Opinion ID: 2789478
Heading Depth: 4
Heading Rank: 1

Heading: a court reporter is provided by the court.

Text: b._____electronic recording only is provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party’s expense. c._____ neither electronic recording nor 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 {identify applicable court personnel by name, address, and telephone number} at least 7 days before your scheduled court appearance, or immediately upon receiving this notification if the time before the scheduled appearance is less than 7 days; if you are hearing or voice impaired, call 711. 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 dating violence and/or Petitioner has reasonable cause to believe he or she is in imminent danger of becoming a victim of an act of dating violence by Respondent, and that an immediate and present danger of dating 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, Florida Supreme Court Approved Family Law Form 12.980(o), Temporary Injunction for Protection Against Dating Violence (03/15) - 586 - unless extended by court order. If a final order of injunction is issued, the terms of this temporary injunction will be extended until service of the final injunction is effected upon Respondent. This 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 dating 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, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, or false imprisonment, or any criminal offense resulting in physical injury or death. 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: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(o), Temporary Injunction for Protection Against Dating Violence (03/15) - 587 - {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 or Designated E-Mail Address(es). Respondent shall notify the Clerk of the Court of any change in either his or her mailing address, or designated e-mail address(es), within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served either by mail to Respondent’s last known mailing address or by e-mail to Respondent’s designated e-mail address(es). Service shall be complete upon mailing or e-mailing. 5. Additional order(s) necessary to protect Petitioner from dating 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 {Unless ordered otherwise by the judge, all provisions in this injunction are considered mandatory provisions and should be interpreted as part of this injunction.} 1. The Sheriff of ______________ County, or any other authorized law enforcement officer, is ordered to serve this temporary injunction upon Respondent as soon as possible after its issuance. Florida Supreme Court Approved Family Law Form 12.980(o), Temporary Injunction for Protection Against Dating Violence (03/15) - 588 - 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. DONE AND ORDERED in ___________________________, Florida on . _______________________________________ CIRCUIT JUDGE COPIES TO: Sheriff of ________ County Petitioner: Florida Supreme Court Approved Family Law Form 12.980(o), Temporary Injunction for Protection Against Dating Violence (03/15) - 589 - __ by U. S. Mail __ by hand delivery in open court _____ by e-mail to designated e-mail address(es) Respondent: __ forwarded to sheriff for service ____ State Attorney’s Office __ Other: ________________________ I CERTIFY the foregoing is a true copy of the original Temporary Injunction for Protection Against Dating Violence as it appears on file in the office of the Clerk of the Circuit Court of County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By:_______________________________________ {Deputy Clerk or Judicial Assistant} Florida Supreme Court Approved Family Law Form 12.980(o), Temporary Injunction for Protection Against Dating Violence (03/15) - 590 - 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 DATING VIOLENCE (AFTER NOTICE) The Petition for Injunction for Protection Against Dating 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. Section 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe. SECTION I. HEARING This cause came before the Court for a hearing to determine whether an Injunction for Protection Against Dating Violence in this case should be: ____ issued ____ modified ____ extended. The hearing was attended by: ____ Petitioner ____Petitioner’s Counsel ____Respondent ____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. Florida Supreme Court Approved Family Law Form 12.980(p), Final Judgment of Injunction for Protection Against Dating Violence (After Notice) (03/15) - 591 - 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 dating violence and/or Petitioner has reasonable cause to believe he or she is in imminent danger of becoming a victim of an act of dating violence by Respondent, and that an immediate and present danger of dating violence exists to Petitioner or to a member of Petitioner's immediate family. SECTION III. INJUNCTION AND TERMS This injunction shall be in full force and effect until ____ further order of the Court or ____ {date} __________________________. This injunction is valid and enforceable throughout all counties in 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 dating 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, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, or false imprisonment, or any criminal offense resulting in physical injury or death. 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} Florida Supreme Court Approved Family Law Form 12.980(p), Final Judgment of Injunction for Protection Against Dating Violence (After Notice) (03/15) - 592 - ___________________________________________________________ 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 the Respondent's possession to the___________________ County Sheriff's Department. c. ____Other directives relating to firearms and ammunition:___________________________ _____________________________________________________________________________ . 4. Mailing Address or Designated E-Mail Address(es). Respondent shall notify the Clerk of the Court of any change in either his or her mailing address, or designated e-mail address(es), within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served either by mail to Respondent’s last known mailing address or by e-mail to Respondent’s designated e-mail address(es). Service shall be complete upon mailing or e-mailing. 5. Additional order(s) necessary to protect Petitioner from dating violence: ______________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ . Florida Supreme Court Approved Family Law Form 12.980(p), Final Judgment of Injunction for Protection Against Dating Violence (After Notice) (03/15) - 593 - 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 {Unless ordered otherwise by the judge, all provisions in this injunction are considered mandatory provisions and should be interpreted as part of this injunction.} 1. 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 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. DONE AND ORDERED in____________________________, Florida on _____________________. __________________________________________ CIRCUIT JUDGE Florida Supreme Court Approved Family Law Form 12.980(p), Final Judgment of Injunction for Protection Against Dating Violence (After Notice) (03/15) - 594 - 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) _____ by e-mail to designated e-mail address 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 ____ Other _____________________________________________ I CERTIFY the foregoing is a true copy of the original Final Judgment of Injunction for Protection Against Dating Violence as it appears on file in the office of the Clerk of the Circuit Court of _______ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By:_______________________________________ Deputy Clerk or Judicial Assistant ACKNOWLEDGMENT I, {Name of Petitioner} ___________________________, acknowledge receipt of a certified copy of this Injunction for Protection. Florida Supreme Court Approved Family Law Form 12.980(p), Final Judgment of Injunction for Protection Against Dating Violence (After Notice) (03/15) - 595 - 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(p), Final Judgment of Injunction for Protection Against Dating Violence (After Notice) (03/15) - 596 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(q) PETITION FOR INJUNCTION FOR PROTECTION AGAINST SEXUAL VIOLENCE (03/15) When should this form be used? If you are a victim of sexual violence or the parent or legal guardian of a minor child who is living at home and is a victim of sexual violence, you can use this form to ask the court for a protective order prohibiting sexual violence. Sexual violence means any one incident of:  sexual battery, as defined in Chapter 794, Florida Statutes;  a lewd or lascivious act, as defined in Chapter 800, Florida Statutes, committed upon or in the presence of a person younger than 16 years of age;  luring or enticing a child, as described in Chapter 787, Florida Statutes;  sexual performance by a child, as described in Chapter 827, Florida Statutes; or  any other forcible felony wherein a sexual act is committed or attempted In order to get an injunction you must have reported the sexual violence to a law enforcement agency and be cooperating in the criminal proceeding if there is one. It does not matter whether criminal charges based on the sexual violence have been filed, reduced, or dismissed by the state attorney’s office. You may also seek an injunction for protection against sexual violence if the respondent was sent to prison for committing one of the sexual violence crimes listed above against you or your minor child living at home and respondent is out of prison or is getting out of prison within 90 days of your petition. Attach the notice of inmate release to your petition. 