PETITION FOR
INJUNCTION FOR PROTECTION
AGAINST DOMESTIC VIOLENCE
The undersigned petitioner ... (name)... declares under penalties of perjury that the following statements are true:
(Petitioner may furnish address to the court in a separate confidential filing if, for safety reasons, the petitioner requires the location of the current residence to be confidential.)
Race............
Sex............
Date of birth............
Height............
Weight............
Eye color............
Hair color............
Distinguishing marks or scars............
The petitioner should also describe any previous or pending attempts by the petitioner to obtain an injunction for protection against domestic violence in this or any other circuit, and the results of that attempt:.............................................................
Case numbers should be included if available.
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.....committed or threatened to commit domestic violence defined in s. 741.28, Florida Statutes, as any assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any criminal offense resulting in physical injury or death of one family or household member by another. With the exception of persons who are parents of a child in common, the family or household members must be currently residing or have in the past resided together in the same single dwelling unit.
.....previously threatened, harassed, stalked, or physically abused the petitioner.
.....attempted to harm the petitioner or family members or individuals closely associated with the petitioner.
.....threatened to conceal, kidnap, or harm the petitioner's child or children.
.....intentionally injured or killed a family pet.
.....used, or has threatened to use, against the petitioner any weapons such as guns or knives.
.....physically restrained the petitioner from leaving the home or calling law enforcement.
.....a criminal history involving violence or the threat of violence (if known).
.....another order of protection issued against him or her previously or from another jurisdiction (if known).
.....destroyed personal property, including, but not limited to, telephones or other communication equipment, clothing, or other items belonging to the petitioner.
.....engaged in a pattern of abusive, threatening, intimidating, or controlling behavior composed of a series of acts over a period of time, however short.
.....engaged in any other behavior or conduct that leads the petitioner to have reasonable cause to believe he or she is in imminent danger of becoming a victim of domestic violence.
.....A minor child or minor children reside with the petitioner whose names and ages are as follows:..........................................................................................
.....Petitioner needs the exclusive use and possession of the dwelling that the parties share.
.....Petitioner is unable to obtain safe alternative housing because:.............................................................
.....Petitioner genuinely fears that respondent imminently will abuse, remove, or hide the minor child or children from petitioner because:.............................................................
.....Immediately restraining the respondent from committing any acts of domestic violence.
.....Restraining the respondent from committing any acts of domestic violence.
.....Awarding to the petitioner the temporary exclusive use and possession of the dwelling that the parties share or excluding the respondent from the residence of the petitioner.
.....Providing a temporary parenting plan, including a temporary timesharing schedule, with regard to the minor child or children of the parties which might involve prohibiting or limiting time-sharing or requiring that it be supervised by a third party.
..... Designating that the exchange of the minor child or children of the parties must occur at a neutral safe exchange location as provided in s. 125.01(8) or a location authorized by a supervised visitation program as defined in s. 753.01 if temporary time-sharing of the child is awarded to the respondent.
.....Establishing temporary support for the minor child or children or the petitioner.
.....Directing the respondent to participate in a batterers' intervention program.
.....Providing any terms the court deems necessary for the protection of a victim of domestic violence, or any minor children of the victim, including any injunctions or directives to law enforcement agencies.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE. I UNDERSTAND THAT THE STATEMENTS MADE IN THIS PETITION ARE BEING MADE UNDER PENALTIES OF PERJURY, PUNISHABLE AS PROVIDED IN SECTION 92.525 , FLORIDA STATUTES.
...(initials)...
In making its determination under this paragraph, the court is not limited to those factors enumerated in subparagraphs 1.-11.
If the respondent has been served previously with the temporary injunction and has failed to appear at the initial hearing on the temporary injunction, any subsequent petition for injunction seeking an extension of time may be served on the respondent by the clerk of the court by certified mail in lieu of personal service by a law enforcement officer.
Fla. Stat. § 741.30