Florida-Petition-for-Injunction-for-Protection-Against-Dating-Violence

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.

Petitioner currently lives at the following address:

Address:


City, State, Zip


Date of Birth of Petitioner:
Designated E-Mail Address(es):


Area Code and Phone:

Area Code and Fax:



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.

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


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


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


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

Respondent’s City, State and Zip

Respondent’s Driver’s License Number {if known}

Petitioner has 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 (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? YesYes
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?
   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?
   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
   
   Please indicate here if you are attaching additional pages to continue these facts.
8. Imminent Danger
   {Please complete either paragraph a or b below}

   a. Petitioner is a victim of dating violence and has reasonable cause to believe he or she is in imminent danger of becoming a victim of another act of dating violence. {Explain what Respondent has done to make you a victim of dating violence and to make you fear that you are in imminent danger of becoming a victim of another act of dating violence.}
   

   OR

   b. Petitioner has reasonable cause to believe he or she is in imminent danger of becoming a victim of dating violence as demonstrated by the fact that Respondent has: {Explain what Respondent has done that makes you fear that you are in imminent danger of becoming a victim of dating violence.}

9. Additional Information
   {Indicate all that apply}
   Respondent owns, has, and/or is known to have guns or other weapons.
   Describe weapon(s):
   
10. This or other 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:
   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;

      {Choose 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.

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.