Florida Probate Rule 5.920 - FORMS RELATED TO INJUNCTION FOR PROTECTION | Syfert Law

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Florida Probate Rule 5.920

RULE 5.920. FORMS RELATED TO INJUNCTION FOR PROTECTION
AGAINST EXPLOITATION OF A VULNERABLE ADULT


(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

In re: Protection of
Case No.:
Adversary Proceeding

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

(c) The results of any such reports or investigations:




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:

(c) Available resources the vulnerable adult has for such
alternative provisions:
; 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:




OR

(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

In re:
Case No.:

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 his or her due process rights.
Date of service

OR

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 shall 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)

OR
$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.)

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.
(c) Order Denying Injunction and Notice of Hearing.

IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

In re:
Case No.:

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 upon 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.

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.)

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.
CLERK OF THE CIRCUIT COURT

(SEAL)

By:
Deputy Clerk or Judicial
Assistant

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.
(d) Final Protective Injunction.

IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA

In re:
Case No.:

Vulnerable Adult

,

Petitioner,

and

,

Respondent.

PERMANENT INJUNCTION FOR PROTECTION AGAINST
EXPLOITATION OF A VULNERABLE ADULT

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 the testimony presented and 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. 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)

OR

$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.)

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