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Instructions for Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (11/15)INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(q) PETITION FOR INJUNCTION FOR PROTECTION AGAINST SEXUAL VIOLENCE (11/15) 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 defned in Chapter 794, Florida Statutes;  a lewd or lascivious act, as defned 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 fled, reduced, or dismissed by the state attorneyss ofce. Yoou 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 specifc 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. Instructions for Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (11/15)This form should be typed or printed in black ink. Yoou 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 . Yoou 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 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, unless the respondent is incarcerated, and in such instance the temporary injunction is efective 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--YoOU. Section I of the temporary injunction gives a date that you should appear in court for a hearing. Yoou 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 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 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 fnal 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 ! Instructions for Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (11/15)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 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 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 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. 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. Yoou 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 Instructions for Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (11/15)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 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 fle it with the clerk of the circuit court and write confdential in the space provided for your address on the petition. IN THE CIRCUIT COURT OF THE _______________________ JUDICIAL CIRCUIT, IN AND FOR ________________________ COUNTYo, 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 fle a Request for Confdential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), and write confdential 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.) Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (11/15) 1. Respondent currently lives at the following address: {address, city, state, and zip code} _______ ______________________________________________________________________________ Respondentss Driverss License number is: {if known} ____________________________________ Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (11/15) 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 attorneyss 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 Respondentss parent or legal guardian is: ______________________________________________________________________________ ______________________________________________________________________________ SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION (This section must be completed.) 1. Petitioner has sufered sexual violence as shown by the fact that the Respondent has: {describe the acts of violence} _____________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _________________________________________________________________________ _____ ______________________________________________________________________________ ______________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (11/15) ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ _____ ______ Please indicate here if you are attaching additional pages to continue these facts. Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (11/15) {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: ________________ {If there is a criminal case, include case number, if known} _____ . b. _____ Respondent was sent to prison for committing sexual violence against Petitioner or Petitionerss 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? _____ Yoes _____ 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? _____ Yoes _____ 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} : ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Additional Information {Indicate all that apply} a. Respondent owns, has, and/or is known to have guns or other weapons. Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (11/15) Describe weapon(s):_________________________________________________________ b. _____ This or prior acts of violence have been previously reported to: {person or agency} _________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (11/15) SECTION IV. INJUNCTION (This section must be completed.) 1. Petitioner asks the Court to enter a TEMPORARYo 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 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 Petitionerss 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 Petitionerss immediate family must go to often:_________________________________ __________________________________________________________________________ __________________________________________________________________________ f. _____ prohibiting Respondent from knowingly and intentionally going to or within 100 feet of Petitionerss motor vehicle; AND any other terms the Court deems necessary for the safety of Petitioner and Petitionerss immediate family. Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (11/15) 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 STATE OF FLORIDA COUNTYo OF Sworn to or afrmed and signed before me on by NOTARYo PUBLIC or DEPUTYo CLERK {Print, type, or stamp commissioned name of notary or clerk.} _ Personally known _ Produced identifcation Type of identifcation produced Florida Supreme Court Approved Family Law Form 12.980(q), Petition for Injunction for Protection Against Sexual Violence (11/15)

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