Fl. Prob. R. 5.920

As amended through January 1, 2025

Rule 5.920 - FORMS RELATED TO INJUNCTION FOR PROTECTION AGAINST EXPLOITATION OF A VULNERABLE ADULT

(a) Petition for Injunction. Petitioners should take steps to protect confidential information within the petition for injunction under Florida Rule of General Practice and Judicial Administration 2.420 and minimize sensitive information within the petition for injunction under Florida Rule of General Practice and Judicial Administration 2.425.

IN THE CIRCUIT COURT OF THE___________ JUDICIAL CIRCUIT, IN AND FOR__________ COUNTY, FLORIDA

In re: Protection of

_______________________

Case No.:_______________

Adversary Proceeding

Vulnerable Adult

_______________________,

Petitioner,

and

___________________________,

Respondent.

PETITION FOR INJUNCTION FOR PROTECTION AGAINST EXPLOITATION OF A VULNERABLE ADULT UNDER SECTION 825.1035, FLORIDA STATUTES

Before me, the undersigned authority, personally appeared petitioner who has been sworn and says that the following statements are true:

1. The vulnerable adult, ______________________, whose age is, who resides at (address): __________________

2. Section 825.101, Florida Statutes, provides that a vulnerable adult is a person whose ability to perform the normal activities of daily living or to provide for the vulnerable adult's own care or protection is impaired due to a mental, emotional, sensory, long-term physical, or developmental disability or dysfunction, or brain damage, or the infirmities of aging. Please describe the vulnerable adult's inability to perform the normal activities of daily living.

3. The petitioner's relationship to the vulnerable adult is:, and the petitioner has the right to bring the petition because: ____

____________________________

___________________________

4. The respondent,, resides at (last known address):

___________________________

5. The respondent's last known place of employment is:

___________________________

6. The physical description of the respondent is:

Race:___________

Sex:___________

Date of Birth:___________

Height:___________

Weight:___________

Eye Color:___________

Hair Color:___________

Distinguishing Marks/Scars:___________

7. Aliases of the respondent are:

8. The respondent is associated with the vulnerable adult as follows:

9. The following describes other causes of action:

(a) _______________there is/are 1 or more cause(s) of action currently pending between the petitioner and the respondent, and/or a proceeding under the Florida Guardianship Code, chapter 744, Florida Statutes, concerning the vulnerable adult. Describe causes of action here:_________

___________________________

(b) Related case numbers and county where filed, if available:___________

___________________________

(c) ___________there are previous or pending attempts by the petitioner to obtain an injunction for protection against exploitation of the vulnerable adult in this or any other circuit. Describe attempts here:__________

___________________________

(d) The results of any such attempts:_______________________________

___________________________

10. The following describes the petitioner's knowledge of:

(a) Any reports made to a government agency, such as the Department of Elder Affairs or the Department of Children and Families:__________

___________________________

(b) Any investigations performed by a government agency relating to abuse, neglect, or exploitation of the vulnerable adult: ___________________

___________________________

and

(c) The results of any such reports or investigations: ______________

___________________________

11. The petitioner knows or has reasonable cause to believe the vulnerable adult is either a victim of exploitation or is in imminent danger of becoming a victim of exploitation, because the respondent (include a description of any incidents or threats of exploitation by the respondent here):__________

___________________________

12. The following describes:

(a) The petitioner's knowledge of the vulnerable adult's dependence on the respondent for care:_________________________

___________________________

(b) Alternative provisions for the vulnerable adult's care in the absence of the respondent, if necessary:__________________

___________________________

(c) Available resources the vulnerable adult has for such alternative provisions:__________________; and

(d) The vulnerable adult's willingness to use such alternative provisions: ____________

___________________________

13. The petitioner knows the vulnerable adult maintains assets, accounts, or lines of credit at the following institutions:

Institution	Address	Account Number
_____________________	_____________________	_____________________
_____________________	_____________________	_____________________
_____________________	_____________________	_____________________
_____________________	_____________________	_____________________
_____________________	_____________________	_____________________

14. If petitioner is seeking to freeze assets of the vulnerable adult, petitioner believes that the vulnerable adult's assets to be frozen are (check 1):

_____Worth less than $1,500

_____Worth from $1,500 to $5,000

_____Worth more than $5,000

15. The petitioner genuinely fears imminent exploitation of the vulnerable adult by the respondent.

16. The petitioner seeks an injunction for the protection of the vulnerable adult, including (mark appropriate section or sections):

_____Prohibiting the respondent from having any direct or indirect contact with the vulnerable adult.

_____Immediately restraining the respondent from committing any acts of exploitation against the vulnerable adult.

_____Freezing the below assets, accounts, and lines of credit of the vulnerable adult, listed below even if titled jointly with the respondent, or in the respondent's name only, in the court's discretion.

