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SERVICE INFORMATION FOR
INJUNCTIONS
FOR
PROTECTION
UCN
#
5220_____DR ______________XXFDFD REFERENCE NO:
.:
_______________________
The following information is REQUIRED to help the Sheriff’s Office in serving the Respondent
as
soon as possible. It also may alert the deputy to any potential DANGER that might be
encountered
while attempting to serve this injunction. THIS INFORMATION WILL NOT BE PROVIDED TO
THE RESPONDENT.
Respondent's Name: ____________________________________________________________________
First
Middle
Last
Alias/Nicknames: __________________________________________________________________
Previous or Maiden Names:
_________________
Date of Birth:
Month Day
Year
Home Telephone Number: (_____) ______________
Work Telephone Number: (_____) ______________
Cell Phone Number: (_____) ______________
Other Contact Numbers: (_____) ______________
Current Address: ____________________________________________________________________
Street
____________________________________________________________________________
City State Zip
What day of the week and time is Respondent usually at this address? ____________________
Respondent’s Alternate or Previous Address:
____________________________________________________________________________
Street
____________________________________________________________________________
City State Zip
What day of the week and time is Respondent usually at this address? ____________________
Respondent’s Alternate or Previous Address:
____________________________________________________________________________
Street
____________________________________________________________________________
City State Zip
What day of the week and time is Respondent usually at this address? ____________________
Is Respondent currently incarcerated? _____ Yes _____ No _____ I don’t know
Please attach additional sheets listing Respondent’s other alternate or previous addresses, if
needed.
Other possible addresses where Respondent may be found:
(List any addresses that you think may be helpful to law enforcement. Examples include, but
are not limited to, addresses for Respondent’s relatives; Respondent’s
girlfriend/boyfriend/spouse’s address; locations where Respondent frequents, such as a school
or university, restaurants, bars, nightclubs, health clubs or gyms, sports facilities, clubs or
organizations, public parks, government buildings, etc. Please provide as much information as
you can to assist law enforcement.)
1. _________________________________________________________________________
Name (of resident or business)
____________________________________________________________________________
Street
____________________________________________________________________________
City State Zip
What day of the week and time is Respondent usually at this address? ____________________
Relationship to Respondent: _____________________________________________________
2. _________________________________________________________________________
Name (of resident or business)
____________________________________________________________________________
Street
____________________________________________________________________________
City State Zip
What day of the week and time is Respondent usually at this address? ____________________
Relationship to Respondent: _____________________________________________________
3. _________________________________________________________________________
Name (of resident or business)
____________________________________________________________________________
Street
____________________________________________________________________________
City State Zip
What day of the week and time is Respondent usually at this address? ____________________
Relationship to Respondent: _____________________________________________________
Description of Respondent
Race _____ White/Caucasian
_____ Black or African American
_____ Hispanic or Latino
_____ Asian
_____ Native American or Alaska Native
_____ Native Hawaiian or Other Pacific Islander
_____ Other (specify __________________________)
Sex: _____ Male _____ Female
Hair color: ________________________ Height:_______ ft ______ inches
Eye color: ________________________ Weight: ________
Tattoos: ___________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Piercings: __________________________________________________________________________
Scars/Marks: _______________________________________________________________________
Other description (facial hair, glasses, prosthetics, etc.) ______________________________________
__________________________________________________________________________________
Language(s) spoken by Respondent: ___________________________________________________
Is an interpreter needed? _____ Yes _____ No
Is the Respondent known to be violent with anyone other than you?
_____ Yes _____ No _____ I don’t know
Firearms and Weapons
Does the Respondent currently own or possess a firearm? _____ Yes _____ No _____ I don’t know
Has the Respondent possessed a firearm in the past? _____ Yes _____ No _____ I don’t know
Is the Respondent known to have any other weapons? _____ Yes _____ No _____ I don’t know
If yes, list the weapons: _______________________________________________________________
__________________________________________________________________________________
Is the Respondent required to carry/use a firearm in the capacity of his/her job?
_____ Yes _____ No _____ I don’t know
Vehicle Information
(automobiles, trucks, motorcycles, etc.)
Vehicle 1:
Make: ______________________ Model: ______________________ Year: ____________
Color: ______________________ Tag: ________________________
Vehicle 2:
Make: ______________________ Model: ______________________ Year: ____________
Color: ______________________ Tag: ________________________
Respondent’s Employer Information
Employer 1
Name: ____________________________________________________________________________
Employer’s Address: _________________________________________________________________
Street
____________________________________________________________________________
City State Zip
Employer’s Phone: __________________________________________________________________
Supervisor’s Name: __________________________________________________________________
Respondent’s Normal Work Schedule: ___________________________________________________
Days
___________________________________________________
Hours
Does Respondent travel for work? _____ Yes _____ No
If so, provide locations/route: __________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Employer 2
Name: ____________________________________________________________________________
Employer’s Address: _________________________________________________________________
Street
____________________________________________________________________________
City State Zip
Employer’s Phone: __________________________________________________________________
Supervisor’s Name: __________________________________________________________________
Respondent’s Normal Work Schedule: ___________________________________________________
Days
___________________________________________________
Hours
Does Respondent travel for work? _____ Yes _____ No
If so, provide locations/route: __________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Additional Information
Please provide any additional information that may assist law enforcement in locating Respondent.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Petitioner:
Law enforcement may need to contact you for further information on Respondent. Information
in this form is intended to remain confidential and will not be filed in the court file. If your
address is confidential pursuant to Florida law, you may choose not to list it below. In that case,
please provide a phone number where you can be reached so that law enforcement can contact
you, if necessary, for additional information on Respondent.
Petitioner’s Name ___________________________________________________________________
First Middle Last
Petitioner’s Address: _________________________________________________________________
Street
____________________________________________________________________________
City State Zip
Petitioner’s home phone (_____) ______________
Petitioner’s work phone: (_____) ______________
Petitioner’s cell phone: (_____) ______________
Alternate phone: (_____) ______________
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Completed 10 February 2021

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