IN THE CIRCUIT COURT OF THE THIRTEENTH
IN AND FOR
HILLSBOROUGH

Par;cl ij-e

JUDICIAL CIRCUIT,

COUNTY, FLORIDA

Case No.:

rer-m.

I-0

Division:

CV

-

/ 01 (p

zit
'

0
C--

and

fArnooky,
(,
II?

Res p o n de n

cr, ,---,

---,.

Petitioner,

Y

-

D CI ricl R a e

following statements are true:

e

-

2.3
--

cf.)

treilh,

being

sworn.

-:

certify that the

SECTION I. PETITIONER
(This section is about you. It must be completed; however, if
you require that your address be
confidential for safety reasons, you should
complete and file a Request for Confidential Filing of Address,
Florida Supreme Court Approved Family Law Form
12.980(h), and write confidential in the space provided
on this form for
your address and

telephone number.)

resides at the

{indicate if applicable)

Petitioner seeks

injunction for protection
legal guardian of (full legal name)
minor child who is living at home.

parent
a

2.

an

on

behalf of

a

or

minor child. Petitioner is the

Petitioner's attorney's name, address, and
telephone number is:

(If you do not have an attorney, write "none.")
SECTION II. RESPONDENT
(This section is about the person you want to be
1.

It must be

completed.)

Responeni, resides at the following address: {provide last known street address,

zip code

Florida Supreme Court Approved

(03/15)

protected from.

tf

òJf

Family Law Form 12.980(t), Petition

for

..-----

-,

-

___S

PETITION FOR INJUNCTION FOR PROTECTION
AGAINST STALKING
I, {full leaal name)

.----

—

city, state, and

Injunction for Protection Against Stalking

an---

 Respondent's last known place of employment:
Employment address:

2.

Working hours

of Respondent:

Physical description

3.

Uk

'd)

Distinguishing marks and/or scars:
Vehicle: (make/model)
4.

Other

A) 1 e
ciVi IA)
nii00140

Respondri:

of

V
Female
jiSg:Male
i
Height:w. eight: V•Ob Eye Color: 0/-3
Race:

A

Date of Birth:

VI

Hair Color:

Colorlf_c_ta_ Tag

rokfn

Number (if known)

Respondent goes by (aliasys or nicknames): 1, n5 ht, rim—, q I )
i 4
if)--it ,/-0./tn 4---i ritily e rs
5

33. Y5

p.is ,ip.S4P
(
'.,
names

name,

address, and telephone number

(lf you do not know whether Respondent has
not haVe an attorney, write
"none.")

an

Has Petitioner ever received or tried to
rar any other court?
in t

Respondent
Yes

2.

Has

4(

)

get

lf yes, what

happened

Yes

tl-Kor any other court?
V

No

lf yes, what

—

F--

—

{Include case number, if known)

for

protection against stalking against

happened in that case? (Include case number, if known)

Describe any other court case that is either
going
Petitioner and Respondent (Include case

3.

(This section must be completed.)

in that case?

Respondent ever received or tried to get an injunction

Petitioner in

is:

injunction for protection against stalking against

an

•

No

'

attorney, write "unknown." lf Respondent does

SECTION III. CASE HISTORY AND REASON FOR
SEEKING PETITION
1.

'

-

Respondent's attorney's

4.

6) / d 1 Mcd

on now or

number, ifjcnown):

0

that

happened

in the

past between

Ve-fri —7/

PetitionerXa victim of stalking because Respondent has: (please mark all sections that apply)
a.

b.
c.

kiommitted stalking;
kr Previously threatened, harassed, stalked,
cyberstalked,

tj:titioner;

Ireatened to harm Petitioner or family members

with

d.
e.

f.

Petitioner;
ptentionally injured

killed

a

physically abused

A

criminal

the

individuals closely associated

family pet;

/Used, or threatened to use, against Petitioner any weapons such as

Florida Supreme Court

(03/15)

or

or

or

history involving violence or the threat

Approved Family Law Form 12.980(t),

or

Petition for

guns

violence, if known;

or

knives;

Injunction for Protection Against Stalking

 Another order of

protection issued against him or her previously from another
jurisdiction, if known;
h. t.....-Istroyed personal
property, including, but not lirnited to, telephones or other
communication equipment, clothing, or other items belonging to Petitioner.
g.

