Title: Amendments to the Florida Family Law Rules and Forms Appendix C - Part 3

State: florida

Issuer: Florida Supreme Court

Document:

Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Affidavit and Motion for Waiver of Fees for Petition
for Injunction for Protection (9/00)
C-342
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM
12.980(a), AFFIDAVIT AND MOTION FOR WAIVER OF FEES FOR PETITION FOR
INJUNCTION FOR PROTECTION
When should this form be used?
If you need to file a petition for an injunction for protection against domestic violence or repeat violence and
you do not have enough money to pay filing fees to the clerk of the circuit court or service fees to the
sheriff, you may use this form to request that the fees be waived.  Later, the court will decide who, if anyone,
should pay those fees.
This form should be typed or printed in black ink.  You should complete the first section of this form, and sign
it in front of a notary public or deputy clerk.  You should then file the original of this form with your
petition for injunction for protection.  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 next?
A copy of this form must be mailed, faxed and mailed, or hand delivered to the respondent in your case.
Special notes...
With this form you will also need to file the following:
C
Family Law Financial Affidavit, O” Florida Family Law Rules of Procedure Form 12.902(b) or
(c).
Florida  Supreme Court Approved Family Law Form 12.980(a), Affidavit and Motion for Waiver of Fees for Petition for Injunction
for Protection (9/00)
C-343
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT,
IN AND FOR                                                       COUNTY, FLORIDA
Case No.: 
Division: 
                                                                      ,
Petitioner,
and
                                                                       ,
Respondent.
AFFIDAVIT AND MOTION FOR WAIVER OF FEES FOR PETITION FOR
INJUNCTION FOR PROTECTION
I, {full legal name of petitioner} 
,
certify that I do not have enough money to pay filing fees to the Clerk of the Circuit Court or service fees to
the sheriff or other authorized law enforcement agency and ask that, as allowed by section 741.30(2)(a) or
section 784.046(3)(b), Florida Statutes, the fees be waived subject to a later order of the Court about the
payment of those fees.
I understand that I am swearing or affirming under oath to the truthfulness of the claims
made in this affidavit and motion 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                                               
Florida  Supreme Court Approved Family Law Form 12.980(a), Affidavit and Motion for Waiver of Fees for Petition for Injunction
for Protection (9/00)
C-344
CLERK’S CERTIFICATE AS TO AFFIDAVIT AND MOTION FOR WAIVER OF FEES
I, 
, as Clerk of the Circuit Court, do hereby certify that
I received and filed the above without payment of fees necessary to process the petition and serve the
injunction, subject to a subsequent order of the Court relative to the payment of such fees.
CLERK OF THE CIRCUIT COURT
(SEAL)
By: 
      Deputy Clerk
Instructions for Florida Supreme Court Approved Family Law Form 12.980(b), Petition for Injunction for Protection Against
Domestic Violence (9/00)
C-345
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM
12.980(b),
PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE
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 who are residing
in the same single dwelling unit with petitioner.
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 child(ren), whether or not you have ever been married or ever
lived together.  If the respondent is not one of the above, you should look at Petition for Injunction for
Protection Against Repeat Violence, O” Florida Supreme Court Approved Family Law Form 12.980(g),
to determine if your situation will qualify for an injunction for protection against repeat 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 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 an immediate 
Temporary Injunction
for Protection Against Domestic Violence with Minor Child(ren), O” Florida Supreme Court
Approved Family Law Form 12.980(d)(1).  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 should 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
Instructions for Florida Supreme Court Approved Family Law Form 12.980(b), Petition for Injunction for Protection Against
Domestic Violence (9/00)
C-346
a Final Judgment of Injunction for Protection Against Domestic Violence with Minor
Child(ren)(After Notice), O” Florida Supreme Court Approved Family Law Form 12.980(e)(1), 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 the imposition of court costs.
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 imminent danger of domestic
violence exists, the court will set a full hearing, at the earliest possible time, 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 Against Domestic Violence or Repeat Violence, O’ Florida Family Law Form 12.980 (h);
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.
Special notes...
With this form you may also need to file the following:
C
Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, O’ Florida Supreme Court
Approved Family Law Form 12.902(d), must be completed and filed if you are asking the court to
determine issues of temporary custody or visitation with regards to a minor child(ren).
C
Notice of Social Security Number, O’ 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.
C
Family Law Financial Affidavit, O’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.
C
Child Support Guidelines Worksheet, O’ 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 Petitioner’s Request for Confidential Filing of Address, O’ Florida Supreme Court Approved
Family Law Form 12.980(i), and file it with the clerk of the circuit court and write “confidential” in the space
provided on the petition.
Florida Supreme Court Approved Family Law Form 12.980(b), Petition for Injunction for Protection Against Domestic Violence
(9/00)
C-347
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
Petitioner’s Request for Confidential Filing of Address, O’ Florida Supreme Court Approved Family
Law Form 12.980(i), and write “confidential” in the space provided on this form for your address and
telephone number.)
1.
Petitioner currently lives at: {street address} 
{city, state and zip code} 
Telephone Number: {area code and number} 
2.
Filing Fees
[ / one only]
       
a.  Petitioner is paying the filing fee and sheriff’s or other authorized law enforcement agency’s
service fees.
       
b.  Petitioner does not have enough money to pay the filing fee or service fees and is filing an
Affidavit and Motion for Waiver of Fees for Petition for Injunction for Protection , O”
Florida  Supreme Court Approved Family Law Form 12.980(a), and a Family Law Financial
Affidavit, O” Florida Family Law Rules of Procedure Form 12.902(b) or (c).  Petitioner asks that
he or she not have to pay the fees necessary to process the petition and serve the injunction and other
motions or orders needed to enforce the injunction, subject to later order(s) of the Court about the
payment of such fees.
3.
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.)
Florida Supreme Court Approved Family Law Form 12.980(b), Petition for Injunction for Protection Against Domestic Violence
(9/00)
C-348
1.
Respondent currently lives at: {street address, city, state, and zip code} 
.
Respondent’s Driver’s License number is: {if known} 
.
2.
Respondent is:
[ / all that apply]
       
a.  the spouse of Petitioner.  Date of Marriage: 
       
b.  the former spouse of Petitioner.
Date of Marriage: 
Date of Divorce: 
       
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)
2.
Has Respondent ever received or tried to get an injunction for protection against domestic violence
against Petitioner?
          Yes              No If yes, what happened in that case? (include case number, if known)
Florida Supreme Court Approved Family Law Form 12.980(b), Petition for Injunction for Protection Against Domestic Violence
(9/00)
C-349
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 the victim of an act of domestic violence or has reasonable cause to believe that he or
she is in imminent danger of becoming the victim of an act 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.  (Use additional sheets if necessary.)
On {date} 
, at {location} 
,
the Respondent 
.
9 Check here if you are attaching additional pages to continue these facts.
5.
Additional Information
[ / 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
Florida Supreme Court Approved Family Law Form 12.980(b), Petition for Injunction for Protection Against Domestic Violence
(9/00)
C-350
Is Respondent supposed to take medication for mental health problems?  (    ) Yes      (    ) No
If yes, is Respondent currently taking his/her medication?  (    ) Yes      (    ) No
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:
[ / 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:
[ / 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 CUSTODY OF MINOR CHILD(REN)  (Complete this section only
if you are seeking temporary custody of any minor child.  You must be the natural parent, adoptive parent,
or guardian by court order of the minor child(ren).  If you are asking the court to determine issues of
temporary custody with regards to a minor child, you must also complete and file a Uniform Child Custody
Jurisdiction Act (UCCJA) Affidavit, O’ Florida Supreme Court Approved Family Law Form 12.902(d).
Note:  If the paternity of the minor child(ren) listed below has not been established through either
marriage or court order, the Court may deny temporary custody, visitation, and/or support.
1.
Petitioner is the natural parent, adoptive parent, or guardian by court order of the minor child(ren)
whose name(s) and age(s) is (are) listed below.
Name
Place of Birth
Birth date
Sex
2.
The minor child(ren) whom Petitioner is seeking temporary custody of:
Florida Supreme Court Approved Family Law Form 12.980(b), Petition for Injunction for Protection Against Domestic Violence
(9/00)
C-351
[ / 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 child(ren) who were there when the domestic violence happened.  Include
child(ren)’s name, age, sex, and parents’ names. 
4.
Visitation
[ / all that apply]
       
a.  Petitioner requests that the Court order reasonable visitation by Respondent with the minor
child(ren), as follows: 
       
b.  Petitioner requests that the Court order supervised exchange of the minor child(ren) 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 visitation by Respondent with the minor child(ren).  Explain:
       
d.  Petitioner requests that the Court prohibit visitation by Respondent with the minor child(ren)
because Petitioner genuinely fears that Respondent imminently will abuse, remove, or hide the minor
child(ren) from Petitioner.  Explain: 
SECTION VI.  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, O’ Florida
Family Law Rules of Procedure Form 12.902(b) or (c), and Notice of Social Security Number, O’ Florida
Supreme Court Approved Family Law Form 12.902(j), if you are seeking child support. A Child Support
Guidelines Worksheet, O’ 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.)
[ / 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
Florida Supreme Court Approved Family Law Form 12.980(b), Petition for Injunction for Protection Against Domestic Violence
(9/00)
C-352
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 child(ren) for the court to order the respondent to pay child support.)  Temporary child
support is requested in the amount of $                     every (    ) week (    ) other week (    ) month.
SECTION VII.  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;
[ / all that apply]
       
d.  prohibiting Respondent from going to or within 500 feet of the following place(s) Petitioner or
Petitioner’s minor child(ren) must go often {include address}: 
       
e.  granting Petitioner temporary exclusive use and possession of the home Petitioner and Respondent
share;
       
f.  granting Petitioner temporary exclusive custody of the parties’ minor child(ren);
       
g.  establishing visitation rights with the parties’ minor child(ren);
       
h.  granting temporary alimony for Petitioner;
       
i.  granting temporary child support for the minor child(ren);
       
j.  ordering Respondent to participate in treatment, intervention, and/or counseling services;
       
k.  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 child(ren),
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 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.
               
Florida Supreme Court Approved Family Law Form 12.980(b), Petition for Injunction for Protection Against Domestic Violence
(9/00)
C-353
(initials)
Dated: 
Signature of Petitioner
STATE OF FLORIDA
COUNTY OF                                         
Sworn to or affirmed and signed before me on                                by 
.
NOTARY PUBLIC or  DEPUTY CLERK
       
Personally known
[Print, type, or stamp commissioned name of notary or clerk.]
       