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 seeking an injunction for protection against sexual violence on behalf of a minor child who is living at home, the parent or legal guardian must have been an eyewitness to, or have direct physical evidence or affidavits from eyewitnesses of, the specific facts and circumstances that form the basis of the petition. 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. 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 is the other parent of your child(ren) whether or not you have ever been married or ever lived together, you should use Petition for Injunction for Protection Against Domestic Violence, Florida Supreme Court Approved Family Law Form 12.980(a), rather than this form. This form should be typed or printed in black ink. You should complete this form (giving as much detail as possible) and sign it the presence of a notary or in front of the clerk of the circuit court in the county Instructions for Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (03/15) - 597 - 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 an immediate and present danger of violence exists, the judge will sign a Temporary Injunction for Protection Against Sexual Violence, Florida Supreme Court Approved Family Law Form 12.980(r). 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, unless the respondent is incarcerated, and in such instance the temporary injunction is effective for 15 days following the date the respondent is released from incarceration. The court may extend the temporary injunction beyond 15 days for a good reason, which may include failure to obtain service on the respondent. The temporary injunction is issued ex parte. This means that the judge has considered only the information presented by one side--YOU. Section I of the temporary injunction gives a date that you should appear in court for a hearing. You will be expected to testify about the facts in your petition. The respondent will be given the opportunity to testify at this hearing, also. At the hearing, the judge will decide whether to issue a Final Judgment of Injunction for Protection Against Sexual Violence (After Notice), Florida Supreme Court Approved Family Law Form 12.980(s), which will remain in effect for a specific time period or until modified or dissolved by the court. If you and/or the respondent do not appear, the temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including entry of a permanent injunction and the imposition of court costs. You and respondent will be bound by the terms of any injunction or order issued at the final hearing. IF EITHER YOU OR RESPONDENT DO NOT APPEAR AT THE FINAL HEARING, YOU WILL BOTH BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED IN THIS MATTER. If the judge signs a temporary or final injunction, the clerk will provide you with the necessary copies. Make sure that you keep one certified copy of the injunction with you at all times! What can I do if the judge denies my petition? If your petition is denied on the grounds that it appears to the court that no immediate and present danger of sexual 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 Instructions for Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (03/15) - 598 - your petition by filing a Supplemental Affidavit in Support of Petition for Injunction for Protection, Florida Supreme Court Approved Family Law Form 12.980 (g); attend the hearing and present facts that support your petition; and/or dismiss your petition. Where can I look for more information? Before proceeding, you should read General Information for Self-Represented Litigants found at the beginning of these forms. The words that are in bold underline are defined in that section. The clerk of the circuit court or family law intake staff will provide you with necessary forms. For further information, see section 784.046, Florida Statutes. IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be filed electronically except in certain circumstances. Self-represented litigants may file petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to file your pleadings or other documents electronically, you must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. The rules and procedures should be carefully read and followed. IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION After the initial service of process of the petition or supplemental petition by the Sheriff or certified process server, the Florida Rules of Judicial Administration now require that all documents required or permitted to be served on the other party must be served by electronic mail (e-mail) except in certain circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial Administration. SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the procedures must always be followed once the initial election is made. To serve and receive documents by e-mail, you must designate your e-mail addresses by using the Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915, and you must provide your e-mail address on each form on which your signature appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516. Special Notes . . . Instructions for Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (03/15) - 599 - If you fear that disclosing your address would put you in danger, you should complete a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), and file it with the clerk of the circuit court and write confidential in the space provided for your address on the petition. Instructions for Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (03/15) - 600 - 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 SEXUAL VIOLENCE I, {full legal name} ____________________________________ being sworn, certify that the following statements are true: SECTION I. PETITIONER (This section is about you. It must be completed; however, if you fear that disclosing your address to the respondent would put you in danger, you should complete and file a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), and write confidential in the space provided on this form for your address.) 1. Petitioner currently lives at the following address: {address, city, state, zip code} ______ Date of Birth of Petitioner: {Indicate if applicable} _____ Petitioner seeks an injunction for protection on behalf of a minor child. Petitioner is the parent or legal guardian of {full legal name}_________________ , a minor child who is living at home. 2. Petitioner's attorney's name, address, and telephone number is:_________________ ________________________________________________________________________ (If you do not have an attorney, write none.) SECTION II. RESPONDENT (This section is about the person you want to be protected from. It must be completed.) 1. Respondent currently lives at the following address: {address, city, state, and zip code} Family Supreme Court Approved Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (03/15) - 601 - ________________________________________________________________________ _______________________________________________________________________ Respondent’s Driver’s License number is: {if known} ____________________________________ 2. Respondent's last known place of employment:________________________________________ Employment address:_____________________________________________________________ Working hours: __________________________ 3. 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: 4. Other names Respondent goes by (aliases or nicknames):________________________________ ______________________________________________________________________________ 5. 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.) 6. If Respondent is a minor, the address of Respondent’s parent or legal guardian is: ____________ SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION (This section must be completed.) 1. Petitioner has suffered sexual violence as shown by the fact that the Respondent has: {describe the acts of violence} . _____ Please indicate here if you are attaching additional pages to continue these facts. {Indicate all that apply} a. ____ Petitioner reported the sexual violence to law enforcement and is cooperating in any criminal proceeding. The incident report number by law enforcement is: _______________ . b. {If there is a criminal case, include case number, if known} . Family Supreme Court Approved Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (03/15) - 602 - c. _____Respondent was sent to prison for committing sexual violence against Petitioner or Petitioner’s minor child living at home and Respondent is out of prison or is getting out of prison within 90 days. The notice of inmate release is attached. 2. Has Petitioner ever received or tried to get an injunction for protection against domestic violence, dating violence, repeat violence, or sexual violence against Respondent in this or any other court? _____ Yes _____No If yes, what happened in that case? {Include case number, if known} ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________. 3. Has Respondent ever received or tried to get an injunction for protection against domestic violence, dating violence, repeat violence, or sexual violence against Petitioner in this or any other court? _____ Yes _____ No If yes, what happened in that case? {Include case number, if known} ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________. 4. 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}: ______________________________________________________________________________ ______________________________________________________________________________ ____. 