01/15/2008 15:D.

..

OJ

~ Q~?~\t. \J ~S~~,,~~"'~PetItioner

[t>..IHt:-.(fReUn COURT OF 1HEi,:1i F,1)lCIAL CIRCUIT, IN A..lI[()~OR bROWARD COLNTY, FLORIDA

L \ ~' - ::, I ~ ( ";"):-{ '\.' t "I . \.' ,_ ~ ." J

'R Co..V\,t, t. rv~L' ') 5>

Respondeat

AFFlDA VIT

SectJOD74130 Flonda StatlJlcS (DomestIc VIOlence)

Section 784.046 Flonda Statutes (Repeal VIOlence)

Section 784 046 Flonda SLa1uu::,> lDallug VIOlence)

L-.) Sectiou 784 046 Flon~ St.aJUIt:.~ (SeXlJaJV1oknce)

J HEREBY CER I IFY that on lW-~.~- ~.'~=-'~/__.2o__ a COP)oftb~ (Check one).

LL) Temporary Injunction

Final Judgmeot

Exten.slOn/Notice of Heanng

Vac.at.ed

Dismissal

Other:

was forwarded or mailed within 24 hours from the tune of J:.seorry to IDe sbenff recervwg the ongmaJnotification of we IDJunctlOfl,to wit

i,i-.. ~::.. r .Agency Name' . , . --"::'--~...._.- .- -. --- ---. _.---

Address

.....

. .- ~---_._--

/Howard t Forman. CLERK

I

\ . I,. \ iB \ \ I X '1.' ,. \,' i L fy \._" ~ " . '.~~. +1--->, L....-.-.

Deputy Clerk I./

I01/1&/2008 15:~~ r...

1 ...~..- L

IN mE CIRCUIT COI1U OF THE SEVENTEE~ItL_.IN A,}\,mFOR ___ BROWARD

_n_._ NDIClALCIRC'CIT,_ COUNTY. FLORIDA

Ca~f '\.u

01\ 1~lGr.J2~CE 08-315

__ ~9 _ ___

---".-..--

RACHELLE WASHINGTO~.Petition a ,

and

RANDY G. MOS~___Respondent.

,---

""Q

TEMPORARY INJl.:~CTlON FOR PROTECTION A(..AL ST DATING VIOLENCE'.:":a'\ 1.' .

Tbe PetitIOn for InJ\Wctlon for Protection Agaffist DatLDgvI(lienee \Wdcr section 784.~, Flo~ ?,Statutes, and other papers filed 111this Court hav~ beco revlcwc.d Coda the laws of Florida, thO'Court basJurisdiction of the petitioner and the subject maner and has .IunsdlCtloo of the respondent upon sm'Ke of thetemporary injunction The term "PetitJoner" 8Sused m thIS UIJuoctlOn!Deludes the ~son on whose behalfthis injunction J9entered

It is In'ended that .bls protection order meet tbe requtrements of 18 U.S.C. § 2265 aDdtbe.-efon: intended tbat it be accorded fuB fajtb and credh by tbe court of anotber state OTIndian tribe

and enforced as jf It were tbe order of the eoforclng s'atf' or of tbe Indian tribe,

SECTION I. NOTICE OF BEARINC

Bocause \JUSTemporary injunctIOn for Protection Agalllst Dal111g VlolO1CC has bun ISSUed WithOutnotice to Rcspoodetlt, PetItioner and Respondent are 1Dstrucred~31tbe e scheduled to appear and teshfy ata heanng regBJdwgthISmane! on {dale} 1/28/08 .at _3:09. p. when the Court will c011s1derwhether the Court should Issue a FinaJ Judgment of InjunctlOD 101PIOeellon Ag810st Datmg VioJence, whichshaJI rema.tD1Ddkct untLlmodified or dissolved by the Coun, and wbctbel othe-r tbmgs shouJd be ,,!derOO.The hearing WIll be before TIle I-toDorable {flome} JUDGE M UESIB.)'._. 8t {locotlOn} ROOM 870 ,201 SE 6m Street, Fort Lauderdale, flonda. If Petitioner and,OJ Respondent do not appear, thIs temporaryinjunction may be cODtlOuedw force, extended, or dll,IDJsscC.and/ol addltJonaJ ordas may be grantec1,including the lillposltionof court costs. All witnesses and e' ,dcnce, L1an)', must be presented at this ttIDe.