Institution	Address	Account Number
_____________________	_____________________	_____________________
_____________________	_____________________	_____________________
_____________________	_____________________	_____________________
_____________________	_____________________	_____________________
_____________________	_____________________	_____________________

_____Providing any terms the court deems necessary for the protection of the vulnerable adult or the vulnerable adult's assets, including any injunctions or directives to law enforcement agencies, including:_________

_____________________________________

17. If the court enters an injunction freezing assets, accounts, and credit lines:

(a) the petitioner believes that the critical expenses of the vulnerable adult will be paid for or provided by the following persons or entities: _________________________

________________________________________

(b) The petitioner requests that the following expenses be paid notwithstanding the freezing of assets, accounts, or lines of credit from the following institution(s): _________________________

________________________________________

I ACKNOWLEDGE THAT UNDER SECTION 415.1034, FLORIDA STATUTES, ANY PERSON WHO KNOWS, OR HAS REASONABLE CAUSE TO SUSPECT, THAT A VULNERABLE ADULT HAS BEEN OR IS BEING ABUSED, NEGLECTED, OR EXPLOITED HAS A DUTY TO IMMEDIATELY REPORT SUCH KNOWLEDGE OR SUSPICION TO THE CENTRAL ABUSE HOTLINE. I HAVE REPORTED THE ALLEGATIONS IN THIS PETITION TO THE CENTRAL ABUSE HOTLINE.

I HAVE READ EACH STATEMENT MADE IN THIS PETITION AND EACH SUCH STATEMENT IS TRUE AND CORRECT. I UNDERSTAND THAT THE STATEMENTS MADE IN THIS PETITION ARE BEING MADE UNDER PENALTY OF PERJURY PUNISHABLE AS PROVIDED IN SECTION 837.02, FLORIDA STATUTES.

__________________

Signature of Party

Printed Name:________________

Address:_______________

City, State, Zip:___________________

Telephone Number:__________________

Designated E-mail Address(es):___________

_______________________

STATE OF FLORIDA

COUNTY OF______________

Sworn to or affirmed and signed before me on .....(date)......

________________________________________

Printed Name

________________________________________

Notary Public or Deputy Clerk

___________Personally known or___________ Produced identification

Type of identification produced:________________________

(b) Temporary Protective Injunction Against Exploitation of a Vulnerable Adult.

IN THE CIRCUIT COURT OF THE_________________ JUDICIAL CIRCUIT,

IN AND FOR______________ COUNTY, FLORIDA

In re:

Case No.:______________

________________

Vulnerable Adult

________________ ,

Petitioner,

and

________________ ,

Respondent.

TEMPORARY PROTECTIVE INJUNCTION AGAINST EXPLOITATION OF A VULNERABLE ADULT AND NOTICE OF HEARING

This cause came before the court, which has jurisdiction over the parties and subject matter under state law. The court having reviewed the petition and affidavits and considered argument of counsel, finds as follows:

______Reasonable notice and opportunity to be heard was given to the respondent in a manner sufficient to protect his or her due process rights. Date of service

__________The court conducted its review ex parte.

3. An immediate and present danger of exploitation of the vulnerable adult exists.

4. There is a likelihood of irreparable harm and unavailability of an adequate legal remedy.

5. There is a substantial likelihood of success on the merits.

6. The threatened injury to the vulnerable adult outweighs possible harm to the respondent.

7. Granting a temporary injunction will not disserve the public interest.

8. This injunction provides for the vulnerable adult's physical or financial safety.

9. These findings were based on the following facts: ________________

_________________________________

Accordingly, it is hereby ADJUDGED that:

The petitioner's request for a temporary protective injunction is GRANTED. This injunction is valid for 15 days from the date of this order or______. The full hearing is set for .....(date)....., at .....(time)......The hearing will be held before the Honorable____________ at__________, Florida.

