INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED
FAMILY LAW FORM 12.980(n)
PETITION FOR INJUNCTION FOR PROTECTION AGAINST
DATING VIOLENCE (11/15)
When should this form be used?
If you are a victim of dating violence , and have reasonable cause to believe you
are in imminent danger of becoming the victim of another act of dating violence ,
or if you have reasonable cause to believe that you are in imminent danger of
becoming a victim of dating violence , you can use this form to ask the court for a
protective order prohibiting dating violence. Dating violence means violence
between individuals who have or have had a continuing and signifcant relationship
of a romantic or intimate nature. The dating relationship must have existed
within the past six months, the nature of the relationship must have been
characterized by the expectation of afection or sexual involvement
between the parties, and the frequency and type of interaction must have
included that the persons have been involved over time and on a
continuous basis during the course of the relationship. Dating violence
does not include violence in a casual acquaintanceship or violence
between individuals who only have engaged in ordinary fraternization in a
business or social context. Dating violence includes assault, aggravated assault,
battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated
stalking, kidnapping, or false imprisonment, or any criminal ofense resulting in
physical injury or death. Because you are making a request to the court, you are
called the petitioner . The person whom you are asking the court to protect you
from is called the respondent . If you are under the age of eighteen and have never
been married or had the disabilities of nonage removed by a court, one of your
parents or your legal guardian must sign this petition on your behalf.
If you are fling on behalf of a child or children
The parent or legal guardian of any minor child who is living at home may seek an
injunction for protection against dating violence on behalf of the minor child. With
respect to a minor child who is living at home, if the party against whom the
protective injunction is sought is also a parent, stepparent, or legal guardian, you,
as the parent or legal guardian fling the petition, must have been an eye-witness
to, or have direct physical evidence or affidavits from eye-witnesses of, the
specifc facts and circumstances that form the basis of the petition. If the party
against whom the protective injunction is sought is a person OTHER THAN a
parent, stepparent, or legal guardian of the minor child, you, as the parent or legal
guardian fling the petition, must state why you have reasonable cause to believe
that the minor child is a victim of dating violence.
Additional Information
Instructions for Florida Supreme Court Approved Family Law Form 12.980(n), Petition for
Injunction for Protection Against Dating Violence (11/15)
If the respondent is your spouse , former spouse, related to you by blood or
marriage, living with you now or has lived with you in the past (if you are or were
living as a family), or the other parent of your child(ren), whether or not you have
ever been married or ever lived together, you should use Petition for Injunction
for Protection Against Domestic Violence , 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 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 staf 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 dating violence exists, the judge will sign a Temporary
Injunction for Protection Against Dating Violence , Florida Supreme Court
Approved Family Law Form 12.980(o). A temporary injunction is issued without
notice to the respondent. The clerk will give your petition , the temporary
injunction, and any other papers fled with your petition to the sherif or other law
enforcement ofcer for personal service on the respondent. The temporary
injunction will take efect 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 frst. 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
Dating Violence (After Notice) , Florida Supreme Court Approved Family Law
Form 12.980(p), which will remain in efect for a specifc time period or until
modifed 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 fnal 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.
Instructions for Florida Supreme Court Approved Family Law Form 12.980(n), Petition for
Injunction for Protection Against Dating Violence (11/15)
If the judge signs a temporary or fnal injunction, the clerk will provide you with the
necessary copies. Make sure that you keep one certifed 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 dating violence exists, the court will set a full
hearing on your petition. The respondent will be notifed by personal service of
your petition and the hearing. If your petition is denied, you may: amend your
petition by fling 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 defned in that section. The clerk of the circuit court
or family law intake staf will help you complete any necessary forms. For further
information, see Section 784.046, Florida Statutes, and Rule 12.610, Florida Family
Law Rules of Procedure.
IMPORTANT INFORMATION REGARDING E-FILING
The Florida Rules of Judicial Administration now require that all petitions, pleadings,
and documents be fled electronically except in certain circumstances. Self-
represented litigants may fle petitions or other pleadings or documents
electronically; however, they are not required to do so. If you choose to fle
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 fle. 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
Sherif or certifed 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. If you elect to participate in electronic service, which
Instructions for Florida Supreme Court Approved Family Law Form 12.980(n), Petition for
Injunction for Protection Against Dating Violence (11/15)
means serving or receiving pleadings by electronic mail (e-mail), or through the
Florida Courts E-Filing Portal, you must review Florida Rule of Judicial
Administration 2.516. You may fnd this rule at www.flcourts.org through the link to
the Rules of Judicial Administration provided under either Family Law Forms: Getting
Started, or Rules of Court in the A-Z Topical Index.
SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL;
HOWEVER, THEY ARE NOT REQUIRED TO DO SO. If a self-represented litigant
elects to serve and receive documents by e-mail, the procedures must always be
followed once the initial election is made.
