IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
Case No.:
Division:
,
Petitioner,
and
,
Respondent.
TEMPORARY INJUNCTION FOR PROTECTION AGAINST
DOMESTIC VIOLENCE WITH MINOR CHILD(REN)
The Petition for Injunction for Protection Against Domestic Violence under section
741.30, Florida Statutes, and other papers fled 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.
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 Domestic Violence has
been issued without prior 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
Domestic Violence, which would remain in efect until modifed or dissolved by the
Court, and whether other things should be ordered, including, for example, such
matters as time-sharing and support. The hearing will be before The Honorable
{name}_________________________________, at {room name/number, location,
address, city}
_____________________________________________________________________________,
Florida.
If Petitioner and/or Respondent do not appear, this temporary injunction may be
continued in force, extended, dismissed, and/or additional orders may be granted,
including 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 fnal 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
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Temporary Injunction for
Protection Against Domestic Violence with Minor Child(ren) (03/15)
OR ORDER ISSUED IN THIS MATTER.
All witnesses and evidence, if any, must be presented at this time. In cases where
temporary support issues have been alleged in the pleadings, each party is ordered
to bring his or her fnancial afdavit Florida Family Law Rules of Procedure Form
12.902(b) or (c)), tax return, pay stubs, and other evidence of fnancial income to
the hearing.
NOTICE: Because this is a civil case, there is no requirement that these proceedings
be transcribed at public expense.
YOU ARE ADVISED THAT IN THIS COURT:
a. ____a court reporter is provided by the court.
b. ____an 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 phone 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 impaired, call 711.
SECTION II. FINDINGS
The statements made under oath by Petitioner make it appear that section 741.30,
Florida Statutes, applies to the parties. It also appears that Petitioner is a victim of
domestic violence by Respondent, and/or Petitioner has reasonable cause to believe
he/she is in imminent danger of becoming a victim of domestic violence by
Respondent, and that there is an immediate and present danger of domestic
violence to Petitioner or persons lawfully with Petitioner.
SECTION III. TEMPORARY INJUNCTION AND TERMS
This injunction shall be efective until the hearing set above and in no
event for longer than 15 days, unless extended by court order. If a fnal
order of injunction is issued, the terms of this temporary injunction will be
extended until service of the fnal injunction is efected upon Respondent.
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Temporary Injunction for
Protection Against Domestic Violence with Minor Child(ren) (03/15)
This injunction is valid and enforceable in all counties of the State of
Florida. The terms of this injunction may not be changed by either party
alone or by both parties together. Only the Court may modify the terms of
this injunction. Either party may ask the Court to change or end this
injunction.
Any violation of this injunction, whether or not at the invitation of
Petitioner or anyone else, may subject Respondent to civil or indirect
criminal contempt proceedings, including the imposition of a 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 Petitioner unless
otherwise provided in this Section, or unless paragraph 14 below
provides for contact connected with the temporary 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}
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Temporary Injunction for
Protection Against Domestic Violence with Minor Child(ren) (03/15)
or any residence to which Petitioner may move; Petitioner’s current or any
subsequent place of employment {list address of current employment}
___________________________________________________________________ _____ or
place where Petitioner attends school {list address of school} ;
or the following other places (if requested by Petitioner) where Petitioner or
Petitioner’s minor child(ren) go often: .
Respondent may not knowingly come within 100 feet of Petitioner's
automobile at any time.
b. _____Other provisions regarding contact:
3. Firearms.
{Initial all that apply; write N/A if does not apply}
a. _____Respondent shall not use or possess a frearm or ammunition.
b. _____Respondent shall surrender any frearms and ammunition in the
Respondent's possession to the County Sherif's
Department until further order of the court.
c. _____Other directives relating to frearms and ammunition:
____________________________ _____________________________________________
___________________________________________________________________________
_________________________________________________________________________.
NOTE: RESPONDENT IS ADVISED THAT, IF A PERMANENT INJUNCTION
FOR PROTECTION AGAINST DOMESTIC VIOLENCE IS ISSUED
FOLLOWING A HEARING REGARDING THIS MATTER, IN MOST CASES IT
WILL BE A VIOLATION OF 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. ADDITIONALLY, IT WILL BE A FEDERAL CRIMINAL
FELONY OFFENSE TO SHIP OR TRANSPORT IN INTERSTATE OR
FOREIGN COMMERCE, OR POSSESS IN OR AFFECTING COMMERCE,
ANY FIREARM OR AMMUNITION; OR TO RECEIVE ANY FIREARM OR
AMMUNITION WHICH HAS BEEN SHIPPED OR TRANSPORTED IN
INTERSTATE OR FOREIGN COMMERCE WHILE SUBJECT TO SUCH AN
INJUNCTION. 18 U.S.C. SECTION 922(g)(8).
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 the fnal injunction, if entered without Respondent
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Temporary Injunction for
Protection Against Domestic Violence with Minor Child(ren) (03/15)
being present at the hearing, and 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 domestic
violence:
.
TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME
{Initial all that apply; write N/A if does not apply}
6. ____ Possession of the Home. ____ Petitioner ____ Respondent shall have
temporary exclusive use and possession of the dwelling located at:
______________________________________
.
7. ____ Transfer of Possession of the Home. A law enforcement ofcer with
jurisdiction over the home shall accompany ____ Petitioner ____ Respondent
to the home, and shall place ____ Petitioner ____ Respondent in possession of
the home.
8. ____ Personal Items. ____ Petitioner ____ Respondent, in the presence of a
law enforcement 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, 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 home from which these items are to be retrieved shall
accompany ____ Petitioner
____ Respondent to the home and stand by to insure that he/she vacates the
premises with only his/her personal clothing, toiletries, tools of the trade, and
any items listed in paragraph 10 below. The law enforcement agency shall
not be responsible for storing or transporting any property. IF THE
RESPONDENT IS NOT AWARDED POSSESSION OF THE HOME AND
GOES TO THE HOME WITHOUT A LAW ENFORCEMENT OFFICER, IT IS A
VIOLATION OF THIS INJUNCTION.
9. ____ Petitioner ____ Respondent shall not damage or remove any furnishings
or fxtures from the parties' former shared premises.
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Temporary Injunction for
Protection Against Domestic Violence with Minor Child(ren) (03/15)
10. ____Other:_____________________________________________________________
________
TEMPORARY SUPPORT
Temporary support, if requested by Petitioner in the Petition for Injunction
for Protection Against Domestic Violence, will be addressed by the Court
after notice to Respondent and hearing on the matter.
TEMPORARY PARENTING PLAN WITH TIME-SHARING WITH MINOR
CHILD(REN)
11. 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 12 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 ____________________________.)
12. Temporary Order for 100% Time-Sharing With Respect to Minor
Child(ren). ____ Petitioner ____ Respondent shall, on a temporary basis,
have 100% time sharing with respect to the parties’ minor child(ren) listed
below:
Name Birth date
When requested by the parent to whom 100% time-sharing is awarded on a
temporary basis herein, 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 100% time-sharing is awarded on a
temporary basis herein. The other parent shall not take the child(ren) from
the parent to whom 100% time-sharing is awarded on a temporary basis
herein or any child care provider or other person entrusted by the parent to
whom 100% time-sharing is awarded on a temporary basis herein with the
care of the child(ren).
{Initial if applies; write N/A if does not apply}
______ Neither party shall remove the minor child(ren) from the State of
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Temporary Injunction for
Protection Against Domestic Violence with Minor Child(ren) (03/15)
Florida, which is the jurisdiction of this Court, prior to the hearing on this
temporary injunction. Violation of this custody order may constitute a felony
of the third degree under sections 787.03 and 787.04, Florida Statutes.
13. Contact with Minor Child(ren) . Unless otherwise provided in
paragraph 14 below, the
____ Petitioner ____ Respondent (i.e., the parent to whom 100% time-sharing
is not awarded on a temporary basis herein) shall have no contact with the
parties’ minor child(ren) until further order of the Court.
14. Other Additional Provisions Relating to the Minor Child(ren).
.
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 Sherif of _____ County, or any other authorized law
enforcement ofcer, is ordered to serve this temporary injunction upon
Respondent as soon as possible after its issuance.
2. This injunction is valid in all counties of the State of Florida. Violation
of this injunction should be reported to the appropriate law enforcement
agency. Law enforcement 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 which constitutes a criminal act
under section 741.31, Florida Statutes.
3. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW
ENFORCEMENT OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION
901.15(6), FLORIDA STATUTES. The arresting agent shall notify the State
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Temporary Injunction for
Protection Against Domestic Violence with Minor Child(ren) (03/15)
Attorney's Ofce immediately after arrest.
4. THIS IS A “CUSTODY ORDER” FOR PURPOSES OF THE UCCJEA AND
ALL STATUTES MAKING IT A CRIME TO INTERFERE WITH CUSTODY
UNDER CHAPTER 787 OF FLORIDA STATUTES AND OTHER SIMILAR
STATUTES .
5. 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.
DONE AND ORDERED at ___________________________, Florida on
.
CIRCUIT JUDGE
COPIES TO:
Sherif of ___________________ County
Petitioner: (or his or her attorney)
_____ by U.S. Mail
_____ by hand-delivery in open court
_____by e-mail to designated e-mail address(es)
Respondent:
_____ forwarded to the Sherif for service
_____ State’s Attorney’s Ofce
_____ Other:_________________________________
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Temporary Injunction for
Protection Against Domestic Violence with Minor Child(ren) (03/15)
I CERTIFY the foregoing is a true copy of the original Temporary 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}
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Temporary Injunction for
Protection Against Domestic Violence with Minor Child(ren) (03/15)