the beginning of these forms. The words that are in bold underline are defined in that section. The clerk of the circuit court or family law intake staff will provide you with necessary forms. For further information, see section 784.046, Florida Statutes. Special Notes . . . If you fear that disclosing your address would put you in danger, you should complete a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), and file it with the clerk of the circuit court and write confidential in the space provided for your address on the petition. Instructions for Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (06/12) - 119 - IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR COUNTY, FLORIDA Case No.: Division: ________________, Petitioner, and _________________, Respondent. PETITION FOR INJUNCTION FOR PROTECTION AGAINST SEXUAL VIOLENCE I, {full legal name} ____________________________________ being sworn, certify that the following statements are true: SECTION I. PETITIONER (This section is about you. It must be completed; however, if you fear that disclosing your address to the respondent would put you in danger, you should complete and file a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), and write confidential in the space provided on this form for your address.) 1. Petitioner currently lives at the following address: {address, city, state, zip code} ______ . Date of Birth of Petitioner: [Indicate if applicable] _____Petitioner seeks an injunction for protection on behalf of a minor child. Petitioner is the parent or legal guardian of {full legal name}_________________ , a minor child who is living at home. 2. Petitioner's attorney's name, address, and telephone number is:_________________ ________________________________________________________________________ (If you do not have an attorney, write "none.") Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (06/12) - 120 - SECTION II. RESPONDENT (This section is about the person you want to be protected from. It must be completed.) 1. Respondent currently lives at the following address: {address, city, state, and zip code} ________________________________________________________________________ _______________________________________________________________________. Respondent s Driver s License number is: {if known} _____________________________ 2. Respondent's last known place of employment:________________________________ Employment address:_____________________________________________________ Working hours: ___________________________________________________________ 3. Physical description of Respondent: Race: _____ Sex: Male ___ Female ___ Date of Birth: Height: _____ Weight: _____ Eye Color: _____ Hair Color: Distinguishing marks and/or scars: Vehicle: (make/model) _______________ Color: _________ Tag Number: 4. Other names Respondent goes by (aliases or nicknames):________________________ 5. Respondent's attorney s name, address, and telephone number is:_________________ ________________________________________________________________________ (If you do not know whether Respondent has an attorney, write "unknown." If Respondent does not have an attorney, write "none.") 6. If Respondent is a minor, the address of Respondent s parent or legal guardian is: ____ SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION (This section must be completed.) 1. Petitioner has suffered sexual violence as shown by the fact that the Respondent has: {describe the acts of violence} ______________________________________________________________________________ ______________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (06/12) - 121 - ___Please indicate here if you are attaching additional pages to continue these facts. a. b. [Choose all that apply] ____ Petitioner reported the sexual violence to law enforcement and is cooperating in any criminal proceeding. The incident report number by law enforcement is:__________. {If there is a criminal case, include case number, if known}_________________________.} ____ Respondent was sent to prison for committing sexual violence against Petitioner or Petitioner s minor child living at home and Respondent is out of prison or is getting out of prison within 90 days. The notice of inmate release is attached. 2. Has Petitioner ever received or tried to get an injunction for protection against domestic violence, dating violence, repeat violence, or sexual violence against Respondent in this or any other court? ( ) Yes ( ) No If yes, what happened in that case? {include case number, if known}:_________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 3. Has Respondent ever received or tried to get an injunction for protection against domestic violence, dating violence, repeat violence, or sexual violence against Petitioner in this or any other court? ( ) Yes ( ) No If yes, what happened in that case? {include case number, if known}:________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 4. Describe any other court case that is either going on now or that happened in the past between Petitioner and Respondent {include case number, if known}: ________________________________________________________________________ ________________________________________________________________________ 5. Additional Information [Choose all that apply] a. ____Respondent owns, has, and/or is known to have guns or other weapons. {Describe weapon(s)}: _____________________________________________________ b. ____This or prior acts of violence have been previously reported to: {person or agency}________________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (06/12) - 122 - SECTION IV. INJUNCTION (This section must be completed.) 