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Fla. Prob. R. 5.920

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Rule 5.920 Forms Related to Injunction for Protection Against Exploitation of a Vulnerable Adult

Part V: Forms

Rule Text

(a) Petition for Injunction. Petitioners should take steps to protect confidential information within the petition for injunction under Florida Rule of General Practice and Judicial Administration 2.420 and minimize sensitive information within the petition for injunction under Florida Rule of General Practice and Judicial Administration 2.425.

In the Circuit Court of the

__________________ Judicial

Circuit,

in and for ______________

County, Florida

Case No.: ______________

ADVERSARY PROCEEDING

In re: Protection of

________________________

Vulnerable Adult

________________________ ,

Petitioner,

and

________________________ ,

Respondent.

PETITION FOR INJUNCTION FOR PROTECTION AGAINST EXPLOITATION OF A VULNERABLE ADULT UNDER SECTION 825.1035, FLORIDA STATUTES

Before me, the undersigned authority, personally appeared petitioner ____

_____________ who has been sworn and says that the following statements are true:

1. The vulnerable adult, ____________________ , whose age is ____ , who resides at (address): ______________________________

2. Section 825.101, Florida Statutes, provides that a vulnerable adult is a person whose ability to perform the normal activities of daily living or to provide for the vulnerable adult’s own care or protection is impaired due to a mental, emotional, sensory, long-term physical, or developmental disability or dysfunction, or brain damage, or the infirmities of aging. Please describe the vulnerable adult’s inability to perform the normal activities of daily living. ______

______________________________

3. The petitioner’s relationship to the vulnerable adult is: ______ , and the petitioner has the right to bring the petition because: ______________________

______________________________

4. The respondent, ___________________ , resides at (last known address): ______________________________

5. The respondent’s last known place of employment is: ______________

______________________________

6. The physical description of the respondent is:

Race: __________________ Sex: ______ Date of Birth: __________

Height: __________ Weight: __________ Eye Color: _____________

Hair Color: _______ Distinguishing Marks/Scars: ___________________

7. Aliases of the respondent are: ______________________________

8. The respondent is associated with the vulnerable adult as follows:

______________________________

9. The following describes other causes of action:

(a) ____________ there is/are 1 or more cause(s) of action currently pending between the petitioner and the respondent, and/or a proceeding under the Florida Guardianship Code, chapter 744, Florida Statutes, concerning the vulnerable adult. Describe causes of action here: ______

______________________________

(b) Related case numbers and county where filed, if available: ____

______________________________

(c) ____________ there are previous or pending attempts by the petitioner to obtain an injunction for protection against exploitation of the vulnerable adult in this or any other circuit. Describe attempts here: ___________

______________________________

(d) The results of any such attempts: __________________________

______________________________

10. The following describes the petitioner’s knowledge of:

(a) Any reports made to a government agency, such as the Department of Elder Affairs or the Department of Children and Families: ______

______________________________

(b) Any investigations performed by a government agency relating to abuse, neglect, or exploitation of the vulnerable adult: _______________

______________________________

and

______________________________

11. The petitioner knows or has reasonable cause to believe the vulnerable adult is either a victim of exploitation or is in imminent danger of becoming a victim of exploitation, because the respondent (include a description of any incidents or threats of exploitation by the respondent here): ____

______________________________

12. The following describes:

(a) The petitioner’s knowledge of the vulnerable adult’s dependence on the respondent for care: ______________________________

______________________________

(b) Alternative provisions for the vulnerable adult’s care in the absence of the respondent, if necessary: ______________________________

____________ ; and

(d) The vulnerable adult’s willingness to use such alternative provisions: ______________________________

______________________________

13. The petitioner knows the vulnerable adult maintains assets, accounts, or lines of credit at the following institutions:

Institution	Address	Account Number

14. If petitioner is seeking to freeze assets of the vulnerable adult, petitioner believes that the vulnerable adult’s assets to be frozen are (check 1):

______ Worth less than $1,500

______ Worth from $1,500 to $5,000

______ Worth more than $5,000

15. The petitioner genuinely fears imminent exploitation of the vulnerable adult by the respondent.

16. The petitioner seeks an injunction for the protection of the vulnerable adult, including (mark appropriate section or sections):

______ Prohibiting the respondent from having any direct or indirect contact with the vulnerable adult.

______ Immediately restraining the respondent from committing any acts of exploitation against the vulnerable adult.

______ Freezing the below assets, accounts, and lines of credit of the vulnerable adult, listed below even if titled jointly with the respondent, or in the respondent’s name only, in the court’s discretion.

