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IN THE CIRCUIT COURT OF THE IN AND FOR

JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: ,

Petitioner, and , Respondent. TEMPORARY INJUNCTION FOR PROTECTION AGAINST SEXUAL VIOLENCE The Petition for Injunction for Protection Against Sexual Violence under section 784.046, Florida Statutes, and other papers filed 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. The term "Petitioner" as used in this injunction includes the person on whose behalf this injunction is entered. It is intended that this protection order meet the requirements of 18 U.S.C. § 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 Sexual Violence has been issued without notice to Respondent, 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 the Court should issue a Final Judgment of Injunction for Protection Against Sexual Violence, which shall remain in effect until modified or dissolved by the Court, and whether other things should be ordered. 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, or dismissed, and/or additional orders may be granted, including the imposition of court costs. All witnesses and evidence, if any, must be presented at this time. NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at public expense.
Florida Supreme Court Approved Family Law Form 12.980(r), Temporary Injunction for Protection Against Sexual Violence (07/04)

YOU ARE ADVISED THAT IN THIS COURT: ______ a. a court reporter is provided by the court. ______ b. electronic audio tape 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. ______ c. no electronic audio tape recording or court reporting services are 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 {name} , {address}____________________________________________, {telephone} , within 2 working days of your receipt of this temporary injunction. If you are hearing or voice impaired, call TDD 1-800-955-8771. SECTION II. FINDINGS

The statements made under oath by Petitioner make it appear that section 784.046, Florida Statutes, applies to the parties, that Petitioner is a victim of sexual violence by Respondent and meets the requirements for an injunction established by law. SECTION III. TEMPORARY INJUNCTION AND TERMS

This injunction shall be effective until the hearing set above and in no event for longer than 15 days, unless extended by court order or unless the Respondent is incarcerated, and if incarcerated, shall be effective for 15 days following the date Respondent is released from incarceration. If a final order of injunction is issued, the terms of this temporary injunction will be extended until service of the final injunction is effected upon Respondent. 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. Willful violation of the terms of this injunction, such as refusing to vacate the dwelling which the parties share, going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction, telephoning, contacting or communicating with Petitioner, if prohibited by this injunction, or committing an act of sexual violence against Petitioner constitutes a misdemeanor of the first degree punishable
Florida Supreme Court Approved Family Law Form 12.980(r), Temporary Injunction for Protection Against Sexual Violence (07/04)

by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes. Any party violating this injunction may be subject to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment and also may be charged with a crime punishable by a fine, jail, or both, as provided by Florida Statutes. ORDERED and ADJUDGED: 1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of violence against Petitioner, including assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnaping, or false imprisonment, or any criminal offense resulting in physical injury or death. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word, or act to do violence to Petitioner. No Contact. Respondent shall have no contact with the Petitioner unless otherwise provided in this section. 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}_____________________________________ 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: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ [Initial if applies; write N/A if not applicable] ____ b. Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time. ____ c. Other provisions regarding contact:_________________________________________ ________________________________________________________________________ ________________________________________________________________________ 3. Firearms. [Initial all that apply; write N/A if does not apply]
Florida Supreme Court Approved Family Law Form 12.980(r), Temporary Injunction for Protection Against Sexual Violence (07/04)

2.

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a. Respondent shall not use or possess a firearm or ammunition. b. Respondent shall surrender any firearms and ammunition in Respondent's possession to the County Sheriff's Department. ____ c. Other directives relating to firearms and ammunition: ___________________________ ________________________________________________________________________ ________________________________________________________________________ 4. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within 10 days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent's last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Fla.Fam.L.R.P., section 784.046, Florida Statutes. Additional order(s) necessary to protect Petitioner from sexual violence: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

5.

SECTION IV. OTHER SPECIAL PROVISIONS (This section to be used for inclusion of local provisions approved by the chief judge.) SECTION V. DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION (Provisions in this injunction that do not include a line for the judge to either initial or write N/A are considered mandatory provisions and should be interpreted to be part of this injunction.) 1. 2. The Sheriff of ______________ County, or any other authorized officer, is ordered to serve this temporary injunction upon Respondent as soon as possible after its issuance. This injunction is valid and enforceable in all counties of the State of Florida. Violation of this injunction should be reported to the appropriate law enforcement agency. Law enforcement officers of the jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this injunction and are authorized to arrest without a warrant pursuant to section 901.15, Florida Statutes, for any violation of its provisions, which constitutes a criminal act under section 784.047, Florida Statutes. Should any Florida law enforcement officer having jurisdiction have probable cause to

3.

Florida Supreme Court Approved Family Law Form 12.980(r), Temporary Injunction for Protection Against Sexual Violence (07/04)

believe that Respondent has knowingly violated this injunction, the officer may arrest Respondent, confine him/her in the county jail without bail, and shall bring him/her before the Initial Appearance Judge on the next regular court day so that Respondent can be dealt with according to law. The arresting agent shall notify the State Attorney's Office immediately after arrest. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES. 4. 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 affidavit in support of the violation or Petitioner may contact the State Attorney's office for assistance in filing 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 file a criminal charge, if warranted by the evidence. ORDERED on _________________________________. __________________________________________ CIRCUIT JUDGE COPIES TO: Sheriff of County Petitioner: by U. S. Mail by hand delivery forwarded to sheriff for service Respondent: Other: 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

Florida Supreme Court Approved Family Law Form 12.980(r), Temporary Injunction for Protection Against Sexual Violence (07/04)