1. Petitioner asks the Court to enter a TEMPORARY INJUNCTION for protection against sexual violence that will be in place from now until the scheduled hearing in this matter. 2. Petitioner asks the Court to enter an injunction prohibiting Respondent from committing any acts of violence against Petitioner and: a. prohibiting Respondent from going to or within 500 feet of any place Petitioner lives; b. prohibiting Respondent from going to or within 500 feet of Petitioner s place(s) of employment or the school that Petitioner attends; the address of Petitioner's place(s) of employment and/or school is: _____________________________________________ ; c. prohibiting Respondent from contacting Petitioner by telephone, mail, by e-mail, in writing, through another person, or in any other manner; d. ordering Respondent not to use or possess any guns or firearms; [Choose all that apply] e. ____prohibiting Respondent from going to or within 500 feet of the following place(s) Petitioner or Petitioner s immediate family must go often: ______________________ ________________________________________________________________________ ; f. ____prohibiting Respondent from knowingly and intentionally going to or within 100 feet of Petitioner s motor vehicle; AND any other terms the Court deems necessary for the safety of Petitioner and Petitioner s immediate family. I UNDERSTAND THAT BY FILING THIS PETITION, I AM ASKING THE COURT TO HOLD A HEARING ON THIS PETITION, THAT BOTH THE RESPONDENT AND I WILL BE NOTIFIED OF THE HEARING, AND THAT I MUST APPEAR AT THE HEARING. I UNDERSTAND THAT IF EITHER RESPONDENT OF I FAIL TO APPEAR AT THE FINAL HEARING, WE WILL BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED AT THAT HEARING. I UNDERSTAND THAT I AM SWEARING OR AFFIRMING UNDER OATH TO THE TRUTHFULNESS OF THE CLAIMS MADE IN THIS PETITION AND THAT THE PUNISHMENT FOR KNOWINGLY MAKING A FALSE STATEMENT INCLUDES FINES AND/OR IMPRISONMENT. Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (06/12) - 123 - Dated: ____________________________ Signature of Petitioner Printed Name:________________________________ Address:____________________________________ City, State, Zip: Telephone Number:___________________________ Fax Number: STATE OF FLORIDA COUNTY OF _________________ Sworn to or affirmed and signed before me on_______________ by _____________________. NOTARY PUBLIC or DEPUTY CLERK [Print, type, or stamp commissioned name of notary or clerk.] ___Personally known _Produced identification _____________________Type of identification produced Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (06/12) - 124 - IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: _________________, Petitioner, and ___________________, Respondent. TEMPORARY INJUNCTION FOR PROTECTION AGAINST SEXUAL VIOLENCE The Petition for Injunction for Protection Against Sexual Violence under Section 784.046, Florida Statutes, and other papers filed in this Court have been reviewed. Under the laws of Florida, the Court has jurisdiction of the petitioner and the subject matter and has jurisdiction of the respondent upon service of the temporary injunction. The term Petitioner as used in this injunction includes the person on whose behalf this injunction is entered. It is intended that this protection order meet the requirements of 18 U.S.C. Section 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe. SECTION I. NOTICE OF HEARING Because this Temporary Injunction for Protection Against Sexual Violence has been issued without notice to Respondent, Petitioner and Respondent are instructed that they are scheduled to appear and testify at a hearing regarding this matter on {date} __________________________, at _____ a.m./p.m., when the Court will consider whether the Court should issue a Final Judgment of Injunction for Protection Against Sexual Violence, which shall remain in effect until modified or dissolved by the Court, and whether other things should be ordered. The hearing will be before The Honorable {name} ________________________________, at {room name/number, location, address, city} ______________________________________________________________________________,Florida. If Petitioner and/or Respondent do not appear, this temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including entry of a permanent injunction and the imposition of court costs. Petitioner and Respondent will be bound by the terms of any injunction or order issued at the final hearing. All witnesses and evidence, if any, must be presented at this time. Florida Supreme Court Approved Family Law Form 12.980(r), Temporary Injunction for Protection Against Sexual Violence (06/12) - 125 - IF EITHER PETITIONER OR RESPONDENT DOES NOT APPEAR AT THE FINAL HEARING, HE OR SHE WILL BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED IN THIS MATTER. 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 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.