INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED
FAMILY LAW FORM 12.980(g)
SUPPLEMENTAL AFFIDAVIT IN SUPPORT OF PETITION FOR
INJUNCTION FOR PROTECTION AGAINST DOMESTIC, REPEAT,
DATING, OR SEXUAL VIOLENCE, OR STALKING (11/15)
When should this form be used?
You may use this form if your Petition for Injunction for Protection Against
Domestic Violence , Florida Supreme Court Approved Family Law Form 12.980(a),
your Petition for Injunction for Protection Against Repeat Violence , Florida
Supreme Court Approved Family Law Form 12.980(f), your Petition for Injunction
for Protection Against Dating Violence , Florida Supreme Court Approved Family
Law Form 12.980(n), your Petition for Injunction for Protection Against
Sexual Violence, Florida Supreme Court Approved Family Law Form 12.890(q), or
your Petition for Injunction for Protection Against Stalking, Florida Supreme
Court Approved Family Law Form 12.980(t), was denied by the judge .
You should use this supplemental affidavit to add facts or clarify the facts you
wrote in your original petition .
For a domestic violence case, you should include facts that establish that you have
been a victim of violence or are in imminent danger of becoming a victim of
violence from the respondent .
For a repeat violence case, you should include facts that establish that you or a
member of your immediate family have or has been a victim of at least two prior
incidents of violence, that one of those incidents occurred within the last six months
and that there is an immediate and present risk of danger to you or a member of
your immediate family.
For a dating violence case, you should include fact that establish that you have
been a victim of violence or are in imminent danger of becoming a victim of
violence from the respondent who is an individual with whom you have or have
had a continuing and signifcant relationship of a romantic or intimate nature, to be
determined by consideration of such facts as: whether the dating relationship
existed within the past six months; whether the nature of the relationship included
an expectation of afection or sexual involvement; and whether the frequency and
type of interaction between you and the individual included involvement over time
and on a continued basis. Dating violence does not include violence in a casual
acquaintanceship or violence between individuals who have only engaged in
ordinary fraternization in a business or social context.
For a sexual violence case, you should include facts that establish that you are a
victim of sexual violence or the parent of a minor child living at home who is a
victim of sexual violence, and that you have reported the sexual violence to law
enforcement and are cooperating in the criminal proceeding if there is one. If the
respondent was in state prison for sexual violence against you or the minor child
Instructions for Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental
Affidavit in Support of Petition for Injunction for Protection Against Domestic, Repeat, Dating,
or Sexual Violence, or Stalking (11/15)
and the respondent is out of prison or is getting out within 90 days of the petition,
include that information in your supplemental affidavit, along with a copy of the
notice of inmate release.
For a stalking case, you should include facts that establish that you are either a
victim of stalking or cyberstalking, or that you are the parent or legal guardian of a
minor child living at home who is a victim of stalking or cyberstalking. The facts
must establish that stalking exists in order for the judge to order a temporary
injunction for protection against stalking. Please be specifc as to where the
incidents of stalking took place. These locations may include, but need not be
limited to, a home, school, or place of employment. For cyberstalking, please
include a description of all evidence of contacts and/or threats made by the
respondent in voice messages, texts, emails, or other electronic communication.
This form should be typed or printed in black ink. After completing this form, you
should sign the form before a notary public or the clerk of the circuit court .
You should then file the original with the clerk in the county where the petition was
fled 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 fled 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 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.
What should I do next?
After you complete this supplemental affidavit, the clerk will attach it to your
original petition and all the documents will be submitted to the judge as your
Amended Petition.
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
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.
Instructions for Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental
Affidavit in Support of Petition for Injunction for Protection Against Domestic, Repeat, Dating,
or Sexual Violence, or Stalking (11/15)
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.
Instructions for Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental
Affidavit in Support of Petition for Injunction for Protection Against Domestic, Repeat, Dating,
or Sexual Violence, or Stalking (11/15)
IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR __________________________ COUNTY, FLORIDA
Case No: _________________________
Division: _________________________
____________________________________,
Petitioner,
and
__ ,
Respondent,
SUPPLEMENTAL AFFIDAVIT IN SUPPORT OF PETITION FOR
INJUNCTION FOR PROTECTION AGAINST
( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE
( ) DATING VIOLENCE ( ) SEXUAL VIOLENCE ( ) STALKING
I, {full legal name} __________________________________________________________, being
sworn, certify that the following statements are true:
{Please complete all paragraphs that relate to your case}
1. On {date} ____________________ , at {place and address}
_______________________________
______________________________________________________________________________
,
Respondent said or did the following things that hurt me or a member of my
immediate family and made me afraid for my or my family member’s safety:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____ Please indicate here if you are attaching additional pages to continue
these facts.
Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental Affidavit in
Support of Petition for Injunction for Protection Against Domestic, Repeat, Dating, or Sexual
Violence, or Stalking (11/15)
2. On {date} ____________________ , at {place and address}
______________________________,
the following event(s) took place:
___________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____ Please indicate here if you are attaching additional pages to continue
these facts.
3. On {date} ____________________ , 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}__________________________________________________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
For cyberstalking, the following is 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.
4. _____ Please indicate here if you are attaching copies of medical records for
treatment you may have received for injuries referred to in your petition or in
this supplemental affidavit, copies of any police or sherif reports concerning
incidents of violence involving you and Respondent, or any notice of inmate
release.
Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental Affidavit in
Support of Petition for Injunction for Protection Against Domestic, Repeat, Dating, or Sexual
Violence, or Stalking (11/15)
I understand that I am swearing or affirming under oath to the
truthfulness of the claims made in this supplemental affidavit and that the
punishment for knowingly making a false statement includes fines and/or
imprisonment.
Dated: _______________ ______________________________________________
Signature of Petitioner
Printed Name:
Address:
City, State, Zip Code:
Telephone Number:
Number:
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 deputy clerk.}
____ Personally known
____ Produced identifcation
Type of identifcation produced ________________________________
Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental Affidavit in
Support of Petition for Injunction for Protection Against Domestic, Repeat, Dating, or Sexual
Violence, or Stalking (11/15)