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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(t), PETITION BY AFFIDAVIT FOR ORDER TO SHOW CAUSE FOR A VIOLATION OF FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE, REPEAT VIOLENCE, DATING VIOLENCE, OR SEXUAL VIOLENCE When should this form be used? You may use this form if you have a valid Final Judgment of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence in force which has been violated. You should use this affidavit to state the essential facts which establish a violation of the Final Judgment of Injunction. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or the clerk of the circuit court. You should then file the original with such clerk or judge as determined by the chief judge of your circuit to be the recipient of affidavits of violation, provide a copy to the state attorney of that circuit and keep a copy for your records.

Instructions for Florida Supreme Court Approved Family Law Form 12.980(t), Petition by Affidavit for Rule to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (03/04)

IN THE CIRCUIT COURT OF THE IN AND FOR

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

Petitioner, and , Respondent. PETITION BY AFFIDAVIT FOR ORDER TO SHOW CAUSE FOR A VIOLATION OF FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE ( ) DATING VIOLENCE ( ) SEXUAL VIOLENCE I, {full legal name} ___________________________________________, being sworn, certify that I have actual knowledge of the following facts as set forth and the following statements are true: 1. The Court has previously issued [ / one only] ____ a. Final Judgment of Injunction for Protection Against Domestic Violence ____ b. Final Judgment of Injunction for Protection Against Repeat Violence ____ c. Final Judgment of Injunction for Protection Against Dating Violence _____ d. Final Judgment of Injunction for Protection Against Sexual Violence in this case on the ___ day of ____________________, _____. 2. The Final Judgment of Injunction for Protection was served on Respondent on the ___ day of ____________________, _____. On {date} _________________________, at {place and address} ___________________ _________________________________________________________________________, the following event(s) took place:_____________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

3.

Florida Supreme Court Approved Family Law Form 12.980(t), Petition By Affidavit for Rule to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (03/04)

________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 9 Check here if you are attaching additional pages to continue these facts. 4. Respondent has willfully violated the Injunction by (explain what Respondent did that violated the Order of Protection.) ________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

9 Check here if you are attaching additional pages to continue these facts. 5. ____ Check here if you are attaching copies of medical records for treatment you may have received for injuries referred to in your affidavit, or copies of any police or sheriff reports concerning incidents of violence involving you and Respondent. Respondent acted to impair, interfere with, delay, hinder, lessen the authority of, dignity of, and embarrass the cause of justice in a manner contemptuous of this court.

6.

WHEREFORE, I respectfully request that the Court issue an Order to Show Cause, requiring Respondent to appear before the Court to show cause why Respondent should not be held in contempt of court for failure to abide by the terms and conditions of the Final Judgment of Injunction for Protection. I understand that by filing this affidavit, I am asking the court to hold a hearing, that both Respondent and I will be notified of the hearing, and that I must appear at the hearing. In addition to my own testimony, I understand that I can bring other proof of the violation such as, for example, people who saw Respondent violate the order, pictures, medical records,
Florida Supreme Court Approved Family Law Form 12.980(t), Petition By Affidavit for Rule to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (03/04)

police reports, or anything that might help show the judge how Respondent violated the Final Judgment of Injunction for Protection. I have read every statement made in this affidavit and each statement is true and correct. I understand that the statements made in this affidavit are being made under penalty of perjury, punishable as provided in Section 837.02, Florida Statutes and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: ___________________________ _______________________________________ Signature of Petitioner STATE OF FLORIDA COUNTY OF Sworn to or affirmed and signed before me on by .

NOTARY PUBLIC or DEPUTY CLERK

[Print, type, or stamp commissioned name of notary or clerk.] Personally known Produced identification Type of identification produced I certify that a copy of this document was [/ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} . Other party or his/her attorney: Name: Address: City, State, Zip: Fax Number:

Florida Supreme Court Approved Family Law Form 12.980(t), Petition By Affidavit for Rule to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (03/04)