Produced identification
Type of identification produced                                               
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Order Setting Hearing on Petition for Injunction for Protection
Against Domestic Violence or Repeat Violence without Issuance of an Interim Temporary Injunction (9/00)
C-354
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT,
IN AND FOR                                                       COUNTY, FLORIDA
Case No.: 
Division: 
                                                                      ,
Petitioner,
and
                                                                       ,
Respondent.
ORDER SETTING HEARING ON PETITION FOR INJUNCTION
FOR PROTECTION AGAINST
(    ) DOMESTIC VIOLENCE (    ) REPEAT VIOLENCE
WITHOUT ISSUANCE OF AN INTERIM TEMPORARY INJUNCTION
The Petition for Injunction for Protection Against Domestic Violence filed under section 741.30,
Florida Statutes, or Repeat Violence under section 784.046, Florida Statutes, has been reviewed.  This Court
has jurisdiction of the parties and of the subject matter.  A Temporary Injunction for Protection Against
Domestic or Repeat Violence, pending the hearing scheduled below, is NOT being entered at this time but
an injunction may be entered after the hearing, depending on the findings made by the Court at that time.
FINDINGS
The Court finds that the facts, as stated in the Petition alone and without a hearing on the matter, do
not demonstrate that Petitioner is a victim of domestic or repeat violence or that Petitioner has reasonable
cause to believe that he or she is in imminent danger of becoming a victim of domestic violence.  Therefore,
there is not a sufficient factual basis upon which the court can enter a Temporary Injunction for Protection
Against Domestic or Repeat Violence prior to a hearing.  A hearing is scheduled on the Petition for Injunction
for Protection Against Domestic or Repeat Violence in section II of this Order.  Petitioner may amend or
supplement the Petition at any time to state further reasons why a Temporary Injunction should be ordered
which would be in effect until the hearing scheduled below.
NOTICE OF HEARING
Petitioner and Respondent are ordered to appear and testify at a hearing on the Petition for Injunction
for Protection Against Domestic or Repeat Violence on {date} 
,
at 
 a.m./p.m. at {location} 
,
at which time the Court will consider whether a Final Judgment of Injunction for Protection Against Domestic
or Repeat Violence should be entered.  If entered, the injunction will remain in effect until a fixed date set
by the Court or until modified or dissolved by the Court.  At the hearing, the Court will determine whether
other things should be ordered, including, for example, such matters as visitation, support and who should pay
the filing fees and costs.
If Petitioner and/or Respondent do not appear, orders may be entered, including the imposition of
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Order Setting Hearing on Petition for Injunction for Protection
Against Domestic Violence or Repeat Violence without Issuance of an Interim Temporary Injunction (9/00)
C-355
court costs or an injunction.
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 (O’
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.  electronic audio tape 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.
   c.  no electronic audio tape recording or court reporting services are 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
{name} 
,
{address} 
, {telephone} 
,
within 2 working days of your receipt of this order.  If you are hearing or voice impaired, call TDD 1-800-
955-8771.
Nothing in this order limits Petitioner’s rights to dismiss the petition.
ORDERED on                                            .
CIRCUIT JUDGE
COPIES TO:
Petitioner:
         by hand delivery in open Court
         by U.S. mail
Respondent:
         forwarded to sheriff for service
Other:                                                                                            
I CERTIFY the foregoing is a true copy of the original 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
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Order Setting Hearing on Petition for Injunction for Protection
Against Domestic Violence or Repeat Violence without Issuance of an Interim Temporary Injunction (9/00)
C-356
indicated above.
CLERK OF THE CIRCUIT COURT
(SEAL)
By: 
      Deputy Clerk
Florida Supreme Court Approved Family Law Form 12.980(c)(2), Order Denying Petition for Injunction for Protection Against
Domestic Violence or Repeat Violence (9/00)
C-357
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT,
IN AND FOR                                                       COUNTY, FLORIDA
Case No.: 
Division: 
                                                                      ,
Petitioner,
and
                                                                       ,
Respondent.
ORDER DENYING PETITION FOR INJUNCTION
FOR PROTECTION AGAINST
(    ) DOMESTIC VIOLENCE (    ) REPEAT VIOLENCE
The Court has reviewed the Petition for Injunction for Protection Against Domestic or Repeat
Violence filed in this cause and finds that Petitioner has failed to comply with one or more statutory
requirements applicable to that petition including the following:
       
1.  Petitioner has failed to allege in a petition directed to domestic violence that Respondent is a
member of Petitioner’s family or resides in the same dwelling unit with Petitioner.
       
2.  Petitioner has used a petition form other than that which is approved by the Court and the form
used lacks the statutorily required components.
       
3.  Petitioner has failed to complete a mandatory portion of the petition.
       
4.  Petitioner has failed to sign the petition.
       
5.  Petitioner has failed to allege facts sufficient to support the entry of an injunction for protection
against domestic or repeat violence because: 
.
       
6.  Other: 
.
It is therefore, ORDERED AND ADJUDGED that the Petition is denied without prejudice to amend
or supplement the petition to cure the above stated defects.
ORDERED ON 
.
CIRCUIT JUDGE
COPIES TO:
Florida Supreme Court Approved Family Law Form 12.980(c)(2), Order Denying Petition for Injunction for Protection Against
Domestic Violence or Repeat Violence (9/00)
C-358
Petitioner:
         by hand delivery in open Court
         by U.S. mail
I CERTIFY the foregoing is a true copy of the original 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
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Temporary Injunction for Protection Against Domestic Violence
with Minor Child(ren)  (9/00)
C-359
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 
WITH 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.  The Court has jurisdiction of the parties
and the subject matter under the laws of Florida. 
It is intended that this protection order meet the requirements of 18 U.S.C. § 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.
NOTICE OF HEARING
Because this Temporary Injunction for Protection Against Domestic Violence has been issued
without prior notice to Respondent, 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 the Court should 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 visitation, support and who should pay the
filing fees and costs. 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 the imposition of court costs.
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
(O’ 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:
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Temporary Injunction for Protection Against Domestic Violence
with Minor Child(ren)  (9/00)
C-360
   a.  a court reporter is provided by the court.
   b.  electronic audio tape 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.
   c.  no electronic audio tape recording or court reporting services are 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
{name}
,
{address}
, {telephone} 
,
within 2 working days of your receipt of this temporary injunction.  If you are hearing or voice impaired, call
TDD 1-800-955-8771.
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.
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.  This 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 Petitioner's residence, place
of employment, school, or other place prohibited in this injunction; telephoning, contacting or
communicating with Petitioner if prohibited by this injunction; 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. § 2262.
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Temporary Injunction for Protection Against Domestic Violence
with Minor Child(ren)  (9/00)
C-361
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, kidnaping,
false imprisonment, or any other criminal offense resulting in physical injury or death to Petitioner or
any of Petitioner's family or household members who are residing in the same single dwelling unit
with Petitioner.  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, or unless paragraph 14 below provides for contact connected with the
temporary custody of and visitation with minor child(ren).
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:     
.
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 § 790.233,
FLORIDA STATUTES, AND A FIRST DEGREE MISDEMEANOR, FOR RESPONDENT TO
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Temporary Injunction for Protection Against Domestic Violence
with Minor Child(ren)  (9/00)
C-362
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. § 922(g)(8).
4.
Mailing Address.  Respondent shall notify the Clerk of the Court of any change in his or her mailing
address within ten (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 by mail to Respondent’s last known address.  Such service by mail shall be complete
upon mailing.  Rule 12.080, Fla.Fam.L.R.P., section 741.30, Florida Statutes.
5.  
Additional order necessary to protect Petitioner from domestic violence: 
 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.  
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Temporary Injunction for Protection Against Domestic Violence
with Minor Child(ren)  (9/00)
C-363
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.
TEMPORARY CUSTODY OF  MINOR CHILD(REN)
11.
Jurisdiction.   Jurisdiction to determine custody of any minor child(ren) listed in paragraph 12 below
is proper under the Uniform Child Custody Jurisdiction Act (UCCJA).
12.
Temporary Custody of Minor Child(ren).  (    ) Petitioner (    ) Respondent shall have temporary
custody of the parties’ minor child(ren) listed below:
Name               
Birth date
When requested by the custodial parent, law enforcement officers shall use any and all reasonable
and necessary force to physically deliver the minor child(ren) listed above to custodial parent.  The
noncustodial parent shall not take the child(ren) from the custody of custodial parent or any child care
provider or other person entrusted by the custodial parent with the care of the child(ren).
[Initial if applies; write N/A if does not apply]
       
Neither party shall remove the minor child(ren) from the State of Florida, which is the jurisdiction of
this Court, prior to the hearing on this temporary injunction. Violation of this custody order may
constitute a felony of the third degree under sections 787.03 and 787.04, Florida Statutes.
13.
Contact with Minor Child(ren).  Unless otherwise provided in paragraph 14 below,  the
noncustodial parent shall have no contact with the parties’ minor child(ren) until further order of the
Court.
14.  
Other Additional Provisions Relating to the Minor Child(ren).  
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Temporary Injunction for Protection Against Domestic Violence
with Minor Child(ren)  (9/00)
C-364
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.)
DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION
(Provisions in this injunction that do not include a line for the judge to either initial or write N/A
are considered mandatory provisions and should be interpreted to be 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.
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Temporary Injunction for Protection Against Domestic Violence
with Minor Child(ren)  (9/00)
ORDERED on                                            .
CIRCUIT JUDGE
COPIES TO:
Sheriff of                                County
Petitioner (or his or her attorney):        by U. S. Mail          by hand delivery in open court
 
Respondent:           forwarded to sheriff for service
          State Attorney’s Office
         Other:                                                                                            
I CERTIFY the foregoing is a true copy of the original 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
Florida Supreme Court Approved Family Law Form 12.980(d)(2), Temporary Injunction for Protection Against Domestic Violence
without Minor Child(ren)  (9/00)
C-366
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.  The Court has jurisdiction of the parties
and the subject matter under the laws of Florida. 
It is intended that this protection order meet the requirements of 18 U.S.C. § 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.
NOTICE OF HEARING
Because this Temporary Injunction for Protection Against Domestic Violence has been issued
without prior notice to Respondent, 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 the Court should 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 who should pay the filing fees and costs, and
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 the imposition of court costs.
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
(O’ 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:
Florida Supreme Court Approved Family Law Form 12.980(d)(2), Temporary Injunction for Protection Against Domestic Violence
without Minor Child(ren)  (9/00)
C-367
   a.  a court reporter is provided by the court.
   b.  electronic audio tape 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.
   c.  no electronic audio tape recording or court reporting services are 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
{name}
,
{address}
, {telephone} 
,
within 2 working days of your receipt of this temporary injunction.  If you are hearing or voice impaired, call
TDD 1-800-955-8771.
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.  
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.  This 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 Petitioner's residence, place
of employment, school, or other place prohibited in this injunction; telephoning, contacting or
communicating with Petitioner if prohibited by this injunction; 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. § 2262.
Florida Supreme Court Approved Family Law Form 12.980(d)(2), Temporary Injunction for Protection Against Domestic Violence
without Minor Child(ren)  (9/00)
C-368
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, kidnaping,
false imprisonment, or any other criminal offense resulting in physical injury or death to Petitioner or
any of Petitioner's family or household members who are residing in the same single dwelling unit
with Petitioner.  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:     
.
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 § 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
Florida Supreme Court Approved Family Law Form 12.980(d)(2), Temporary Injunction for Protection Against Domestic Violence
without Minor Child(ren)  (9/00)
C-369
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. § 922(g)(8).
4.
Mailing Address.  Respondent shall notify the Clerk of the Court of any change in his or her mailing
address within ten (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 by mail to Respondent’s last known address.  Such service by mail shall be complete
upon mailing.  Rule 12.080, Fla.Fam.L.R.P., section 741.30, Florida Statutes.
5.  
Additional order necessary to protect Petitioner from domestic violence: 
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
Florida Supreme Court Approved Family Law Form 12.980(d)(2), Temporary Injunction for Protection Against Domestic Violence
without Minor Child(ren)  (9/00)
C-370
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.
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.)
DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION
(Provisions in this injunction that do not include a line for the judge to either initial or write N/A
are considered mandatory provisions and should be interpreted to be 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.
ORDERED on                                            .
Florida Supreme Court Approved Family Law Form 12.980(d)(2), Temporary Injunction for Protection Against Domestic Violence
without Minor Child(ren)  (9/00)
CIRCUIT JUDGE
COPIES TO:
Sheriff of                                County
Petitioner (or his or her attorney):        by U. S. Mail          by hand delivery in open court
 
