Your Full Legal Name:
I am the:  petitionerother Petitioner's full legal name (only if you aren't the petitioner):
Respondent's full legal name:



Respondent Information:

Address:
City, State, Zip:
Phone:

Fax:

Attorney's name: (if Respondent has no attorney, or you're not sure, leave this blank)


Attorney's Phone: (if known)


Attorney's Fax: (if known)


Attorney's Address: (if known)


Attorney's City, State and Zip: (if known)



IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR Select your county Alachua Baker Bay Bradford Brevard Broward Calhoun Charlotte Citrus Clay Collier Columbia DeSoto Dixie Duval Escambia Flagler Franklin Gadsden Gilchrist Glades Gulf Hamilton Hardee Hendry Hernando Highlands Hillsborough Holmes Indian River Jackson Jefferson Lafayette Lake Lee Leon Levy Liberty Madison Manatee Marion Martin Miami-Dade Monroe Nassau Okaloosa Okeechobee Orange Osceola Palm Beach Pasco Pinellas Polk Putnam Santa Rosa Sarasota Seminole St. Johns St. Lucie Sumter Suwannee Taylor Union Volusia Wakulla Walton Washington  COUNTY, FLORIDA Case No:
(From the original injunction) ,
Division:
(from the original injunction),

,
Petitioner,

and

,
Respondent.

PETITION BY AFFIDAVIT FOR ORDER TO SHOW CAUSE FOR A VIOLATION OF FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST
DOMESTIC VIOLENCEREPEAT VIOLENCEDATING VIOLENCESEXUAL VIOLENCE

I, , being sworn, certify that I have actual knowledge of the following facts as set forth and the following statements are true:

1. Date the original Final Injunction for Protection Against was issued by the court:
On {Date}:

2. Date the Final Judgment of Injunction for Protection was served on the Respondent:

Statements about the Violation
3. On {date} , at {place and address} , the following event(s) took place:

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.)

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.

6. 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.

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 PETITION, I AM ASKING THE COURT TO HOLD A HEARING ON THIS PETITION, THAT BOTH THE RESPONDENT AND I WILL BE NOTIFIED OF THE HEARING, AND THAT I MUST APPEAR AT THE HEARING. I UNDERSTAND THAT IF EITHER RESPONDENT OR I FAIL TO APPEAR AT THE FINAL HEARING, WE WILL BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED AT THAT HEARING.

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: 05-24-13

I certify that a copy of this document was [check one only] mailed
faxed and mailed
furnished to a law enforcement officer for personal service to the person(s) listed below

on{date}

Sent to: respondent
his/her attorney