It is further ordered that:

__________The respondent shall not commit any act of exploitation against the vulnerable adult.

____________The respondent will have no contact with vulnerable adult.

_________The vulnerable adult is awarded temporarily exclusive use and possession of any dwelling the vulnerable adult shares with the respondent.

___________The respondent is barred from entering the residence of the vulnerable adult.

____________The vulnerable adult's assets, accounts, and credit lines are hereby frozen until further court order except:____________

_________________________________

___________Institution(s) served on .....(date)......

________The following institution(s)_____________ holding the vulnerable adult's assets must use the vulnerable adult's unencumbered assets to pay the clerk of court the following filing fee:

____________$75.00 (if assets are between $1,500-$5,000)

___________$200.00 (if assets are more than $5,000).

If the court enters an injunction, these fees will be taxed as costs against the respondent.

Law enforcement is hereby directed to:_____________

_________________________________

Other relief:____________________

_________________________________

This injunction is valid and enforceable in all Florida counties, does not affect title to real property, and law enforcement may use their section 901.15(6), Florida Statutes, arrest powers to enforce its terms.

DONE and ORDERED on .....(date).....at .....(time)......

_________________________________

Judge

CC: All parties and counsel of record

COPIES TO: (Check those that apply)

Petitioner:

____________by U. S. Mail

________by hand delivery in open court (Petitioner must acknowledge receipt in writing on the original order-see below.)

Vulnerable Adult (if not petitioner)

_____by U. S. Mail

_____by hand delivery in open court

_____Respondent:

_____forwarded to Sheriff for service

_____by U. S. Mail

_____by hand delivery in open court (Respondent must acknowledge receipt in writing on the original order-see below.)

_____by certified mail (May only be used when respondent is present at the hearing and respondent fails or refuses to acknowledge the receipt of a certified copy of this injunction.)

_______Other:__________________

Petitioner's Attorney:_______________ by e-mail

Respondent's Attorney: __________by e-mail

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the clerk of the circuit court of_____________ County, Florida, and that I have furnished copies of this order as indicated above on .....(date)......

CLERK OF THE CIRCUIT COURT

By:__________________

Deputy Clerk

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 telephone 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 or voice impaired, call 711.

(c) Order Denying Injunction and Notice of Hearing.

IN THE CIRCUIT COURT OF THE_______________ JUDICIAL CIRCUIT,

IN AND FOR_______________

COUNTY, FLORIDA

In re:

Case No.:______________

________________________

Vulnerable Adult

________________________ ,

Petitioner,

and

_____________________ ,

Respondent.

ORDER DENYING REQUEST FOR TEMPORARY INJUNCTION AND SETTING HEARING ON PETITION FOR INJUNCTION FOR PROTECTION AGAINST EXPLOITATION OF A VULNERABLE ADULT

A petition for injunction for protection against exploitation of a vulnerable adult has been reviewed. This court has jurisdiction over the parties and of the subject matter. Based upon the facts stated in the petition, the court finds:

The facts supporting the denial of the request for an ex parte injunction are:__________________

__________________________________

The court finds that based on the facts, as stated in the petition alone and without a hearing in the matter, there is no appearance of an immediate and present danger of exploitation of a vulnerable adult.

IT IS THEREFORE ORDERED:

The request for a temporary injunction for protection against exploitation of a vulnerable adult is denied. A hearing is scheduled on the petition for injunction for protection against exploitation of a vulnerable adult. The petitioner has the right to promptly amend any petition consistent with court rules.

NOTICE OF HEARING

A hearing is scheduled regarding this matter on .....(date)....., at .....(time)....., when the court will fully hear the allegations in the petition for injunction for protection against exploitation of a vulnerable adult. The hearing will be before The Honorable .....(name)....., at the following .....(address)....., Florida. All witnesses and evidence, if any, must be presented at this time.

IF EITHER PETITIONER OR RESPONDENT DO NOT APPEAR AT THE FINAL HEARING, THE PETITIONER OR RESPONDENT WILL BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED IN THIS MATTER.

Nothing in this order limits petitioner's rights to dismiss the petition.

DONE AND ORDERED in,___________ Florida, on .....(date)......

______________________

JUDGE

COPIES TO:

Sheriff of________________ County

CERTIFICATE OF SERVICE:

Petitioner:___________ by U. S. Mail____________ by e-mail to designated e-mail address(es)

Respondent will be served by sheriff.

