Petition for Injunction for Protection Against Domestic Violence · Step 2 of 6

Marriage & Relationship Facts

the spouse of Petitioner. Check this if you are currently married to the other person. Date of Marriage: Enter the date you and your spouse got married. the former spouse of Petitioner. Check this if you used to be married to the other person but are now divorced. Date of Marriage: Enter the date you and your former spouse got married. Date of Dissolution of Marriage: Enter the date your divorce became final. related by blood or marriage to Petitioner. Check this if the other person is your relative by birth or by marriage. Specify relationship: Explain how you are related, such as brother, cousin, or in-law. a person who is or was living in one home with Petitioner, as if a family. Check this if you and the other person live or used to live together like a family. a person with whom Petitioner has a child in common, even if Petitioner and Respondent never were married or living together. Check this if you and the other person have a child together, even if you were never married or never lived together. committed or threatened to commit domestic violence defined in s. 741.28, Florida Statutes... Check this if the other person hurt you or threatened to hurt you in a way listed here, like assault, battery, or stalking. previously threatened, harassed, stalked, or physically abused the petitioner. Check this if the other person threatened, harassed, stalked, or physically abused you in the past. attempted to harm the petitioner or family members or individuals closely associated with the petitioner. Check this if the other person tried to harm you, your family, or people close to you. threatened to conceal, kidnap, or harm the petitioner's child or children. Check this if the other person threatened to hide, take, or hurt your child or children. intentionally injured or killed a family pet. Check this if the other person hurt or killed a family pet on purpose. used, or has threatened to use, against the petitioner any weapons such as guns or knives. Check this if the other person used or threatened to use a weapon against you, like a gun or knife. physically restrained the petitioner from leaving the home or calling law enforcement. Check this if the other person held you back or stopped you from leaving home or calling for help. a criminal history involving violence or the threat of violence (if known). Check this if you know the other person has a criminal record involving violence or threats of violence. another order of protection issued against him or her previously or from another jurisdiction (if known). Check this if you know another protection order was issued against the other person before, here or in another place. destroyed personal property, including, but not limited to, telephones or other communication equipment, clothing, or other items belonging to the petitioner. Check this if the other person broke or destroyed your belongings, like your phone, clothing, or other items. engaged in a pattern of abusive, threatening, intimidating, or controlling behavior composed of a series of acts over a period of time, however short. Check this if the other person did a series of abusive, threatening, or controlling acts over time, even a short time. engaged in any other behavior or conduct that leads the petitioner to have reasonable cause to believe he or she is in imminent danger of becoming a victim of domestic violence. Check this if the other person did anything else that makes you fear you are in danger of being hurt soon. On {date} Enter the date the most recent act or threat of violence happened. This shows the judge how recent the danger is. at {location} Write where the latest incident took place, such as a home address or other place. Respondent: Describe in your own words what the other person did or said that made you afraid. Include details about what happened. Please indicate here if you are attaching additional pages to continue these facts. Check this box if you ran out of room and are adding extra pages to finish your story. Other acts or threats of domestic violence as described on attached sheet. Check this if you listed more acts or threats of violence on a separate sheet you attached. This or other acts of domestic violence have been previously reported to {person or agency}: Check this if you or someone else told a person or agency about this or earlier violence before. {person or agency}: Write the name of the person, police department, or other agency you reported the violence to. Respondent owns, has, and/or is known to have guns or other weapons. Check this if the other person owns or is known to have guns or other weapons. Describe weapon(s): Describe the weapons the other person has, such as the type of gun or other weapon. Respondent has a drug problem. Check this if the other person has a problem with drugs. Respondent has an alcohol problem. Check this if the other person has a problem with alcohol. Respondent has a history of mental health problems. Check this if the other person has had mental health problems in the past. If you check it, answer the questions below. Has Respondent ever been the subject of a Baker Act proceeding? Yes Check Yes if the other person was ever held for mental health evaluation under the Baker Act. Has Respondent ever been the subject of a Baker Act proceeding? No Check No if the other person was never held for mental health evaluation under the Baker Act. Is Respondent supposed to take medication for mental health problems? Yes Check Yes if the other person is supposed to take medicine for mental health problems. Is Respondent supposed to take medication for mental health problems? No Check No if the other person is not supposed to take medicine for mental health problems. If yes, is Respondent currently taking his/her medication? Yes Check Yes if the other person is taking their mental health medicine now. If yes, is Respondent currently taking his/her medication? No Check No if the other person is not taking their mental health medicine now.

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