____ neither electronic recording nor 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__________________________ __________________________________________________________________ {identify applicable court personnel by name, address, and telephone number} at least 7 days before your scheduled court appearance, or immediately upon receiving this notification if the time before the scheduled appearance is less than 7 days; if you are hearing or voice impaired, call 711. SECTION II. FINDINGS The statements made under oath by Petitioner make it appear that Section 784.046, Florida Statutes, applies to the parties, that Petitioner is a victim of sexual violence by Respondent and meets the requirements for an injunction established by law. SECTION III. TEMPORARY INJUNCTION AND TERMS This injunction shall be effective until the hearing set above and in no event for longer than 15 days, unless extended by court order or unless the Respondent is incarcerated, and if incarcerated, shall be effective for 15 days following the date Respondent is released from incarceration. If a final order of injunction is issued, the terms of this temporary injunction will be extended until service of the final Florida Supreme Court Approved Family Law Form 12.980(r), Temporary Injunction for Protection Against Sexual Violence (06/12) - 126 - injunction is effected upon Respondent. This injunction is valid and enforceable in all counties of the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction. Willful violation of the terms of this injunction, such as refusing to vacate the dwelling which the parties share, going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction, telephoning, contacting or communicating with Petitioner, if prohibited by this injunction, or committing an act of sexual violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by Sections 775.082 and 775.083, Florida Statutes. Any party violating this injunction may be subject to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment and also may be charged with a crime punishable by a fine, jail, or both, as provided by Florida Statutes. ORDERED and ADJUDGED: 1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of violence against Petitioner, including assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, or false imprisonment, or any criminal offense resulting in physical injury or death. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word, or act to do violence to Petitioner. 2. No Contact. Respondent shall have no contact with the Petitioner unless otherwise provided in this section. a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner s current residence {list address}_______________________________________________________ or any residence to which Petitioner may move; Petitioner s current or any subsequent place of employment {list address of current employment} _____________________________________ ________________________________ or place where Petitioner attends school {list address of school}___________________________________________________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner s minor child(ren) go often: ______________________________________________________________________________ _____________________________________________________________________________________ ____________________________________________________________________________________ [Initial if applies; write N/A if not applicable] b. ____Respondent may not knowingly come within 100 feet of Petitioner s automobile at any Florida Supreme Court Approved Family Law Form 12.980(r), Temporary Injunction for Protection Against Sexual Violence (06/12) - 127 - time. c.____ Other provisions regarding contact:_________________________________________ ________________________________________________________________________ ________________________________________________________________________ 3. Firearms. [Initial all that apply; write N/A if does not apply] a. ____Respondent shall not use or possess a firearm or ammunition. b. ____Respondent shall surrender any firearms and ammunition in Respondent's possession to the ____________________County Sheriff's Department. c. ____Other directives relating to firearms and ammunition:_______________________ ____________________________________________________________________________ ____________________________________________________________________________ 4. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent s last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Florida Family Law Rules of Procedure; Section 784.046, Florida Statutes. 5. Additional order(s) necessary to protect Petitioner from sexual violence:___________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ SECTION IV. OTHER SPECIAL PROVISIONS (This section to be used for inclusion of local provisions approved by the chief judge.) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ SECTION V. DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION {Unless ordered otherwise by the judge, all provisions in this injunction are considered mandatory provisions and should be interpreted as part of this injunction.) 