COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM JUDICIAL SUBPOENA Plaintiff(s) 12.980(g), -against: SUPPLEMENTAL AFFIDAVIT IN SUPPORT OF PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE, REPEAT VIOLENCE, DATING : VIOLENCE, OR SEXUAL VIOLENCE : When should this form be used? Defendant(s) : . .You. may. use .this . . . . . if. your .Petition. for .Injunction.for. Protection Against Domestic . . . . . . . . . . . . form . . . . . . . . . . . . . . . . . . . . . . . . . . Violence, O’ Florida Supreme Court Approved Family Law Form 12.980(a), or your Petition for Injunction for Protection Against Repeat Violence, O’ Florida Supreme Court Approved Family Law Form 12.980(f), or NEW YORK THE PEOPLE OF THE STATE OF your Petition for Injunction for Protection Against Dating Violence, O’ Florida Supreme Court Approved Family Law Form 12.980(n), or your Petition TO Injunction for Protection Against Sexual Violence, O’ Florida Supreme Court Approved for Family Law Form 12.890(q), was denied by the judge. You should use this supplemental affidavit to add facts or clarify the facts you wrote in your original petition. For a domestic violence case, you should include FACTS that establish that you have been a victim of violence GREETINGS: or are in imminent danger of becoming a victim of violence from the respondent. For a repeat violence case, you should include FACTS that establish that you oraside, you and each of you attend before WE COMMAND YOU, that all business and excuses being laid a member of your immediate family have or has been a victim of at least two prior incidents of violence, that one of those , the Honorable at the Court incidents located months and that there is an immediate and present risk of County of occurred within the last six at For indanger to you or onmember of your immediate, family., at a dating violence case, you and at any recessed room , a the day of 20 o'clock in the noon, should orinclude FACTSto testify and give evidence as a witness in this action on the part of the adjourned date, that establish that you have been a victim of violence or are in imminent danger of becoming a victim of violence from the respondent who is an individual with whom you have or have had a continuing and significant relationship of a romantic or intimate nature, to be determined by consideration of such facts as the dating relationship existed within the past six Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to months, the nature of the relationship included for a maximum penalty of $50 sexual involvement the party on whose behalf this subpoena was issued an expectation of affection or and all damages sustained as a and the frequency and type result of your failure to comply.of interaction between you and the individual included involvement over time and on a continued basis. Dating violence does not include violence in a casual acquaintanceship or violence between individuals who only have engaged of the Justices of the Witness, Honorable , one in ordinary fraternization in a business or social context. For a sexual violence case, you should include Court in County, day of , 20 FACTS that establish that you are a victim of sexual violence or the parent of a minor child living at home who is a victim of sexual violence, that you have reported the sexual violence to law enforcement and are cooperating in the criminal proceeding if there is one. If the respondent was in state prison for sexual violence against you or the (Attorneychildsign above and type nameout of minor must and respondent is below) prison or is getting out within 90 days of the petition, include that information in your supplemental affidavit, along with a copy of the notice of inmate release. Attorney(s) for 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 the clerk in the county where the petition was filed and keep a copy for your Office and P.O. Address records. Telephone No.: Instructions for Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental Affidavit in Support of Petition for Injunction for Facsimile No.: Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (07/04) E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : : What should I do next? Plaintiff(s) Index No. Calendar No. JUDICIAL SUBPOENA : After you complete this -againstsupplemental affidavit, the clerk will attach it to your original petition and all the documents will be submitted to the judge as your “Amended Petition.” : : Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK TO GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Instructions for Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental Affidavit in Support of Petition for Injunction for Facsimile No.: Protection Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (07/04) E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : : IN THE CIRCUIT COURT OF THE Plaintiff(s) IN AND FOR -against- Calendar No. JUDICIAL CIRCUIT, JUDICIAL SUBPOENA : COUNTY, FLORIDA Case No.: : Division: , : Petitioner, Defendant(s) : ...................................................... and , THE PEOPLE OF THE STATE OF NEW YORK Respondent. TO SUPPLEMENTAL AFFIDAVIT IN SUPPORT OF PETITION FOR INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE ( ) DATING VIOLENCE GREETINGS: ( ) SEXUAL VIOLENCE WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before I, {full legal name} , being sworn, certify , the Honorable at the Court that the following statements are true: located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed at {place and address} On {date} or1. adjourned date, to testify and give evidence as a, witness in this action on the part of the , Respondent said or did the following things that hurt me or a member of my immediate family and to comply with this my or my punishable as a contempt of Your failure made me afraid forsubpoena is family member’s safety: court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for 9 Check here if you are attaching additional pages to continue these facts. 2. On {date} Office and P.O. , at {place and address} Address , the following event(s) took place: Telephone No.: Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental Affidavit in Support of Petition for Injunction for Protection Facsimile No.: Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (07/04) E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : : Plaintiff(s) -against- Calendar No. JUDICIAL SUBPOENA : : : Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK TO 9 Check here if you are attaching additional pages to continue these facts. 3. Check here if you are attaching copies of medical records for treatment you may GREETINGS: have received for injuries referred to in your petition or in this supplemental affidavit, copies of any police or sheriff reports concerning incidents of violence involving you that all business and excuses being inmate release. WE COMMAND YOU,and Respondent, or any notice of laid aside, you and each of you attend before , the Honorable at the Court located at County ofI understand that I am swearing or affirming under oath to the truthfulness of the inclaims made in, this supplemental affidavit and thatat punishment for knowingly making recessed room on the day of , 20 , the o'clock in the noon, and at any oraadjourned date, to testify andfinesevidence imprisonment. action on the part of the give and/or as a witness in this false statement includes Dated: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Signature of Petitioner STATE OF FLORIDA COUNTY OF Honorable Witness, Court in County, , one of the Justices of the day of Sworn to or affirmed and signed before me on , 20 by . (Attorney must sign above and type name below) NOTARY PUBLIC or DEPUTY CLERK Attorney(s) for [Print, type, or stamp commissioned name of notary or clerk.] Personally known Produced identification Type of identification produced Office and P.O. Address Telephone No.: Facsimile No.: Florida Supreme Court Approved Family Law Form 12.980(g), Supplemental Affidavit in Support of Petition for Injunction for Protection E-Mail Address: Against Domestic Violence, Repeat Violence, Dating Violence, or Sexual Violence (07/04) Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com