To serve and receive documents by e-mail, you must designate your e-mail
addresses by using the Designation of Current Mailing and E-mail Address ,
Florida Supreme Court Approved Family Law Form 12.915, and you must provide
your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certifcate 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(n), Petition for
Injunction for Protection Against Dating Violence (11/15)
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
DATING VIOLENCE
I, {full legal name} , being sworn,
certify that the following statements are true:
SECTION I. PETITIONER
(This section is about you. It must be completed.)
1. Petitioner currently lives at 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
Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for
Protection Against Dating Violence (11/15)
completed.)
1. Respondent currently lives at the following address: {address, city, state, and
zip code} ________
______________________________________________________________________________
Respondent’s Driver’s License number is: {if known}
____________________________________
2. Petitioner has known Respondent since
{date} _____________________________________.
3. Respondent's last known place of
employment:_____________________________________
Employment
address:_________________________________________________________
Working hours: ___________________________
4. Physical description of Respondent:
Race: _____ Sex: Male ____ Female ____ Date of Birth:
Height: _____ Weight: _____ Eye Color: _____ Hair
Color:________________
Distinguishing marks and/or scars:
Vehicle: (make/model) _______________ Color: __________ Tag Number:
____________
5. Other names Respondent goes by (aliases or
nicknames):______________________________
_____________________________________________________________________________.
6. Respondent's attorney’s name, address, and telephone number is:
_______________________
(If you do not know whether Respondent has an attorney, write "unknown." If
Respondent does not have an attorney, write "none.")
7. 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. Have the Petitioner and Respondent been involved in a dating relationship
within the past six months? _______Yes __________No
2. Describe the nature of the relationship between the Petitioner and
Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for
Protection Against Dating Violence (11/15)
Respondent {Include the length of time of the relationship, the romantic or
intimate nature of the relationship, the frequency or type of interaction, and
any other facts that characterize the relationship}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
.
_____Please indicate here if you are attaching additional pages to continue
these facts.
3. Has Petitioner ever received or tried to get an injunction for protection
against domestic violence, dating violence, repeat violence, or sexual
violence, or stalking against Respondent in this or any other court?
Florida Supreme Court Approved Family Law Form 12.980(n), Petition for Injunction for
Protection Against Dating Violence (11/15)
_____ Yes _____ No If yes, what happened in that case? {Include case
number, if known}
4. Has Respondent ever received or tried to get an injunction for protection
against domestic violence, dating violence, repeat violence, or sexual
violence, or stalking against Petitioner in this or any other court?
_____ Yes _____ No If yes, what happened in that case? {Include case
number, if known}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
.
5. 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}:
_____________________________________________________________________________
_
_____________________________________________________________________________
_
_____________________________________________________________________________
_
_____________________________________________________________________________.
6. Respondent has directed an incident of violence, meaning assault,
aggravated assault, battery, aggravated battery, sexual assault, sexual
battery, stalking, aggravated stalking, kidnapping, or false imprisonment, or
any criminal ofense resulting in physical injury or death against Petitioner or
a minor child living at home. The incident (including date and location) is
described below.
On {date} , at {location}
___________________________ ,
Respondent ______________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________.
_____Please indicate here if you are attaching additional pages to continue
these facts.
7. Other prior incidents (including dates and location) are described below:
On {date(s)} , at {location(s)}
_____________________________ ,
Respondent___________________________________________________________________
_
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
.
_____Please indicate here if you are attaching additional pages to continue
these facts.
8. Imminent Danger
{Please complete either paragraph a or b below}
a. ________Petitioner is a victim of dating violence and has reasonable cause
to believe he or she is in imminent danger of becoming a victim of another
act of dating violence . {Explain what Respondent has done to make you a
victim of dating violence and to make you fear that you are in imminent
danger of becoming a victim of another act of dating violence. }
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
.
OR
b. _____Petitioner has reasonable cause to believe he or she is in imminent
danger of becoming a victim of dating violence as demonstrated by the fact
that Respondent has: {Explain what Respondent has done that makes you
fear that you are in imminent danger of becoming a victim of dating
violence.}
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
9. 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 dating 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 dating
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 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 frearms;
{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 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 UNDERSTAND THAT I AM SWEARING OR AFFIRMING UNDER OATH TO THE
TRUTHFULNESS OF THE CLAIMS MADE IN THIS PETITION AND THAT THE
PUNISHMENT FOR KNOWINGLY MAKING A FALSE STATEMENT INCLUDES
FINES AND/OR IMPRISONMENT.
Dated:____________________________ _______________________________________
Signature of Petitioner
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-Mail
Address(es):______________
_______________________________________
STATE OF FLORIDA
COUNTY OF
Sworn to or afrmed and signed before me on by .
NOTARY PUBLIC or DEPUTY CLERK
[Print, type, or stamp commissioned
name of notary or clerk.]
Personally known
Produced identifcation
Type of identifcation produced