(b) The sworn petition must be in substantially the following form:
PETITION FOR INJUNCTION FOR PROTECTION AGAINST
REPEAT VIOLENCE, SEXUAL VIOLENCE, OR DATING VIOLENCE
Before me, the undersigned authority, personally appeared Petitioner (Name), who has been sworn and says that the following statements are true:
1. Petitioner resides at
(address) (A petitioner for an injunction for protection against sexual violence may furnish an address to the court in a separate confidential filing if, for safety reasons, the petitioner requires the location of his or her current residence to be confidential pursuant to s.
119.071(2)(j), Florida Statutes.)
2. Respondent resides at
(address).
3.
a. Petitioner has suffered repeat violence as demonstrated by the fact that the respondent has:
(enumerate incidents of violence)
_______________________________________________________
b. Petitioner has suffered sexual violence as demonstrated by the fact that the respondent has:
(enumerate incident of violence and include incident report number from law enforcement agency or attach notice of inmate release.)
_____________________________________________________________________
c. Petitioner is a victim of dating violence and has reasonable cause to believe that he or she is in imminent danger of becoming the victim of another act of dating violence or has reasonable cause to believe that he or she is in imminent danger of becoming a victim of dating violence, as demonstrated by the fact that the respondent has:
(list the specific incident or incidents of violence and describe the length of time of the relationship, whether it has been in existence during the last 6 months, the nature of the relationship of a romantic or intimate nature, the frequency and type of interaction, and any other facts that characterize the relationship.)
_______________________________________________________________________________________
4. Petitioner genuinely fears repeat violence by the respondent.
5. Petitioner seeks: an immediate injunction against the respondent, enjoining him or her from committing any further acts of violence; an injunction enjoining the respondent from committing any further acts of violence; and an injunction providing any terms the court deems necessary for the protection of the petitioner and the petitioner's immediate family, including any injunctions or directives to law enforcement agencies.