IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
Case No.:
Division:
,
Petitioner,
and
,
Respondent.
FINAL JUDGMENT OF INJUNCTION FOR PROTECTION
AGAINST DOMESTIC VIOLENCE WITH MINOR CHILD(REN)
(AFTER NOTICE)
The Petition for Injunction for Protection Against Domestic Violence under section
741.30, Florida Statutes, and other papers fled in this Court have been reviewed.
The Court has jurisdiction of the parties and the subject matter.
It is intended that this protection order meet the requirements of 18
U.S.C. 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 Domestic Violence in this case should be:
_____ issued ____ modifed ____ extended.
The hearing was attended by:
____ Petitioner
____ Respondent
____ Petitioner’s Counsel
____ Respondent’s Counsel
SECTION II. FINDINGS
On {date} , a notice of this hearing was served on Respondent
together with a copy of Petitioner’s petition to this Court and the temporary
injunction, if issued. Service was within the time required by Florida law, and
Respondent was aforded an opportunity to be heard.
After hearing the testimony of each party present and of any witnesses, or upon
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction
for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (03/15)
consent of Respondent, the Court fnds, based on the specifc facts of this case,
that Petitioner is a victim of domestic violence or has reasonable cause to believe
that he/she is in imminent danger of becoming a victim of domestic violence by
Respondent.
SECTION III. INJUNCTION AND TERMS
This injunction shall be in full force and efect until either _____ further
order of the Court or
_____ {date} _______. 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 at any time.
Any violation of this injunction, whether or not at the invitation of
Petitioner or anyone else, may subject Respondent to civil or indirect
criminal contempt proceedings, including the imposition of a fne or
imprisonment. Certain willful violations of the terms of this injunction,
such as: refusing to vacate the dwelling that the parties share; going to
or being within 500 feet of Petitioner's residence, going to Petitioner’s
place of employment, school, or other place prohibited in this injunction;
telephoning, contacting or communicating with Petitioner if prohibited by
this injunction; knowingly or intentionally coming within 100 feet of
Petitioner’s motor vehicle, whether or not it is occupied; defacing or
destroying Petitioner’s personal property; refusing to surrender frearms
or ammunition if ordered to do so by the court; or committing an act of
domestic violence against Petitioner constitutes a misdemeanor of the
frst degree punishable by up to one year in jail, as provided by sections
775.082 and 775.083, Florida Statutes. In addition, it is a federal criminal
felony ofense, punishable by up to life imprisonment, depending on the
nature of the violation, to cross state lines or enter Indian country for the
purpose of engaging in conduct that is prohibited in this injunction. 18
U.S.C. SECTION 2262.
ORDERED and ADJUDGED:
1. Violence Prohibited. Respondent shall not commit, or cause any other
person to commit, any acts of domestic violence against Petitioner. Domestic
violence includes: assault, aggravated assault, battery, aggravated battery,
sexual assault, sexual battery, stalking, aggravated stalking, kidnapping,
false imprisonment, or any other criminal ofense resulting in physical injury
or death to Petitioner or any of Petitioner's family or household members.
Respondent shall not commit any other violation of the injunction through an
intentional unlawful threat, word or act to do violence to the Petitioner.
2. No Contact. Respondent shall have no contact with the Petitioner
unless otherwise provided in this section, or unless paragraphs 13
through 19 below provide for contact connected with the temporary
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction
for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (03/15)
parenting plan and temporary time-sharing with respect to the
minor child(ren).
a. Unless otherwise provided herein, Respondent shall have no contact
with Petitioner. Respondent shall not directly or indirectly contact
Petitioner in person, by mail, e-mail, fax, telephone, through another
person, or in any other manner. Further, Respondent shall not contact or
have any third party contact anyone connected with Petitioner's
employment or school to inquire about Petitioner or to send any messages
to Petitioner. Unless otherwise provided herein, Respondent shall not
go to, in, or within 500 feet of: Petitioner’s current residence {list
address}
___________________________________________________________________________
or any residence to which Petitioner may move; Petitioner’s current or any
subsequent place of employment {list address of current employment}
___________________________
______________________________________ or place where Petitioner attends
school {list address of school} ;
or the following other places (if requested by Petitioner) where Petitioner
or Petitioner’s minor child(ren) go
often:______________________________________________________
___________________________________________________________________________
Respondent may not knowingly come within 100 feet of Petitioner's
automobile at any time.
b._____Other provisions regarding contact:
.
