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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW (Florida)

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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED
FAMILY LAW FORM 12.980(a)
PETITION FOR INJUNCTION FOR PROTECTION AGAINST
DOMESTIC VIOLENCE (06/21)
When should this form be used?
If you are a victim of any act of domestic violence or have reasonable cause to believe that you are in
imminent danger of becoming a victim of domestic violence, you can use this form to ask the court for a
protective order prohibiting domestic violence. 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. 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 by any of petitioner’s family or
household members. In determining whether you have reasonable cause to believe you are in
imminent danger of becoming a victim of domestic violence, the court must consider all relevant factors
alleged in the petition, including, but not limited to the following:
1. The history between the petitioner and the respondent, including threats, harassment, stalking,
and physical abuse.
2. Whether the respondent has attempted to harm the petitioner or family members or individuals
closely associated with the petitioner.
3. Whether the respondent has threatened to conceal, kidnap, or harm the petitioner’s child or
children.
4. Whether the respondent has intentionally injured or killed a family pet.
5. Whether the respondent has used, or has threatened to use, against the petitioner any weapons
such as guns or knives.
6. Whether the respondent has physically restrained the petitioner from leaving the home or
calling law enforcement.
7. Whether the respondent has a criminal history involving violence or the threat of violence.
8. The existence of a verifiable order of protection issued previously or from another jurisdiction.
9. Whether the respondent has destroyed personal property, including, but not limited to,
telephones or other communications equipment, clothing, or other items belonging to the
petitioner.
10. Whether the respondent engaged in any other behavior or conduct that leads the petitioner to
have reasonable cause to believe that he or she is in imminent danger of becoming a victim of
domestic violence.
The domestic violence laws only apply to your situation 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 children whether or not you have ever been married
or ever lived together. With the exception of persons who have a child in common, the family or
Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection
Against Domestic Violence (06/21)
household members must be currently residing together or have in the past resided together in the
same single dwelling unit. If the respondent is not one of the above, you should look at Petition for
Injunction for Protection Against Repeat Violence, Florida Supreme Court Approved Family Law Form
12.980(f), to determine if your situation will qualify for an injunction for protection against repeat
violence, or Petition for Injunction for Protection Against Dating Violence, Florida Supreme Court
Approved Family Law Form 12.980(n), to determine if your situation will qualify for an injunction for
protection against dating violence, or Petition for Injunction for Protection Against Sexual Violence,
Florida Supreme Court Approved Family Law Form 12.980(q), to determine if your situation will qualify
for an injunction for protection against sexual violence.
If you are under the age of eighteen and you have never been married or had the disabilities of nonage
removed by a court, then one of your parents, custodians, or your legal guardian must sign this petition
with you.
This form should be typed or printed in black ink. You should complete this form (giving as much detail
as possible) and sign it in front of a notary public or 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 you are a victim of domestic violence or
that an imminent danger of domestic violence exists, the judge will sign either an immediate
Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren), Florida
Supreme Court Approved Family Law Form 12.980(c)(1) or an immediate Temporary Injunction for
Protection Against Domestic Violence without Minor Child(ren), Florida Supreme Court Approved
Family Law Form 12.980(c)(2). 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. The temporary injunction gives a date that you must appear
in court for a hearing. At that 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 either a Final Judgment of Injunction for Protection Against Domestic
Violence with Minor Child(ren)(After Notice), Florida Supreme Court Approved Family Law Form
12.980(d)(1), or a Final Judgment of Injunction for Protection Against Domestic Violence without
Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection
Against Domestic Violence (06/21)
Minor Child(ren)(After Notice), Florida Supreme Court Approved Family Law Form 12.980(d)(2). Either
of these final judgments will remain in effect for a specific time period or until modified or dissolved by
the court. If either you or the respondent do not appear at the final hearing, 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 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 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 solely on the grounds that it appears to the court that no imminent danger of
domestic violence exists, the court will set a full hearing, at the earliest possible time, on your petition,
unless you request that no hearing be set. 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 Against Domestic Violence,
Repeat or Dating Violence, Florida 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 domestic violence forms
and can give you information about local domestic violence victim assistance programs, shelters, and
other related services. You may also call the Domestic Violence Hotline at 1-800-500-1119. For further
information, see Chapter 741, Florida Statutes, and Rule 12.610, Florida Family Law Rules of Procedure.