Respondent:           forwarded to sheriff for service
          State Attorney’s Office
         Other:                                                                                            
I CERTIFY the foregoing is a true copy of the original 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
Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic
Violence with Minor Child(ren) (After Notice) (9/00)
C-372
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT, 
IN AND FOR                                                         COUNTY, FLORIDA
Case No.: 
Division:  
                                                                       ,
Petitioner,
and
                                                                        ,
Respondent.
FINAL JUDGMENT OF INJUNCTION 
FOR PROTECTION AGAINST DOMESTIC VIOLENCE
WITH MINOR CHILD(REN) (AFTER NOTICE) 
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.  The Court has jurisdiction of the parties
and the subject matter.  
It is intended that this protection order meet the requirements of 18 U.S.C. § 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.
HEARING
This cause came before the Court for a hearing to determine whether an Injunction for Protection
Against Domestic Violence in this case should be (    ) issued  (    ) modified (    ) extended.
The hearing was attended by 
(    ) Petitioner 
(    ) Respondent
(    ) Petitioner’s Counsel
(    ) Respondent’s Counsel
FINDINGS
On {date} 
, a notice of this hearing was served on Respondent together
with a copy of Petitioner’s petition to this Court and the temporary injunction, if issued.  Service was within
the time required by Florida law, and Respondent was afforded an opportunity to be heard. 
After hearing the testimony of each party present and of any witnesses, or upon consent of
Respondent, the Court finds, based on the specific facts of this case, that Petitioner is a victim of domestic
violence or has reasonable cause to believe that he/she is in imminent danger of becoming a victim of
domestic violence by Respondent.
INJUNCTION AND TERMS
This injunction shall be in full force and effect until(   ) further order of the Court or 
(  )
. This 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
Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic
Violence with Minor Child(ren) (After Notice) (9/00)
C-373
to change or end this injunction at any time.
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 Petitioner's residence, place
of employment, school, or other place prohibited in this injunction; telephoning, contacting or
communicating with Petitioner if prohibited by this injunction; 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. § 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, kidnaping,
false imprisonment, or any other criminal offense resulting in physical injury or death to Petitioner or
any of Petitioner's family or household members who is residing in the same single dwelling unit with
Petitioner.  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 the Petitioner unless otherwise
provided in this section, or unless paragraphs 13 through 19 below provide for contact
connected with the temporary custody of and visitation with minor child(ren).   
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:     
.
Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time.
       
b.  Other provisions regarding contact:  
Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic
Violence with Minor Child(ren) (After Notice) (9/00)
C-374
3. 
Firearms.  Unless paragraph a. is initialed below, Respondent shall not have in his or her
care, custody, possession or control any firearm or ammunition.  It is a violation of section
790.233, Florida Statutes, and a first degree misdemeanor, for the respondent to have in
his or her care, custody, possession or control any firearm or ammunition.  
[Initial if applies; Write N/A if not applicable]
        
a. Respondent is a state or local officer as defined in section 943.10(14), Florida Statutes, who holds
an active certification, who receives or possesses a firearm or ammunition for use in performing
official duties on behalf of the officer’s employing agency and is not prohibited by the court from
having in his or her care, custody, possession or control a firearm or ammunition.  The officer’s
employing agency may prohibit the officer from having in his or her care, custody, possession or
control a firearm or ammunition.
       
b. Respondent shall surrender any firearms and ammunition in the Respondent's possession to the
 County Sheriff's Department.
       
c. Other directives relating to firearms and ammunition:
NOTE:  RESPONDENT IS ADVISED THAT IT IS 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. § 922(g)(8).
4.  
Evaluation/Counseling. 
[Initial all that apply; write N/A if does not apply]
a.  The Court finds that Respondent has:
        
i.  willfully violated the ex parte injunction;
        
ii.  been convicted of, had adjudication withheld on, or pled nolo contendere to a crime
involving violence or a threat of violence;  and/or
         
iii.  in this state or any other state, had at any time a prior injunction for protection entered
against the respondent after a hearing with notice.
Note:  If respondent meets any of the above enumerated criteria, the Court must order the
Respondent to attend a batterers' intervention program unless it makes written factual findings
stating why such a program would not be appropriate.  See § 741.30(6)(d), Florida Statutes.
b.  Within (    )10 days (    )
days, (but no more than 10 days) of the date of this injunction,
Respondent shall enroll in and thereafter without delay complete the following, and Respondent shall
provide proof of such enrollment to the Clerk of Circuit Court within (    )30 days (    )
days,  
(but no more than 30 days) of the date of this injunction:
       
i.  A certified batterers’ intervention program from a list of programs to be provided by the
Court or any entity designated by the Court.  Respondent shall also successfully complete
any substance abuse or mental health evaluation that the assessing program counselor deems
necessary as a predicate to completion of the batterers’ intervention program. 
       
ii.  A substance abuse evaluation at: 
 or a similarly qualified facility and any substance abuse treatment
recommended by that evaluation.
Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic
Violence with Minor Child(ren) (After Notice) (9/00)
C-375
       
iii.  A mental health evaluation by a licensed mental health professional at: 
 or any other similarly qualified facility and any mental health
treatment recommended by that evaluation.
       
iv.  Other: 
        
c.  Although Respondent meets the statutory mandate of attendance at a batterers’ intervention
program, the Court makes the following written findings as to why the condition of batterers’
intervention program would be inappropriate:   
        
d.  Petitioner is referred to a certified domestic violence center and is provided with a list of certified
domestic violence centers in this circuit, which Petitioner may contact.
5. 
Court Costs.   Pursuant to section 741.30(2)(a), Florida Statutes, filing fees to the Clerk of the
Circuit Court and service fees to the sheriff are waived, subject to subsequent order of the Court;
OR costs in the amount of $
 for the filing fee, plus $
 for the sheriff’s fee, for
a total of $
 
are taxed against (    ) Petitioner (    ) Respondent (    ) Other (explain)
,
for which sum let execution issue.  This amount shall be paid to the {county}
 Clerk of
the Circuit Court, within 30 days of the date of this injunction.  If Respondent is directed to pay filing
fees or service fees and Petitioner has previously paid said fees, the clerk shall refund same to
Petitioner, upon payment by Respondent.
6.
Mailing Address.  Respondent shall notify the Clerk of the Court of any change in his or her mailing
address within ten (10) days of the change.  All further papers (excluding pleadings requiring personal
service) shall be served by mail to Respondent’s last known address.  Such service by mail shall be
complete upon mailing.  Rule 12.080, Fla.Fam.L.R.P., section 741.30, Florida Statutes.
7.  
Other provisions necessary to protect Petitioner from domestic violence:
 
Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic
Violence with Minor Child(ren) (After Notice) (9/00)
C-376
TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME
[Initial if applies; Write N/A if not applicable]
8.          Possession of the Home.  (    ) Petitioner (    ) Respondent shall have temporary exclusive use
and 
possession of the dwelling located at: 
.
9.         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.
10.          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, accompanied by a law enforcement officer only,  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 premises shall go with (    )  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 11 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.  
11.         The following other personal possessions  may also be removed from the premises at this time:
12.          Other: 
TEMPORARY CUSTODY OF  AND VISITATION WITH MINOR CHILD(REN) 
13.
Jurisdiction.   Jurisdiction to determine custody of and visitation with any minor child(ren) listed in
paragraph 2 below is proper under the Uniform Child Custody Jurisdiction Act (UCCJA).
14.
Temporary Custody of Minor Child(ren).  (    ) Petitioner (    ) Respondent shall have temporary
custody of the parties’ minor child(ren) listed below:
Name                 
Birth date
Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic
Violence with Minor Child(ren) (After Notice) (9/00)
C-377
When requested by the custodial parent, law enforcement officers shall use any and all reasonable
and necessary force to physically deliver the minor child(ren) listed above to custodial parent.  The
noncustodial parent shall not take the child(ren) from the custody of custodial parent or any child care
provider or other person entrusted by the custodial parent with the care of the child(ren).
15.
Type of Contact/Visitation with Minor Child(ren).    The noncustodial parent shall have:
[Initial one only]
       
a.   no contact with the parties minor child(ren) until further order of the Court. 
         
b.   the following specified visitation with the parties’ minor child(ren), subject to any limitations
set  out below: {specify days and times} 
16.
Limitations on Visitation.     The above specified visitation shall be:
[Initial all that apply; write N/A if does not apply]
       
a.  unsupervised.
       
b.  supervised by the following specified responsible adult:
.
       
c.  at a supervised visitation center located at: 
.
and shall be subject to the available times and rules of the supervised visitation center.  The cost of
such visits shall be paid by (    ) custodial parent (    ) noncustodial parent (    ) both:
.
17.
Arrangements for Contact/Visitation with Minor Child(ren).  
[Initial all that apply; write N/A if does not apply]
       
a.   A responsible person shall coordinate the visitation arrangements of the minor child(ren). 
If specified, the responsible person shall be: {name} 
       
b.  Other conditions for visitation arrangements as follows: 
18.
Exchange of Minor Child(ren).
[Initial all that apply; write N/A if does not apply]
       
a.  The parties shall exchange the child(ren) at  (    ) school or daycare, or  (    ) at the following
location(s): 
       
b.  A  responsible person shall conduct all exchanges of the child(ren).  The noncustodial parent shall
not be present during the exchange.  If specified, the responsible person shall be: {name}            
Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic
Violence with Minor Child(ren) (After Notice) (9/00)
C-378
       
c.  Other conditions for visitation exchange as follows: 
19.
Other Additional Provisions Relating to the Minor Child(ren).  
TEMPORARY SUPPORT
20.
Temporary Alimony.  
[Initial all that apply; write N/A if does not apply]
        
a.  The court finds that there is a need for temporary alimony and that (    ) Petitioner (    )
Respondent (hereinafter Obligor) has the present ability to pay alimony and shall pay temporary
alimony to (    ) Petitioner (    ) Respondent (hereinafter Obligee) in the amount of  $
 per
month, payable (    ) in accordance with Obligor’s employer’s payroll cycle, and in any event, at least
once a month (    ) other {explain} 
beginning {date} 
.  This alimony shall continue until modified by court order, until a
final judgment of dissolution of marriage is entered, until Obligee dies, until this injunction expires, or
until {date} 
,  whichever occurs first.
        