3. Firearms. Unless paragraph a. is initialed below, Respondent shall
not have in his or her care, custody, possession or control any
frearm or ammunition. It is a violation of section 790.233, Florida
Statutes, and a frst degree misdemeanor, for the respondent to
have in his or her care, custody, possession or control any frearm or
ammunition.
[Initial if applies; write N/A if not applicable]
a.____Respondent is a state or local ofcer as defned in section
943.10(14), Florida Statutes, who holds an active certifcation, who
receives or possesses a frearm or ammunition for use in performing
ofcial duties on behalf of the ofcer’s employing agency and is not
prohibited by the court from having in his or her care, custody, possession
or control a frearm or ammunition. The ofcer’s employing agency may
prohibit the ofcer from having in his or her care, custody, possession or
control a frearm or ammunition.
b.____Respondent shall surrender any frearms and ammunition in the
Respondent's possession to the County Sherif's
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction
for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (03/15)
Department.
c.____Other directives relating to frearms and ammunition:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________.
NOTE: RESPONDENT IS ADVISED THAT IT IS A FEDERAL CRIMINAL
FELONY OFFENSE TO SHIP OR TRANSPORT IN INTERSTATE OR
FOREIGN COMMERCE, OR POSSESS IN OR AFFECTING COMMERCE,
ANY FIREARM OR AMMUNITION; OR TO RECEIVE ANY FIREARM OR
AMMUNITION WHICH HAS BEEN SHIPPED OR TRANSPORTED IN
INTERSTATE OR FOREIGN COMMERCE WHILE SUBJECT TO SUCH AN
INJUNCTION. 18 U.S.C. SECTION 922(g)(8).
4. Evaluation/Counseling.
[Initial all that apply; write N/A if does not apply]
a. The Court fnds that Respondent has:
i. ____willfully violated the ex parte injunction;
ii.____been convicted of, had adjudication withheld on, or pled nolo
contendere to a crime involving violence or a threat of violence;
and/or
iii.____in this state or any other state, had at any time a prior injunction
for protection entered against the Respondent after
a hearing with notice.
Note: If Respondent meets any of the above enumerated criteria, the Court must
order the Respondent to attend a batterers' intervention program unless it makes
written factual findings stating why such a program would not be appropriate eee
eection 741 30(6)(e), Florida etatutes
a. Within ____10 days ______ days, (but no more than 10 days) of the date of
this injunction, Respondent shall enroll in and thereafter without delay
complete the following, and Respondent shall provide proof of such
enrollment to the Clerk of Circuit Court within
____ 30 days or ____ days, (but no more than 30 days) of the date of this
injunction:
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction
for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (03/15)
i. ___A certifed batterers’ intervention program from a list of programs
to be provided by the Court or any entity designated by the Court.
Respondent shall also successfully complete any substance abuse or
mental health evaluation that the assessing program counselor deems
necessary as a predicate to completion of the batterers’ intervention
program.
ii. ____A substance abuse evaluation
at:_________________________________________
or a similarly qualifed facility and any substance abuse treatment
recommended by that evaluation.
iii. ____A mental health evaluation by a licensed mental health
professional at:
________________________________or any other similarly qualifed facility
and any mental health treatment recommended by that evaluation.
iv. ____Other:_____________________________________________________________
_
_______________________________________________________________________.
b. ____Although Respondent meets the statutory mandate of attendance at a
batterers’ intervention program, the Court makes the following written
fndings as to why the condition of batterers’ intervention program would
be inappropriate:
__________________________________________________________________________
.
c. ____Petitioner is referred to a certifed domestic violence center and is
provided with a list of certifed domestic violence centers in this circuit,
which Petitioner may contact.