NOTICE. Because tlus IS8 civil case, there ISno requuement that these proceedings be transcribed atpubhc expense

YOU ARE A.D\lSED THAT IN nns COURT:

a, a cow1 reporter ISprovided by the court.Lb. electronic audio tape recordlOg only IS proVldea hy the court. A party may ammge ill advance

for the services of and pro\'lde for a court reporter to plep/U c a wrmen transc.npt of the ploceedwgs at thatparty"s expense

c. no electroDic audio tape recordlOg or court rep0J1Wg ser"'Il:CSare provIded by the court Aparty may anangc Lnadvancc for the services of and pro\'ldc for 8 COUr1reporter to prepare a wnneo

transcript of the proceed.u1gsat that party's expense.

-

Flanda Suprctnc CO\ll1 Approva:l Famll)- I..w Form 12980(0), Tc:mporll')' J.oj t..'" !,.. PJotc:c1l00 Agau:IS1Dm.o8 V,olUl';c (03/{)4)

01/1G/2008 15:0:r-

A RECORD. WHICH INClL'DES A TRANSCRIPT. MAY HI JU:VURED TO SUPPORT ANAPPEAL nn: pARTY SEEKING mE APPEAL IS R.f.SPO,-SIHlE fOR HAYING THETRANSCRIPT PREPARED BY A COURT REPORTER "1111:TRA:-JSCRIPT MUST BE Fll..ED wlTIITHE REVIEWING COURT OR TIlE APPEAL rv1AY BE 01-:1'.1ED

If you are a person wIth 8 dlsaoility who needs any accOID.(1)Oc18tlonif) order to partIcipate in thISprocoediDg, you are entitled. .11nOcost to you, to tbe pr(lVIS'~1\1of ceIUl.OBssiSlMlce Please conuet A.D.AInfonnatioo a' 954-831-6364. Bl"owud Couoty Courtbouse. w.tblD 2 worlung days ofyow receipt ofthis tcmporlU)' IO.lUUCtJooIf you are hearing or VOIceunpaired. (,<111TDD 1-800-9~5.877l

SECTION O. FDlDINGS

The ~t.8teroeoISmade Ill\de:roath by Petltiooer make: II appc8J tba.1section 784.046, Honda Statutes,

apphes to the parties, that peutioner ISa victun of dating viOieuce audlor Pel1tJODeTbas reasonable cause tobelieve be or she If.lJIlIIUTUI'cntdanger of be;.:oming a VlClUllof an aci of daUDgvIOlence by Respondent, andthat an i.m.roed!8teaDd preseut danga of dating violence t::\I~I:>10 PetltJouer or to a IDC1J'IbeTof PetItIOner'simmedlat-c f8.IIlJIv

SECTION ID. TEMPORARY INJ1JNCTJON ANn TI':RMS

TbJa injunction sb.U be effective uottl the beanng sel aboH Bod in DOneot for longer tban 15days, unless extended by court order. If a fioal order of inJunction II issued, the terms oftbis temporaryinjunction will be extcnded until service of the {'mal lojul1ctloo i8 effccted upon Respondent. Thisinjunction is valid Bnd enforceable in an counties of tbe StAte ot "-'or1da. The terms of Ibis injunctionmay not be cba nged by dther party alone or by botb pa rUe. togetber. Only tbe Court may modify tbeterms of tbili 10,lunction. Eltber party may ask tbe ('ourt to change or end tbillujunctloo.

Willful violation ot the terml or thislnJunction, ~uch 8S re(u5tng to vacate tbe dweWng wbichtbe parties share, going to PetJdoner', I"estdence, place ot cmploymt:ot. ubool, 01"other place probibitedIn tbis injuodion, telepbooing, eontacttng or communJcartng with Petitioner, If prohibited by thistnjunctio~ or committing ao ad of dating violence 8g81mt Petitiooer- constitutes 8 misdemeanor oftbeOnt deg..-eepun.isbable by up to ooe year In jaO, as pro,;ded by sectioos 775.082 aDd 775.083, florid.Statutes. .

