Florida Supreme Court Approved Family Law Form 12.980(_), 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)
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 respectfully 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 837.02, Florida Statutes and that the punishment for knowingly
making a false statement includes fines and/or imprisonment.