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. Other provisions necessary to protect Petitioner from domestic
violence: _________________
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction
for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (03/15)
TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME
[Initial if applies; write N/A if not applicable]
7. ____ Possession of the Home. ____ Petitioner ____ Respondent shall have
temporary exclusive use and possession of the dwelling located
at:
_____________________________________________________________________________ _
___________________________________________________________________________.
8. ____ Transfer of Possession of the Home. A law enforcement ofcer with
jurisdiction over the home shall accompany ____ Petitioner ____
Respondent to the home, and shall place
____ Petitioner ____ Respondent in possession of the home.
9.____ Personal Items. ____ Petitioner ____ Respondent, in the presence of a
law enforcement ofcer , may return to the premises described above
on {date} ___ , at
a.m./p.m., or ____ at a time arranged with the law enforcement
department with jurisdiction over the home, accompanied by a law
enforcement ofcer only, for the purpose of obtaining his or her clothing
and items of personal health and hygiene and tools of the trade. A law
enforcement ofcer with jurisdiction over the premises shall go with
____ Petitioner ____ Respondent to the home and stand by to insure that
he/she vacates the premises with only his/her personal clothing, toiletries,
tools of the trade, and any items listed in paragraph 10 below. The law
enforcement agency shall not be responsible for storing or transporting
any property. IF THE RESPONDENT IS NOT AWARDED POSSESSION OF
THE HOME AND GOES TO THE HOME WITHOUT A LAW ENFORCEMENT
OFFICER, IT IS A VIOLATION OF THIS INJUNCTION.
10.____The following other personal possessions may also be removed from the
premises at this time:
____________________________________________________________________
_______________________________________________________________________.
11. ____Other:
______ _____________________________________________________________
.
TEMPORARY PARENTING PLAN AND TIME-SHARING WITH MINOR
CHILD(REN)
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction
for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (03/15)
12. Jurisdiction . [Initial one only]
_____ Jurisdiction to determine issues relating to parenting plan and time-
sharing with respect to any minor child(ren) listed in paragraph 13 below is
proper under the Uniform Child Custody Jurisdiction and Enforcement Act
(UCCJEA).
_____ Jurisdiction is exclusive to the dependency court, and accordingly no
order is made herein. {Case Number ____________________________ }
13. Temporary Parenting Plan for Minor Child(ren). Except for that time-
sharing (if any) specifed for the other parent in paragraph 14, below, _____
Petitioner _____ Respondent shall on a temporary basis have 100% of the
time-sharing with the parties’ minor child(ren) listed below and shall have
sole decision-making responsibility until further court order:
Name Birth date
When requested by the parent to whom the majority of overnight time-
sharing with the child(ren) is awarded on a temporary basis herein, in this
case the _____ Petitioner
_____ Respondent, law enforcement ofcers shall use any and all reasonable
and necessary force to physically deliver the minor child(ren) listed above to
the parent to whom the majority of overnight time-sharing with the child(ren)
is awarded on a temporary basis herein. The other parent shall not take the
child(ren) from the parent to whom the majority of overnight time-sharing
with the child(ren) is awarded on a temporary basis herein or any child care
provider or other person entrusted by the parent to whom the majority of
overnight time-sharing with the child(ren) is awarded on a temporary basis
herein with the care of the child(ren).
14. Temporary Parenting Plan with Time-Sharing for Minor Child(ren) .
The Petitioner and Respondent shall have time-sharing with the minor
child(ren) on the following schedule:
{Initial one only}
a. ____ Petitioner ____ Respondent shall have 100% of time-sharing and
____ Petitioner
____ Respondent shall have 0% of time sharing with the child(ren) until
further order of the Court. Until further order of the Court, all parenting
decisions shall be made by the parent with 100% of the time-sharing.
b.____ Petitioner ____ Respondent shall have time-sharing from ___________
a.m./p.m. to
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction
for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (03/15)
______a.m./p.m on the following
day(s)_________________________________. The
other parent will have the remaining time-sharing.