An)' party violating this iojunction may be subject to chi] 01" indirect criminal cootemptproceedings, including tht Impodtion of 8 fine 01"imprisonment, and also way be cbarged with a crimepunJsbab)" b~' 8 noe, j8U, or botb, as pro\1ded by Flo..-tda Starutes

ORDER£D aDd ADJUDGED:

J.V'oleoct' Probibilt'd. Respondent shalJ not commit. or cause any other person to COmIDll.any acts ofviolence agalost PetItioner, including assault, aggrs\-Jiled assault. battery, aggravated batteT)', sexualaS8ault. :lC~ua1battery, stalking, aggravated staUung. ludnappmg, or false imprisonment, Or anyCruD.lDsioff~ge resulting in phYSicalmJury OJdealh Respondent sba.UDOtcommit anyotherviolat1OoOftbe LDJunctionthrough an mtentJoDal un]swfulllut:al, word. or act 10do vIOlence to the PetJtJOoer.

No ('ootact. Respondent shan have 00 eoolBet \.\1th tbc Pefltiooer unJe55 otherwjse provided intbb 8ecl1oo. -2

Flond. Supremo<C(>\II'1App"'~ famIly UW Form 12 980(0). T~ InJunc::.oo 10<Pmt.«""" Ap.ul8t DaI:uIa vlOICDI;c (03104)

01/10/2008 15:~.

a. Unless Oth~l&e provided herein, R~poncknl ~<I]l have 00 contact wIth Petitioner. Respondentshall nol duectly or IDdirectJy contact Ptlittoner m per :ion. by mall. erID.a1l, fax, telephone, throughanotha person, OJ in any other manner Furtba. RespondeDt sha.1JDOtCODtact or have any thud partycontBct anyooe COT\DCCJedwith Petjtioner's employmOJI or c;.~hoollOmljuin~ about Pct.ittona or to sendany messages to PetItioner. UnJcss otherwise PIOViJt:.d b(;1eill. R...espoodcot sbsU Dot 20 to, in. orwithiD ~OO feet of: Petitioner's cUTTentresidence (IJ1/ n.ddJI?H)_

,

OJ any residence to which Petitioner may move, Petltlona's current or any subsequenl place ofemployment (l1Sladdress of cun-€m employment) _______

or place where Pe11110na anends school {lisl address ofschool)or the followillg otherchild(len) go often: _ _.

- - - --. ,places (if requeskd by PetJtJooer) wheJe PeUttoner or Petittoner's minor

~-_. .-,.-.-- -----

[Initial if applies, wnre N/A .. Dot app1.Jcable] _

--X... b Respondenl may not knowingly come wlthlD IOU kcr OTPel1tloner's automobile at any timeN/Ac OthCTprovisIOns regarding cODtact . _____

-------_.- -

3. Fi,-,:arms.

[IDlt1al aU that apply, wnte N/A If doe. Dot apply]--X... 8. Respondent shall not use: or possess a firc:.arrn or 8JJ)Ulu.(}1110U~ b Respondent &ball surrender any firearms and ammunitIOn lD Respondent's possessIon to the

_~rowaId ___ _County Sheriff's Dcpanmenl or other locallav.; enforcement officIalunul further order of the cowt.

~ c. Otbo du-ec1Jvesrelating to fIrearms and ammunition _ That the Respondent must 1IIlJ))ocitatelySUJTe:nderany concukd weapODSpermit (.9)10 Browsrd County Sh<::nff'sDcvartment or otherloea] lBw (:J)[orc:;em(JJ..1 officials. __ .. __'___ . .