5. Additional Information {Indicate 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 violence have been previously reported to: {person or agency} ______________________________________________________________________________ SECTION IV. INJUNCTION (This section must be completed.) 1. Petitioner asks the Court to enter a TEMPORARY INJUNCTION for protection against sexual violence that will be in place from now until the scheduled hearing in this matter. 2. Petitioner asks the Court to enter an injunction prohibiting Respondent from committing any Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (03/15) - 603 - acts of violence against Petitioner and: a. prohibiting Respondent from going to or within 500 feet of any place Petitioner lives; b. prohibiting Respondent from going to or within 500 feet of Petitioner’s place(s) of employment or the school that Petitioner attends; the address of Petitioner's place(s) of employment and/or school is: _______________________ ; c. prohibiting Respondent from contacting Petitioner by telephone, mail, by e-mail, in writing, through another person, or in any other manner; d. ordering Respondent not to use or possess any guns or firearms; {Indicate all that apply} e. _____ prohibiting Respondent from going to or within 500 feet of the following place(s) Petitioner or Petitioner’s immediate family must go to often: ____________________________ ________________________________ ; f. _____ prohibiting Respondent from knowingly and intentionally going to or within 100 feet of Petitioner’s motor vehicle; AND any other terms the Court deems necessary for the safety of Petitioner and Petitioner’s immediate family. I UNDERSTAND THAT BY FILING THIS PETITION, I AM ASKING THE COURT TO HOLD A HEARING ON THIS PETITION, THAT BOTH THE RESPONDENT AND I WILL BE NOTIFIED OF THE HEARING, AND THAT I MUST APPEAR AT THE HEARING. I UNDERSTAND THAT IF EITHER RESPONDENT OF I FAIL TO APPEAR AT THE FINAL HEARING, WE WILL BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED AT THAT HEARING. I UNDERSTAND THAT I AM SWEARING OR AFFIRMING UNDER OATH TO THE TRUTHFULNESS OF THE CLAIMS MADE IN THIS PETITION AND THAT THE PUNISHMENT FOR KNOWINGLY MAKING A FALSE STATEMENT INCLUDES FINES AND/OR IMPRISONMENT. Dated: _______________________ _______________________________________ Signature of Petitioner Printed Name: ________________________________ Address: ____________________________________ Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (03/15) - 604 - City, State, Zip: ________ Telephone Number: ___________________________ Fax Number: _______ Designated E-Mail Address(es): ___________________________________________ 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(q), Petition for Injunction for Protection Against Sexual Violence (03/15) - 605 - IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: Division: __________________, Petitioner, and ___________________, Respondent. TEMPORARY INJUNCTION FOR PROTECTION AGAINST SEXUAL VIOLENCE The Petition for Injunction for Protection Against Sexual Violence under Section 784.046, Florida Statutes, and other papers filed in this Court have been reviewed. Under the laws of Florida, the Court has jurisdiction of the petitioner and the subject matter and has jurisdiction of the respondent upon service of the temporary injunction. 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. Section 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe. SECTION I. NOTICE OF HEARING Because this Temporary Injunction for Protection Against Sexual Violence has been issued without notice to Respondent, the Petitioner and Respondent are instructed that they are scheduled to appear and testify at a hearing regarding this matter on {date} _____________________, at __________ a.m./p.m., when the Court will consider whether to issue a Final Judgment of Injunction for Protection Against Sexual Violence, which shall remain in effect until modified or dissolved by the Court, and whether other things should be ordered. 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 entry of a permanent injunction and the imposition of court costs. Petitioner and Respondent will be bound by the terms of any injunction or order issued at the final hearing. All witnesses and evidence, if any, must be presented at this time. IF EITHER PETITIONER OR RESPONDENT DO NOT APPEAR AT THE FINAL HEARING, HE OR SHE WILL BE Florida Supreme Court Approved Family Law Form 12.980(r), Temporary Injunction for Protection Against Sexual Violence (03/15) - 606 - BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED IN THIS MATTER. 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 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.____ neither electronic recording nor 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 {identify applicable court personnel by name, address, and telephone number} at least 7 days before your scheduled court appearance, or immediately upon receiving this notification if the time before the scheduled appearance is less than 7 days; if you are hearing or voice impaired, call 711. 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 sexual violence by Respondent and meets the requirements for an injunction established by law. 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 or unless the Respondent is incarcerated, and if incarcerated, shall be effective for 15 days following the date Respondent is released from incarceration. If a final order of Florida Supreme Court Approved Family Law Form 12.980(r), Temporary Injunction for Protection Against Sexual Violence (03/15) - 607 - injunction is issued, the terms of this temporary injunction will be extended until service of the final injunction is effected upon Respondent. 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 sexual 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, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, or false imprisonment, or any criminal offense resulting in physical injury or death. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word, or act to do violence to 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: ______________________________________________________________________________ ______________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(r), Temporary Injunction for Protection Against Sexual Violence (03/15) - 608 - ______________________________________________________________________________ {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 or Designated E-Mail Address(es). Respondent shall notify the Clerk of the Court of any change in either his or her mailing address, or designated e-mail address(es), within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served either by mail to Respondent’s last known mailing address or by e-mail to Respondent’s designated e-mail address(es). Service by mail shall be complete upon mailing or e-mailing. 5. Additional order(s) necessary to protect Petitioner from sexual 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 Florida Supreme Court Approved Family Law Form 12.980(r), Temporary Injunction for Protection Against Sexual Violence (03/15) - 609 - {Unless ordered otherwise by the judge, all provisions in this injunction are considered mandatory provisions and should be interpreted as part of this injunction.} 1. The Sheriff of ______________ County, or any other authorized 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. DONE AND ORDERED in ________________________, Florida on ______________________ . __________________________________________ CIRCUIT JUDGE COPIES TO: Sheriff of ________ County Petitioner: (or his or her attorney) __ by U. S. Mail __ by hand delivery in open court Florida Supreme Court Approved Family Law Form 12.980(r), Temporary Injunction for Protection Against Sexual Violence (03/15) - 610 - ____ by e-mail to designated e-mail address(es) Respondent: __ forwarded to sheriff for service ____ State Attorney’s Office __ Other: ________________________ I CERTIFY the foregoing is a true copy of the original Temporary Injunction for Protection Against Sexual Violence as it appears on file in the office of the Clerk of the Circuit Court of County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By: _________________________________________ Deputy Clerk or Judicial Assistant Florida Supreme Court Approved Family Law Form 12.980(r), Temporary Injunction for Protection Against Sexual Violence (03/15) - 611 - 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 SEXUAL VIOLENCE (AFTER NOTICE) The Petition for Injunction for Protection Against Sexual 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. Section 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe. SECTION I. HEARING This cause came before the Court for a hearing to determine whether an Injunction for Protection Against Sexual Violence in this case should be: ____ issued ____ modified ____ extended. The hearing was attended by: ____Petitioner ____Petitioner’s Counsel ____Respondent ____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. Florida Supreme Court Approved Family Law Form 12.980(s), Final Judgment of Injunction for Protection Against Sexual Violence (After Notice) (03/15) - 612 - 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 sexual violence by Respondent and meets the requirements for an injunction established by law. SECTION III. INJUNCTION AND TERMS This injunction shall be in full force and effect until ____ further order of the Court or ____ {date} __________________________. This injunction is valid and enforceable throughout all counties in 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 sexual 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, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, or false imprisonment, or any criminal offense resulting in physical injury or death. 