b. (    ) Petitioner (    ) Respondent shall be required to maintain health insurance coverage for the
other party.  Any uncovered medical costs for the party awarded alimony shall be assessed as
follows: 
.
        
c.  Other provisions relating to alimony: 
21.
Temporary Child Support.  
[Initial all that apply; write N/A if does not apply]
        
a.  The Court finds that there is a need for temporary child support and that the noncustodial parent
(hereinafter Obligor) has the present ability to pay child support.  The amounts in the Child Support
Guidelines Worksheet,O” Florida Family Law Form12.902(e), filed by  (    ) Petitioner (    )
Respondent are correct OR the Court makes the following findings:  The Petitioner’s net monthly
income is $ 
, (Child Support Guidelines 
%).  The Respondent’s net monthly income
is  $
, (Child Support Guidelines 
%).  Monthly child care costs are $ 
.
Monthly health/dental insurance costs are $
.
        
b.  Amount.  Obligor shall pay temporary child support in the amount of  $ 
         , per month
Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic
Violence with Minor Child(ren) (After Notice) (9/00)
C-379
payable (    ) in accordance with Obligor’s employer’s payroll cycle, and in any event at least once
a month (    ) other {explain}: 
,
beginning {date} 
, and continuing until further order of the court, or until {date/event}
,
{explain} 
.
If the child support ordered deviates from the guidelines by more than 5%, the factual findings which
support that deviation are: 
        
c. (    ) Petitioner (    ) Respondent shall be required to maintain (    ) health (   ) dental insurance
coverage for the parties’ minor child(ren) so long as reasonably available.  OR (    ) Health (    )
dental insurance is not reasonably available at this time.  
        
d.  Any reasonable and necessary uninsured medical/dental/prescription drug costs for the
minor child(ren) shall be assessed as follows: 
.
        
e.  O” Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security
Number, is incorporated herein by reference.  
        
 f.  Other provisions relating to child support: 
22.
Method of Payment.
[Initial one only]
       
a.  Obligor shall pay any temporary child support/alimony ordered through income deduction, and such
support shall be paid to the state disbursement unit.  Obligor is individually responsible for paying this
support obligation in the event that all or any portion of said support is not deducted from Obligor’s
income.  Obligor shall also pay the applicable state disbursement unit service charge.  Until child
support/alimony payments are deducted from Obligor’s paycheck pursuant to the Income Deduction
Order, Obligor is responsible for making timely payments directly to the state disbursement unit.
       
b.  Temporary child support/alimony shall be paid through the state disbursement unit in the office of
the {name of county}
 County  Clerk of Circuit Court.  Obligor shall also pay the
applicable state disbursement unit service charge.  Income deduction is not in the best interests of
the child(ren) because:
.
       
c.  Other provisions relating to method of payment: 
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.)
DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION
Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic
Violence with Minor Child(ren) (After Notice) (9/00)
C-380
(Provisions in this injunction that do not include a line for the judge to either initial or write N/A are
considered mandatory provisions and should be interpreted to be part of this injunction.)
1.
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, except those regarding child support and/or alimony, which constitutes a criminal act
under section 741.31, Florida Statutes.  When inconsistent with this order, any subsequent
court order issued under Chapter 61, Florida Statutes, shall take precedence over this
order on all matters relating to property division, alimony, child custody, or child support.
2.
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. 
3.
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.
4.
Respondent, upon service of this injunction, shall be deemed to have knowledge of and to be bound
by all matters occurring at the hearing and on the face of this injunction. 
5.
The temporary injunction, if any, entered in this case is  extended until such time as service of this
injunction is effected upon Respondent.
ORDERED on                                            .
CIRCUIT JUDGE
COPIES TO:
Sheriff of                                County
Petitioner (or his or her attorney):               
by U. S. Mail 
                 
by hand delivery in open court (Petitioner must
acknowledge receipt in writing on the face of the original
order - see below.)
Respondent (or his or her attorney):            
forwarded to sheriff for service 
    
                
by hand delivery in open court (Respondent must
acknowledge receipt in writing on the face of the original
order - see below.)
Florida Supreme Court Approved Family Law Form 12.980(e)(1), Final Judgment of Injunction for Protection Against Domestic
Violence with Minor Child(ren) (After Notice) (9/00)
C-381
               
by certified mail (may only be used when
Respondent is present at the hearing and Respondent
fails or refuses to 
acknowledge the receipt of a
certified copy of this 
injunction.)
         State Attorney’s Office
         Batterer’s intervention program (if ordered)
         Central Governmental Depository (if ordered)
         Department of Revenue
         Other:                                                                                            
I CERTIFY the foregoing is a true copy of the original 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
ACKNOWLEDGMENT
I, {Name of Petitioner}
,acknowledge receipt of a
certified copy of this Injunction for Protection.
             
Petitioner
ACKNOWLEDGMENT
I, {Name of Respondent}
, acknowledge receipt of a
certified copy of this Injunction for Protection.
             
Respondent
Florida Supreme Court Approved Family Law Form 12.980(e)(2), Final Judgment of Injunction for Protection Against Domestic
Violence without Minor Child(ren) (After Notice) (9/00)
C-382
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT, 
IN AND FOR                                                         COUNTY, FLORIDA
Case No.: 
Division:  
                                                                       ,
Petitioner,
and
                                                                        ,
Respondent.
FINAL JUDGMENT OF INJUNCTION 
FOR PROTECTION AGAINST DOMESTIC VIOLENCE
WITHOUT MINOR CHILD(REN) (AFTER NOTICE) 
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.  The Court has jurisdiction of the parties
and the subject matter.  
It is intended that this protection order meet the requirements of 18 U.S.C. § 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.
HEARING
This cause came before the Court for a hearing to determine whether an Injunction for Protection
Against Domestic Violence in this case should be (    ) issued  (    ) modified (    ) extended.
The hearing was attended by 
(    ) Petitioner 
(    ) Respondent
(    ) Petitioner’s Counsel
(    ) Respondent’s Counsel
FINDINGS
On {date} 
, a notice of this hearing was served on Respondent together with
a copy of Petitioner’s petition to this Court and the temporary injunction, if issued.  Service was within the
time required by Florida law, and Respondent was afforded an opportunity to be heard. 
After hearing the testimony of each party present and of any witnesses, or upon consent of
Respondent, the Court finds, based on the specific facts of this case, that Petitioner is a victim of domestic
violence or has reasonable cause to believe that he/she is in imminent danger of becoming a victim of
domestic violence by Respondent.
INJUNCTION AND TERMS
This injunction shall be in full force and effect until (   ) further order of the Court (   )
. This 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
Florida Supreme Court Approved Family Law Form 12.980(e)(2), Final Judgment of Injunction for Protection Against Domestic
Violence without Minor Child(ren) (After Notice) (9/00)
C-383
to change or end this injunction at any time.
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 Petitioner's residence, place
of employment, school, or other place prohibited in this injunction; telephoning, contacting or
communicating with Petitioner if prohibited by this injunction; 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. § 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, kidnaping,
false imprisonment, or any other criminal offense resulting in physical injury or death to Petitioner or
any of Petitioner's family or household members who is residing in the same single dwelling unit with
Petitioner.  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 the 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:     
.
Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time.
       
b.  Other provisions regarding contact:  
Florida Supreme Court Approved Family Law Form 12.980(e)(2), Final Judgment of Injunction for Protection Against Domestic
Violence without Minor Child(ren) (After Notice) (9/00)
C-384
3. 
Firearms.  Unless paragraph a. is initialed below, Respondent shall not have in his or her
care, custody, possession or control any firearm or ammunition.  It is a violation of section
790.233, Florida Statutes, and a first degree misdemeanor, for the respondent to have in
his or her care, custody, possession or control any firearm or ammunition.  
[Initial if applies; Write N/A if not applicable]
       
a. Respondent is a state or local officer as defined in section 943.10(14), Florida Statutes, who holds
an active certification, who receives or possesses a firearm or ammunition for use in performing
official duties on behalf of the officer’s employing agency and is not prohibited by the court from
having in his or her care, custody, possession or control a firearm or ammunition.  The officer’s
employing agency may prohibit the officer from having in his or her care, custody, possession or
control a firearm or ammunition.
       
b. Respondent shall surrender any firearms and ammunition in the Respondent's possession to the
 County Sheriff's Department.
       
c. Other directives relating to firearms and ammunition:
NOTE:  RESPONDENT IS ADVISED THAT IT IS 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. § 922(g)(8).
4.  
Evaluation/Counseling. 
[Initial all that apply; write N/A if does not apply]
a.  The Court finds that Respondent has:
        
i.  willfully violated the ex parte injunction;
        
ii.  been convicted of, had adjudication withheld on, or pled nolo contendere to a crime
involving violence or a threat of violence;  and/or
         
iii.  in this state or any other state, had at any time a prior injunction for protection entered
against the respondent after a hearing with notice.
Note:  If respondent meets any of the above enumerated criteria, the Court must order the
Respondent to attend a batterers' intervention program unless it makes written factual findings
stating why such a program would not be appropriate.  See § 741.30(6)(d), Florida Statutes.
b.  Within (    )10 days (    )
 days, (but no more than 10 days) of the date of this injunction,
Respondent shall enroll in and thereafter without delay complete the following, and Respondent shall
provide proof of such enrollment to the Clerk of Circuit Court within (    )30 days (    )
 days, (but
no more than 30 days) of the date of this injunction:
       
i.  A certified batterers’ intervention program from a list of programs to be provided by the
Court or any entity designated by the Court.  Respondent shall also successfully complete
any substance abuse or mental health evaluation that the assessing program counselor deems
necessary as a predicate to completion of the batterers’ intervention program. 
       
ii.  A substance abuse evaluation at: 
 or a similarly qualified facility and any substance abuse treatment
recommended by that evaluation.
Florida Supreme Court Approved Family Law Form 12.980(e)(2), Final Judgment of Injunction for Protection Against Domestic
Violence without Minor Child(ren) (After Notice) (9/00)
C-385
       
iii.  A mental health evaluation by a licensed mental health professional at: 
 or any other similarly qualified facility and any mental health
treatment recommended by that evaluation.
       