4. MBUiog Address. Respondent shall notify the Clerk. 0t the Court of any cbange IDblS OJbermaIling addJes&Wltb.to10 days of the change All !\1nbcr papas (excluding pleadings requIringpersoDalservIce) ~aU be servedby mail to Resp0J)dcul'" 14&1known adciJes6 Such service byID8il&ballbe complete upon majling. Rule 12080. t'la "am LR.P. SUtion 784.046, FlondaStatutes

5. AddJdODal order(s) oecellary 10 protect Pdjtloou from dsting \1oleoce:

.-----.-- ..~_.~--_.--.-----.-------. --. ~

SECTION IV. OTHER SPECIAL PROVISIONS(This section to be used foy inclusion of local provISlO115'1ppro~.ed by the chIef judge as proVIded 111

Flonda Fa,,,,Iy Luv. Ru/.: 1/ fJin )

SECTION V. DI:RECTIONS TO LA W ENFORCLm~:\1T OFnCER IN ENFORCING THISINJUNCTION

(pro,.Jsions in this injunction that do not ;nclud~ a lin~ jor Ih~judge Iv ~;tlter inid4lor K'rlk N/A art!

-

Flonda Supn:mt COUJ1 Appro\ft:d Fa.auJ). La'" Fonn 12 980(0). Ttmpcrrvy InJuncwn tor PrNetDOO AgaUUII Danna VjolQ)cc (03/04)

-PAGE 06

p.1 ,,...~ t)..:I/LL

01/10/2008 15:C:O~fl~' ~OOD !~. o~

~Dd "'F"~~",~.IItII.1uHJd ~ m~"" kJ18lf vfdJU hY-c:#rJ }

I . Tb~ SbenB Df_8nnqrd Cooory, or IUIy otlJft autbonztxll.aw cnfon:aneol offica. CIordI:nd IX>-~ tbi. tauponIry ~junct.iOD upon R~I M 500D U poMjb}e a.ftI::riu isI.waocc.

2 n.n iD/IIDdiea8I8 ti.. aad Ulfonabk 8DaD ~ of die SIB" ofFlorlcla. Vl:Olabonofrhi5 tnjUDCtiOBGhouldbe Jupw;W (0 &he.pptOJIf'\AU la,., t~c:anart aarmcy. Uw~'o1'f1c.crJoftbe jurlScfiction in which a 'IIiolJlrion ofthu m]CDCt1ouoocnn !hAU enbu theprov1~OO' of thlll mjuoclion ac.d are ~ IX>annst itbout a ~t ponD8I1t 10 8rCb(]b901.] 5, Plar1da St&IUtIaI,tOr any viDLdion of iD.pl'ovl~OD~. bich canlitib11e!18 c:ri:rniIul..ct 1mdc'lIec:t1on184.041, Florida S~cs.

3. Shoo.Ldany F10ridIIUrwenfOt~t offiar baVU18JUruldtrt'lonh~ve prob.bJr caue to bdimIc that~dsn ba3 lr:nowiDBlYVJotm:dthu iDjlWroon.Ibeofticn may arres\Rc:$pDrldCDl,CODfincb1mIhEt1Dthe c.oantyJail...nboutbai!, ad shall br-mr;bimlhe bdolT.the Iniual AppelUmlCCJudgeou dlcr.~rqalu CO\ut day S) IUr RDpoodezn CIIIIbe <kaJ1"1tb acwrding to law. ~ ~ 8&OIt sbaJ]

ooUfyIbI:5mb: Altcnq'.Offic;c i~""1y after arrest. THIS INJUNcr10N IS ENFOJlCE.ABLEIN AU COtJNTr£S Of FLORIDA .AND LA\V ENFORCEMENT OFP1CERS MAY EFFECTAARE"STSPURSUANT TO SECTION 901.1.s(6), H.ORIDA STAI1JTES

(SEAL) By. -Deputy Clcrl .. .------.

-

01/1&/2008 15:u-PtlGE 07. RESPONDENT DESCRJ,..nON INFORMA'l10N

ON-LAWENFORCEMENT OFFI~ PLEASEREMOVE -11US~H~RITO SERVICE.. PLEASE DO NOT GIVE THIS SH I<:ICI TO THE ~E.C;;P()NDENT.

,=.cnON n: PHYSICAL DESCRIPTION

M:E~ MAI~\../ ~ BDaBD-"T1='7.//3/7" AGI-J 0, ..

AIIt~:EYE~ OLtlt:K~ATmOS_____U1

ECIlON III: RESPONDENTS ADDRESS -Ul..-

-.--

Lo\.MEOFco~____

:rrY~ Be J j" ."\.