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}________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(s), Final Judgment of Injunction for Protection Against Sexual Violence (After Notice) (03/15) - 613 - 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 the Respondent's possession to the ____________________ County Sheriff's Department. c. ____Other directives relating to firearms and ammunition: ____________________________ . 4. Mailing Address or Designated E-Mail Address(es). Respondent shall notify the Clerk of the Court of any change in either his or her mailing address, or designated e-mail address(es), within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served either by mail to Respondent’s last known mailing address or by e-mail to Respondent’s designated e-mail address(es). Service shall be complete upon mailing or e-mailing. 5. Additional order(s) necessary to protect Petitioner from sexual violence: _________________ _____________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ . Florida Supreme Court Approved Family Law Form 12.980(s), Final Judgment of Injunction for Protection Against Sexual Violence (After Notice) (03/15) - 614 - 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 {Unless ordered otherwise by the judge, all provisions in this injunction are considered mandatory provisions and should be interpreted as part of this injunction.} 1. 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 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 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. DONE AND ORDERED in ___________________________, Florida on ____________________. _____________________________________________ CIRCUIT JUDGE Florida Supreme Court Approved Family Law Form 12.980(s), Final Judgment of Injunction for Protection Against Sexual Violence (After Notice) (03/15) - 615 - 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.) ____ by e-mail to designated e-mail address 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 ____ Other __________________________________________________ I CERTIFY the foregoing is a true copy of the original Final Judgment of Injunction for Protection Against Sexual Violence as it appears on file in the office of the Clerk of the Circuit Court of _______ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By: __________________________________________ Deputy Clerk or Judicial Assistant ACKNOWLEDGMENT I, {Name of Petitioner} ___________________________, acknowledge receipt of a certified copy of this Florida Supreme Court Approved Family Law Form 12.980(s), Final Judgment of Injunction for Protection Against Sexual Violence (After Notice) (03/15) - 616 - 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(s), Final Judgment of Injunction for Protection Against Sexual Violence (After Notice) (03/15) - 617 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(t) PETITION FOR INJUNCTION FOR PROTECTION AGAINST STALKING (03/15) When should this form be used? If you are a victim of stalking, you can use this form to ask the court for a protective order prohibiting stalking. Stalking means the repeated following, harassment, or cyberstalking of one person by another. Cyberstalk means to engage in a course of conduct to communicate, or to cause to be communicated, words, images, or language by or through the use of electronic mail or electronic communication, directed at a specific person, causing substantial emotional distress to that person and serving no legitimate purpose. 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, and are living at home, 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 stalking on behalf of the minor child. 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 may, instead, choose to use the Petition for Injunction for Protection Against Domestic Violence, Florida Supreme Court Approved Family Law Form 12.980(a), rather than this form. This form should be typed or printed in black ink. You should complete this form (giving as much detail as possible) and sign it the presence of a notary or in front of the clerk of the circuit court in one of the following: the circuit where you currently or temporarily reside; the circuit where the respondent resides; or the circuit where the stalking occurred. 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. There is no filing fee for a petition for protection against stalking. What should I do if the judge grants my petition? If the facts contained in your petition convince the judge that stalking or cyberstalking exists, the judge will sign a Temporary Injunction for Protection Against Stalking, Florida Supreme Court Approved Family Law Form 12.980(u). A temporary injunction is issued without notice to the respondent. The clerk Instructions for Florida Supreme Court Approved Family Law Form 12.980(t), Petition for Injunction for Protection Against Stalking (03/15) - 618 - 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 hearing can be held or for a period of 15 days, whichever comes first. The court may extend the temporary injunction beyond 15 days for a good reason, which may include failure to obtain service on the respondent. The temporary injunction is issued ex parte. This means that the judge has considered only the information presented by one side--YOU. Section I of the temporary injunction gives a date that you should appear in court for a hearing. You will be expected to testify about the facts in your petition. The respondent will be given the opportunity to testify at this hearing also. At the hearing, the judge will decide whether to issue a Final Judgment of Injunction for Protection Against Stalking (After Notice), Florida Supreme Court Approved Family Law Form 12.980(v), which will remain in effect for a specific time period or until modified or dissolved by the court. If either you or the respondent do not appear at the hearing, the temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including entry of a permanent injunction and the imposition of court costs. You and the respondent will be bound by the terms of any injunction or order issued at the final hearing. IF EITHER YOU OR THE RESPONDENT DO NOT APPEAR AT THE FINAL HEARING, YOU WILL BOTH BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED IN THIS MATTER. If the judge signs a temporary or final injunction, the clerk will provide you with the necessary copies. Make sure that you keep one certified copy of the injunction with you at all times! What can I do if the judge denies my petition or does not issue a Temporary Injunction? If your petition is denied, you may amend your petition by filing a Supplemental Affidavit in Support of Petition for Injunction for Protection, Florida Supreme Court Approved Family Law Form 12.980(g). If the only ground for not granting an ex parte temporary injunction is no appearance of immediate and present danger of stalking, the court shall set a full hearing on your petition for injunction at the earliest possible time. The respondent will be notified by personal service of your petition and the hearing. You must attend the hearing, present facts, and bring evidence that supports your petition; failure to attend the hearing may result in dismissal of 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 Instructions for Florida Supreme Court Approved Family Law Form 12.980(t), Petition for Injunction for Protection Against Stalking (03/15) - 619 - the circuit court or family law intake staff will help you complete any necessary forms. For further information, see Section 784.0485, Florida Statutes, and Rule 12.610, Florida Family Law Rules of Procedure. IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be filed electronically except in certain circumstances. Self-represented litigants may file petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to file your pleadings or other documents electronically, you must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. The rules and procedures should be carefully read and followed. IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION After the initial service of process of the petition or supplemental petition by the Sheriff or certified process server, the Florida Rules of Judicial Administration now require that all documents required or permitted to be served on the other party must be served by electronic mail (e-mail) except in certain circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial Administration. SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the procedures must always be followed once the initial election is made. To serve and receive documents by e-mail, you must designate your e-mail addresses by using the Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915, and you must provide your e-mail address on each form on which your signature appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516. Special Notes If you require that your address be confidential for safety reasons, you should complete a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), and file it with the clerk of the circuit. You should then write confidential in the space provided on the petition. Instructions for Florida Supreme Court Approved Family Law Form 12.980(t), Petition for Injunction for Protection Against Stalking (03/15) - 620 - 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 STALKING 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 require that your address be confidential for safety reasons, you should complete and file a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), and write confidential in the space provided on this form for your address and telephone number.) 