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Petition for Injunction for Protection

The following is an electronic reproduction of what the court document looks like:

IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT IN AND
FOR CHARLOTTE COUNTY CIVIL ACTION
                               )
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                               )
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Petitioner,                    )
                               )
vs                             )             Case No.:            
                               )
                               )
Respondent                     )

            PETITION FOR INJUNCTION FOR PROTECTION

BEFORE ME, the undersigned authority, personally appeared Petitioner,  who has

been sworn and says that the following statements are true:

(a)   Petitioner resides at                                    

(b)   Respondent's name                                        

      and resides at                                           

(c)   Respondent is the spouse or former spouse of the   

      Petitioner.

(d)   The following describes any other cause of action pending

      between the petitioner and respondent:                   

(e)   Petitioner has suffered or have reasonable cause to fear 

      domestic violence because respondent has:________________________________
___________________________________
___________________________________
___________________________________

(f)   Petitioner alleges the following additional specific facts:

      Petitioner is the custodian of a minor child or children whose names and ages

      are as follows:                                                                                   

      Petitioner needs the exclusive use and possession of the

      dwelling that the parties share.

      Petitioner is unable to obtain safe alternative housing

      because:                                                                                                        

      Petitioner genuinely fears that respondent will abuse,  remove, or hide the minor child or      

      children from petitioner because:                                                                                             

(g)   Petitioner genuinely fears domestic violence by respondent.

(h)   Petitioner seeks an injunction:

        Immediately restraining the respondent from committing any acts of domestic violence.

        Restraining the respondent from committing any acts of domestic violence.

        Awarding to the petitioner the temporary exclusive use and possession of the dwelling that the 

        parties share or excluding the respondent from the residence of the petitioner.

        Awarding temporary custody of, or temporary visitation rights with regard to, the minor child 

        or children of the petitioner.

        Establishing temporary support for the minor child or children of the petitioner.

        Directing the respondent to participate in treatment of counseling services.

        Providing any terms the court deems necessary for the protection of a victim of domestic      

        violence, including any injunctions or directives to law enforcement agencies.

                               ____________                                                               

                                Petitioner


Subscribed and sworn to on this_____ day of_____________19_____.


                               BARBARA T. SCOTT

                          CLERK OF THE CIRCUIT COURT

                             By:_________________             
                                Deputy Clerk