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IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, (Florida)

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IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR _____________ COUNTY, FLORIDA
Case No.:
Division:
_________________,
Petitioner,
and
___________________,
Respondent.
TEMPORARY INJUNCTION FOR PROTECTION AGAINST DOMESTIC
VIOLENCE WITHOUT MINOR CHILD(REN)
The Petition for Injunction for Protection Against Domestic Violence under section 741.30, Florida
Statutes, and other papers filed in this Court have been reviewed. Under the laws of Florida, the Court
has jurisdiction of the Petitioner and the subject matter and has jurisdiction of the Respondent upon
service of the temporary injunction.
It is intended that this protection order meet the requirements of 18 U.S.C. Section 2265 and
therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe
and enforced as if it were the order of the enforcing state or of the Indian tribe.
SECTION I. NOTICE OF HEARING
Because this Temporary Injunction for Protection Against Domestic Violence has been issued without
prior notice to Respondent, the Petitioner and Respondent are instructed that they are scheduled to
appear and testify at a hearing regarding this matter on {date} _____________________,
at a.m./p.m., when the Court will consider whether to issue a Final Judgment of Injunction
for Protection Against Domestic Violence, which would remain in effect until modified or dissolved by
the Court, and whether other things should be ordered, including, for example, such matters as support.
The hearing will be before The Honorable {name}
_______________________________________,at {room name/number, location, address, city}
______________________________________________________________________________, Florida.
If Petitioner and/or Respondent do not appear, this temporary injunction may be continued in force,
extended, dismissed, and/or additional orders may be granted, including entry of a permanent
injunction and the imposition of court costs. Petitioner and Respondent will be bound by the terms of
any injunction or order issued at the final hearing.
IF EITHER PETITIONER OR RESPONDENT DO NOT APPEAR AT THE FINAL HEARING, HE OR SHE WILL BE
BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED IN THIS MATTER.
Florida Supreme Court Approved Family Law Form 12.980(c)(2), Temporary Injunction for Protection Against
Domestic Violence without Minor Child(ren) (03/15)
__________________________________________________________________
All witnesses and evidence, if any, must be presented at this time. In cases where temporary support
issues have been alleged in the pleadings, each party is ordered to bring his or her financial affidavit
(Florida Family Law Rules of Procedure Form 12.902(b) or (c)), tax return, pay stubs, and other evidence
of financial income to the hearing.
NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at
public expense.
YOU ARE ADVISED THAT IN THIS COURT:
a. ____ a court reporter is provided by the court.
b. ____ an electronic recording only is provided by the court.
A party may arrange in advance for the services of and provide for a court reporter
to prepare a written transcript of the proceedings at that party’s expense.
A RECORD, WHICH INCLUDES A TRANSCRIPT, MAY BE REQUIRED TO SUPPORT AN APPEAL. THE PARTY
SEEKING THE APPEAL IS RESPONSIBLE FOR HAVING THE TRANSCRIPT PREPARED BY A COURT REPORTER.
THE TRANSCRIPT MUST BE FILED WITH THE REVIEWING COURT OR THE APPEAL MAY BE DENIED.
If you are a person with a disability who needs any accommodation in order
to participate in this proceeding, you are entitled, at no cost to you, to the
provision of certain assistance. Please contact__________________________
{identify applicable court personnel by name, address and telephone number} at
least 7 days before your scheduled court appearance, or immediately upon
receiving this notification if the time before the scheduled appearance is less
than 7 days; if you are hearing impaired, call 711.
SECTION II. FINDINGS
The statements made under oath by Petitioner make it appear that section 741.30, Florida Statutes,
applies to the parties. It also appears that Petitioner is a victim of domestic violence by Respondent,
and/or Petitioner has reasonable cause to believe he/she is in imminent danger of becoming a victim of
domestic violence by Respondent, and that there is an immediate and present danger of domestic
violence to Petitioner or persons lawfully with Petitioner.
SECTION III. TEMPORARY INJUNCTION AND TERMS
This injunction shall be effective until the hearing set above and in no event for longer than 15 days,
unless extended by court order. If a final order of injunction is issued, the terms of this temporary
injunction will be extended until service of the final injunction is effected upon Respondent. This
Florida Supreme Court Approved Family Law Form 12.980(c)(2), Temporary Injunction for Protection Against
Domestic Violence without Minor Child(ren) (03/15)
injunction is valid and enforceable in all counties of the State of Florida. The terms of this injunction
may not be changed by either party alone or by both parties together. Only the Court may modify the
terms of this injunction. Either party may ask the Court to change or end this injunction.