1. Petitioner resides at the following address: {address, city, state, zip code} . {Indicate if applicable} __Petitioner seeks an injunction for protection on behalf of a minor child. Petitioner is the parent or legal guardian of {full legal name} ___________________, a minor child who is living at home. 2. Petitioner's attorney's name, address, and telephone number is: . (If you do not have an attorney, write none.) SECTION II. RESPONDENT (This section is about the person you want to be protected from. It must be completed.) 1. Respondent resides at the following address: {provide last known street address, city, state, and zip code} . Florida Supreme Court Approved Family Law Form 12.980(t), Petition for Injunction for Protection Against Stalking (03/15) - 621 - 2. Respondent's last known place of employment: Employment address: Working hours of Respondent: ____________________________ 3. 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 (if known)________________ 4. Other names Respondent goes by (aliases or nicknames): ______________________________________________________________________________ 5. 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 stalking 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 stalking against Petitioner in this or any other court? _ Yes _ No If yes, what happened in that case? {include case number, if known} . 3. Describe any other court case that is either going on now or that happened in the past between Petitioner and Respondent {include case number, if known}: ______________________________________________________________________________. 4. Petitioner is a victim of stalking because Respondent has: {please mark all sections that apply} a. ____Committed stalking; b. ____Previously threatened, harassed, stalked, cyberstalked, or physically abused the Petitioner; c. ____Threatened to harm Petitioner or family members or individuals closely associated with Petitioner; Florida Supreme Court Approved Family Law Form 12.980(t), Petition for Injunction for Protection Against Stalking (03/15) - 622 - d. ____Intentionally injured or killed a family pet; e. ____Used, or threatened to use, against Petitioner any weapons such as guns or knives; f. ____A criminal history involving violence or the threat or violence, if known; g. ____Another order of protection issued against him or her previously from another jurisdiction, if known; h. ____ Destroyed personal property, including, but not limited to, telephones or other communication equipment, clothing, or other items belonging to Petitioner. 5. Below is a description of the specific incidents of stalking or cyberstalking: {for cyberstalking, please include a description of all evidence of contacts and/or threats made by Respondent in voice messages, texts, emails, or other electronic communication} On {dates} _____________ the following incidents of stalking occurred at the following locations: {the locations may include, but need not be limited to, a home, school, or place of employment} . _____Please indicate here if you are attaching additional pages to continue these facts. 6. Additional Information ____Respondent owns, has, and/or is known to have guns or other weapons. Describe weapon(s) and where they may be located, if known: ___________________________ . SECTION IV. INJUNCTION {This section must be completed} 1. Petitioner asks the Court to enter a TEMPORARY INJUNCTION for protection against stalking that will be in place from now until the scheduled hearing in this matter, which will immediately restrain Respondent from committing any acts of stalking, and which will provide any terms the Court deems necessary for the protection of a victim of stalking, including any injunctions or directives to law enforcement agencies. 2. Petitioner asks the Court to enter, after a hearing has been held on this petition, a FINAL JUDGMENT for protection against stalking prohibiting Respondent from committing any acts of stalking against Petitioner and: a. prohibiting Respondent from going to or within 500 feet of any place Petitioner lives, or to any specified place regularly frequented by Petitioner and any named family members or individuals closely associated with Petitioner; ___________________________________________________________________________. 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: ; Florida Supreme Court Approved Family Law Form 12.980(t), Petition for Injunction for Protection Against Stalking (03/15) - 623 - c. prohibiting Respondent from contacting Petitioner by telephone, mail, by e-mail, in writing, through another person, or in any other manner; d. ordering Respondent that he or she shall not have in his or her care, custody, possession, or control any firearm or ammunition; e. prohibiting Respondent from knowingly and intentionally going to or within 100 feet of Petitioner’s motor vehicle, whether or not that vehicle is occupied; 3. Petitioner asks the Court to enter any other terms it deems necessary to protect Petitioner from stalking by Respondent. I UNDERSTAND THAT BY FILING THIS PETITION, I AM ASKING THE COURT TO HOLD A HEARING ON THIS PETITION, THAT BOTH THE RESPONDENT AND I WILL BE NOTIFIED OF THE HEARING, AND THAT I MUST APPEAR AT THE HEARING. I UNDERSTAND THAT IF EITHER THE RESPONDENT OR I FAIL TO APPEAR AT THE FINAL HEARING, WE WILL BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED AT THAT HEARING. I 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. Dated: ____ ____________________________________________ Signature of Petitioner Printed Name: Address: City, State, Zip: Telephone Number: Designated E-Mail Address(es): ___________________________________________________________ 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(t), Petition for Injunction for Protection Against Stalking (03/15) - 624 - IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR ___________ COUNTY, FLORIDA Case No.: Division: __________________, Petitioner, and __________________, Respondent. TEMPORARY INJUNCTION FOR PROTECTION AGAINST STALKING The Petition for Injunction for Protection Against Stalking under Section 784.0485, Florida Statutes, and other papers filed in this Court have been reviewed. Under the laws of Florida, the Court has jurisdiction of the Petitioner and the subject matter, and has jurisdiction of the Respondent upon service of the temporary injunction. 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. Section 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe. SECTION I. NOTICE OF HEARING Because this Temporary Injunction for Protection Against Stalking 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 it should issue a Final Judgment of Injunction for Protection Against Stalking, which shall remain in effect until modified or dissolved by the Court, and whether other things should be ordered. The hearing will be before The Honorable {name} ___________________________, at the following address: __________________________________________________________________, 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 entry of a permanent injunction and the imposition of court costs. All witnesses and evidence, if any, must be presented at this time. Petitioner and Respondent will be bound by the terms of any injunction or order issued at the final hearing. IF EITHER PETITIONER OR RESPONDENT DO NOT APPEAR AT THE FINAL HEARING, HE OR SHE WILL BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED IN THIS MATTER. NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at Florida Supreme Court Approved Family Law Form 12.980(u), Temporary Injunction for Protection Against Stalking (03/15) - 625 - public expense. YOU ARE ADVISED THAT IN THIS COURT: a.____ a court reporter is provided by the court. b.____ electronic recording only is provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party’s expense. A RECORD, WHICH INCLUDES A TRANSCRIPT, MAY BE REQUIRED TO SUPPORT AN APPEAL. THE PARTY SEEKING THE APPEAL IS RESPONSIBLE FOR HAVING THE TRANSCRIPT PREPARED BY A COURT REPORTER. THE TRANSCRIPT MUST BE FILED WITH THE REVIEWING COURT OR THE APPEAL MAY BE DENIED. If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {identify applicable court personnel by name, address, and telephone number} at least 7 days before your scheduled court appearance, or immediately upon receiving this notification if the time before the scheduled appearance is less than 7 days; if you are hearing or voice impaired, call 711. SECTION II. FINDINGS The statements made under oath by Petitioner make it appear that Section 784.0485, Florida Statutes, applies to the parties, and that stalking exists. SECTION III. TEMPORARY INJUNCTION AND TERMS This injunction shall be in effect until the hearing set above and in no event for longer than 15 days, unless extended by court order. If a final order of injunction is issued, the terms of this temporary injunction will be extended until service of the final injunction is effected upon Respondent. This 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: committing an act of stalking against Petitioner; going to or being within 500 feet of Petitioner's residence, place of employment, school, or other place prohibited in this injunction; knowingly and intentionally coming within 100 feet of Petitioner’s motor vehicle, whether or not that vehicle is occupied; committing any other violation of this injunction through an intentional unlawful threat, word or act to do violence to Petitioner; telephoning, contacting or communicating with Petitioner, unless indirect contact through a third Florida Supreme Court Approved Family Law Form 12.980(u), Temporary Injunction for Protection Against Stalking (03/15) - 626 - party is specifically allowed by this injunction; defacing or destroying Petitioner’s personal property, including Petitioner’s motor vehicle; or refusing to surrender firearms or ammunition if ordered to so by the Court, constitutes a misdemeanor of the first degree punishable 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. Prohibited Actions. Respondent shall not commit, or cause any other person to commit, any acts of stalking against Petitioner, including stalking, cyberstalking, aggravated stalking, or any criminal offense resulting in physical injury or death. Respondent shall not commit any other violation of this injunction through an intentional unlawful threat, word, or act to do violence to 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, including any electronic means or use of social media. 