Below is

5.

a
description of the specific incidents of stalking or cyberstalking: {for
cyberstalking,
include
a description
please
of all evidence of contacts and/or threats made by Respondent in voice
message t ts, emals, or other electronic communication)
On {dates
16 2 V the following incidents of stalking occurred at the
following locations:
(the loco o s may include, but need not be limited to, a home,
oriolace of employment)
7- fill f-- 740 h-ei n I- are c" / Y .7,71 scho9l,
a±
a 4 A-7

I

a

/

riA. d

íln

and

Please indicafe here if you

Ofl 7vre/ ò 4 C
OAtir4 s.
are attaching additional
pages to continue these facts:

Additional Information

Respondent owns, has, and/or is known to have guns or other weapons.
weapon(s) and where they may be located, if known:

Describe

SECTION IV. INJUNCTION

{This section

must be

completed)

Petitioner asks the Court to enter a TEMPORARY INJUNCTION for
protection against stalking that
place from now until the scheduled hearing in this matter, which will
immediately
restrain Respondent from committing
any acts of stalking, and which will provide any terms the
Court deems necessary for the
protection of a victim of stalking, including any injunctions or
directives to law enforcement agencies.

1.

will be in

2.

Petitioner asks the Court to enter, after a hearing has been heki on this
petition, a FINAL JUDGMENT
for protection against stalking
from
prohibiting Respondent
committing any acts of stalking
against Petitioner and:

prohibiting Respondent from going to or within 500 feet of any place Petitioner lives, or to
specified place regularly frequented by Petitioner and any named family members or
individuals closely associated with Petitioner;
a.

any

b.
or

Florida

(03/15)

prohibiting Respondent from going to or within 500 feet of Petitioner's place(s) of
employment
the school that Petitioner attends; the address of Petitioner's
place(s) of employment and/or

Supreme

Court

Approved Family Law

Form

12.980(t),

Petition for

Injunction for Protection Against Stalking

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USE BLACK INK ONLY
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A1 <school is:
c.

prohibiting Respondent

through another person,
d.

or

or

motor

he

she shall not have in his

or

or

ammunition;

prohibiting Respondent

Petitioner's

•

contacting Petitioner by telephone, mail, by e-mail,

in any other manner;

ordering Respondent that

control any firearm
e.

from

from

knowingly

vehicle, whether or

and

not that

her care,

intentionally going

vehicle is

to

in

writing,

custody, possession,
or

occupied;

or

within 100 feet of

Petitioner asks the Court to enter
any other terms it deems necessary to protect Petitioner from

stalking by Respondent.

UNDERSTAND THAT BY FILING THIS PETITION,
PETITION, THAT BOTH THE RESPONDENT AND I
I

I AM ASKING THE COURT TO HOLD A HEARING
ON THIS
WILL BE NOTIFIED OF THE
AND
THAT
I MUST
HEARING,

APPEAR AT THE HEARING. I UNDERSTAND THAT IF EITHER
THE RESPONDENT OR I FAIL TO APPEAR AT
HEARING, WE WILL BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER
ISSUED AT
THAT HEARING.
THE FINAL

I HAVE READ EVERY STATEMENT MADE IN THIS
PETITION AND EACH STATEMENT IS TRUE AND
CORRECT. I UNDERSTAND THAT THE STATEMENTS MADE IN
THIS PETITION ARE BEING MADE UNDER
PENALTY OF PERJURY, PUNISHABLE AS PROVIDED IN SECTION
837.02, FLORIDA STATUTES.

Dated:
Si aiure of Petitioner
Printed Name:
Address:

City, State, Zip:
Telephone Number:
Designated E-Mail Address(es);
STATE OF

FLORiD%,

COUNTY OF
Sworn to

or

eI \AS

il

bor-bLT

affirmed and signed before

me on

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(03/15)

ITZ- Ini A/ MC-01 al14-04

NOTARY PUBLIC

Laiw Form

(Print, type,
clerk.)
12.980(t),

tiDEPUTY

or s i,mp

CLERK

commissioned

La
name

of notary or

Petition for Injunction for Protection
Against Stalking

 ersonally known
Produced identification
Type of identification produced

Florida Supreme Court

(03/15)

Approved Family Law Form 12.980(t),

Petition for

Injunction

for Protection

Against Stalking