IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT COUNTY, FLORIDA Case No.: Division: , Petitioner, and , Respondent. TEMPORARY INJUNCTION TO PREVENT REMOVAL OF MINOR CHILD(REN) AND/OR DENIAL OF PASSPORT SERVICES (AFTER NOTICE) Upon verified motion of ( ) Petitioner ( ) Respondent, the Court has jurisdiction of the parties and the subject matter and the Court being fully advised, it is ORDERED and ADJUDGED that: [Choose all that apply] 1. The following minor child(ren) shall not be removed from the jurisdiction of this Court during the pendency of this proceeding, or until further order of this Court: Name Birth date ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 2. ( ) Petitioner ( ) Respondent shall not apply for any passports or passport services on behalf of the child(ren). 3. ( ) Petitioner ( ) Respondent shall immediately deliver any existing passports for the child(ren) to {name} _____________________________________________________________. 4. The Court may enforce compliance with the terms of this injunction through civil and/or indirect criminal contempt proceedings, which may include arrest, incarceration, and/or the imposition of a fine. 5. Violation of this injunction may constitute criminal contempt of court. Florida Supreme Court Approved Family Law Form 12.941(c), Temporary Injunction to Prevent Removal of Minor Child(ren) and/or Denial of Passport Services (After Notice) (12/10) American LegalNet, Inc. www.FormsWorkFlow.com 6. Bond. a. Bond is waived because this injunction is issued solely to prevent physical injury or abuse of a natural person. b. This order is conditioned upon ( ) Petitioner ( ) Respondent posting bond in the sum of $ with the clerk of this Court. 7. Expiration. This temporary injunction shall remain in effect until the minor child(ren) reaches the age of 18, or until {date} ____________________, not to exceed one year from the date of this order, whichever occurs first, unless modified by further order of this Court. DONE AND ORDERED at ______________________________, Florida, on {date} ___________________. ____________________________________________ CIRCUIT JUDGE A copy of the {name of document(s)} ______________________________________________ was [Choose one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the parties listed below on {date}________________ by {clerk of court or designee} ___________________________________. Petitioner (or his or her attorney) Respondent (or his or her attorney) U.S. Department of State Office of Children's Issues 2201 "C" Street NW CA/OCS/CI Washington, D.C. 20520 Fax (202) 736-9133 preventabduction@state.gov Florida Supreme Court Approved Family Law Form 12.941(c), Temporary Injunction to Prevent Removal of Minor Child(ren) and/or Denial of Passport Services (After Notice) (12/10) American LegalNet, Inc. www.FormsWorkFlow.com