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FORM 12.980(q): 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(q), Petition for Injunction for
Protection Against Sexual Violence (11/15)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.980(q)
PETITION FOR INJUNCTION FOR PROTECTION AGAINST SEXUAL
VIOLENCE (11/15)
When should this form be used?
If you are a victim of sexual violence or the parent or legal guardian of a minor child who is living at home
and is a victim of sexual violence, you can use this form to ask the court for a protective order prohibiting
sexual violence. Sexual violence means any one incident of:
sexual battery, as defined in Chapter 794, Florida Statutes;
a lewd or lascivious act, as defined in Chapter 800, Florida Statutes, committed upon or in
the presence of a person younger than 16 years of age;
luring or enticing a child, as described in Chapter 787, Florida Statutes;
sexual performance by a child, as described in Chapter 827, Florida Statutes; or
any other forcible felony wherein a sexual act is committed or attempted
In order to get an injunction you must have reported the sexual violence to a law enforcement agency
and be cooperating in the criminal proceeding if there is one. It does not matter whether criminal charges
based on the sexual violence have been filed, reduced, or dismissed by the state attorney’s office. You
may also seek an injunction for protection against sexual violence if the respondent was sent to prison for
committing one of the sexual violence crimes listed above against you or your minor child living at home
and respondent is out of prison or is getting out of prison within 90 days of your petition. Attach the
notice of inmate release to your petition.
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 seeking an injunction for
protection against sexual violence on behalf of a minor child who is living at home, the parent or legal
guardian must have been an eyewitness to, or have direct physical evidence or affidavits from
eyewitnesses of, the specific facts and circumstances that form the basis of the petition. 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 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 is 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.
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.
Instructions for Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for
Protection Against Sexual Violence (11/15)
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
violence exists, the judge will sign a Temporary Injunction for Protection Against Sexual Violence, Florida
Supreme Court Approved Family Law Form 12.980(r). 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, unless the
respondent is incarcerated, and in such instance the temporary injunction is effective for 15 days
following the date the respondent is released from incarceration. 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 Sexual Violence (After
Notice), Florida Supreme Court Approved Family Law Form 12.980(s), 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 sexual 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.
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 provide you with necessary forms. For further information,
Instructions for Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for
Protection Against Sexual Violence (11/15)
see section 784.046, Florida Statutes.
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.
Special Notes . . .
If you fear that disclosing your address would put you in danger, you should complete a Request for
Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), and file it
with the clerk of the circuit court and write confidential in the space provided for your address on the
petition.
Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual
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 SEXUAL 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; however, if you fear that disclosing your address to the
respondent would put you in danger, you should complete and file a Request for Confidential Filing of
Address, Florida Supreme Court Approved Family Law Form 12.980(h), and write confidential in the space
provided on this form for your address.)
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(q), Petition for Injunction for Protection Against Sexual
Violence (11/15)
2. Respondent's last known place of employment: _______________________________________
Employment address: ____________________________________________________________
Working hours: _________________________________________________________________
3. 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: __________________
4. Other names Respondent goes by (aliases or nicknames): _______________________________
______________________________________________________________________________
5. 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.")
6. 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. Petitioner has suffered sexual violence as shown by the fact that the Respondent has: {describe
the acts of violence} _____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________
___________ Please indicate here if you are attaching additional pages to continue these facts.
Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual
Violence (11/15)
{Indicate all that apply}
a. _____ Petitioner reported the sexual violence to law enforcement and is cooperating in any
criminal proceeding. The incident report number by law enforcement is: ________________
{If there is a criminal case, include case number, if known} _____.
b. _____ Respondent was sent to prison for committing sexual violence against Petitioner or
Petitioner’s minor child living at home and Respondent is out of prison or is getting out of
prison within 90 days. The notice of inmate release is attached.
2. 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?
_____ Yes _____ No If yes, what happened in that case? {Include case number, if known}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
3. 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?
_____ Yes _____ No If yes, what happened in that case? {Include case number, if known}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
4. 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}:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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 violence have been previously reported to: {person or agency}
_________________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual
Violence (11/15)
SECTION IV. INJUNCTION
(This section must be completed.)
1. Petitioner asks the Court to enter a TEMPORARY INJUNCTION for protection against sexual
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(q), Petition for Injunction for Protection Against Sexual
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 OF 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
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(q): 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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