BOILDING __ _ AP.AJaMEN'rJLOI1:-,

SIATF-{YJ/l ZIP C\..>DE ___ P'BDNENO..:,

'A~l"BONENO..:_______

9OB.K~: N(I L J..-, J< --' .r-.

---.----

-----

ZIP CODE ____ PHONENO.:

--. -..--

:::rry ~

SECTION IV: RESPONDENT'S Q.DSE B.ELA.TIVES

AAME: N 17 }c...,.c'-v"-- ~ _____

SIAIE-

SECTION V: UCENSErVEHICLE INFORMATION

DOES:KESroNDENI" BA.VI. A VAI.lD DIUVF.lt'S l1C£NSE? dJ YES LJ NO, S'IA U::___

VEHIa.E#1:MAn: J hf,"" +)l MODFL~G_LISCOLOR~ TAGt::

-

___ S"IAJE.: Ii r

MDDEL ___ -----

COLOR __ 'IAGjt;-- - __ S1:A:IE

-01/1b/2008 15:0: ':'54 'b 7:'1 37

PAGE 08

SECTION VI: LETIiALITY ASSESSMENT

DOES RESJ'ONDENT BA VE ANY WEAPONS: 2bJ YES ~ NO. TYPE Of W1:.APON',[. '" "'-<)

DOES RESPONDENT BA VE A DRUG OR ALCOHOL PROBLEM: ~ Yl~ C _.1NO

OOES RESPONDENT HA VE CHILDRrn IN BI.SIHER CARE L-J YES Li.J NO, HOW MANY _ISTHE RESPONDENT WANTED BY THE POUeE.:L..JYES c.1JNO, lOR WBA 1_ __

DOES TIlE RESPONDENT BA VE A CRIMINAL RECX>RD:CiJ YES L j NO, FOR WBAT

IS THE R:EsPONDENT IXPFCTING nus ORDa ~ YES L-J NO

~PLE.ASE An'ACB A PHOTOGRAPH OF RESPONDENT ff YOV HAVE ONE_'--

PETITIONER INFORMATION

AlTENTlON LAW ENFORCEMENT OFFlCIALPLEASE DO NOT GIVE THIS INFORMA110N TO RESPONDENT

?etitiODdsName: nCltl.rlll \.Jc,<L'~c f".;,... DOB.i.0.~ Race: B __ Sr::x"M([)

o\.ddress (only if not confidedti2l) __ CJfV..HU . ___ Stat.c:_ ZIP CODE _

If you filed on behalf of y0l..lr children, fill ir. t:'"1efollowing WOI:UlB.tion. If the

address is confidenual, 'Y)te "Confidentl.al"

Name: DOB --~: Sex.: MIF

Address : . CITy .. St3k _

Name: D.Ol~ '_ R4ce.

A..d..cir'e:ss: CITY _ .______ Stak:_

Name: D O.B .__ . ~.

A.ddIess: __-..0-0 CIty: _-_ Stak '_

...:>too- ways Petitioner may be contacted:

_._ _ _ n_._'_

01/15/2008 15:0? r>AGE 09

IN THe CIRCUIT COURT OF THESEVENTFE_NTH DtC&ALCIRCUITIN AND F-OP BROWARD COUNTY,FLORIOA

Case Number 59VS.

- .~

CLERK'S CERTIFICATE OF COMPLIANCE

<.r1

UlN

I hereby certify that pursuant to Administrative Ord('r, No. U-9S.F.S, "FAMILY COURT

MODIFICATIONS, SUBSEQUENT FILINGS, CONSOLIDATION, REOPENED REPORTING,

AND FILE STORAGE", the Clerk hasconducted a search for all previous existing

domestic cases related to these two part'es.

Listed below are all the aforementioned related cases:

NO CASES

By

-

01/1&/2008 15:03 -' -r

.ClYIL COVER ~ID'lEE QVIL COVER smLT AND -mE IN:FUIZMA"IJaIl aJNTAIJIlEI) ~ NErnlER RD"LAt'ESNOR SOf'fiD.fiNIS 1HE. DLING .AND StXVJQ: OF J'LEAD1NbS OR ~ PAPERS ASREQ(JIEID BY LAW. 1Br£ FORM: IS RF.,QUmED FCJJt mE USE. OF 'lEE ("I.EIlE: Of C.DOKI FORlEE J"ORJ'OSE OF RD'uKJ1N(; roJ>fCIA.1. WORKLOAD DllA 'f"QRS(jA.""ITn) Fl-CHaIH sr A"T'C1E25.IJ'E.