1. The Sheriff of ______________ County, or any other authorized officer, is ordered to serve this temporary injunction upon Respondent as soon as possible after its issuance. Florida Supreme Court Approved Family Law Form 12.980(r), Temporary Injunction for Protection Against Sexual Violence (06/12) - 128 - 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. DONE AND ORDERED in ________________________, Florida on ______________________. __________________________________________ CIRCUIT JUDGE COPIES TO: Sheriff of Petitioner: by U. S. Mail by hand delivery County Respondent: forwarded to sheriff for service ____ Other: ________________________________ I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of ______________ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT Florida Supreme Court Approved Family Law Form 12.980(r), Temporary Injunction for Protection Against Sexual Violence (06/12) - 129 - (SEAL) By: __________________________________________ Deputy Clerk Florida Supreme Court Approved Family Law Form 12.980(r), Temporary Injunction for Protection Against Sexual Violence (06/12) - 130 - IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR COUNTY, FLORIDA Case No.:____________________ Division:____________________ _________________, Petitioner, and __________________, Respondent. FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST SEXUAL VIOLENCE (AFTER NOTICE) The Petition for Injunction for Protection Against Sexual Violence under Section 784.046, Florida Statutes, and other papers filed in this Court have been reviewed. The Court has jurisdiction of the parties and the subject matter. The term Petitioner as used in this injunction includes the person on whose behalf this injunction is entered. It is intended that this protection order meet the requirements of 18 U.S.C. Section 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe. SECTION I. HEARING This cause came before the Court for a hearing to determine whether an Injunction for Protection Against Sexual Violence in this case should be: ( ) issued ( ) modified ( ) extended. The hearing was attended by ( ) Petitioner ( ) Respondent ( ) Petitioner s Counsel ( ) Respondent s Counsel SECTION II. FINDINGS On {date} _____________________, a notice of this hearing was served on Respondent together with a copy of Petitioner s petition to this Court and the temporary injunction, if issued. Service was within the time required by Florida law, and Respondent was afforded an opportunity to be heard. After hearing the testimony of each party present and of any witnesses, or upon consent of Respondent, the Court finds, based on the specific facts of this case, that Petitioner is a victim of sexual violence by Florida Supreme Court Approved Family Law Form 12.980(s), Final Judgment of Injunction for Protection Against Sexual Violence (After Notice) (06/12) - 131 - Respondent and meets the requirements for an injunction established by law. SECTION III. INJUNCTION AND TERMS This injunction shall be in full force and effect until ( ) further order of the Court or ( ) {date} __________________________. This injunction is valid and enforceable throughout all counties in the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction. Willful violation of the terms of this injunction, such as refusing to vacate the dwelling which the parties share, going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction, telephoning, contacting or communicating with Petitioner, if prohibited by this injunction, or committing an act of sexual violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by Sections 775.082 and 775.083, Florida Statutes. Any party violating this injunction shall be subject to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment, and also may be charged with a crime punishable by a fine, jail, or both, as provided by Florida Statutes. ORDERED and ADJUDGED: 1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of violence against Petitioner, including assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, or false imprisonment, or any criminal offense resulting in physical injury or death. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner. 2. No Contact. Respondent shall have no contact with Petitioner unless otherwise provided in this section. a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner s current residence {list address} Florida Supreme Court Approved Family Law Form 12.980(s), Final Judgment of Injunction for Protection Against Sexual Violence (After Notice) (06/12) - 132 - ________________________________________________________________or any residence to which Petitioner may move; Petitioner s current or any subsequent place of employment {list address of current employment}________________________________ or place where Petitioner attends school {list address of school} _____________________ _______________________________________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner s minor child(ren) go often: ______________________________________________________________________________ ______________________________________________________________________________ ________________________________________________________________________ . [Initial if applies; write N/A if not applicable] b.____ Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time. c. ____Other provisions regarding contact:___________________________________________ 3. Firearms. [Initial all that apply; write N/A if does not apply] a. ____Respondent shall not use or possess a firearm or ammunition. b. ____Respondent shall surrender any firearms and ammunition in the Respondent's possession to the ____________________ County Sheriff's Department. c. ____Other directives relating to firearms and ammunition: ____________________________ 4. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent s last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Florida Family Law Rules of Procedure; Section 784.046, Florida Statutes. 5. Additional order(s) necessary to protect Petitioner from sexual violence: _________________ _____________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(s), Final Judgment of Injunction for Protection Against Sexual Violence (After Notice) (06/12) - 133 - SECTION IV. OTHER SPECIAL PROVISIONS (This section to be used for inclusion of local provisions approved by the chief judge.) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ SECTION V. DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION {Unless ordered otherwise by the judge, all provisions in this injunction are considered mandatory provisions and should be interpreted as 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 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. DONE AND ORDERED in ___________________________, Florida on ____________________. _____________________________________________ CIRCUIT JUDGE Florida Supreme Court Approved Family Law Form 12.980(s), Final Judgment of Injunction for Protection Against Sexual Violence (After Notice) (06/12) - 134 - COPIES TO: Sheriff of ____________________ County Petitioner (or his or her attorney): ____ by U. S. Mail ____ by hand delivery in open court (Petitioner must acknowledge receipt in writing on the face of the original order--see below) Respondent (or his or her attorney): ____ forwarded to sheriff for service ____ by hand delivery in open court (Respondent must acknowledge receipt in writing on the face of the original order--see below) ____ by certified mail (may only be used when Respondent is present at the hearing and Respondent fails or refuses to acknowledge the receipt of certified copy of this injunction) ____ State Attorney s Office ____ Other: ______________________________ I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of ___________ ___County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By: __________________________________________ Deputy Clerk ACKNOWLEDGMENT I, {Name of Petitioner} ___________________________, acknowledge receipt of a certified copy of this Injunction for Protection. _____________________________________________ Petitioner ACKNOWLEDGMENT I, {Name of Respondent}___________________________, acknowledge receipt of a certified copy of this Injunction for Protection. _____________________________________________ Respondent Florida Supreme Court Approved Family Law Form 12.980(s), Final Judgment of Injunction for Protection Against Sexual Violence (After Notice) (06/12) - 135 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(t), PETITION BY AFFIDAVIT FOR ORDER TO SHOW CAUSE FOR A VIOLATION OF FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE, REPEAT VIOLENCE, DATING VIOLENCE, OR SEXUAL VIOLENCE (06/12) When should this form be used? You may use this form if you have a valid Final Judgment of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence in force which has been violated. You should use this affidavit to state the essential facts which establish a violation of the Final Judgment of Injunction. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or the clerk of the circuit court. You should then file the original with such clerk or judge as determined by the chief judge of your circuit to be the recipient of affidavits of violation, provide a copy to the state attorney of that circuit and keep a copy for your records. Instructions for Florida Supreme Court Approved Family Law Form 12.980(t), Petition by Affidavit for Order to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 136 - IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: __________________________________ Petitioner, and ___________________________________, Respondent. PETITION BY AFFIDAVIT FOR ORDER TO SHOW CAUSE FOR A VIOLATION OF FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE ( ) DATING VIOLENCE ( ) SEXUAL VIOLENCE I, {full legal name} ___________________________________________, being sworn, certify that I have actual knowledge of the following facts as set forth and the following statements are true: 1. The Court has previously issued [Choose one only] a.____ Final Judgment of Injunction for Protection Against Domestic Violence b. ____ Final Judgment of Injunction for Protection Against Repeat Violence c. ____ Final Judgment of Injunction for Protection Against Dating Violence d. ____ Final Judgment of Injunction for Protection Against Sexual Violence in this case on ______________________. 2. The Final Judgment of Injunction for Protection was served on Respondent on _____________________________________________,. 3. On {date} _________________________, at {place and address} _______________________ ____________________________________________________________________________, the following event(s) took place: _________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(t), Petition by Affidavit for Order to Show Cause for a Violation of Fi nal Judgment of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 137 - _____________________________________________________________________________ _____________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _____Please indicate here if you are attaching additional pages to continue these facts. 4. Respondent has willfully violated the Injunction by: {explain what Respondent did that violated the Order of Protection} ________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ ___________________________________________________________________________ __________________________________________________________________________ ___________________________________________________________________________ _____Please indicate here if you are attaching additional pages to continue these facts. 