iv.  Other: 
       
c.  Although Respondent meets the statutory mandate of attendance at a batterers’ intervention
program, the Court makes the following written findings as to why the condition of batterers’
intervention program would be inappropriate:   
       
d.  Petitioner is referred to a certified domestic violence center and is provided with a list of certified
domestic violence centers in this circuit, which Petitioner may contact.
5. 
Court Costs.   Pursuant to section 741.30(2)(a), Florida Statutes, filing fees to the Clerk of the
Circuit Court and service fees to the sheriff are waived, subject to subsequent order of the Court;
OR costs in the amount of $
 for the filing fee, plus $
 for the sheriff’s fee, for
a total of $
 
are taxed against (    ) Petitioner (    ) Respondent (    ) Other (explain)
,
for which sum let execution issue.  This amount shall be paid to the {county}
 Clerk of
the Circuit Court, within 30 days of the date of this injunction.  If Respondent is directed to pay filing
fees or service fees and Petitioner has previously paid said fees, the clerk shall refund same to
Petitioner, upon payment by Respondent.
6.
Mailing Address.  Respondent shall notify the Clerk of the Court of any change in his or her mailing
address within ten (10) days of the change.  All further papers (excluding pleadings requiring personal
service) shall be served by mail to Respondent’s last known address.  Such service by mail shall be
complete upon mailing.  Rule 12.080, Fla.Fam.L.R.P., section 741.30, Florida Statutes.
7.  
Other provisions necessary to protect Petitioner from domestic violence:
Florida Supreme Court Approved Family Law Form 12.980(e)(2), Final Judgment of Injunction for Protection Against Domestic
Violence without Minor Child(ren) (After Notice) (9/00)
C-386
TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME
[Initial if applies; Write N/A if not applicable]
8.          Possession of the Home.  (    ) Petitioner (    ) Respondent shall have temporary exclusive use
and possession of the dwelling located at: 
.
9.           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.
10.         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, accompanied by a law enforcement officer only,  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 premises shall go with (    )  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 12 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.  
11.        The following other personal possessions  may also be removed from the premises at this time:
12.       Other: 
TEMPORARY SUPPORT
13.
Temporary Alimony.  
[Initial all that apply; write N/A if does not apply]
        
a.  The court finds that there is a need for temporary alimony and that (    ) Petitioner (    )
Respondent (hereinafter Obligor) has the present ability to pay alimony and shall pay temporary
alimony to (    ) Petitioner (    ) Respondent (hereinafter Obligee) in the amount of  $
 per
month, payable (    ) in accordance with Obligor’s employer’s payroll cycle, and in any event, at least
once a month (    ) other {explain} 
beginning {date} 
.  This alimony shall continue until modified by court order, until a
final judgment of dissolution of marriage is entered, until Obligee dies, until this injunction expires, or
until {date} 
,  whichever occurs first.
        
b. (    ) Petitioner (    ) Respondent shall be required to maintain health insurance coverage for the
other party.  Any uncovered medical costs for the party awarded alimony shall be assessed as
follows: 
Florida Supreme Court Approved Family Law Form 12.980(e)(2), Final Judgment of Injunction for Protection Against Domestic
Violence without Minor Child(ren) (After Notice) (9/00)
C-387
.
        
c.  Other provisions relating to alimony: 
            
14.
Method of Payment.
[Initial one only]
       
a.  Obligor shall pay any temporary alimony ordered through income deduction, and such support shall
be paid to the Central Government Depository in 
County.  Obligor is
individually responsible for paying this support obligation in the event that all or any portion of said
support is not deducted from Obligor’s income.  Obligor shall also pay the applicable Central
Government Depository service charge. Until alimony payments are deducted from Obligor’s
paycheck pursuant to the Income Deduction Order, Obligor is responsible for making timely
payments directly to the Central Government Depository.
       
b.  Temporary alimony shall be paid through the Central Government Depository in the office of the
{name of county}
 County  Clerk of Circuit Court.  Obligor shall also pay the
applicable Central Government Depository service charge.
       
c.  Other provisions relating to method of payment: 
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.)
DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION
(Provisions in this injunction that do not include a line for the judge to either initial or write N/A are
considered mandatory provisions and should be interpreted to be part of this injunction.)
1.
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, except those regarding child support and/or alimony, which constitutes a criminal act
under section 741.31, Florida Statutes.  When inconsistent with this order, any subsequent
court order issued under Chapter 61, Florida Statutes, shall take precedence over this
order on all matters relating to property division, alimony, child custody, or child support.
2.
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. 
3.
Reporting alleged violations.  If Respondent violates the terms of this injunction and there has not
Florida Supreme Court Approved Family Law Form 12.980(e)(2), Final Judgment of Injunction for Protection Against Domestic
Violence without Minor Child(ren) (After Notice) (9/00)
C-388
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.
4.
Respondent, upon service of this injunction, shall be deemed to have knowledge of and to be bound
by all matters occurring at the hearing and on the face of this injunction. 
5.
The temporary injunction, if any, entered in this case is extended until such time as service of this
injunction is effected upon Respondent.
ORDERED on                                            .
CIRCUIT JUDGE
COPIES TO:
Sheriff of                                County
Petitioner (or his or her attorney):               
by U. S. Mail 
                 
by hand delivery in open court (Petitioner must
acknowledge receipt in writing on the face of the original
order - see below.)
Respondent (or his or her attorney):            
forwarded to sheriff for service 
    
                
by hand delivery in open court (Respondent must
acknowledge receipt in writing on the face of the original
order - see below.)
               
by certified mail (may only be used when
Respondent is present at the hearing and Respondent
fails or refuses to 
acknowledge the receipt of a
certified copy of this 
injunction.)
         State Attorney’s Office
         Batterer’s intervention program (if ordered)
         Central Governmental Depository (if ordered)
         Department of Revenue
         Other:                                                                                            
I CERTIFY the foregoing is a true copy of the original 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
Florida Supreme Court Approved Family Law Form 12.980(e)(2), Final Judgment of Injunction for Protection Against Domestic
Violence without Minor Child(ren) (After Notice) (9/00)
C-389
ACKNOWLEDGMENT
I, {Name of Petitioner}
,acknowledge receipt of a
certified copy of this Injunction for Protection.
             
Petitioner
ACKNOWLEDGMENT
I, {Name of Respondent}
,acknowledge receipt of a
certified copy of this Injunction for Protection.
             
Respondent
Florida Supreme Court Approved Family Law Form 12.980(f), Order of Dismissal of Temporary Injunction for Protection Against
Domestic Violence or Repeat Violence (9/00)
C-390
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT,
IN AND FOR                                                       COUNTY, FLORIDA
Case No.: 
Division: 
                                                                      ,
Petitioner,
and
                                                                       ,
Respondent.
ORDER OF DISMISSAL OF TEMPORARY INJUNCTION FOR
PROTECTION AGAINST (    ) DOMESTIC VIOLENCE (    ) REPEAT VIOLENCE
THIS CAUSE came before the Court on {date} 
, upon Petitioner’s
action for an injunction for protection against domestic violence or repeat violence, and it appearing to the
Court as follows:
[ / all that apply]
       
Petitioner failed to appear at the hearing scheduled in this cause.
       
Petitioner appeared at the hearing but desires to voluntarily dismiss this action.
       
The evidence presented is insufficient under Florida law (section 741.30 or 784.046, Florida Statutes)
to allow the Court to issue an injunction for protection against domestic or repeat violence.
Accordingly, the case is dismissed without prejudice.
      
Petitioner shall pay filing fees to the Clerk of the Circuit Court for a total of $
, for
which sum let execution issue.  This amount shall be paid to the {county} 
Clerk of the Circuit Court, within 30 days of the date of this order.
ORDERED on                                            .
CIRCUIT JUDGE
COPIES TO:
Sheriff of                          County
Petitioner         by U.S. Mail         by hand delivery in open court
Respondent         by U.S. Mail         by hand delivery in open court
         State Attorney’s Office
         Other:                                                                                            
I CERTIFY the foregoing is a true copy of the original 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
Instructions for Florida Supreme Court Approved Family Law Form 12.980(g), Petition for Injunction for Protection Against Repeat
Violence (9/00)
C-391
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM
12.980(g), 
PETITION FOR INJUNCTION FOR PROTECTION AGAINST REPEAT VIOLENCE
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, battery,
sexual battery, or stalking.  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, O’ Florida Supreme Court Approved Family Law Form
12.980(b), 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 were
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, O”
Florida Supreme Court Approved Family Law Form 12.980(l).  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
Instructions for Florida Supreme Court Approved Family Law Form 12.980(g), Petition for Injunction for Protection Against Repeat
Violence (9/00)
C-392
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), O” Florida
Supreme Court Approved Family Law Form 12.980(m), 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 the imposition of court costs. 
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,O’ Florida
Supreme Court Approved Family Law Form 12.980 (h); 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.
C-393
Florida Supreme Court Approved Family Law Form 12.980(g), Petition for Injunction for Protection Against Repeat Violence (9/00)
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: {address, city, state, zip code} 
.
[/ if applies]
          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 (    ) is not living at home.
2.
Filing Fees 
[ / one only]
       
a.  Petitioner is paying the filing fee and sheriff's (or other authorized law enforcement agency's)
service fees.
       