IMPORTANT INFORMATION REGARDING E-FILING
The Florida Rules of General Practice and 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 General Practice and 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.
Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection
Against Domestic Violence (06/21)
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 General Practice and 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 General Practice and 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 General Practice and Judicial Administration
2.516. You may find this rule at www.flcourts.org through the link to the Rules of General Practice and
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 General Practice and Judicial
Administration 2.516.
Special notes…
With this form you may also need to file the following:
• Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme
Court Approved Family Law Form 12.902(d), must be completed and filed if you are asking the
court to determine issues with regard to your parenting plan or time-parenting plan means a
document created to govern the relationship between the parents relating to the decisions that
must be made regarding the minor child(ren) and must contain a time-sharing schedule for the
parents and child(ren). The issues concerning the minor child(ren) may include, but are not
limited to, the child(ren)’s education, health care, and physical, social, and emotional well-being.
In creating the plan, all circumstances between the parents, including their historic relationship,
domestic violence, and other factors must be taken into consideration. The parenting plan shall
be developed and agreed to by the parents and approved by a court, or established by the
court, with or without the use of a court-ordered parenting plan recommendation. If the
parents cannot agree, or if the parents agreed to a plan that is not approved by the court, a
parenting plan shall be established by the court. “Time-sharing schedule” means a timetable
that must be included in the parenting plan that specifies the time, including overnights and
holidays, that a minor child will spend with each parent. If developed and agreed to by the
parents of a minor child, it must be approved by the court. If the parents cannot agree, of if
Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection
Against Domestic Violence (06/21)
their agreed-upon schedule is not approved by the court, the schedule shall be established by
the court.
• Notice of Related Cases, Florida Family Law Rules of Procedure Form 12.900(h), must be
completed and filed.
• Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j),
must be completed and filed if you are asking the court to determine issues of temporary child
support.
• Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c),
must be completed and filed if you are seeking temporary alimony or temporary child support.
• Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e),
MUST be filed with the court at or prior to a hearing to establish or modify child support.
Additionally, if you fear that disclosing your address to the respondent 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 on the petition.
Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection
Against Domestic Violence (06/21)
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 DOMESTIC 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 and telephone number.)
1. Petitioner’s current address is: {street address}
{city, state and zip code}
Telephone Number: {area code and number}
Physical description of Petitioner:
Race: _____ Sex: Male _____ Female _____ Date of Birth: _________________________
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’s current address is: {street address, city, state, and zip code}
.
Respondent’s Driver’s License number is: {if known} _____________________________ __.
Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against
Domestic Violence (06/21)
2. Respondent is: {Indicate all that apply}
a. the spouse of Petitioner.
Date of Marriage:
b. the former spouse of Petitioner.
Date of Marriage:
Date of Dissolution of Marriage:
c. related by blood or marriage to Petitioner.
Specify relationship:
d. a person who is or was living in one home with Petitioner, as if a family.
e. a person with whom Petitioner has a child in common, even if Petitioner and
Respondent never were married or living together.
3. Petitioner has known Respondent since {date}
4. Respondent’s last known place of employment:
Employment address:
Working hours:
5. Physical description of Respondent:
Race: _____ Sex: Male _____ Female _____ Date of Birth: _______________________________
Height: Weight: Eye Color: Hair Color:
Distinguishing marks or scars:
Vehicle: (make/model) Color: Tag Number:
6. Other names Respondent goes by (aliases or nicknames):
7. 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 against Respondent in this or any other court?
Yes No If yes, what happened in that case? {Include case number, if known}
.
Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against
Domestic Violence (06/21)
______
2. Has Respondent ever received or tried to get an injunction for protection against domestic
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,
including a dissolution of marriage, paternity action, or child support enforcement action,
between Petitioner and Respondent {Include city, state, and case number, if known}:
______________________________________________________________________________.
4. Petitioner is either a victim of domestic violence or has reasonable cause to believe he or she is
in imminent danger of becoming a victim of domestic violence because respondent has: {Mark
all sections that apply and describe in the spaces below the incidents of violence or threats of
violence, specifying when and where they occurred, including, but not limited to, locations such
as a home, school, place of employment, or time-sharing exchange}
a. committed or threatened to commit domestic violence defined in s. 741.28, Florida
Statutes, as any assault, aggravated assault, battery, aggravated battery, sexual assault,
sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any
criminal offense resulting in physical injury or death of one family or household member
by another. With the exception of persons who are parents of a child in common, the
family or household members must be currently residing or have in the past resided
together in the same single dwelling unit.
b. previously threatened, harassed, stalked, or physically abused the petitioner.
c. attempted to harm the petitioner or family members or individuals closely associated
with the petitioner.
d. threatened to conceal, kidnap, or harm the petitioner's child or children.
e. intentionally injured or killed a family pet.
f. used, or has threatened to use, against the petitioner any weapons such as guns or
knives.
g. physically restrained the petitioner from leaving the home or calling law enforcement.
h. a criminal history involving violence or the threat of violence (if known).
i. another order of protection issued against him or her previously or from another
jurisdiction (if known).
j. destroyed personal property, including, but not limited to, telephones or other
communication equipment, clothing, or other items belonging to the petitioner.
k. engaged in any other behavior or conduct that leads the petitioner to have reasonable
cause to believe he or she is in imminent danger of becoming a victim of domestic
violence.
Below is a brief description of the latest act of violence or threat of violence that causes
Petitioner to honestly fear imminent domestic violence by Respondent.
Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against
Domestic Violence (06/21)
{Please begin your narrative below. Use additional pages if necessary but please do not write in
the margins or on the back of any of the pages Please indicate below if you are using additional
pages.}
On {date} ________, at {location} ___________________________________,
Respondent:
.
_______ Please indicate here if you are attaching additional pages to continue these facts.
5. Additional Information
{Indicate all that apply}
a. Other acts or threats of domestic violence as described on attached sheet.
b. This or other acts of domestic violence have been previously reported to {person or
agency}: _____________________________________________________________
c. Respondent owns, has, and/or is known to have guns or other weapons.
Describe weapon(s):
d. Respondent has a drug problem.
e. Respondent has an alcohol problem.
f. Respondent has a history of mental health problems. If checked, answer the following,
if known:
Has Respondent ever been the subject of a Baker Act proceeding? _____ Yes _____ No
Is Respondent supposed to take medication for mental health problems? _____Yes
_____ No
If yes, is Respondent currently taking his/her medication? _____ Yes _____ No
Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against
Domestic Violence (06/21)
SECTION IV. TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME (Complete this section only if
you want the Court to grant you temporary exclusive use and possession of the home that you share
with the Respondent.)
1. Petitioner claims the following about the home that Petitioner and Respondent share or that
Petitioner left because of domestic violence:
{Indicate all that apply}
a. Petitioner needs the exclusive use and possession of the home that the parties share at
{street address} ,
{city, state, zip code} .
b. Petitioner cannot get another safe place to live because:
.
c. If kept out of the home, Respondent has the money to get other housing or may live
without money at {street address} ,
{city, state, zip code} .
2. The home is:
{Choose one only}
a. owned or rented by Petitioner and Respondent jointly.
b. solely owned or rented by Petitioner.
c. solely owned or rented by Respondent.
SECTION V. TEMPORARY PARENTING PLAN WITH TEMPORARY TIME-SHARING SCHEDULE FOR MINOR
CHILDREN (Complete this section only if you are asking the court to provide a temporary parenting plan,
including a temporary time-sharing schedule with regard to, the minor child or children of the parties
which might involve prohibiting or limiting time-sharing or requiring that it be supervised by a third
party. You must be the natural parent, adoptive parent, or guardian by court order of the minor child or
children. If you are asking the court to provide a temporary parenting plan, including a temporary time-
sharing schedule with regard to, the minor child or children of the parties which might involve prohibiting
or limiting time-sharing or requiring that it be supervised by a third party, you must also complete and
file a Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme
Court Approved Family Law Form 12.902(d)).
