Florida Petition for Injunction for Protection Against Domestic Violence

Petition for Injunction for Protection Against Domestic Violence

IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR COUNTY, FLORIDA

Case No.:

Division:

Petitioner:

Respondent:

SECTION I. PETITIONER

Full legal name:

Current address:

City, state and zip code:

Telephone Number:

Physical description of Petitioner:

Race: Sex: Male Female Date of Birth:

Attorney’s name, address, and telephone number:

SECTION II. RESPONDENT

Respondent’s current address:

Respondent’s Driver’s License number:

Respondent is: spouse of Petitioner Date of Marriage: former spouse Date of Marriage: Date of Dissolution:

related by blood or marriage. Specify relationship:

a person who is or was living in one home with Petitioner, as if a family.

a person with whom Petitioner has a child in common.

Petitioner has known Respondent since:

Last known place of employment:

Employment address:

Working hours:

Physical description of Respondent:

Race: Sex: Male Female Date of Birth:

Height: Weight: Eye Color: Hair Color:

Distinguishing marks or scars:

Vehicle make/model: Color: Tag Number:

Other names (aliases or nicknames):

Respondent’s attorney’s name, address, and telephone number:

SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION

1. Petitioner ever received or tried to get an injunction against Respondent? Yes No

If yes, what happened?

2. Respondent ever received or tried to get an injunction against Petitioner? Yes No

If yes, what happened?

3. Other court case between Petitioner and Respondent:

4. Petitioner is a victim or fears imminent domestic violence because Respondent has:

committed or threatened domestic violence.

previously threatened, harassed, stalked, or physically abused Petitioner.

attempted to harm Petitioner or family members.

threatened to conceal, kidnap, or harm children.

intentionally injured or killed a family pet.

used or threatened to use weapons.

physically restrained Petitioner from leaving or calling law enforcement.

has a criminal history involving violence or threat of violence.

has another order of protection.

destroyed personal property.

engaged in other behavior causing fear of imminent domestic violence.

Brief description of latest act of violence or threat of violence:

On , at , Respondent:

Please indicate here if you are attaching additional pages to continue these facts.

5. Additional Information

Other acts or threats of domestic violence as described on attached sheet.

This or other acts have been previously reported to:

Respondent owns/has/is known to have guns or other weapons.

Describe weapon(s):

Respondent has a drug problem.

Respondent has an alcohol problem.

Respondent has a history of mental health problems.

Baker Act proceeding? Yes No

Supposed to take medication? Yes No

Currently taking medication? Yes No

SECTION IV. TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME

Petitioner needs exclusive use and possession of the home at ,

Petitioner cannot get another safe place to live because:

If kept out of the home, Respondent has money to get other housing or may live without money at ,

2. The home is: owned or rented jointly. solely owned or rented by Petitioner. solely owned or rented by Respondent.

SECTION V. TEMPORARY PARENTING PLAN WITH TEMPORARY TIME-SHARING SCHEDULE FOR MINOR CHILD(REN)

Minor child(ren) name(s) and birth date(s):

2. The minor child(ren) for whom Petitioner is asking the court to provide a temporary parenting plan:

saw the domestic violence described in this petition happen.

were at the place where the domestic violence happened but did not see it.

were not there this time but have seen previous acts of domestic violence.

have not witnessed domestic violence by Respondent.

3. Other minor child(ren) present:

4. Temporary Parenting Plan and Temporary Time-Sharing Schedule

Petitioner requests a temporary parenting plan and time-sharing schedule.

Petitioner requests supervised exchange or exchange through a responsible person.

Petitioner requests that the Court limit time-sharing by Respondent.

Petitioner requests that the Court prohibit time-sharing by Respondent.

Petitioner requests only supervised time-sharing.

Supervision should be provided by:

SECTION VI. TEMPORARY SUPPORT

Petitioner claims a need for the money requested and that Respondent can pay.

Temporary alimony requested: $ every: week other week month

Temporary child support requested: $ every: week other week month

SECTION VII. INJUNCTION

Temporary injunction requested until hearing.

Prohibit Respondent from committing domestic violence.

Prohibit Respondent from going to or within 500 feet of Petitioner’s home.

Prohibit Respondent from going to or within 500 feet of Petitioner’s place of employment or school.

Employment/school address:

Prohibit contact by mail, telephone, another person, or any other manner.

Prohibit going to or within 100 feet of Petitioner’s motor vehicle.

Prohibit defacing or destroying Petitioner’s personal property.

Prohibit Respondent from going to or within 500 feet of other specified places.

Grant temporary exclusive use and possession of the home.

Grant 100% of the time-sharing with the parties’ minor child(ren).

Establish a temporary parenting plan and time-sharing schedule.

Grant temporary alimony.

Grant temporary child support.

Order Respondent to participate in treatment, intervention, and/or counseling services.

Refer Petitioner to a certified domestic violence center.

Other terms requested:

I understand that by filing this petition, I am asking the Court to hold a hearing. I understand that if either party fails to appear, we will be bound by any injunction issued.

I have read every statement in this petition, and each statement is true and correct under penalty of perjury.

Initials: