2.

Has Respondent ever received or tried to get an injunction

violence against Petitioner in this or any other court?
No lf
happened in tha,t case?.fln
Yes

for protection against domestic

known]

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3.

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that is either going on now or that happened in the past,
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Describe

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case'

including a dissolution of marriage, paternity action, or child support enforcernpnt actiqn,

t, stote, ond case number, f (nown;:\)$p\gtn!rv
lr qnd Respondent

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s. 20l6bt,b0btt67

Petitioner is either a victim of domestic violence or has reasonable cause to believe he or she is
in imminent danger of becoming a victim of domestic violence because respondent has: {mork
all sections thdt apply and describe in the spaces below the incidents of violence or threats of
vialence, specifying when and where they occurred, including, but not limited to, locotions such
as o home, school, place of employment, or time-shoring exchange]
,

a. Y .orritted

or threatened to commit domestic violence defined in s. 741.28, Florida

assault,
aggravated assault, battery aggravated battery, sexual assault,
Statutes, as any
sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any riminal
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
sar4e single dwelling unit.

b. /

previously threatened, harassed, stalked, or physically abused the petitioner.

to harm the petitioner or family members or individuals closely associated

"attempted
with the petitioner.
d.
threatened to conceal, kidnap, or harm the petitioner's child or children.
e. _intentionally injured or killed a family pet.
f.

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X

c.
h.
i.

i.
k.

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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).
t' Oestroyed personal property, including, but not limited to, -lglggbgnes or other
copmunication equipment, clothing, or other items belonging to the petitioner.
X engaged in any other behavior or conduct that leads the petitioner to have reasonable

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l"ftqt{ii,ffi
r?vTordomes'lcvoence
of violence that causes
Below is a brief deicription of the latest act'of vjolence or
0iW"rifi

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lhreth

Petitioner to honestly fear imminent domestic violence by Respondent.

Florida Supreme Court Approved Family Law Form 12.980(a), Petition'ior lnjunction for Protection Against
Domestic Violence (03/15)