Note: If the paternity of the minor children listed below has not been established through either
marriage or court order, the Court may deny a request to provide a temporary parenting plan,
including a temporary time-sharing schedule with regard to, the minor child or children, and/or a
request for child support.
1. Petitioner is the natural parent, adoptive parent, or guardian by court order of the minor
children whose name(s) and age(s) are listed below.
Name Birth date
Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against
Domestic Violence (06/21)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
2. The minor children for whom Petitioner is asking the court to provide a temporary parenting
plan, including a temporary time-sharing schedule with regard to:
{Choose one only}
a. saw the domestic violence described in this petition happen.
b. were at the place where the domestic violence happened but did not see it.
c. were not there when the domestic violence happened this time but have seen previous
acts of domestic violence by Respondent.
d. have not witnessed domestic violence by Respondent.
3. Name any other minor children who were there when the domestic violence happened. Include
children’s name, age, and parents’ names.
4. Temporary Parenting Plan and Temporary Time-Sharing Schedule
{Indicate all that apply}
a. Petitioner requests that the Court provide a temporary parenting plan, including a
temporary time-sharing schedule, with regard to the minor child or children of the
parties, as follows:
___________________________________________________________________ ____.
b. Petitioner requests that the Court order supervised exchange of the minor children or
exchange through a responsible person designated by the Court. The following person
is suggested as a responsible person for purposes of such exchange. {Explain}:
___________________________________________________________________ ____.
c. Petitioner requests that the Court limit time-sharing by Respondent with the minor
children. {Explain}:
.
d. Petitioner requests that the Court prohibit time-sharing by Respondent with the minor
children because Petitioner genuinely fears that Respondent imminently will abuse,
remove, or hide the minor children from Petitioner. {Explain}:
.
e. Petitioner requests that the Court allow only supervised time-sharing by Respondent
with the minor children. Explain: ____________________________________________
_______________________________________________________________________.
Supervision should be provided by a Family Visitation Center, or other (specify):
_______________________________________________________________________.
Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against
Domestic Violence (06/21)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
SECTION VI. EXCLUSIVE CARE, POSSESSION, OR CONTROL OF FAMILY PET(S) (Complete this section
only if you are seeking exclusive care, possession, or control of an animal owned, possessed, harbored,
kept, or held by you (the Petitioner), the Respondent, or a minor child residing in either your residence or
household or Respondent’s residence or household. The court may order the Respondent to have no
contact with the animal and may prohibit the Respondent from taking, transferring, encumbering,
concealing, harming, or otherwise disposing of the animal. You may not request to have exclusive care,
possession, or control of an animal owned primarily for a bona fide agricultural purpose, as defined in
section 193.461, Florida Statutes, or a service animal, as defined in section 413.08, Florida Statutes, if
Respondent is the service animal’s handler.) {Indicate all that apply}.
1. Petitioner requests to have exclusive care, possession, and control of the following animal(s)
which are owned, possessed, harbored, kept, or held by Petitioner, Respondent, or a minor
child residing in Petitioner’s or Respondent’s residence or household: __________________
___________________________________________________________________________.
2. Petitioner requests that Respondent have no contact with the following animal(s) and be
prohibited from taking, transferring, encumbering, concealing, harming, or otherwise
disposing of them ____________________________________________________________
___________________________________________________________________________.
SECTION VII. TEMPORARY SUPPORT (Complete this section only if you are seeking financial support
from the Respondent. You must also complete and file a Family Law Financial Affidavit, Florida Family
Law Rules of Procedure Form 12.902(b) or (c), and Notice of Social Security Number, Florida Supreme
Court Approved Family Law Form 12.902(j), if you are seeking child support. A Child Support Guidelines
Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), must be filed with the court at or
prior to a hearing to establish or modify child support.)
{Indicate all that apply}
1. Petitioner claims a need for the money he or she is asking the Court to make Respondent
pay, and that Respondent has the ability to pay that money.