Institution	Address	Account Number

______ Providing any terms the court deems necessary for the protection of the vulnerable adult or the vulnerable adult’s assets, including any injunctions or directives to law enforcement agencies, including: __________

______________________________

17. If the court enters an injunction freezing assets, accounts, and credit lines:

(a) the petitioner believes that the critical expenses of the vulnerable adult will be paid for or provided by the following persons or entities: ______________________________

______________________________

(b) The petitioner requests that the following expenses be paid notwithstanding the freezing of assets, accounts, or lines of credit from the following institution(s): ______________________________

______________________________

I ACKNOWLEDGE THAT UNDER SECTION 415.1034, FLORIDA STATUTES, ANY PERSON WHO KNOWS, OR HAS REASONABLE CAUSE TO SUSPECT, THAT A VULNERABLE ADULT HAS BEEN OR IS BEING ABUSED, NEGLECTED, OR EXPLOITED HAS A DUTY TO IMMEDIATELY REPORT SUCH KNOWLEDGE OR SUSPICION TO THE CENTRAL ABUSE HOTLINE. I HAVE REPORTED THE ALLEGATIONS IN THIS PETITION TO THE CENTRAL ABUSE HOTLINE.

I HAVE READ EACH STATEMENT MADE IN THIS PETITION AND EACH SUCH STATEMENT IS TRUE AND CORRECT. I UNDERSTAND THAT THE STATEMENTS MADE IN THIS PETITION ARE BEING MADE UNDER PENALTY OF PERJURY PUNISHABLE AS PROVIDED IN SECTION 837.02, FLORIDA STATUTES.

______________________________

Signature of Party

Printed Name: _____________________

Address: ___________________________

City, State, Zip: ____________________

Telephone Number: ________________

Designated E-mail Address(es): _____

______________________________

STATE OF FLORIDA

COUNTY OF _______________________

Sworn to or affirmed and signed before me on .....(date)......

______________________________

Printed Name

______________________________

Notary Public or Deputy Clerk

______ Personally known or ______ Produced identification

Type of identification produced: ______________________________

(b) Temporary Protective Injunction Against Exploitation of a Vulnerable Adult.

In the Circuit Court of the

__________________ Judicial

Circuit,

in and for ______________

County, Florida

Case No.: ______________

In re:

________________________

Vulnerable Adult

________________________ ,

Petitioner,

and

________________________ ,

Respondent.

TEMPORARY PROTECTIVE INJUNCTION AGAINST EXPLOITATION OF A VULNERABLE ADULT AND NOTICE OF HEARING

This cause came before the court, which has jurisdiction over the parties and subject matter under state law. The court having reviewed the petition and affidavits and considered argument of counsel, finds as follows:

1. ______ Reasonable notice and opportunity to be heard was given to the respondent in a manner sufficient to protect the respondent’s due process rights. Date of service ________

2. ______ The court conducted its review ex parte.

3. An immediate and present danger of exploitation of the vulnerable adult exists.

4. There is a likelihood of irreparable harm and unavailability of an adequate legal remedy.

5. There is a substantial likelihood of success on the merits.

6. The threatened injury to the vulnerable adult outweighs possible harm to the respondent.

7. Granting a temporary injunction will not disserve the public interest.

8. This injunction provides for the vulnerable adult’s physical or financial safety.

9. These findings were based on the following facts: __________________

______________________________

Accordingly, it is hereby ADJUDGED that:

The petitioner’s request for a temporary protective injunction is GRANTED. This injunction is valid for 15 days from the date of this order or ____

______ . The full hearing is set for .....(date)....., at .....(time)...... The hearing will be held before the Honorable ___________________ at _______________ , Florida.

It is further ordered that:

______ The respondent must not commit any act of exploitation against the vulnerable adult.

______ The respondent will have no contact with vulnerable adult.

______ The vulnerable adult is awarded temporarily exclusive use and possession of any dwelling the vulnerable adult shares with the respondent.

