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1 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM (_) PETITION BY AFFIDAVIT FOR RULE TO SHOW CAUSE FOR A VIOLATION OF FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE REPEAT VIOLENCE OR DATING 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 or Dating 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 (_)Petition by Affidavit for Rule to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic Violence Repeat Violence or Dating Violence (DATE)

2 IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT COUNTY FLORIDA Petitioner Case No.: Division: and Respondent. 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 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 in this case on the day of. 2. The Final Judgment of Injunction for Protection was served on the Respondent on the day of. 3. On {date} at {place and address} the following event(s) took place: Florida Supreme Court Approved Family Law Form (_) Petition By Affidavit for Rule to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic Violence Repeat Violence or Dating Violence (date)

3 9 Check here if you are attaching additional pages to continue these facts. 4. The Respondent has willfully violated the Injunction by (explain what the 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. 6. The 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 respec tfully request that the Court issue an Order to Show Cause requiring the Respondent to appear before the Court to show cause why the Respondent should not be held in contempt of court for failure to abide by the terms and conditions of the Final Judgment 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 the Respondent violate the order pictures medical records police reports or anything that might help show the judge how the 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 Florida Statutes and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Florida Supreme Court Approved Family Law Form (_) Petition By Affidavit for Rule to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic Violence Repeat Violence or Dating Violence (date)

4 Dated: Signature of Petitioner STATE OF FLORIDA COUNTY OF Sworn to or affirmed and signed before me on by. NOTARY PUBLIC or DEPUTY CLERK Personally known Produced identification Type of identification produced [Print type or stamp commissioned name of notary or clerk.] 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}. Respondent or his/her attorney: Name: Address: City State Zip: Fax Number: IF A NONLAWYER HELPED YOU FILL OUT THIS FORM HE/SHE MUST FILL IN THE BLANKS BELOW: [ N fill in all blanks] I {full legal name and trade name of nonlawyer} a nonlawyer located at {street} {city} {state} {phone} helped {name} [ / one only] ( ) Husband ( ) Wife or ( ) both fill out this form. Florida Supreme Court Approved Family Law Form (_) Petition By Affidavit for Rule to Show Cause for a Violation of Final Judgment of Injunction for Protection Against Domestic Violence Repeat Violence or Dating Violence (date)

5 IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT COUNTY FLORIDA Petitioner Case No.: Division: and Respondent. Description of Respondent: Sex: Eye color: Race: Hair color: Height: Last known address: Weight: DOB: ORDER TO SHOW CAUSE This cause comes before the court for review based upon the alleged conduct of the Respondent for the issuance of an Order to Show Cause directed to {name} for violation of the Final Judgment of Injunction for Protection as is more specifically set forth in the Petition By Affidavit For Rule To Show Cause For a Violation Of Final Judgment Of Injunction For Protection a copy of which is attached hereto and made a part hereof. NOW THEREFORE you{name} are hereby ORDERED to appear before this court before Judge {name} on {date} at {time} m. in Room of the Courthouse located at to show cause why you should not be held in contempt of this court for violation of the Final Judgment of Injunction for Protection as is stated in the attached Petition By Affidavit For Rule To Show Cause For a Violation Of Final Judgment Of Injunction For Protection. Respondent is advised that he/she is entitled to be represented by counsel to have compulsory process for attendance of witnesses and to testify in his/her own behalf. All issues of law and fact shall be determined by the judge. Respondent may be arraigned at the time of the hearing or prior thereto at Respondent s request. IT IS FURTHER ORDERED that the Sheriff of this county serve this Order to Show Cause by delivering copies to the Respondent with proof of Sheriff s service. ORDERED in County Florida on {date}. Florida Supreme Court Approved Family Law Form (_) Order to Show Cause (date)

6 Copies to: State Attorney Petitioner or Counsel for Petitioner Respondent or Counsel for Respondent Judge Florida Supreme Court Approved Family Law Form (_) Order to Show Cause (date)

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