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: b. Petitioner’s current residence {list address} ________________________________________________________________________ or any residence to which Petitioner may move; c. Petitioner’s current or any subsequent place of employment {list address of current employment} ________________________________________________________________________ d. where Petitioner attends school {list address of school} ______________________________________________________________________ ; or e. the following other places (if requested by Petitioner) where Petitioner, specific members of Petitioner’s family, or individuals closely associated with Petitioner, regularly frequent: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________. f. Respondent shall not knowingly and intentionally come within 100 feet of Petitioner’s motor vehicle at any time, whether or not that vehicle is occupied; Florida Supreme Court Approved Family Law Form 12.980(u), Temporary Injunction for Protection Against Stalking (03/15) - 627 - g. Other provisions regarding contact: _____________________________________________ ___________________________________________________________________________ _ . 3. Firearms. {Initial all that apply; 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, possession, or control any firearm or ammunition. b. ____Respondent shall not use or possess a firearm or ammunition. c. ____Respondent shall surrender any firearms and ammunition in the Respondent's possession to the___________________ County Sheriff's Department. d. _____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 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent’s last known address of record. Such service by mail shall be complete upon mailing. Rule 12.080, Florida Family Law Rules of Procedure; Section 784.0485, Florida Statutes. 5. Additional order(s) necessary to protect Petitioner from stalking: _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 6. Referral to Appropriate Services for Petitioner: Petitioner may contact the following services as needed: ____________________________________________________________________________ _____________________________________________________________________________ . SECTION IV. OTHER SPECIAL PROVISIONS (This section to be used for inclusion of local provisions approved by the chief judge as provided in Florida Family Law Rule 12.610.) __________________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(u), Temporary Injunction for Protection Against Stalking (03/15) - 628 - __________________________________________________________________________________ __________________________________________________________________________________. SECTION V. DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION (Unless ordered otherwise by the judge, all provisions in this injunction are considered mandatory provisions and should be interpreted as part of this injunction.) 1. The Sheriff of ______________ _____County, or any other authorized law enforcement officer, is ordered to serve this temporary injunction upon Respondent as soon as possible after its issuance. 2. This injunction is valid 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 784.0487, 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 has not been arrested, Petitioner may contact the clerk of the circuit court of the county in which the violation is alleged to have occurred. The clerk shall assist Petitioner in preparing an affidavit in support of reporting the violation or direct Petitioner to the office operated by the court that has been designated by the chief judge of that circuit as the central intake point for violations of injunctions for protection where Petitioner can receive assistance in the preparation of the affidavit in support of the violation. The affidavit shall be immediately forwarded by the office assisting Petitioner to the state attorney of that circuit and to the judge designated by the chief judge as the recipient of affidavits of violations of an injunction. Procedures relating to reporting alleged violations are governed by section 784.0487, Florida Statutes. DONE AND ORDERED in ____________________________, Florida, on _________________ . CIRCUIT JUDGE COPIES TO: Sheriff of ________ County Florida Supreme Court Approved Family Law Form 12.980(u), Temporary Injunction for Protection Against Stalking (03/15) - 629 - Petitioner: __ 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 Temporary Injunction for Protection Against Stalking 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(u), Temporary Injunction for Protection Against Stalking (03/15) - 630 - 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 STALKING (AFTER NOTICE) The Petition for Injunction for Protection Against Stalking under Section 784.0485, 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. Section 2265 and therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe and enforced as if it were the order of the enforcing state or of the Indian tribe. SECTION I. HEARING This cause came before the Court for a hearing to determine whether an Injunction for Protection Against Stalking in this case should be: ____ issued ____ modified____ extended. The hearing was attended by: ____Petitioner ____Petitioner’s Counsel ____Respondent ____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 Florida Supreme Court Approved Family Law Form 12.980(v), Final Judgment of Injunction for Protection Against Stalking (After Notice) (03/15) - 631 - 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 stalking. SECTION III. INJUNCTION AND TERMS This injunction shall be in full force and effect until either ____ further order of the Court or ____ until {date} ___________________. This injunction is valid and enforceable throughout all counties in 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: committing an act of stalking against Petitioner; going to or being within 500 feet of Petitioner's residence, place of employment, school, or other place prohibited in this injunction; knowingly and intentionally coming within 100 feet of Petitioner’s motor vehicle, whether or not that vehicle is occupied; committing any other violation of this injunction through an intentional unlawful threat, word or act to do violence to Petitioner; telephoning, contacting or communicating with Petitioner, unless indirect contact through a third party is specifically allowed by this injunction; defacing or destroying Petitioner’s personal property, including Petitioner’s motor vehicle; having care, custody, use or possession of a firearm or ammunition unless authorized by section 790.233(3), Florida Statutes, constitutes a misdemeanor of the first degree punishable 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. Prohibited Actions. Respondent shall not commit, or cause any other person to commit, any acts of stalking against Petitioner, including stalking, cyberstalking, aggravated stalking, or any criminal offense resulting in physical injury or death. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to 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, including any electronic means or use of social media. Further, Respondent shall not contact or have any third party contact anyone connected with Florida Supreme Court Approved Family Law Form 12.980(v), Final Judgment of Injunction for Protection Against Stalking (After Notice) (03/15) - 632 - 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: b. Petitioner’s current residence {list address} ____________________________________ or any residence to which Petitioner may move; c. Petitioner’s current or any subsequent place of employment {list address of current employment} ______________________________________________________________ ; d. Petitioner’s school {list address of school} ______________________________________________________________________ ; or e. the following other place(s) regularly frequented by Petitioner and any named family members or individuals closely associated with Petitioner: _________________________________________________________________________ ___________________________________________________________________________. f. Respondent shall not knowingly or intentionally come within 100 feet of Petitioner’s motor vehicle, whether or not that vehicle is occupied; g. Respondent shall not deface or destroy Petitioner’s personal property, including Petitioner’s motor vehicle h. Other provisions regarding contact: _________________ . 