1 _ ;-..,:-" ~.

.-" ..7~-]_,~.. ,. ~Utccmr COURT CASE NO. _ :s ,.~..__

LT1

cJ1N

n.. TI'1'E OF CASE a'l..ACE AN T' IN ONE BOX ONLY IF TIn CASl:..fTIS MOREmA.~ ONE TYPE OF CASF-. !'\ELF..cr THE MOST DEFINJTIVE.)

~~~':-r~' E~ (~~:. ~- ~~=:~=

'~__ _.~-=~-~ ~cncr ( .y-r~:;:;'~;~==--~~L..~LL\J!JUTY ~~n"'D"~

L__lArro~ +s=--~~"---- -_. -.-.-.-...------.-..

, .)C7IHER~

£. }M(.IIITl"!'<.I. RJ£EC~

t '(~-'

..

_;~I lJOMAI"-- --- ---, -- .-. --------C _)(JlRnl___A ._ n_ ___-__

~ _~~.' . r~ . .. .~~ ~-~~ ~._~~

DL JS JURJ' UllAL DFMANDED J!'. COMPLAINT!( )"YES

DA= ( % ;'IJ~h1_-

SJGN.ATIJRE OF PARIT ["I:IJA TI"'G ACDON

,./ ...._-..

"'._~----

c -

""'

"

DOMESDC RELAllO

..- -DIS91rI

L- -

L...JSOI"'CIIU-JV-D

L.JSOI"'OICl .I)

L- )"(JJI;f;S6..JV-I>

l--I>

<.:n JD(Ml:SD:

L-)(JmDt DO!>IESJXIt[;

01/15/2008 15:0:r ,.

~4.' _ ...~ ~ ..PAGE 11

. TN THE CffiCUIT COURT OF THE

INAND FUR ~rc\.:::T-~-_ __'_ JlIDICIAL CIRCUIT,

COUNTY. FLORIDA

(Jsr )J0

1)1\ ISlor,'r h

..JPet1l10nel,

and

1) - l'. G:~\~55>~--- Respondent

oco" -:?..,.-

PETITION FOR INJLNCTION FOR PROTECTION AGAJNST DATlNG VJOLE~E i'. U1 -

I, {fi.lIlcgal name,' JtI. LLr' t\<- \J l\.S ~: ",J" A ___, being ~ ~ Jthe following statements are true-

SECTION L PETITIONER (ThIs section IS ah0u1 YllU It must be completed.)

L

IW;.currentlY lives at: (address, city. SIOIF_Z

.

:P l'Od

.

er_

~. t L Cl...)~,,-.L. 1-( __.l~L l~_LQ~Dateof u1hof Petitioner' (0/1. 2-1 C)~, , - - -,---

---

rl if applies]Pt'titiooer seeks aD injunction fOT protection on behalf of

PetItIoner IS the parenr or legal g\.la.rdl~ I)! {full legal Mume}_amllJor child who IShVlng at home

9 mjnor chlld_

---,

2,

(ItyO\! do not havr. -an attorney, write "none,":,

SECTION II. RESPONDENT (This section ISaOI)\11the person you want to be protected from,It must be completed)

1. Respondent currently lives at. {address. city. stale Jnd :lpcodeJ._ EO!} 10/1. c.lJlt+-q:H qJ~.fdJ S/ .

2.

Respondent's Onver's License nwnberJs: {ifmo\-11'i, _1", 1 J.t..b___h.

PetltJoner has !cnoVo/TlRespoodent smce (date)~(~ .J._(~l19-2 ..

.--.---

flood. Supn-mc Coun "Pvrn~ r o""r, Law form: 1980(11), PCI,LJonlor Ir'lu,"" '>0 '';r Prcta:1,on p.R1'n.r Danrl~ \'lOlenCt (03/~ I

01/1&/2008 15:B~ %4/b _137 PAGE 12

3 Respondent's lasrknown place of emplOy1nenr

Employment address: r cd ~~~..WorkloghoUIS _ \.-c.f- },..c",-

--_._-

4. PhY~HOIldescnptlon of RespondentRacr. ~ Sex ~ale X.

Height ~'i" WeIght.1 iDDistlng-tllshmg marks aDd/or scarsVeruclc trnake/rJlodel)

Fem;IJe Date of Birth:

Eye l olor !-,"_J.:. Hall Color: rh l A..

Colen ____ TagNumber:______

5. Other names Respondent goes by (abases or rucKnames\ _.___.._

6.

----- --..----- -------

you 00 mlt Know whethel~espondent has aI, 3~torney ",Tite "unknoWD." If Respondent

does not have an .Htomey, wnte "none ")