5. ____ Please indicate here if you are attaching copies of medical records for treatment you may have received for injuries referred to in your affidavit, or copies of any police or sheriff reports concerning incidents of violence involving you and Respondent. 6. Respondent acted to impair, interfere with, delay, hinder, lessen the authority of, dignity of, and embarrass the cause of justice in a manner contemptuous of this court. WHEREFORE, I respectfully request that the Court issue an Order to Show Cause, requiring Respondent to appear before the Court to show cause why Respondent should not be held in contempt of court for failure to abide by the terms and conditions of the Final Judgment of Injunction for Protection. Florida Supreme Court Approved Family Law Form 12.980(t), Petition by Affidavit for Order to Show Cause for a Violation of Fi nal Judgment of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 138 - I understand that by filing this affidavit, I am asking the court to hold a hearing, that both Respondent and I will be notified of the hearing, and that I must appear at the hearing. In addition to my own testimony, I understand that I can bring other proof of the violation such as, for example, people who saw Respondent violate the order, pictures, medical records, police reports, or anything might help show the judge how Respondent violated the Final Judgment of Injunction for Protection. I have read every statement made in this affidavit and each statement is true and correct. I understand that the statements made in this affidavit are being made under penalty of perjury, punishable as provided in Section 837.02, Florida Statutes and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: ___________________________ _______________________________________ Signature of Petitioner STATE OF FLORIDA COUNTY OF _____________________ Sworn to or affirmed and signed before me on by . NOTARY PUBLIC or DEPUTY CLERK [Print, type, or stamp commissioned name of notary or clerk.] Personally known Produced identification ______________________Type of identification produced I certify that a copy of this document was [Choose one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} . Other party or his/her attorney: Name: Address: City, State, Zip: ______ Fax Number: Florida Supreme Court Approved Family Law Form 12.980(t), Petition by Affidavit for Order to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (06/12) - 139 - IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: __________________, Petitioner, and __________________, Respondent. Description of Respondent: Sex: ________ Race: ________________ Height: _________ Weight: _________ DOB: _________________ Eye color: __________ Hair color: __________ Last known address: _______________________________ ORDER TO SHOW CAUSE This cause comes before the court for review based upon the alleged conduct of Respondent for issuance of an Order to Show Cause directed to {name} violation of the Final Judgment of Injunction for Protection as is more specifically set forth in Petition By Affidavit For Order To Show Cause For a Violation Of Final Judgment Of Injunction Protection, a copy of which is attached hereto and made a part hereof. the for the For NOW, THEREFORE, you,{name}__________________________________________________,are hereby ORDERED to appear before this court before Judge {name} , on {date} ______________, at {time} ___.m. in Room ______ of the ___________________Courthouse, located at ___________________________, to be arraigned. A subsequent hearing will be scheduled requiring Respondent to show cause why he/she should not be held in contempt of this court for violation of the Final Judgment of Injunction for Protection as is stated in the attached Petition By Affidavit For Order To Show Cause For a Violation of Final Judgment of Injunction For Protection. Punishment, if imposed, may include a fine and incarceration. Should the court determine, based on the evidence presented at the hearing, that Respondent s conduct warrants sanctions for civil contempt in addition to or instead of indirect criminal contempt, the court reserves the right to find Respondent guilty of civil contempt and impose appropriate civil sanctions. Florida Supreme Court Approved Family Law Form 12.980(u), Order to Show Cause (06/12) - 140 - The court hereby appoints the State Attorney s Office to prosecute the case. Respondent is advised that he/she is entitled to be represented by counsel. If you are a person with a disability who needs any accommodation to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact:_________________________ __________________________________________________________________ {identify applicable court personnel by name, address, and telephone number} at least 7 days before your scheduled court appearance, or immediately upon receiving this notification if the time before the scheduled appearance is less than 7 days; if you are hearing or voice impaired, call 711. IT IS FURTHER ORDERED that the Sheriff of this county serve this Order to Show Cause by delivering copies to Respondent, with proof of Sheriff s service. DONE AND ORDERED in __________________ County, Florida, on {date} ____. ______________________________ Circuit Judge Copies to: _____ State Attorney _____ Petitioner or Counsel for Petitioner _____ Respondent or Counsel for Respondent Florida Supreme Court Approved Family Law Form 12.980(u), Order to Show Cause (06/12) - 141 -
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