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 Respondent to have in his or her care, custody, possession or control any firearm or ammunition. {Initial all that apply; 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 any firearm or ammunition. b. _____Respondent shall not use or possess a firearm or ammunition. Florida Supreme Court Approved Family Law Form 12.980(v), Final Judgment of Injunction for Protection Against Stalking (After Notice) (03/15) - 633 - c. _____Respondent shall surrender any firearms and ammunition in the Respondent's possession to the___________________ County Sheriff's Department. Failure to surrender either firearms or ammunition if ordered to do so by the court constitutes a misdemeanor of the first degree, punishable as provided in section 775.082 or 775.083, Florida Statutes. d. _____Other directives relating to firearms and ammunition: _____________ ___________________________________________________________________________ ___________________________________________________________________________. 4. Treatment, Intervention, or Counseling. {Initial if applicable; write N/A if not applicable} a. _____Respondent shall participate in the treatment, intervention, or counseling specified below. Respondent shall pay for all services rendered: _____________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ . b. Within _____ days of the date of this Injunction, Respondent shall enroll in, and thereafter complete without delay, the treatment, intervention, or counseling required in paragraph a. above. Respondent shall provide proof of such enrollment to the Clerk of the Court. 5. Mailing Address or Designated E-Mail Address(es). Respondent shall notify the Clerk of the Court of any change in either his or her mailing address, or designated e-mail address(es), within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served either by mail to Respondent’s last known mailing address or by e-mail to Respondent’s designated e-mail address(es). Service shall be complete upon mailing or e-mailing. 6. Additional provisions(s) necessary to protect Petitioner from stalking: _____________________________________________________________________________ _____________________________________________________________________________ . 7. Referral to Appropriate Services for Petitioner. Petitioner may contact the following services as needed: _____________________________________________________________________________ ______________________________________________________________________________ . SECTION IV. OTHER SPECIAL PROVISIONS {This section to be used for inclusion of local provisions approved by the chief judge as provided in Florida Family Law Rule 12.610.} ____________________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(v), Final Judgment of Injunction for Protection Against Stalking (After Notice) (03/15) - 634 - ____________________________________________________________________________________ . SECTION V. DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION {Unless ordered otherwise by the judge, all provisions in this injunction are considered mandatory provisions and should be interpreted as part of this injunction.} 1. 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 784.0485, Florida Statutes. 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 has not been arrested, Petitioner may contact the clerk of the circuit court of the county in which the violation is alleged to have occurred. The clerk shall assist Petitioner in preparing an affidavit in support of reporting the violation or direct Petitioner to the office operated by the court that has been designated by the chief judge of that circuit as the central intake point for violations of injunctions for protection where Petitioner can receive assistance in the preparation of the affidavit in support of the violation. The affidavit shall be immediately forwarded by the office assisting Petitioner to the state attorney of that circuit and to the judge designated by the chief judge as the recipient of affidavits of violations of an injunction. Procedures relating to reporting alleged violations are governed by section 784.0487, Florida Statutes. 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. DONE AND ORDERED in____________________________, Florida, on ____________________. __________________________________________ CIRCUIT JUDGE Florida Supreme Court Approved Family Law Form 12.980(v), Final Judgment of Injunction for Protection Against Stalking (After Notice) (03/15) - 635 - 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.) _____ by e-mail to designated e-mail address(es) 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 _____ Other __________________________ I CERTIFY the foregoing is a true copy of the original Final Judgment of Injunction for Protection Against Stalking as it appears on file in the office of the Clerk of the Circuit Court of ____________ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By:_______________________________________ Deputy Clerk or Judicial Assistant ACKNOWLEDGMENT I, {Name of Petitioner} ___________________________, acknowledge receipt of a certified copy of this Final Judgment of Injunction for Protection Against Stalking. Florida Supreme Court Approved Family Law Form 12.980(v), Final Judgment of Injunction for Protection Against Stalking (After Notice) (03/15) - 636 - Petitioner ACKNOWLEDGMENT I, {Name of Respondent} __________________________, acknowledge receipt of a certified copy of this Final Judgment of Injunction for Protection Against Stalking. Respondent Florida Supreme Court Approved Family Law Form 12.980(v), Final Judgment of Injunction for Protection Against Stalking (After Notice) (03/15) - 637 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(w) PETITION BY AFFIDAVIT FOR ORDER TO SHOW CAUSE FOR A VIOLATION OF FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC, REPEAT, DATING, OR SEXUAL VIOLENCE, OR STALKING (03/15) When should this form be used? You may use this form if you have a valid Final Judgment of Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence, or Stalking, in force which has been violated. You should use this affidavit to state the essential facts which establish a violation of the Final Judgment of Injunction. 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 such clerk or judge as determined by the chief judge of your circuit to be the recipient of affidavits of violation, provide a copy to the state attorney of that circuit and keep a copy for your records. IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be filed electronically except in certain circumstances. Self-represented litigants may file petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to file your pleadings or other documents electronically, you must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. The rules and procedures should be carefully read and followed. IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION After the initial service of process of the petition or supplemental petition by the Sheriff or certified process server, the Florida Rules of Judicial Administration now require that all documents required or permitted to be served on the other party must be served by electronic mail (e-mail) except in certain circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial Administration. SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the procedures must always be followed once the initial election is made. Instructions for Florida Supreme Court Approved Family Law Form 12.980(w), Petition by Affidavit for Order to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence, or Stalking (03/15) - 638 - To serve and receive documents by e-mail, you must designate your e-mail addresses by using the Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915, and you must provide your e-mail address on each form on which your signature appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516. Instructions for Florida Supreme Court Approved Family Law Form 12.980(w), Petition by Affidavit for Order to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence, or Stalking (03/15) - 639 - IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR _________ COUNTY, FLORIDA Case No.: Division: ________ , Petitioner, and , Respondent. PETITION BY AFFIDAVIT FOR ORDER TO SHOW CAUSE FOR A VIOLATION OF FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE ( ) DATING VIOLENCE ( ) SEXUAL VIOLENCE ( ) STALKING I, {full legal name} ___________________________________________, being sworn, certify that I have actual knowledge of the following facts as set forth and the following statements are true: 1. The Court previously issued a {Choose one only} a. ____ Final Judgment of Injunction for Protection Against Domestic Violence b. ____ Final Judgment of Injunction for Protection Against Repeat Violence c. ____ Final Judgment of Injunction for Protection Against Dating Violence d. ____ Final Judgment of Injunction for Protection Against Sexual Violence e. ____ Final Judgment of Injunction for Protection Against Stalking in this case on {date} ______________________. The Final Judgment of Injunction for Protection was served on Respondent on {date} _______________. 2. On {dates} _________________________, at {place and address} _______________________ ____________________________________________________________________________ , the following event(s) took place: _________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(w), Petition By Affidavit for Order to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence, or Stalking (03/15) - 640 - . {For cyberstalking, please include a description of all evidence of contacts and/or threats made by Respondent in voice messages, texts, emails, or other electronic communication} _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ . _____Please indicate here if you are attaching additional pages to continue these facts. 