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FORM 12.980(n): INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED (Pinellas County Clerk of the Circuit Court and Comptroller)

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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)
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.
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
[Print, type, or stamp commissioned name of
notary or clerk.]
Personally known
Produced identification
Type of identification produced
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FORM 12.980(n): INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED (Pinellas County Clerk of the Circuit Court and Comptroller)

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Completed 10 February 2021

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