b.  Petitioner does not have enough money to pay the filing fee or service fees and is filing an
Affidavit and Motion for Waiver of Fees for Petition for Injunction for Protection, O”
Florida  Supreme Court Approved Family Law Form 12.980(a), and a Family Law Financial
Affidavit, O” Florida Family Law Rules of Procedure Form 12.902(b) or (c).  Petitioner asks that
he/she not have to pay the fees necessary to process the petition and serve the injunction and any
motions or orders needed to enforce the injunction, subject to later order(s) of the Court about the
payment of such fees.
3.
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: {address, city, state, and zip code} 
.
Respondent’s Driver’s License number is: {if known}  
.
C-394
Florida Supreme Court Approved Family Law Form 12.980(g), Petition for Injunction for Protection Against Repeat Violence (9/00)
2.
Petitioner has known Respondent since {date}  
.
3.
Respondent's last known place of employment:  
Employment address:  
Working hours:  
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 repeat 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 a repeat violence injunction for protection against
Petitioner? 
        Yes            No
If yes, what happened in that case? (include city, state, and 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, battery, sexual battery,
or stalking 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. 
On {date} 
, at {location}
,
Respondent  
C-395
Florida Supreme Court Approved Family Law Form 12.980(g), Petition for Injunction for Protection Against Repeat Violence (9/00)
G Check 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 
G Check here if you are attaching additional pages to continue these facts.
6.
Petitioner genuinely fears repeat violence by Respondent.  Explain:
7.
Additional Information
[/ 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 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 mail, by e-mail, in writing, through another
C-396
Florida Supreme Court Approved Family Law Form 12.980(g), Petition for Injunction for Protection Against Repeat Violence (9/00)
person, or in any other manner;
d.  ordering Respondent not to use or possess any guns or firearms;
[/ 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: 
;  and 
any other terms the Court deems necessary for the safety of Petitioner and Petitioner’s immediate
family.
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 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 
Printed Name: 
Address:  
City, State, Zip:  
Telephone Number:  
Fax Number: 
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                                                
Instructions for Florida Supreme Court Approved Family Law Form 12.980(h), Supplemental Affidavit in Support of Petition for
Injunction for Protection Against Domestic Violence or Repeat Violence (9/00)
C-397
INSTRUCTIONS FOR FLORIDA  SUPREME COURT APPROVED FAMILY LAW FORM
12.980(h),
SUPPLEMENTAL AFFIDAVIT IN SUPPORT OF PETITION FOR INJUNCTION FOR
PROTECTION AGAINST DOMESTIC VIOLENCE OR REPEAT VIOLENCE
When should this form be used?
You may use this form if your Petition for Injunction for Protection Against Domestic Violence, O’
Florida Supreme Court Approved Family Law Form 12.980(b), or your Petition for Injunction for
Protection Against Repeat Violence, O’ Florida Supreme Court Approved Family Law Form 12.980(g),
was denied by the judge. You should use this supplemental affidavit to add facts or clarify the facts you
wrote in your original petition.  For a domestic violence case, you should include FACTS that establish that
you have been a victim of violence or are in imminent danger of becoming a victim of violence from the
respondent.  For a repeat violence case, you should include FACTS that establish that you or a member of
your immediate family have or has been a victim of at least two prior incidents of violence, that one of those
incidents occurred within the last six months and that there is an immediate and present risk of danger to you
or a member of your immediate family.
This form should be typed or printed in black ink.  After completing this form, you should sign the form before
a notary public or the clerk of the circuit court.  You should then file the original with the clerk in the
county where the petition was filed and keep a copy for your records.
What should I do next?
After you complete this supplemental affidavit, the clerk will attach it to your original petition and all the
documents will be submitted to the judge as your “Amended Petition.”
Florida Supreme Court Approved Family Law Form 12.980(h), Supplemental Affidavit in Support of Petition for Injunction for
Protection Against Domestic Violence or Repeat Violence (9/00)
C-398
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT,
IN AND FOR                                                       COUNTY, FLORIDA
Case No.: 
Division: 
                                                                      ,
Petitioner,
and
                                                                       ,
Respondent.
SUPPLEMENTAL AFFIDAVIT IN SUPPORT OF  PETITION FOR
INJUNCTION FOR PROTECTION AGAINST
(    ) DOMESTIC VIOLENCE (    ) REPEAT VIOLENCE
I, {full legal name} 
, being sworn, certify that the
following statements are true:
1.
On {date} 
, at {place and address} 
,
Respondent said or did the following things that hurt me or a member of my immediate family and
made me afraid for my or my family member’s safety:
9 Check here if you are attaching additional pages to continue these facts.
2.
On {date} 
, at {place and address} 
,
the following event(s) took place: 
Florida Supreme Court Approved Family Law Form 12.980(h), Supplemental Affidavit in Support of Petition for Injunction for
Protection Against Domestic Violence or Repeat Violence (9/00)
C-399
9 Check here if you are attaching additional pages to continue these facts.
3.
       
Check here if you are attaching copies of medical records for treatment you may have
received for injuries referred to in your petition or in this supplemental affidavit, or copies of
any police or sheriff reports concerning incidents of violence involving you and Respondent.
I understand that I am swearing or affirming under oath to the truthfulness of the claims
made in this supplemental affidavit 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                                               
Instructions for Florida Supreme Court Approved Family Law Form 12.980(i), Petitioner’s Request for Confidential Filing of Address
(9/00)
C-400
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM
12.980(i),
PETITIONER’S REQUEST FOR CONFIDENTIAL FILING OF ADDRESS
When should this form be used?
If you are the petitioner in a petition for injunction for protection against domestic violence action and you
fear that disclosing your address to the respondent would put you in danger, you should complete this form
and file it with the clerk of the circuit court.
You cannot use this form in a petition for injunction for protection against repeat violence action.
This form should be typed or printed in black ink.  After completing this form, you should file the original with
the clerk of the circuit court in the county where your petition was filed and keep a copy for your records.
C-401
Florida Supreme Court Approved Family Law Form 12.980(i), Petitioner’s Request for Confidential Filing of Address (9/00)
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT,
IN AND FOR                                                       COUNTY, FLORIDA
Case No.: 
Division: 
                                                                      ,
Petitioner,
and
                                                                       ,
Respondent.
PETITIONER’S REQUEST FOR CONFIDENTIAL FILING OF ADDRESS
I, {full legal name} 
, Petitioner in the above injunction
for protection against domestic violence action, request that the Court maintain and hold as confidential, the
following address:
Address 
     
     
City 
 State 
 Zip 
     
Telephone (area code and number) 
This request is being made for the purpose of keeping the location of my residence unknown to
Respondent for safety reasons pursuant to section 741.30, Florida Statutes.
Dated:                                                   
Signature of Petitioner
CLERK’S CERTIFICATE AS TO PETITIONER’S REQUEST FOR
CONFIDENTIAL FILING OF ADDRESS
I, 
, as Clerk of the Circuit Court, do hereby certify that I
received and filed the above and will keep the above address confidential, subsequent to further order of the
Court relative to such confidentiality.
CLERK OF THE CIRCUIT COURT
(SEAL)
By: 
      Deputy Clerk
Instructions for Florida Supreme Court Approved Family Law Form 12.980(j), Motion for Extension of Injunction for Protection
Against Domestic Violence or Repeat Violence (9/00)
C-402
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM
12.980(j), 
MOTION FOR EXTENSION OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC
VIOLENCE OR REPEAT VIOLENCE
When should this form be used?
If you are the petitioner on a previously entered injunction for protection against domestic violence or repeat
violence and that injunction will soon expire, you may use this form to request that the court extend the
injunction.  You must file a motion for extension BEFORE the previously entered order expires.
This form should be typed or printed in black ink.  After completing this form, you should sign it before a
notary public or the clerk of the circuit court.  You should then file the original with the clerk in the county
where the petition was filed and 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 next?
For your case to proceed, you will need to set a hearing on your motion.   You must properly notify the other
party of the motion and hearing.  You should check with the clerk of court for information on the local
procedure for scheduling a hearing.   When you know the date and time of your hearing, you should file
Notice of Hearing (General), O” Florida Supreme Court Approved Family Law Form 12.923, or other
appropriate notice of hearing form.  You will need to serve a copy of your motion and Notice of Hearing to
the other party.  Service of your motion must be in a manner that is reasonably calculated to apprise the other
party of your motion and the hearing.  *Please note that if notice is mailed, the court in certain circumstances
may not consider mailing to be adequate notice.  If you want to be sure, you should consider using certified
mail, return receipt requested, or having the motion personally served.  This is a technical area of the law;
if you have any questions about it, you should consult a lawyer.  For more information on personal service,
see the instructions for Summons:  Personal Service on an Individual, O” Florida Family Law Rules
of Procedure Form 12.910(a). 
You will need to appear at the hearing on your motion.  After the hearing, if the judge grants your motion, he
or she will prepare an Order Extending Injunction for Protection Against Domestic Violence of
Repeat Violence, 
O’ Florida Supreme Court Approved Family Law Form 12.980(n).  After the judge signs
the order, the clerk will provide you with the necessary copies.  Make sure that you keep a certified copy
of the previously entered injunction AND a certified copy of the order extending that injunction
with you at all times.
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 or repeat
violence forms and will answer any question that you may have.
Instructions for Florida Supreme Court Approved Family Law Form 12.980(j), Motion for Extension of Injunction for Protection
Against Domestic Violence or Repeat Violence (9/00)
C-403
Special notes...
With this form you may also file the following:
C
Petitioner’s Request for Confidential Filing of Address, O’ Florida Supreme Court Approved
Family Law Form 12.980(i), if your petition is for protection against domestic violence and you wish
to keep your address confidential.
C
When completing this form, you should make sure that your reasons for requesting that  the injunction
be extended are stated clearly and that you include all relevant facts.
Florida Supreme Court Approved Family Law Form 12.980(j), Motion for Extension of Injunction for Protection Against Domestic
Violence or Repeat Violence (9/00)
C-404
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT, 
IN AND FOR                                                         COUNTY, FLORIDA
Case No.: 
Division:  
                                                                       ,
Petitioner,
and
                                                                        ,
Respondent.
MOTION FOR EXTENSION OF INJUNCTION FOR  PROTECTION AGAINST (    )
DOMESTIC VIOLENCE (    ) 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.  However, if this
is a domestic violence case and you fear that disclosing your address to the respondent would put
you in danger, you should complete and file Petitioner's Request for Confidential Filing of Address,
O’ Florida Supreme Court Approved Family Law Form 12.980(i), and write "confidential" in the space
provided on this form for your address and telephone number.)
1.
Petitioner currently lives at: {street address} 
{city, state and zip code} 
Telephone Number: {area code and number} 
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.)
New information about Respondent, since the current injunction was issued:  (If known, write Respondent’s
new address, place of employment, physical description, vehicle, aliases or nicknames, or attorney’s name.)
 
Florida Supreme Court Approved Family Law Form 12.980(j), Motion for Extension of Injunction for Protection Against Domestic
Violence or Repeat Violence (9/00)
C-405
SECTION III.  CASE HISTORY AND REASON FOR SEEKING EXTENSION OF INJUNCTION
1.
Describe any attempts since the date of the current injunction by either Petitioner or Respondent to
get an injunction for protection in this or any other court (other than the injunction you are asking to
extend in this motion).  
2.
Describe any other court cases (including city, state, and case numbers, if known) since the date of
the current injunction between Petitioner and Respondent, including any cases involving the parties'
minor child(ren), divorce, juvenile dependency, guardianship, or other civil or criminal cases.  
3.
Petitioner requests that the previously entered injunction for protection against domestic violence or
repeat violence be extended for the following specific reasons: {State in detail why you wish the
injunction to remain in effect.} 
 