7. If Respondt:nt ISa minor, the address of Respondent '$ paJe.nt or legal guardian is:___-. -., - ._------

SECTION Ill. CASE HISTORY A_NDREASON FOR SEEKING PETITION (This sechonmust be completed.,

Descnbe the natuJe of the reJal10nship between !j)(' Pelll100er and RespondeDt (mcludethe leng,th of time nf the relatIOnshIp, the romantIc or ,ntill1ate naTUreof the relationship,

the &equ.en~v or rype of ioteraction,.{ind any otber iaLt< that charactenze the relBtionsblp)

_~Ph~ ~ ~7r~, K!:~:Jl::~~-L'\v{' J}r?n i ~ ~"4-'" t, ~ "- t f!.., ,.. q . £'1" I .. s "'.u__ 19 Cj7. __~ -------- - .---------

---._----.+-- ----

"-

---.._------_. .h __.. ---, ".---

- - - ._--

o Check here if you are attachlOg. additlOnaJ p6.ge- 10 (ontJOue these filets.

2_ Have the Petitioner Bnd Respondent been lTJV(u.ed 111Ii datmg relatIonship within the past

six months') -L Yes . ~o

3 Has Petitioner ever received or tried to get all iLji.mdwn ior protection against domesticvlolence_ datIng v:olence, repeat violence, or sex.ual vIOlence agaU)st Respondent m this orany other court ')

-

..

01/16/2008 15:C: ~... _ji.>J;..:.~'i PAGE 13

If yes, what happened In tha1 case') f/YIelude case l1w1.ber, lfbwwn}--~---

---......-...---......----..- -----

4. Has Respondent ever received or tned 10 get an In)lUKtlon for protection against domesticVIolence. dalmg \ lolenee. repeat vlolenc e, or sex ua I \'\olence agaJOst Petitioner in this or anyother LUUJ1"

If yes, what happened in :hat cilse') {Include case number. if known}-_._---

S Descnbc any other COUJ1case that is elth~ ~,Ollig (>1)now 01 that happened in the past

bet'lHtn Prtitioner and Respondent (rncludt UISCr,umbel. Ifknown):~s.l.b...t'-_----.-----------.---

- . -------..------------

6, Respondent has directed an incident of "vlOlence'-' meamng assault, aggravated assault,bancr)' aggravated battery, sex ual assault, sex ual ba tleT)', slalking, aggravated sta.lkrng,kldnaprng, or false imprison.ment, or any cnm:JIa! uffense ;esultmg in physical injury ordeath agamst PeIJlioner or 8 member of Pell!h)f1eI', IInmedlste family. The Incident(mcJudmg dale and locatIon) ]s described beto\> Co.

On (d(Jte)'J~. y " ..2cG<:(,at (locat1o~)r,_tJ.~w': r?.s; j t' <1CL__,

RespOJ1dcntL U .')., :11-<.1 c~~. tf.! -::..v f ,) h Po:' j I '-I,~,~I f':') (

-L~~__ ~.t'.-'r~< ' J ry__. .K.1?..~ /)".~J, t r['~<::",<,..,.4__~ JLi.[fJj_ p" f; I-<:~,..,~r _:LL<-._ s',.; 1(. . ~ f>cl~l + I'Cr f "'JL--l

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'~"---- ---"..- -.,.----. .,~--

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o Check here If you are at13ching addltlonaJ pages 10 "ontmue these facts.

7. Other pelOl lIIcidents (including dates al'Id IDea!Ion) art: descnbed below:On {dote} __. ,at (taGH/un! ...

Respondeot_..

_ N. t

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Floude Supnomc (",un .o.Pflr("at Famol...UW Form 12 980In). Pet' uon for In'~n. i .on 101Pr, '<cOon AgaIn,. OIling V,o!en ce (03104)

