Fillable INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW (Pinellas County Clerk of the Circuit Court and Comptroller)

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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW (Pinellas County Clerk of the Circuit Court and Comptroller)

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Instructions for Florida Supreme Court Approved Family Law Form 12.980(f), Petition for Injunction for
Protection (11/15)
Against Repeat Violence (11/15)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY
LAW FORM 12.980(f)
PETITION FOR INJUNCTION FOR
PROTECTION AGAINST REPEAT VIOLENCE (11/15)
When should this form be used?
If you or a member of your immediate family are a victim of repeat violence, you can use this form to
ask the court for a protective order prohibiting repeat violence. Repeat violence means that two
incidents of violence have been committed against you or a member of your immediate family by
another person, one of which must have been within 6 months of filing this petition. Repeat 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.
The parent or legal guardian of any minor child who is living at home may seek an injunction for
protection against repeat violence on behalf of the minor child. With respect to a minor child who is
living at home, the parent or legal guardian 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 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.
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 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 you or a member of your immediate
family are a victim of repeat violence and that an immediate and present danger of repeat violence to
you or that family exists, the judge will sign a Temporary Injunction for Protection Against Repeat
Violence,
Instructions for Florida Supreme Court Approved Family Law Form 12.980(f), Petition for Injunction for
Protection (11/15)
Against Repeat Violence (11/15)
Florida Supreme Court Approved Family Law Form 12.980(k). 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 Repeat Violence
(After Notice), Florida Supreme Court Approved Family Law Form 12.980(l), 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 repeat 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 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.
Instructions for Florida Supreme Court Approved Family Law Form 12.980(f), Petition for Injunction for
Protection (11/15)
Against Repeat Violence (11/15)
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.
Family Supreme Court Approved Law Form 12.980(f), Petition for Injunction for Protection Against
Repeat 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 REPEAT 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}
[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} ____________________________________
2. Petitioner has known Respondent since: {date} ________________________________________
3. Respondent's last known place of employment: _______________________________________
Employment address: ____________________________________________________________
Working hours: _________________________________________________________________
Family Supreme Court Approved Law Form 12.980(f), Petition for Injunction for Protection Against
Repeat Violence (11/15)
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.")
SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION (This section must be completed.)
1. Has Petitioner ever received or tried to get an injunction for protection against domestic
violence, repeat violence, dating 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}
________________________________________________________________________
_______________________________________________________________________
2. Has Respondent ever received or tried to get an injunction for protection against
domestic violence, repeat violence, dating 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}
________________________________________________________________________
_______________________________________________________________________
3. 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}:
________________________________________________________________________
________________________________________________________________________
4. Respondent has directed at least two incidents 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 member of Petitioner’s immediate family. One of
these two incidents of violence has occurred within 6 months of the date of filing of this
petition. The most recent incident (including date and location) is described below.
Family Supreme Court Approved Law Form 12.980(f), Petition for Injunction for Protection Against
Repeat Violence (11/15)
On {date} , at {location} _____________________________________ _,
Respondent: ____________________________________________________________________
______________________________________________________________ ________________
________________________________________________________________ ______________
________________________________________________________________ ______________
______________________________________________________________ ________________
___________________________________________________________________ ___________
________________________________________________________________ ______________
__________________________________________________________________ ____________
__________________________________________________________________ ____________
__________________________________________________________________ ____________
______________________________________________________________________________
_______ Please indicate here if you are attaching additional pages to continue these facts.
5. Other prior incidents (including dates and location) are described below:
On {date} , at {location} _____________________________________ _,
Respondent: ____________________________________________________________________
______________________________________________________________ ________________
________________________________________________________________ ______________
________________________________________________________________ ______________
______________________________________________________________ ________________
___________________________________________________________________ ___________
________________________________________________________________ ______________
__________________________________________________________________ ____________
__________________________________________________________________ ____________
__________________________________________________________________ ____________
______________________________________________________________________________
_______ Please indicate here if you are attaching additional pages to continue these facts.
6. Petitioner genuinely fears repeat violence by Respondent. Explain: ______________________
______________________________________________________________ ________________
________________________________________________________________ ______________
________________________________________________________________ ______________
______________________________________________________________ ________________
___________________________________________________________________ ___________
________________________________________________________________ ______________
__________________________________________________________________ ____________
Family Supreme Court Approved Law Form 12.980(f), Petition for Injunction for Protection Against
Repeat Violence (11/15)
__________________________________________________________________ ____________
__________________________________________________________________ ____________
7. Additional Information
[Choose 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 repeat 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
repeat violence that will be in place from now until the scheduled hearing in this matter.
2. Petitioner asks the Court to enter, after a hearing has been held on this petition, a
final judgment of 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.
Family Supreme Court Approved Law Form 12.980(f), Petition for Injunction for Protection Against
Repeat 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
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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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW (Pinellas County Clerk of the Circuit Court and Comptroller)

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Completed 10 February 2021

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