G Check here if you are attaching additional pages to continue these facts.
4.
Petitioner genuinely fears the continued threat of violence by Respondent.
SECTION IV.  REQUESTED RELIEF
1.
Petitioner understands that the Court will hold a hearing on this motion and that he or she must appear
at the hearing.
2.
Petitioner asks the Court to enter an order in this case that extends the previously entered injunction
for a period of (    )  
 or (    ) until modified or dissolved by the court.
I certify that a copy of this document was [/ one only] (    )  mailed  (    ) faxed and mailed (    )
mailed by certified mail, return receipt requested, (    ) furnished to a law enforcement officer for personal
service to the person(s) listed below on {date} 
.
Other party or his/her attorney:
Name: 
Address: 
City, State, Zip: 
Florida Supreme Court Approved Family Law Form 12.980(j), Motion for Extension of Injunction for Protection Against Domestic
Violence or Repeat Violence (9/00)
C-406
Fax Number: 
I understand that I am swearing or affirming under oath to the truthfulness of the claims
made in this motion 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                                                
Instructions for Florida Supreme Court Approved Family Law Form 12.980(k), Motion for Modification of  Injunction for Protection
Against Domestic Violence or Repeat Violence (9/00)
C-407
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM
12.980(k), 
MOTION FOR MODIFICATION OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC
VIOLENCE OR REPEAT VIOLENCE
When should this form be used?
This form may be used if you are a party to a previously entered injunction for protection against domestic
violence or repeat violence and you want the court to modify the terms of the injunction.  If you use this
form, you are called the moving party.  
This form should be typed or printed in black ink.  After completing this form, you should sign the form before
a notary public or the clerk of the circuit court.  You should then file the original with the clerk in the
county where the original petition was filed and keep a copy for your records.  You must file a motion for
modification before the previously entered order expires.   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 next?
For your case to proceed, you will need to set a hearing on your  motion.  You must properly notify the other
party of the motion and hearing.  You should check with the clerk of court for information on the local
procedure for scheduling a hearing.   When you know the date and time of your hearing, you should file
Notice of Hearing (General), O” Florida Supreme Court Approved Family Law Form 12.923, or other
appropriate notice of hearing form.  You will need to serve a copy of your motion and Notice of Hearing to
the other party.  Service of your motion must be in a manner that is reasonably calculated to apprise the other
party of your motion and the hearing.  *Please note that if notice is mailed, the court in certain circumstances
may not consider mailing to be adequate notice.  If you want to be sure, you should consider using certified
mail, return receipt requested, or having the motion personally served.  If you are not represented by an
attorney in this action, you must file proof that the other party personally received notice of your
motion.   This is a technical area of the law; if you have any questions about it, you should consult a lawyer.
For more information on personal service, see the instructions for Summons: Personal Service on an
Individual, O” Florida Family Law Rules of Procedure Form 12.910(a). 
You will need to appear at a hearing on your motion for modification of injunction.  After the hearing, if the
judge grants your motion, he or she will prepare a new injunction for protection that contains the modifications.
After the judge signs the new injunction, the clerk will provide you with the necessary copies.  Make sure
that you keep a certified copy of the new injunction with you at all times!
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 or repeat
violence forms and will answer any question that you may have.
Special notes...
If the injunction you are seeking to modify is for domestic violence and you want the court to modify alimony,
Instructions for Florida Supreme Court Approved Family Law Form 12.980(k), Motion for Modification of  Injunction for Protection
Against Domestic Violence or Repeat Violence (9/00)
C-408
custody of a minor child(ren), or child support, you must establish that there has been a change in
circumstance(s), as required by chapters 61 Florida Statutes, or 741 Florida Statutes, as applicable, that
requires this (these) modification(s).  Be sure that you make these change(s) clear in your motion. 
With this form you may also file the following:
C
Petitioner’s Request for Confidential Filing of Address, O’ Florida Supreme Court Approved
Family Law Form 12.980(i), if your petition is for domestic violence and you wish to keep your
address confidential.
C
Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, O’ Florida Supreme Court
Approved Family Law Form 12.902(d), must be completed and attached if the modification(s) you
are seeking involves temporary custody of any minor child(ren). 
C
Family Law Financial Affidavit, O’ Florida Family Law Rules of Procedure Form 12.902(b) or
(c), must be completed and attached if the modification(s) you are seeking involves temporary
alimony or temporary child support. 
C
When completing this form, you should make sure that your reasons for requesting that the injunction
be modified are stated clearly and that you include all relevant facts.
Florida Supreme Court Approved Family Law Form 12.980(k), Motion for Modification of  Injunction for Protection Against
Domestic Violence or Repeat Violence (9/00)
C-409
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT, 
IN AND FOR                                                         COUNTY, FLORIDA
Case No.: 
Division:  
                                                                       ,
Petitioner,
and
                                                                        ,
Respondent.
MOTION FOR MODIFICATION OF INJUNCTION FOR  PROTECTION AGAINST (    )
DOMESTIC VIOLENCE (    ) REPEAT VIOLENCE 
I, {full legal name} 
, being sworn, certify that the following
statements are true:
SECTION  I.  
MOVING PARTY (This section is about you.  It must be completed.   However,
if you are the Petitioner and this is a domestic violence case and you fear that disclosing your
address to the respondent would put you in danger, you should complete and file Petitioner's Request
for Confidential Filing of Address, O’ Florida Supreme Court Approved Family Law Form 12.980(i), and
write "confidential" in the space provided on this form for your address and telephone number.)
1.
Moving Party is the (     ) Petitioner (     )Respondent in this case.
2.
Moving Party currently lives at: {street address} 
{city, state and zip code} 
Telephone Number: {area code and number} 
3.
Moving Party's attorney's name, address and telephone number is: 
.
(If you do not have an attorney, write "none.")
SECTION II. 
  NEW INFORMATION
New information since the previous injunction was issued:  (If known, write the other party's new address,
place of employment, physical description, vehicle, aliases or nicknames, or attorney’s name.)
SECTION III.  CASE HISTORY AND REASON FOR SEEKING MODIFICATION OF
INJUNCTION
Florida Supreme Court Approved Family Law Form 12.980(k), Motion for Modification of  Injunction for Protection Against
Domestic Violence or Repeat Violence (9/00)
C-410
1.
Describe any attempts since the date of the current injunction by either Petitioner or Respondent to
get an injunction for protection in this or any other court (other than the injunction you are asking to
modify in this motion).  
3.
Describe any other court cases (including case numbers, if known) since the date of the current
injunction between Petitioner and Respondent, including any cases involving the parties' minor
child(ren), divorce, juvenile dependency, guardianship, or other civil or criminal cases.  
4.
Moving Party requests that the previously entered injunction for protection against domestic violence
or repeat violence be modified for the following specific reasons: {State why you wish the
injunction to be changed.} 
G Check here if you are attaching additional pages to continue these facts.
SECTION IV.  REQUESTED RELIEF
1.
Moving Party understands that the court will hold a hearing on this motion and that he or she must
appear at the hearing.
2.
Moving Party asks the Court to enter an order in this case, that modifies the previously entered
injunction in the following ways: {State how you wish the injunction to be changed.}  
Florida Supreme Court Approved Family Law Form 12.980(k), Motion for Modification of  Injunction for Protection Against
Domestic Violence or Repeat Violence (9/00)
C-411
I certify that a copy of this document was [/ one only] (    )  mailed  (    ) faxed and mailed (    )
mailed by certified mail, return receipt requested, (    ) furnished to a law enforcement officer for personal
service to the person(s) listed below on {date} 
.
Other party or his/her attorney:
Name: 
Address: 
City, State, Zip: 
Fax Number: 
I understand that I am swearing or affirming under oath to the truthfulness of the claims
made in this motion and that the punishment for knowingly making a false statement includes fines
and/or imprisonment.
Dated:                                                    
Signature of Party
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                                                
C-412
Florida Supreme Court Approved Family Law Form 12.980(l), Temporary Injunction for Protection Against Repeat Violence  (9/00)
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT, 
IN AND FOR                                                         COUNTY, FLORIDA
Case No.: 
Division:  
                                                                       ,
Petitioner,
and
                                                                        ,
Respondent.
TEMPORARY INJUNCTION FOR PROTECTION AGAINST REPEAT VIOLENCE 
The Petition for Injunction for Protection Against Repeat Violence under section 784.046, Florida
Statutes, and other papers filed in this Court have been reviewed.  The Court has jurisdiction of the parties
and the subject matter under the laws of Florida.  The term “Petitioner” as used in this injunction includes the
person on whose behalf this injunction is entered.
It is intended that this protection order meet the requirements of 18 U.S.C. § 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 Repeat Violence has been issued without
notice to Respondent, 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 the Court should issue a Final Judgment of Injunction for Protection Against Repeat
Violence, which shall remain in effect until modified or dissolved by the Court, and whether other things
should be ordered, including, for example, such matters as who should pay the filing fees and costs. 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, or dismissed, and/or additional
orders may be granted, including the imposition of court costs.  All witnesses and evidence, if any, must be
presented at this time.
   
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.  electronic audio tape 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
C-413
Florida Supreme Court Approved Family Law Form 12.980(l), Temporary Injunction for Protection Against Repeat Violence  (9/00)
party’s expense.
   c.  no electronic audio tape recording or court reporting services are 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
{name}
,
{address}
, {telephone} 
,
within 2 working days of your receipt of this temporary injunction.  If you are hearing or voice impaired, call
TDD 1-800-955-8771.
SECTION II. FINDINGS
The statements made under oath by Petitioner make it appear that section 784.046, Florida Statutes,
applies to the parties, that Petitioner is a victim of repeat violence and that an immediate and present danger
of repeat violence exists to Petitioner or to a member of Petitioner's immediate family.
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.  This 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.
Willful violation of the terms of this injunction, such as refusing to vacate the dwelling which
the parties share, going to Petitioner's residence, place of employment, school, or other place
prohibited in this injunction, telephoning, contacting or communicating with Petitioner, if prohibited
by this injunction, or committing an act of repeat 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.
Any party violating this injunction may be subject to civil or indirect criminal contempt
proceedings, including the imposition of a fine or imprisonment, and also may be charged with a
crime punishable by a fine, jail, or both, as provided by Florida Statutes.  
ORDERED and ADJUDGED:
1.
Violence Prohibited.  Respondent shall not commit, or cause any other person to commit, any acts
of violence against Petitioner, including assault, battery, sexual battery, or stalking.  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 the Petitioner unless otherwise
C-414
Florida Supreme Court Approved Family Law Form 12.980(l), Temporary Injunction for Protection Against Repeat Violence  (9/00)
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:     
[Initial if applies; Write N/A if not applicable]
       
b.  Respondent may not knowingly come within 100 feet of Petitioner’s automobile at any time. 
       