3. Respondent has willfully violated the Injunction by: {explain what Respondent did that violated the Order of Protection} ____________________________________________________________________________ . _____Please indicate here if you are attaching additional pages to continue these facts. 5. ____ Please indicate here if you are attaching copies of medical records for treatment you may have received for injuries referred to in your affidavit, or copies of any police or sheriff reports concerning incidents of violence involving you and Respondent. 6. Respondent acted to impair, interfere with, delay, hinder, lessen the authority of, dignity of, and embarrass the cause of justice in a manner contemptuous of this court. WHEREFORE, I respectfully request that the Court issue an Order to Show Cause, requiring Respondent to appear before the Court to show cause why Respondent should not be held in contempt of court for failure to abide by the terms and conditions of the Final Judgment of Injunction for Protection. I understand that by filing this affidavit, I am asking the court to hold a hearing, that both Respondent and I will be notified of the hearing, and that I must appear at the hearing. In addition to my own testimony, I understand that I can bring other proof of the violation such as, for example, people who saw Respondent violate the order, pictures, medical records, police reports, or anything might help show the judge how Respondent violated the Final Judgment of Injunction for Protection. I have read every statement made in this affidavit and each statement is true and correct. I understand that the statements made in this affidavit are being made under penalty of perjury, punishable as provided in Section 837.02, Florida Statutes and that the punishment for knowingly Florida Supreme Court Approved Family Law Form 12.980(w), Petition By Affidavit for Order to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence, or Stalking (03/15) - 641 - 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 I certify that a copy of this document was ( ) mailed ( ) faxed and mailed ( ) e-mailed ( ) hand delivered to the person(s) listed below on {date} ___________________. Other party or his/her attorney: Name: Address: City, State, Zip: Fax Number: Designated E-mail Address(es):__________________ __________________________________________ Florida Supreme Court Approved Family Law Form 12.980(w), Petition By Affidavit for Order to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence, or Stalking (03/15) - 642 - IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR _________________ COUNTY, FLORIDA Case No.: Division: ___________ , Petitioner, and ____________ , Respondent. Description of Respondent: Sex: ______ Eye color: _______ Height: ________ DOB: __________ Race: _________ Hair color: _________ Weight: _______ Last known address: _______________________________ ORDER TO SHOW CAUSE This cause comes before the court for review based upon the alleged conduct of Respondent for the issuance of an Order to Show Cause directed to {name} for violation of the Final Judgment of Injunction for Protection as is more specifically set forth in the Petition By Affidavit For Order To Show Cause For a Violation Of Final Judgment Of Injunction For Protection, a copy of which is attached hereto and made a part hereof. NOW, THEREFORE, you, {name} _________________________________________________________, are hereby ORDERED to appear before this court before Judge {name} , on {date} __________________, at {time} ___.m., in Room ______ of the _______________Courthouse, located at ______________________________________________________________, to be arraigned. A subsequent hearing will be scheduled requiring Respondent to show cause why he/she should not be held in contempt of this court for violation of the Final Judgment of Injunction for Protection as is stated in the attached Petition By Affidavit For Order To Show Cause For a Violation of Final Judgment of Injunction For Protection. Punishment, if imposed, may include a fine and incarceration. Should the court determine, based on the evidence presented at the hearing, that Respondent’s conduct warrants sanctions for civil contempt in addition to or instead of indirect criminal contempt, the court reserves the right to find Respondent guilty of civil contempt and impose appropriate civil sanctions. _____The court hereby appoints the State Attorney’s Office to prosecute the case. _____Respondent is advised that he/she is entitled to be represented by counsel. If you are a person with a disability who needs any accommodation to participate in this proceeding, you are entitled, at no cost to you, to the Florida Supreme Court Approved Family Law Form 12.980(w), Petition By Affidavit for Order to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence, or Stalking (03/15) - 643 - provision of certain assistance. Please contact: {identify applicable court personnel by name, address, and telephone number} at least 7 days before your scheduled court appearance, or immediately upon receiving this notification if the time before the scheduled appearance is less than 7 days; if you are hearing or voice impaired, call 711. IT IS FURTHER ORDERED that the Sheriff of this county serve this Order to Show Cause by delivering copies to Respondent, with proof of Sheriff’s service. DONE AND ORDERED in __________________ County, Florida, on {date} _________. ___________________________________________ Circuit Judge Copies to: Sheriff of ________________ County Petitioner or Counsel for Petitioner: _____by U.S. Mail _____by e-mail to designated e-mail address(es) Respondent or Counsel for Respondent: _____forwarded to the sheriff for service ____State Attorney’s Office I CERTIFY the foregoing is a true copy of the original Order to Show Cause 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 _____________________________________________ By: Deputy Clerk or Judicial Assistant Florida Supreme Court Approved Family Law Form 12.980(w), Petition By Affidavit for Order to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic, Repeat, Dating, or Sexual Violence, or Stalking (03/15) - 644 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.981(a)(1) STEPPARENT ADOPTION: CONSENT AND WAIVER BY PARENT (03/15) When should this form be used? This form is to be completed and signed by the parent who is giving up all rights to, custody of, and time- sharing with the minor child to be adopted. This consent shall not be executed before the birth of the minor child. For more information about consenting to adoption, you should refer to Chapter 63, Florida Statutes, and sections 63.062 - 63.082, Florida Statutes, in particular. This form should be typed or printed in black ink. It must be signed in the presence of a notary public or deputy clerk and two witnesses other than the notary or clerk. You should file this form with the Joint Petition for Adoption by Stepparent, Florida Supreme Court Approved Family Law Form 12.981(b)(1). After completing this form, you should hand deliver a copy or duplicate original to the parent giving consent and have them sign the original saying they received a copy. Then you should file the original with the clerk of the circuit court in the county where the Joint Petition for Adoption by Stepparent, Florida Supreme Court Approved Family Law Form 12.981(b)(1) is filed and keep a copy for your records. IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be filed electronically except in certain circumstances. Self-represented litigants may file petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to file your pleadings or other documents electronically, you must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. The rules and procedures should be carefully read and followed. IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION After the initial service of process of the petition or supplemental petition by the Sheriff or certified process server, the Florida Rules of Judicial Administration now require that all documents required or permitted to be served on the other party must be served by electronic mail (e-mail) except in certain circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial Administration. SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the procedures must always be followed once the initial election is made. To serve and receive documents by e-mail, you must designate your e-mail addresses by using the Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form Instructions for Florida Supreme Court Approved Family Law Form 12.981(a)(1), Stepparent Adoption: Consent and Waiver by Parent (03/15) - 645 - 12.915, and you must provide your e-mail address on each form on which your signature appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516. Special notes... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. Instructions for Florida Supreme Court Approved Family Law Form 12.981(a)(1), Stepparent Adoption: Consent and Waiver by Parent (03/15) - 646 - IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR COUNTY, FLORIDA Case No.: Division: IN THE MATTER OF THE ADOPTION OF _________________________________________ {use name to be given to minor child(ren)} Adoptee(s). CONSENT AND WAIVER BY PARENT 1. I, {full legal name} , am the {Choose only one} _____ father or _____ mother of the minor child(ren) subject to this consent who is/are: Child’s Current Name Gender Birth date Birthplace {city, county, state} a.