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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, the petitioner. It must be filled out.

I currently live at:

Address:


City, State, Zip


Area Code and Phone:

Area Code and Fax:


Email(s):



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)

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):

SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION

1. Has Petitioner ever received or tried to get an injunction for protection against stalking against Respondent in this or any other court?
   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 stalking against Petitioner in this or any other court?
   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. Petitioner is a victim of stalking because Respondent has: {please mark all sections that apply}
   
   a. Committed stalking;
   b. Previously threatened, harassed, stalked, cyberstalked, or physically abused the Petitioner;
   c. Threatened to harm Petitioner or family members or individuals closely associated with Petitioner;
   d. Intentionally injured or killed a family pet;
   e. Used, or threatened to use, against Petitioner any weapons such as guns or knives;
   f. A criminal history involving violence or the threat or violence, if known;
   g. Another order of protection issued against him or her previously from another jurisdiction, if known;
   h. Destroyed personal property, including, but not limited to, telephones or other communication equipment, clothing, or other items belonging to Petitioner.
5. Below is a description of the specific incidents of stalking or cyberstalking: {for cyberstalking, please include a description of all evidence of contacts and/or threats made by Respondent in voice messages, texts, emails, or other electronic communication}
   On {dates} the following incidents of stalking occurred at the following locations:
   {the locations may include, but need not be limited to, a home, school, or place of employment}
   
   Please indicate here if you are attaching additional pages to continue these facts.

6. Additional Information
   Respondent owns, has, and/or is known to have guns or other weapons.
   Describe weapon(s) and where they may be located, if known:
   

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

1. Petitioner asks the Court to enter a TEMPORARY INJUNCTION for protection against stalking that will be in place from now until the scheduled hearing in this matter, which will immediately restrain Respondent from committing any acts of stalking, and which will provide any terms the Court deems necessary for the protection of a victim of stalking, including any injunctions or directives to law enforcement agencies.

2. Petitioner asks the Court to enter, after a hearing has been held on this petition, a FINAL JUDGMENT for protection against stalking prohibiting Respondent from committing any acts of stalking against Petitioner and:

a. prohibiting Respondent from going to or within 500 feet of any place Petitioner lives, or to any specified place regularly frequented by Petitioner and any named family members or individuals closely associated with Petitioner; (List names and places here)

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 that he or she shall not have in his or her care, custody, possession, or control any firearm or ammunition;

e. prohibiting Respondent from knowingly and intentionally going to or within 100 feet of Petitioner’s motor vehicle, whether or not that vehicle is occupied;

3. Petitioner asks the Court to enter any other terms it deems necessary to protect Petitioner from stalking by Respondent.

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 THE 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.