Instructions for Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental Affidavit in Support of
Petition for Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence, or Stalking (11/15)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.980(g)
SUPPLEMENTAL AFFIDAVIT IN SUPPORT OF PETITION FOR INJUNCTION
FOR PROTECTION AGAINST DOMESTIC, REPEAT, DATING, OR SEXUAL
VIOLENCE, OR STALKING (11/15)
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), your Petition for Injunction for Protection Against
Repeat Violence, Florida Supreme Court Approved Family Law Form 12.980(f), your Petition for
Injunction for Protection Against Dating Violence, Florida Supreme Court Approved Family Law Form
12.980(n), your Petition for Injunction for Protection Against Sexual Violence, Florida Supreme Court
Approved Family Law Form 12.890(q), or your Petition for Injunction for Protection Against Stalking,
Florida Supreme Court Approved Family Law Form 12.980(t), 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 have only 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, and 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 the 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.
For a stalking case, you should include facts that establish that you are either a victim of stalking or
cyberstalking, or that you are the parent or legal guardian of a minor child living at home who is a victim
of stalking or cyberstalking. The facts must establish that stalking exists in order for the judge to order a
Instructions for Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental Affidavit in Support of
Petition for Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence, or Stalking (11/15)
temporary injunction for protection against stalking. Please be specific as to where the incidents of
stalking took place. These locations may include, but need not be limited to, a home, school, or place of
employment. For cyberstalking, please include a description of all evidence of contacts and/or threats
made by the respondent in voice messages, texts, emails, or other electronic communication.
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 petition was filed and keep a copy for your records.
IMPORTANT INFORMATION REGARDING E-FILING
The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or
other pleadings or documents electronically; however, they are not required to do so. If you choose
to file your pleadings or other documents electronically, you must do so in accordance with Florida Rule
of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you
file. The rules and procedures should be carefully read and followed.
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.
IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION
After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of
Judicial Administration. If you elect to participate in electronic service, which means serving or receiving
pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review
Florida Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link
to the Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules
of Court in the A-Z Topical Index.
SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.
To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears.
Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme
Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida
Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.
Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental Affidavit in Support of Petition for
Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence, or Stalking (11/15)
IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR __________________________ 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 ( ) STALKING
I, {full legal name} __________________________________________________________, being sworn,
certify that the following statements are true:
{Please complete all paragraphs that relate to your case}
1. On {date} ____________________, 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, Repeat, Dating, or Sexual Violence, or Stalking (11/15)
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. On {date} ____________________, 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}
__________________________________________________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
For cyberstalking, the following is a description of all evidence of contacts and/or threats made
by Respondent in voice messages, texts, emails, or other electronic communication: __________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____ Please indicate here if you are attaching additional pages to continue these facts.
4. _____ 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.
Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental Affidavit in Support of Petition for
Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence, or Stalking (11/15)
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
Printed Name:
Address:
City, State, Zip Code:
Telephone Number:
Number:
E-Mail Address(es):
_________________________________________________
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
deputy clerk.}
____ Personally known
____ Produced identification
Type of identification produced ________________________________
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