____________________________
_______________________________________________________________________
_______________________________________________________________________.
c.____Other:____________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
.
15. Limitations on Time-Sharing. The time-sharing specifed in paragraph
14, above, for
____ Petitioner ____ Respondent with the child(ren) shall be:
[Initial all that apply; write N/A if does not apply]
a.______ unsupervised
b.______ supervised by the following specifed responsible
adult: _______________________
c.______ at a supervised visitation center located at:
_____________________________________________________________________________
,
and shall be subject to the available times and rules of the supervised
visitation center. The cost associated with the services of the supervised
visitation center shall be paid by the: {choose one } _____ parent to
whom the majority of overnight time-sharing with the child(ren) is awarded
on a temporary basis herein; _____ other parent; or _____ both parents:
______________________________________________________________________________
.
If specifed, the level of supervision shall
be:__________________________________________.
16. Arrangements for Time-Sharing with Minor Child(ren).
{Initial all that apply; write N/A if does not apply}
a._____A responsible person shall coordinate the time-sharing arrangements
with respect to the minor child(ren).
If specifed, the responsible person shall be: {name}
________________________________
b._____Other conditions for time-sharing arrangements as follows:
___________________
.
17. Exchange of Minor Child(ren).
{Initial all that apply; write N/A if does not apply}
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction
for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (03/15)
a._____The parties shall exchange the child(ren) at _____ school or daycare, or
_____ at the following location(s):
.
b._____A responsible person shall conduct all exchanges of the child(ren).
The _____ Petitioner
_____ Respondent shall not be present during the exchange. If specifed,
the responsible person shall be: {name}
__________________________________________________________________________.
c._____Other conditions for exchange as follows:
18. Other Additional Provisions Relating to the Minor Child(ren).
.
TEMPORARY SUPPORT
19. Temporary Alimony.
[Initial all that apply; write N/A if does not apply]
a. _____The court fnds that there is a need for temporary alimony and that
_____ Petitioner _____ Respondent (hereinafter Obligor) has the
present ability to pay alimony and shall pay temporary alimony to ____
Petitioner ____ Respondent (hereinafter Obligee) in the amount of $ _________
per month, payable _____ in accordance with Obligor’s employer’s payroll
cycle, and in any event, at least once a month _____ other {explain}
beginning {date} _________________________ . This alimony shall continue
until modifed by court order, until a fnal judgment of dissolution of
marriage is entered, until Obligee dies, until this injunction expires, or until
{date} _______________________, whichever occurs frst.
b._____ Petitioner _____ Respondent shall be required to maintain health
insurance coverage for the other party. Any uncovered medical costs for
the party awarded alimony shall be assessed as follows:
.
c. ______Other provisions relating to alimony:
.
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction
for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (03/15)
20. Temporary Child Support.
{Initial all that apply; write N/A if does not apply}
a. _____The Court fnds that there is a need for temporary child support and
that
_____ Petitioner _____ Respondent (hereinafter Obligor) has the present
ability to pay child support. The amounts in the Child Support Guidelines
Worksheet, Florida Family Law Form 12.902(e), fled by _____ Petitioner
_____ Respondent are correct OR the Court makes the following fndings:
The Petitioner’s net monthly income is $ __________, (Child Support
Guidelines %).
The Respondent’s net monthly income is $ _________ , (Child Support
Guidelines %). Monthly child care costs are $ __________________.
Monthly health/dental insurance costs are $________________.
b. _____ Amount. Obligor shall pay temporary child support in the amount of
$ _, per month payable _____ in accordance with Obligor’s
employer’s payroll cycle, and in any event at least once a month
_____other {explain}: __________________________________
,
beginning {date} ___________________ , and continuing until further
order of the court, or until {date/event}
_________________________________________________,
{explain} .