Vulnerable Adult will be served by sheriff.

The financial institution will be served by sheriff. (If any assets, accounts, or lines of credit are requested to be frozen, insert names of the financial institutions.)

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office 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

(d) Final Protective Injunction.

IN THE CIRCUIT COURT OF THE______________ JUDICIAL CIRCUIT,

IN AND FOR____________ COUNTY, FLORIDA

In re:

Case No.:_______________

_______________________

Vulnerable Adult

__________________,

Petitioner,

and

____________________,

Respondent.

PERMANENT INJUNCTION FOR PROTECTION AGAINST EXPLOITATION OF A VULNERABLE ADULT

1. Reasonable notice and opportunity to be heard was given to the respondent in a manner sufficient to protect the respondent's due process rights. Respondent was served with the petition for injunction, notice of hearing, and temporary protective injunction, if issued.

2. A hearing was held on .....(date)......

3. The vulnerable adult is a victim of exploitation or in imminent danger of becoming an exploitation victim.

4. There is a likelihood of irreparable harm and unavailability of an adequate legal remedy.

5. The threatened injury to the vulnerable adult outweighs possible harm to the respondent.

6. With regard to freezing the respondent's assets, accounts, and lines of credit that were the proceeds of exploitation, there is probable cause that exploitation has occurred and a substantial likelihood that such assets, accounts, and lines of credit will be returned to the vulnerable adult.

7. This injunction provides for the vulnerable adult's physical or financial safety.

8. These findings were based on the following facts: ______________

________________________________

Accordingly, it is hereby ADJUDGED that:

The petitioner's request for a protective injunction is GRANTED. This injunction remains in effect until it has been modified or dissolved, and it is further ordered that:

__________The respondent must not commit any acts of exploitation against, or have any direct or indirect contact with, the vulnerable adult.

__________The vulnerable adult is awarded exclusive use and possession of any dwelling the vulnerable adult shares with the respondent.

__________The respondent is excluded from the residence of the vulnerable adult.

__________The respondent must, at the respondent's own expense, participate in all relevant treatment, intervention, or counseling services to be paid for by the respondent.

__________Unless ownership is unclear, any temporarily frozen assets, accounts, and credit lines of the vulnerable adult are to be returned to the vulnerable adult.

If not already paid under the order granting temporary protective injunction against exploitation of a vulnerable adult, a final cost judgment is hereby entered against respondent and in favor of the clerk of courts in the amount of (check 1):

__________$75.00 (if assets are between $1,500-$5,000)

__________$200.00 (if assets are more than $5,000).

All for which let execution issue forthwith.

If the amount set forth above has already been paid to the clerk of courts, a final cost judgment is hereby entered against respondent and in favor of the vulnerable adult in the amount set forth above, all for which let execution issue forthwith.

Any other costs associated with this judgment, including filing fees and service charges, are to be paid by the respondent.

Other:__________________________

______________________________________________

This injunction is valid and enforceable in all Florida counties, does not affect title to real property, and law enforcement may use section 901.15(6), Florida Statutes, arrest powers to enforce its terms.

DONE and ORDERED on .....(date)......

____________________

Judge

CC: All parties and counsel of record

COPIES TO: (Check those that apply)

Petitioner:

__________by U. S. Mail

__________by hand delivery in open court (Petitioner must acknowledge receipt in writing on the original order-see below.)

Vulnerable Adult (if not petitioner)

__________ by U. S. Mail

__________ by hand delivery in open court

Respondent:

__________ forwarded to Sheriff for service

__________ by U. S. Mail

__________ by hand delivery in open court (Respondent must acknowledge receipt in writing on the original order-see below.)

__________ by certified mail (May only be used when respondent is present at the hearing and respondent fails or refuses to acknowledge the receipt of a certified copy of this injunction.)

__________ Department of Agriculture and Consumer Services

__________Other: ______________________

Petitioner's Attorney:__________ by e-mail

Respondent's Attorney: __________by e-mail

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the clerk of the circuit court of__________ County, Florida, and that I have furnished copies of this order as indicated above on .....(date)......

CLERK OF THE CIRCUIT COURT

By:__________

Deputy Clerk

Fl. Prob. R. 5.920

Amended by SC2023-1477, effective 12/14/2023; adopted by 2020 WL 5667292, effective 9/24/2020.