______ The respondent is barred from entering the residence of the vulnerable adult.

______ The vulnerable adult’s assets, accounts, and credit lines are hereby frozen until further court order except: ______________________________

______________________________

______ Institution(s) served on .....(date)......

______ The following institution(s) _____________________ holding the vulnerable adult’s assets must use the vulnerable adult’s unencumbered assets to pay the clerk of court the following filing fee:

______ $75.00 (if assets are between $1,500–$5,000)

______ $200.00 (if assets are more than $5,000).

If the court enters an injunction, these fees will be taxed as costs against the respondent.

Law enforcement is hereby directed to: ______________________________

______________________________

Other relief: ______________________________

______________________________

This injunction is valid and enforceable in all Florida counties, does not affect title to real property, and law enforcement may use their section 901.15(6), Florida Statutes, arrest powers to enforce its terms.

DONE and ORDERED on .....(date)..... at .....(time)......

______________________________

Judge

CC: All parties and counsel of record

COPIES TO: (Check those that apply)

Petitioner:

______ by U. S. Mail

______ by hand delivery in open court (Petitioner must acknowledge receipt in writing on the original order—see below.)

Vulnerable Adult (if not petitioner)

______ by U. S. Mail

______ by hand delivery in open court

Respondent:

______ forwarded to Sheriff for service

______ by U. S. Mail

______ by hand delivery in open court (Respondent must acknowledge receipt in writing on the original order—see below.)

______ by certified mail (May only be used when respondent is present at the hearing and respondent fails or refuses to acknowledge the receipt of a certified copy of this injunction.)

______ by substitute service under section 825.1035, Florida Statutes.

Other: ______________________________

Petitioner’s Attorney: _________ by e-mail

Respondent’s Attorney: _______ by e-mail

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the clerk of the circuit court of _______________ County, Florida, and that I have furnished copies of this order as indicated above on .....(date)......

CLERK OF THE CIRCUIT COURT

By: ________________________

Deputy Clerk

If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact [identify applicable court personnel by name, address, and telephone number] at least 7 days before your scheduled court appearance, or immediately upon receiving this notification if the time before the scheduled appearance is less than 7 days; if you are hearing or voice impaired, call 711.

In the Circuit Court of the

__________________ Judicial

Circuit,

in and for ______________

County, Florida

Case No.: ______________

In re:

________________________

Vulnerable Adult

________________________ ,

Petitioner,

and

________________________ ,

Respondent.

ORDER DENYING REQUEST FOR TEMPORARY INJUNCTION AND SETTING HEARING ON PETITION FOR INJUNCTION FOR PROTECTION AGAINST EXPLOITATION OF A VULNERABLE ADULT

A petition for injunction for protection against exploitation of a vulnerable adult has been reviewed. This court has jurisdiction over the parties and of the subject matter. Based on the facts stated in the petition, the court finds:

The facts supporting the denial of the request for an ex parte injunction are: ______________________________

______________________________

The court finds that based on the facts, as stated in the petition alone and without a hearing in the matter, there is no appearance of an immediate and present danger of exploitation of a vulnerable adult.

IT IS THEREFORE ORDERED:

The request for a temporary injunction for protection against exploitation of a vulnerable adult is denied. A hearing is scheduled on the petition for injunction for protection against exploitation of a vulnerable adult. The petitioner has the right to promptly amend any petition consistent with court rules.

NOTICE OF HEARING

A hearing is scheduled regarding this matter on .....(date)....., at .....(time)....., when the court will fully hear the allegations in the petition for injunction for protection against exploitation of a vulnerable adult. The hearing will be before The Honorable .....(name)....., at the following .....(address)....., Florida. All witnesses and evidence, if any, must be presented at this time.

IF EITHER PETITIONER OR RESPONDENT DO NOT APPEAR AT THE FINAL HEARING, THE PETITIONER OR RESPONDENT WILL BE BOUND BY THE TERMS OF ANY INJUNCTION OR ORDER ISSUED IN THIS MATTER.

Nothing in this order limits petitioner’s rights to dismiss the petition.

DONE AND ORDERED in, ________________ Florida, on .....(date)......

______________________________

JUDGE

COPIES TO:

Sheriff of _______________ County

CERTIFICATE OF SERVICE:

Petitioner: ______ by U. S. Mail ____________ by e-mail to designated e-mail address(es)

Respondent will be served by sheriff, or by substitute service under section 825.1035, Florida Statutes.

Vulnerable Adult will be served by sheriff.

The financial institution will be served by sheriff. (If any assets, accounts, or lines of credit are requested to be frozen, insert names of the financial institutions.)