Any violation of this injunction, whether or not at the invitation of Petitioner or anyone else, may
subject Respondent to civil or indirect criminal contempt proceedings, including the imposition of a
fine or imprisonment. Certain willful violations of the terms of this injunction, such as: refusing to
vacate the dwelling that the parties share; going to or being within 500 feet of Petitioner's residence,
going to Petitioner’s place of employment, school, or other place prohibited in this injunction;
telephoning, contacting or communicating with Petitioner if prohibited by this injunction; knowingly
or intentionally coming within 100 feet of Petitioner’s motor vehicle, whether or not it is occupied;
defacing or destroying Petitioner’s personal property; refusing to surrender firearms or ammunition if
ordered to do so by the court; or committing an act of domestic violence against Petitioner
constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by
sections 775.082 and 775.083, Florida Statutes. In addition, it is a federal criminal felony offense,
punishable by up to life imprisonment, depending on the nature of the violation, to cross state lines or
enter Indian country for the purpose of engaging in conduct that is prohibited in this injunction. 18
U.S.C. Section 2262.
ORDERED and ADJUDGED:
1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any
acts of domestic violence against Petitioner. Domestic violence includes: assault, aggravated
assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking,
kidnapping, false imprisonment, or any other criminal offense resulting in physical injury or
death to Petitioner or any of Petitioner's family or household members. Respondent shall not
commit any other violation of the injunction through an intentional unlawful threat, word or act
to do violence to the Petitioner.
2. No Contact. Respondent shall have no contact with Petitioner unless otherwise provided in
this section.
a. Unless otherwise provided herein, Respondent shall have no contact with Petitioner.
Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax,
telephone, through another person, or in any other manner. Further, Respondent shall not
contact or have any third party contact anyone connected with Petitioner's employment or
school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise
provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner’s current
residence {list address}
or any residence to which Petitioner may move; Petitioner’s current or any subsequent place of
employment {list address of current employment}
or place where Petitioner attends school {list address of school} ;
or the following other places (if requested by Petitioner) where Petitioner or Petitioner’s minor
child(ren) go often:
Florida Supreme Court Approved Family Law Form 12.980(c)(2), Temporary Injunction for Protection Against
Domestic Violence without Minor Child(ren) (03/15)
______________________________________________________________________________
.
Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time.
b. Other provisions regarding contact:
.
3. Firearms.
{Initial all that apply; write N/A if does not apply}
a. _____Respondent shall not use or possess a firearm or ammunition.
b. _____Respondent shall surrender any firearms and ammunition in the Respondent's
possession to the _________ County Sheriff's Department until further
order of the court.
c. _____Other directives relating to firearms and ammunition:
.
NOTE: RESPONDENT IS ADVISED THAT, IF A PERMANENT INJUNCTION FOR PROTECTION
AGAINST DOMESTIC VIOLENCE IS ISSUED FOLLOWING A HEARING REGARDING THIS MATTER,
IN MOST CASES IT WILL BE A VIOLATION OF SECTION 790.233, FLORIDA STATUTES, AND A
FIRST DEGREE MISDEMEANOR, FOR RESPONDENT TO HAVE IN HIS OR HER CARE, CUSTODY,
POSSESSION OR CONTROL ANY FIREARM OR AMMUNITION. ADDITIONALLY, IT WILL BE A
FEDERAL CRIMINAL FELONY OFFENSE TO SHIP OR TRANSPORT IN INTERSTATE OR FOREIGN
COMMERCE, OR POSSESS IN OR AFFECTING COMMERCE, ANY FIREARM OR AMMUNITION; OR
TO RECEIVE ANY FIREARM OR AMMUNITION WHICH HAS BEEN SHIPPED OR TRANSPORTED IN
INTERSTATE OR FOREIGN COMMERCE WHILE SUBJECT TO SUCH AN INJUNCTION. 18 U.S.C.
SECTION 922(g)(8).
4. Mailing Address or Designated E-Mail Address(es). Respondent shall notify the Clerk of the
Court of any change in either his or her mailing address, or designated e-mail address(es), within
10 days of the change. All further papers (excluding the final injunction, if entered without
Respondent being present at the hearing, and pleadings requiring personal service) shall be
served either by mail to Respondent’s last known mailing address or by e-mail to Respondent’s
designated e-mail address(es). Service shall be complete upon mailing or e-mailing.
5. Additional order(s) necessary to protect Petitioner from domestic violence:
.
Florida Supreme Court Approved Family Law Form 12.980(c)(2), Temporary Injunction for Protection Against
Domestic Violence without Minor Child(ren) (03/15)
___________________________________________________________________________
___________________________________________________________________________
TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME
{Initial all that apply; write N/A if does not apply}
6. ____Possession of the Home. ____ Petitioner ____ Respondent shall have temporary
exclusive use and possession of the dwelling located at:
.