2. Petitioner requests that the Court order Respondent to pay the following temporary
alimony to Petitioner. (Petitioner must be married to Respondent to ask for temporary
alimony.) Temporary Alimony Requested $__________ every: _____ week _____ other
week _____ month.
3. Petitioner requests that the Court order Respondent to pay the following temporary child
support to Petitioner. (The Respondent must be the natural parent, adoptive parent, or
guardian by court order of the minor children for the court to order the Respondent to pay
child support.) Temporary child support is requested in the amount of $______________
Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against
Domestic Violence (06/21)
_____________________________________________________________________________
every: _____ week _____ other week _____ month.
SECTION VIII. INJUNCTION (This section summarizes what you are asking the Court to include in the
injunction. This section must be completed.)
1. Petitioner asks the Court to enter a TEMPORARY INJUNCTION for protection against domestic
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 on injunction prohibiting Respondent from committing any acts of domestic violence
against Petitioner and:
a. prohibiting Respondent from going to or within 500 feet of any place the Petitioner lives;
b. prohibiting Respondent from going to or within 500 feet of the Petitioner’s place(s) of
employment or school; the address of Petitioner’s place(s) of employment or school is:
____________________________________________________________________________;
c. prohibiting Respondent from contacting Petitioner by mail, by telephone, through another
person, or in any other manner;
d. prohibiting Respondent from knowingly and intentionally going to or within 100 feet of
Petitioner’s motor vehicle;
e. prohibiting Respondent from defacing or destroying Petitioner’s personal property;
{Indicate all that apply}
f. prohibiting Respondent from going to or within 500 feet of the following place(s)
Petitioner or Petitioner’s minor children must go often {include address}: ______
;
g. granting Petitioner temporary exclusive use and possession of the home Petitioner and
Respondent share;
h. granting Petitioner on a temporary basis 100% of the time sharing with the parties’
minor children;
i. establishing a temporary parenting plan including a temporary time-sharing schedule for
the parties’ minor children;
j. granting Petitioner exclusive care, possession, or control of the animal(s) identified in
paragraph 1 of Section VI which are owned, possessed, harbored, kept or held by
Petitioner, Respondent, or a minor child residing in Petitioner or Respondent’s residence
or household;
k. prohibiting Respondent from having any contact with the animal(s) identified in
paragraph 2 of Section VI or from taking, transferring, encumbering, concealing,
harming, or otherwise disposing of them;
l. granting temporary alimony for Petitioner;
m. granting temporary child support for the minor children;
n. ordering Respondent to participate in treatment, intervention, and/or counseling
services;
Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against
Domestic Violence (06/21)
____________
_______________________________
o. referring Petitioner to a certified domestic violence center; and any other terms the
Court deems necessary for the protection of Petitioner and/or Petitioner’s children,
including injunctions or directives to law enforcement agencies, as provided in Section
741.30, Florida Statutes.
I UNDERSTAND THAT BY FILING THIS PETITION, I AM ASKING THE COURT TO HOLD A HEARING ON
THIS PETITION, THAT BOTH 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 HEARING, WE WILL BE BOUND BY THE TERMS OF ANY INJUNCTION ISSUED AT THAT HEARING.
I HAVE READ EVERY STATEMENT MADE IN THIS PETITION, AND EACH STATEMENT IS TRUE AND
CORRECT. I UNDERSTAND THAT THE STATEMENTS MADE IN THIS PETITION ARE BEING MADE UNDER
PENALTY OF PERJURY, PUNISHABLE AS PROVIDED IN SECTION 837.02, FLORIDA STATUTES.
(initials)
Dated:
Signature of Petitioner
STATE OF FLORIDA
COUNTY OF _________________________
Sworn to or affirmed and subscribed before me by means of _____ physical presence or _____ online
notarization this _____ day of _________________, {year} ________ by {name of person making
statement} _____________________________________________.
NOTARY PUBLIC or DEPUTY CLERK
{Print, type, or stamp commissioned name of notary or
clerk.}
_____ Personally known
_____ Produced identification
Type of identification produced ____________________________
Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against
Domestic Violence (06/21)
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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW (Florida)

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Completed 9 February 2022

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