CLERK OF THE CIRCUIT COURT

(SEAL)

By: ______________________________

Deputy Clerk or Judicial

Assistant

(d) Final Protective Injunction.

In the Circuit Court of the

__________________ Judicial

Circuit,

in and for ______________

County, Florida

Case No.: ______________

In re:

________________________

Vulnerable Adult

________________________ ,

Petitioner,

and

________________________ ,

Respondent.

PERMANENT INJUNCTION FOR PROTECTION AGAINST EXPLOITATION OF A VULNERABLE ADULT

1. Reasonable notice and opportunity to be heard was given to the respondent in a manner sufficient to protect the respondent’s due process rights. Respondent was served with the petition for injunction, notice of hearing, and temporary protective injunction, if issued.

2. A hearing was held on .....(date)......

3. The vulnerable adult is a victim of exploitation or in imminent danger of becoming an exploitation victim.

4. There is a likelihood of irreparable harm and unavailability of an adequate legal remedy.

5. The threatened injury to the vulnerable adult outweighs possible harm to the respondent.

6. With regard to freezing the respondent’s assets, accounts, and lines of credit that were the proceeds of exploitation, there is probable cause that exploitation has occurred and a substantial likelihood that such assets, accounts, and lines of credit will be returned to the vulnerable adult.

7. This injunction provides for the vulnerable adult’s physical or financial safety.

8. These findings were based on the following facts: __________________

______________________________

Accordingly, it is hereby ADJUDGED that:

The petitioner’s request for a protective injunction is GRANTED. This injunction remains in effect until it has been modified or dissolved, and it is further ordered that:

______ The respondent must not commit any acts of exploitation against, or have any direct or indirect contact with, the vulnerable adult.

______ The vulnerable adult is awarded exclusive use and possession of any dwelling the vulnerable adult shares with the respondent.

______ The respondent is excluded from the residence of the vulnerable adult.

______ The respondent must, at the respondent’s own expense, participate in all relevant treatment, intervention, or counseling services to be paid for by the respondent.

______ Unless ownership is unclear, any temporarily frozen assets, accounts, and credit lines of the vulnerable adult are to be returned to the vulnerable adult.

If not already paid under the order granting temporary protective injunction against exploitation of a vulnerable adult, a final cost judgment is hereby entered against respondent and in favor of the clerk of courts in the amount of (check 1):

______ $75.00 (if assets are between $1,500–$5,000)

______ $200.00 (if assets are more than $5,000).

All for which let execution issue forthwith.

If the amount set forth above has already been paid to the clerk of courts, a final cost judgment is hereby entered against respondent and in favor of the vulnerable adult in the amount set forth above, all for which let execution issue forthwith.

Any other costs associated with this judgment, including filing fees and service charges, are to be paid by the respondent.

Other: ______________________________

______________________________

This injunction is valid and enforceable in all Florida counties, does not affect title to real property, and law enforcement may use section 901.15(6), Florida Statutes, arrest powers to enforce its terms.

DONE and ORDERED on .....(date)......

______________________________

Judge

CC: All parties and counsel of record

COPIES TO: (Check those that apply)

Petitioner:

______ by U. S. Mail

______ by hand delivery in open court (Petitioner must acknowledge receipt in writing on the original order—see below.)

Vulnerable Adult (if not petitioner)

______ by U. S. Mail

______ by hand delivery in open court

Respondent:

______ forwarded to Sheriff for service

______ by U. S. Mail

______ by hand delivery in open court (Respondent must acknowledge receipt in writing on the original order—see below.)

______ by certified mail (May only be used when respondent is present at the hearing and respondent fails or refuses to acknowledge the receipt of a certified copy of this injunction.)

______ by substitute service under 825.1035, Florida Statutes.

Department of Agriculture and Consumer Services

Other: ______________________________

Petitioner’s Attorney: _________ by e-mail

Respondent’s Attorney: _______ by e-mail

I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the clerk of the circuit court of ____________ County, Florida, and that I have furnished copies of this order as indicated above on .....(date)......

CLERK OF THE CIRCUIT COURT

By: ______________________________

Deputy Clerk

Rule 5.920 Forms Related to Injunction for Protection Against Exploitation of a Vulnerable Adult

Rule Text

Plain-English Summary (for reference only — not a substitute for the rule text above)

Committee Notes

Disclaimer