7. ____ Transfer of Possession of the Home. A law enforcement officer with jurisdiction over
the home shall accompany ____ Petitioner____ Respondent to the home, and shall place
____Petitioner ____ Respondent in possession of the home.
8. ____Personal Items. ____ Petitioner ____ Respondent, in the presence of a law
enforcement officer, may return to the premises described above ____ on ________________,
at _______,a.m./p.m., or ____ at a time arranged with the law enforcement department with
jurisdiction over the home, for the purpose of obtaining his or her clothing and items of
personal health and hygiene and tools of the trade. A law enforcement officer with jurisdiction
over the home from which these items are to be retrieved shall accompany ____ Petitioner
____ Respondent to the home and stand by to insure that he/she vacates the premises with
only his/her personal clothing, toiletries, tools of the trade, and any items listed in paragraph 10
below. The law enforcement agency shall not be responsible for storing or transporting any
property. IF THE RESPONDENT IS NOT AWARDED POSSESSION OF THE HOME AND GOES TO
THE HOME WITHOUT A LAW ENFORCEMENT OFFICER, IT IS A VIOLATION OF THIS INJUNCTION.
9. ____ Petitioner ____ Respondent shall not damage or remove any furnishings or fixtures
from the parties' former shared premises.
10.____ Other: ___________________________________________________________
.
TEMPORARY SUPPORT
Temporary support, if requested by Petitioner in the Petition for Injunction for Protection Against
Domestic Violence, will be addressed by the Court after notice to Respondent and hearing on the
matter.
SECTION IV. OTHER SPECIAL PROVISIONS
{This section to be used for inclusion of local provisions approved by the chief judge as provided in
Florida Family Law Rule 12.610.}
___________________________________________________________________________.
Florida Supreme Court Approved Family Law Form 12.980(c)(2), Temporary Injunction for Protection Against
Domestic Violence without Minor Child(ren) (03/15)
SECTION V. DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION
{Unless ordered otherwise by the judge, all provisions in this injunction are considered mandatory
provisions and should be interpreted as part of this injunction.}
1. The Sheriff of _____ County, or any other authorized law enforcement officer,
is ordered to serve this temporary injunction upon Respondent as soon as possible after its
issuance.
2. This injunction is valid in all counties of the State of Florida. Violation of this injunction should
be reported to the appropriate law enforcement agency. Law enforcement officers of the
jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this
injunction and are authorized to arrest without warrant pursuant to section 901.15, Florida
Statutes, for any violation of its provisions which constitutes a criminal act under section 741.31,
Florida Statutes.
3. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW ENFORCEMENT
OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES. The
arresting agent shall notify the State Attorney's Office immediately after arrest.
4. Reporting alleged violations. If Respondent violates the terms of this injunction and there has
not been an arrest, Petitioner may contact the Clerk of the Circuit Court of the county in which
the violation occurred and complete an affidavit in support of the violation, or Petitioner may
contact the State Attorney’s office for assistance in filing an action for indirect civil contempt or
indirect criminal contempt. Upon receiving such a report, the State Attorney is hereby
appointed to prosecute such violations by indirect criminal contempt proceedings, or the State
Attorney may decide to file a criminal charge, if warranted by the evidence.
DONE AND ORDERED in__________________________, Florida on ____________.
CIRCUIT JUDGE
Florida Supreme Court Approved Family Law Form 12.980(c)(2), Temporary Injunction for Protection Against
Domestic Violence without Minor Child(ren) (03/15)
COPIES TO:
Sheriff of __________________ County
Petitioner: (or his or her attorney)
_____by U.S. Mail
_____ by hand-delivery in open court
_____by e-mail to designated e-mail address(es)
Respondent:
_____ forwarded to the sheriff for service
_____ State’s Attorney’s Office
_____ other:________________________
I CERTIFY the foregoing is a true copy of the original Temporary Injunction for Protection Against
Domestic Violence without Minor Child(ren) as it appears on file in the office of the Clerk of the Circuit
Court of _________________ County, Florida, and that I have furnished copies of this order as indicated
above.
CLERK OF THE CIRCUIT COURT
(SEAL)
By:
{Deputy Clerk or Judicial Assistant}
Florida Supreme Court Approved Family Law Form 12.980(c)(2), Temporary Injunction for Protection Against
Domestic Violence without Minor Child(ren) (03/15)
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IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, (Florida)

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Completed 10 January 2021

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