c.  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 Respondent's possession to the
 County Sheriff's Department.
____
c. Other directives relating to firearms and ammunition:
4.
Mailing Address.  Respondent shall notify the Clerk of the Court of any change in his or her mailing
address within ten (10) days of the change.  All further papers (excluding pleadings requiring personal
service) shall be served by mail to Respondent’s last known address.  Such service by mail shall be
complete upon mailing.  Rule 12.080, Fla.Fam.L.R.P., section 784.046, Florida Statutes.
5.
Additional order(s) necessary to protect Petitioner from repeat violence: 
C-415
Florida Supreme Court Approved Family Law Form 12.980(l), Temporary Injunction for Protection Against Repeat Violence  (9/00)
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.)
SECTION V.  DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS
INJUNCTION  
(Provisions in this injunction that do not include a line for the judge to either initial or write N/A are
considered mandatory provisions and should be interpreted to be 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 and enforceable 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 a warrant pursuant to section 901.15, Florida
Statutes, for any violation of its provisions, which constitutes a criminal act under section 784.047,
Florida Statutes. 
3.
Should any Florida law enforcement officer having jurisdiction have probable cause to believe that
Respondent has knowingly violated this injunction, the officer may arrest Respondent, confine him/her
in the county jail without bail, and shall bring him/her before the Initial Appearance Judge on the next
regular court day so that Respondent can be dealt with according to law. The arresting agent shall
notify the State Attorney's Office immediately after arrest. THIS INJUNCTION IS
ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW ENFORCEMENT OFFICERS
MAY EFFECT ARRESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES.
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.
ORDERED on                                            .
CIRCUIT JUDGE
COPIES TO:
Sheriff of 
 County
Petitioner          by U. S. Mail         by hand delivery 
Respondent:          forwarded to sheriff for service
         Other: 
C-416
Florida Supreme Court Approved Family Law Form 12.980(l), Temporary Injunction for Protection Against Repeat Violence  (9/00)
I CERTIFY the foregoing is a true copy of the original 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
Florida Supreme Court Approved Family Law Form 12.980(m), Final Judgment of Injunction for Protection Against Repeat Violence
(After Notice) (9/00)
C-417
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT, 
IN AND FOR                                                         COUNTY, FLORIDA
Case No.: 
Division:  
                                                                       ,
Petitioner,
and
                                                                        ,
Respondent.
FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST 
REPEAT VIOLENCE (AFTER NOTICE)
The Petition for Injunction for Protection Against Repeat Violence under section 784.046, Florida
Statutes, and other papers filed in this Court have been reviewed.  The Court has jurisdiction of the parties
and the subject matter. The term “Petitioner” as used in this injunction includes the person on whose behalf
this injunction is entered.
It is intended that this protection order meet the requirements of 18 U.S.C. § 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.
HEARING
This cause came before the Court for a hearing to determine whether an Injunction for Protection
Against Repeat Violence in this case should be (    ) issued (    ) modified (    ) extended.
The hearing was attended by
(    ) Petitioner 
(    ) Respondent
(    ) Petitioner’s Counsel
(    ) Respondent’s Counsel
SECTION II. FINDINGS
On {date} 
, a notice of this hearing was served on Respondent together
with a copy of Petitioner’s petition to this Court and the temporary injunction, if issued.  Service was within
the time required by Florida law, and Respondent was afforded an opportunity to be heard. 
After hearing the testimony of each party present and of any witnesses, or upon consent of
Respondent, the Court finds, based on the specific facts of this case, that Petitioner is a victim of repeat
violence.
SECTION III.  INJUNCTION AND TERMS
This injunction shall be in full force and effect until (   ) further order of the Court (   )
{date} 
.  This injunction is valid and enforceable throughout all counties in
Florida Supreme Court Approved Family Law Form 12.980(m), Final Judgment of Injunction for Protection Against Repeat Violence
(After Notice) (9/00)
C-418
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.                                                                                
                                                                                                                                                            
Willful violation of the terms of this injunction, such as refusing to vacate the dwelling which
the parties share, going to Petitioner's residence, place of employment, school, or other place
prohibited in this injunction, telephoning, contacting or communicating with Petitioner, if prohibited
by this injunction, or committing an act of repeat 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.
Any party violating this injunction shall be subject to civil or indirect criminal contempt
proceedings, including the imposition of a fine or imprisonment, and also may be charged with a
crime punishable by a fine, jail, or both, as provided by Florida Statutes. 
ORDERED and ADJUDGED:
1. 
Violence Prohibited.  Respondent shall not commit, or cause any other person to commit, any acts
of violence against Petitioner, including assault, battery, sexual battery, or stalking.  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:     
.
[Initial if applies; Write N/A if not applicable]
           b.   Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time.
           c.   Other provisions regarding contact:  
Florida Supreme Court Approved Family Law Form 12.980(m), Final Judgment of Injunction for Protection Against Repeat Violence
(After Notice) (9/00)
C-419
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.
       
c. Other directives relating to firearms and ammunition:
4.
Court Costs.   Pursuant to section 784.046(3)(b), Florida Statutes, filing fees to the Clerk of the
Circuit Court and service fees to the sheriff are waived, subject to subsequent order of the court; OR
costs in the amount of $
 for the filing fee, plus $
 for the sheriff’s fee, for
a total of $
are taxed against (    ) Petitioner (    ) Respondent (    ) Other {explain} 
,
for which sum let execution issue.  This amount shall be paid to the office of the {name of county}
 Clerk of the Circuit Court, within 30 days of the date of this injunction. 
If Respondent is directed to pay filing fees or service fees and Petitioner has previously paid said
fees, the clerk shall refund same to Petitioner, upon payment by Respondent.  
5.
Mailing Address.  Respondent shall notify the Clerk of the Court of any change in his or her mailing
address within ten (10) days of the change.  All further papers (excluding pleadings requiring personal
service) shall be served by mail to Respondent’s last known address.  Such service by mail shall be
complete upon mailing.  Rule 12.080, Fla.Fam.L.R.P., section 784.046, Florida Statutes.
6.
Additional order(s) necessary to protect Petitioner from repeat violence:
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.)
SECTION V.  DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS 
INJUNCTION 
(Provisions in this injunction that do not include a line for the judge to either initial or write N/A are
considered mandatory provisions and should be interpreted to be part of this injunction.)
1.
This injunction is valid and enforceable in all counties of the State of Florida.  Violation of
this injunction should be reported to the appropriate law enforcement agency.  Law enforcement
Florida Supreme Court Approved Family Law Form 12.980(m), Final Judgment of Injunction for Protection Against Repeat Violence
(After Notice) (9/00)
C-420
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 a warrant pursuant to section 901.15, Florida
Statutes, for any violation of its provision, which constitutes a criminal act under section 784.047,
Florida Statutes.
2.
Should any Florida law enforcement officer having jurisdiction have probable cause to believe that
Respondent has knowingly violated this injunction, the officer may arrest Respondent, confine him/her
in the county jail without bail, and shall bring him/her before the Initial Appearance Judge on the next
regular court day so that Respondent can be dealt with according to law. The arresting agent shall
notify the State Attorney's Office immediately after arrest. THIS INJUNCTION IS
ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW ENFORCEMENT OFFICERS
MAY EFFECT ARRESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES.
3.
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.
4.
Respondent, upon service of this injunction, shall be deemed to have knowledge of and to be bound
by all matters occurring at the hearing and on the face of this injunction.
5.
The temporary injunction, if any, entered in this case is extended until such time as service of this
injunction is effected upon Respondent.
ORDERED on                                            .
CIRCUIT JUDGE
COPIES TO:
Sheriff of                                County
Petitioner (or his or her attorney):
 
by U. S. Mail 
     
 
by hand delivery in open court (Petitioner must
acknowledge receipt in writing on the face of
the original order - see below)
Respondent (or his or her attorney):
forwarded to sheriff for service 
     
by hand delivery in open court (Respondent must
acknowledge receipt in writing on the face of
the original order - see below)
     
 
by certified mail (may only be used when
Respondent is present at the hearing and
Respondent fails or refuses to acknowledge the
receipt of certified copy of this injunction)
         State Attorney’s Office
         Other:                                                                                            
Florida Supreme Court Approved Family Law Form 12.980(m), Final Judgment of Injunction for Protection Against Repeat Violence
(After Notice) (9/00)
C-421
I CERTIFY the foregoing is a true copy of the original 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
ACKNOWLEDGMENT
I, {Name of Petitioner}
, acknowledge receipt of a
certified copy of this Injunction for Protection.
             
Petitioner
ACKNOWLEDGMENT
I, {Name of Respondent}
,acknowledge receipt of a
certified copy of this Injunction for Protection.
             
Respondent
Florida Supreme Court Approved Family Law Form 12.980(n), Order Extending Injunction for Protection Against Domestic Violence
or Repeat Violence (9/00)
C-422
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT,
IN AND FOR                                                       COUNTY, FLORIDA
Case No.: 
Division: 
                                                                      ,
Petitioner
and
                                                                       ,
Respondent.
ORDER EXTENDING  INJUNCTION FOR PROTECTION AGAINST
(    ) DOMESTIC VIOLENCE (    ) REPEAT VIOLENCE
THIS CAUSE came before the Court on {date} 
, upon Petitioner’s action
for an extension of injunction for protection and it appearing to the Court as follows:
       
Ex parte.  The claims in the petition for extension of injunction for protection make it appear to the
Court that there is an immediate and present danger of domestic and repeat violence, as required
under section 741.30 or section 784.046, Florida Statutes.  The previously entered injunction is
extended until {date} 
.  A full hearing on the petition is scheduled for
{date}                                at 
  a.m./p.m. in 
.
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.  electronic audio tape 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.
   c.  no electronic audio tape recording or court reporting services are 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.
To be completed if this order was entered after an ex parte hearing:
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
{name} 
,
{address} 
, {telephone} 
,
Florida Supreme Court Approved Family Law Form 12.980(n), Order Extending Injunction for Protection Against Domestic Violence
or Repeat Violence (9/00)
C-423
within 2 working days of your receipt of this order.  If you are hearing or voice impaired, call TDD
1-800-955-8771.
       
After notice and hearing.  Respondent was served with a copy of the temporary extension, if
applicable, and a notice of this hearing within the time required by Florida law and was afforded an
opportunity to be heard. The notice and opportunity to be heard were sufficient to protect
Respondent’s right to due process.  The following persons attended the hearing: (    ) Petitioner (    )
Respondent.
After hearing the testimony of each party present and of any witnesses, or upon consent of
Respondent, the Court finds that Petitioner is a victim of domestic or repeat violence or reasonably
fears that he/she will become a victim of violence from Respondent. The previously entered
injunction is extended until {date} 
, or until further order of the Court.
ORDERED on                                            .
CIRCUIT JUDGE
COPIES TO:
Sheriff of                                County
Petitioner (or his or her attorney):
       
by U.S. Mail
       
by hand delivery in open court (Petitioner must
acknowledge receipt in writing on the face of the original
order — see below)
Respondent (or his or her attorney):
       
forwarded to sheriff for service
       
by hand delivery in open court (Respondent must
acknowledge receipt in writing on the face of the original
order — see below)
       
by certified mail (may only be used when Respondent is
present at the hearing and Respondent fails or refuses to
acknowledge the receipt of certified copy of this
injunction)
         State Attorney’s Office
         Other:                                                                                            
I CERTIFY the foregoing is a true copy of the original 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
ACKNOWLEDGMENT
Florida Supreme Court Approved Family Law Form 12.980(n), Order Extending Injunction for Protection Against Domestic Violence
or Repeat Violence (9/00)
C-424
I, {Name of Petitioner} 
, acknowledge receipt
of a certified copy of this Injunction for Protection.
             
Petitioner
ACKNOWLEDGMENT
I, {Name of Respondent} 
, acknowledge receipt of a
certified copy of this Injunction for Protection.
Respondent