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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW

FORM 12.980(n)

PETITION FOR INJUNCTION FOR PROTECTION AGAINST DATING

VIOLENCE (11/15)

When should this form be used?

If you are a victim of dating violence, and have reasonable cause to believe you are in imminent danger

of becoming the victim of another act of dating violence, or if you have reasonable cause to believe that

you are in imminent danger of becoming 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.

If you are filing on behalf of a child or children

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,

if the party against whom the protective injunction is sought is also a parent, stepparent, or legal guardian,

you, as the parent or legal guardian filing the petition, must have been an eye-witness to, or have direct

physical evidence or affidavits from eye-witnesses of, the specific facts and circumstances that form the

basis of the petition. If the party against whom the protective injunction is sought is a person OTHER THAN

a parent, stepparent, or legal guardian of the minor child, you, as the parent or legal guardian filing the

petition, must state why you have reasonable cause to believe that the minor child is a victim of dating

violence.

Additional Information

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.

Instructions for Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for Protection

Against Dating Violence (11/15)

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 dating

violence 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 DO 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.

Instructions for Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for Protection

Against Dating Violence (11/15)

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.

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.

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.

Instructions for Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for Protection

Against Dating Violence (11/15)

______________________________________________________________________________

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 DATING 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.)

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 (11/15)

______________________________________________________________________________

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. Have the Petitioner and Respondent been involved in a dating relationship within the past six

months? _______Yes __________No

2. 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.

Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for Protection Against Dating

Violence (11/15)

______________________________________________________________________________

________________________________________________________________________

3. Has Petitioner ever received or tried to get an injunction for protection against domestic violence,

dating violence, repeat violence, or sexual violence, or stalking against Respondent in this or any

other court?

_____ 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, or stalking 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 minor child living at home. 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(s)} , at {location(s)} _____________________________,

Respondent____________________________________________________________________

Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for Protection Against Dating

Violence (11/15)

______________________________________________________________________________

_____________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________.

_____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.}

______________________________________________________________________________.

Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for Protection Against

Dating Violence (11/15)

______________________________________________________________________________

9. Additional Information

{Indicate 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;

{Indicate 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 to 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.

Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for Protection Against Dating

Violence (11/15)

_______________________________________

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:

Designated E-Mail Address(es):______________

STATE OF FLORIDA

COUNTY OF

Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

Personally known

Produced identification

Type of identification produced

[Print, type, or stamp commissioned

notary or clerk.]

name of

Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for Protection Against Dating

Violence (11/15)

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