oJ

01/10/2008 15:0~ PAGE 14

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------------- -----o Check here If YOUare BJtachmg addttlOna: pd~n to contInue: these fuets.

8 Petitioner genUInely fears dating 'fiolence by Re~pondent Explam-

PI :I, '".,.:' r_- .r-L_~;; .'1',1,-..1.: -/, . r L~~___¥-k <-" .c:::;,..? k: ~ '. ~'Y'c. t ,L. ( -Ir~_l ~ .. I

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9_ Addltionsl Jnformation

[,( all that apply]

~ s_ Re'spondent owns, has, and/or ISknO'WTIto ha\c guns or other weaponsDescnbe weapon(s): ,. p -,- }::. " __ ~ ...-

. h__

b. This 01 pi lor 8C!Sof dattng vIolence ha\e bex:l;pre\lOusly repor1ed to (person or agency)

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SECTION 1\1_ J~JUNCTION (This section must be completed"

Petttioner asks the' Court to enter a.nJT)JunctJonpi ohibilll1g Respondent from comnutling anyacts of vloknc-e against PelltJOner and-a prohlbiting Respondent from gOing to or \~1thlD :'iLlOfeet of any place Petitioner lives;b prohibiting Respondent from gOlOg to Or wl:hm ~OO feel of Petjrioner's place(s) ofemplo~'ment or the school that PetItioner al:ends. the address of Petnioner's place(s) ofemployment and/or school is: I'/I~ _______________

---)c prohIbIting Respondent from contacting Pcrlthmer by telephone, m8JI, bye-mail, mwntmg, through another person, or In any other rnann~r,d_ ordering Respondent not to use or possess am gun.. or fu-earms,

[I .u that sppl)'Je prohlbltrng Rt:spondent from gOlDg 10 01 wJ!hllJ )00 feel of the (o))owmg place(s)Petitioner or Pelltloner's Immediate family must go to ofte))

--' -f prohlbltmg Respondent from knowingly and IJIIentIt'nallygomg to or within 100 feet ofPetitIOner's motol vehicle,

01/15/2006 15:0-.J.;" h :-.t'-". .. Pt..:3E 15

and any oL1er lenns the Court deems ne(.es~aJ\. for th~.~ak()' of PetitIOner and Petl1ioner'sIffimedJate faImJ:

I U~DERSTA."'DTHAT BY FILING TillS PlTITION,J A..1\tASKlNG THE COURTTO HOLD A HEARJNGON THIS PETITION. TIIAr BOTHTHE RESPONDE~T A;"lDIWILL BE ~OTJFIEO OF THE HEARJ~C. A'\'O TH,AT I YlllST APPEAR AT THEHEA RLNC.

I U~D£RSTA."'D THAT I A_1\1SW£A~C OR AFFIR-\1ING UNDER OATH TOTHE TRl'THfl}l.:'-JESS OF THE CLAI~S MADE I.'\'THIS PETITION AND THAT THEPl:NISHMENT fOR KNOWINGL Y ;\'tAKING.o\ FALSE STAT[)\1ENT INCLUDES J'NESA."'O/OR I!\tPRJSO!\'~1:E~T.

Deled ~~~

STATE OF FLO&1oA ~., "

COUNTY OF (~~/ ~_j~:_/"~. )/ I 1-Sworn to or aff:nnt'd and sJgne~.before me C)ff~t'_-L-p-~~o;'I

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[PrlOt.'typt :ur:s.~~ cT1~6sroned ~~~e ofnOW! \' ~T .-lor\("}f ~,~ ,r', ' ,

Personally known ,\

Pwduccd Id~I)(lfll:ation _ ,\', '?, "

Type ot IdentdicaJ/on produced ~~" .. !__~~_ ' .~...,

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