If the child support ordered deviates from the guidelines by more than
5%, the factual fndings which support that deviation are:
c. _____ Petitioner _____ Respondent shall be required to maintain ____ health
____ dental insurance coverage for the parties’ minor child(ren) so long as
it is reasonable in cost and accessible to the child(ren) OR ____ Health
____ dental insurance is either not reasonable in cost or accessible to the
child(ren) at this time.
d. _____Any reasonable and necessary uninsured
medical/dental/prescription drug costs for the minor child(ren) shall
be assessed as follows: ___________________________________
.
e. _____Florida Supreme Court Approved Family Law Form 12.902(j), Notice
of Social Security Number , is incorporated herein by reference.
f. _____Other provisions relating to child support:
.
21. Method of Payment.
[Initial one only]
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction
for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (03/15)
a.______ Obligor shall pay any temporary court-ordered child support/alimony
through income deduction, and such support shall be paid to either the
State Disbursement Unit or the central depository. Obligor is individually
responsible for paying this support obligation in the event that all or any
portion of said support is not deducted from Obligor’s income. Obligor shall
also pay any service charge required by statute. Until child support/alimony
payments are deducted from Obligor’s paycheck pursuant to the Income
Deduction Order, Obligor is responsible for making timely payments directly
to either the State Disbursement Unit or the central depository.
b.______ Temporary child support/alimony shall be paid through either the
State Disbursement Unit or the central depository. Obligor shall also pay
any service charge required by statute. Income deduction is not in the best
interests of the child(ren) because: {explain}
_______________________________________________________________________.
c. ______ Other provisions relating to method of payment:
_______________________________________________________________________
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 in all counties of the State of Florida. Violation
of this injunction should be reported to the appropriate law enforcement
agency. Law enforcement ofcers of the jurisdiction in which a violation of
this injunction occurs shall enforce the provisions of this injunction and are
authorized to arrest without warrant pursuant to section 901.15, Florida
Statutes, for any violation of its provisions, except those regarding child
support and/or alimony, which constitutes a criminal act under section
741.31, Florida Statutes. When inconsistent with this order, any
subsequent court order issued under Chapter 61 or Chapter 39 ,
Florida Statutes, shall take precedence over this order on all matters
relating to property division, alimony, parental responsibility,
parenting plan, time-sharing, child custody, or child support.
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction
for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (03/15)
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 Ofce immediately after arrest.
3. Reporting alleged violations. If Respondent violates the terms of this
injunction and there has not been an arrest, Petitioner may contact the Clerk
of the Circuit Court of the county in which the violation occurred and
complete an afdavit in support of the violation, or Petitioner may contact the
State Attorney’s ofce for assistance in fling 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 fle 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 efected upon
Respondent.
6. THIS IS A “CUSTODY ORDER” FOR PURPOSES OF THE UCCJEA AND
ALL STATUTES MAKING IT A CRIME TO INTERFERE WITH CUSTODY
UNDER CHAPTER 787, FLORIDA STATUTES AND OTHER SIMILAR
STATUTES.
DONE AND ORDERED at __________________________, Florida, on
.
__________________________________________
CIRCUIT JUDGE
Sherif 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 sherif for service
____ by hand delivery in open court (Respondent must acknowledge receipt in
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction
for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (03/15)
writing on the face of the original order--see below.)
____ by certifed mail (may only be used when Respondent is present at the hearing
and Respondent fails or refuses to acknowledge the receipt of a certifed copy of
this injunction.)
____ State Attorney’s Ofce
____ Batterer’s intervention program (if ordered)
___ _ State Disbursement Unit (if ordered)
____Central Depository (if ordered)
____ Department of Revenue
____ Other __________________________________________________
I CERTIFY the foregoing is a true copy of the original Final Judgment of Injunction for
Protection Against Domestic Violence with Minor Child(ren) as it appears on fle in
the ofce 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
certifed copy of this Injunction for Protection.
Petitioner_________________________________________
_
ACKNOWLEDGMENT
I, {Name of Respondent} , acknowledge receipt of a
certifed copy of this Injunction for Protection.
Respondent______________________________________
___
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction
for Protection Against Domestic Violence with Minor Child(ren) (After Notice) (03/15)
