980q

Your full legal name:


Respondent’s legal name:


(The respondent is the person you want to be protected from)

I,

, being sworn, certify that the following statements are true:

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

I currently live at:

Address:


City, State, Zip:


Your Date of Birth:
Email address:
Area Code and Phone:

Area Code and Fax:


[Check if applies]

Petitioner seeks an injunction for protection on behalf of a minor child. Petitioner is the parent or legal guardian of {full legal name}:


Your attorney’s name: (If you don’t have an attorney, type “none”)


Your attorney’s Phone: (Leave blank if you don’t have an attorney)


Your attorney’s Address: (Leave blank if you don’t have an attorney)


Your attorney’s City, State and Zip: (Leave blank if you don’t have an attorney)

IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR Select your countyAlachuaBakerBayBradfordBrevardBrowardCalhounCharlotteCitrusClayCollierColumbiaDeSotoDixieDuvalEscambiaFlaglerFranklinGadsdenGilchristGladesGulfHamiltonHardeeHendryHernandoHighlandsHillsboroughHolmesIndian RiverJacksonJeffersonLafayetteLakeLeeLeonLevyLibertyMadisonManateeMarionMartinMiami-DadeMonroeNassauOkaloosaOkeechobeeOrangeOsceolaPalm BeachPascoPinellasPolkPutnamSanta RosaSarasotaSeminoleSt. JohnsSt. LucieSumterSuwanneeTaylorUnionVolusiaWakullaWaltonWashington  COUNTY, FLORIDA



Case No:
(leave blank if you don’t know)
Division:
(leave blank if you don’t know)

Petitioner,
and
Respondent.

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

Respondent’s address (if known)

Respondent’s City, State and Zip (if known)

Respondent’s Driver’s License Number (if known)

You’ve known Respondent since {date}:
Respondent’s last known place of employment:
Employment address:
Working hours:

Physical description of Respondent:
Race:     Sex:
MaleFemale    Birthdate:
Height:    Weight:    Eye Color:    Hair Color:
Distinguishing marks or scars:

Vehicle Make/Model:    Color:    Tag Number:
Other names Respondent goes by (aliases or nicknames):

Respondent’s attorney:
(If you do not know whether Respondent has an attorney, write unknown. If Respondent does not have an attorney, write none.)
Attorney’s Address (leave blank if unknown):
Attorney’s Phone (leave blank if unknown):
If Respondent is a minor, the address of Respondent’s parent or legal guardian is:

SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION

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

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

   {indicate 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?
   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?
   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
   Respondent owns, has, and/or is known to have guns or other weapons.
   Describe weapon(s):
   
6. This or prior acts of violence
   have been 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 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:
1. prohibiting Respondent from going to or within 500 feet of any place Petitioner lives;
2. 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:
   
3. prohibiting Respondent from contacting Petitioner by telephone, mail, by e-mail, in writing, through another person, or in any other manner;
4. ordering Respondent not to use or possess any guns or firearms;

   {Indicate all that apply}

5. prohibiting Respondent from going to or within 500 feet of the following place(s) Petitioner or Petitioner’s immediate family must go to often:
   
6. 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.

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.