Case 9:08-cv-80119-KAM flacument 3 3 Case 9:08-cv-80119-KAM Document 291-4 OO9- Page 1 of 9 Entered on FLSD Docket 09/08/2009 Page 1 of 9 • • • IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT, IN AND FOR PALM BEACH COUNTY, FLORIDA Case No.: DA 6 •020134 Ft • • ion: la-3 S—XXX1C018 Petitioner, and 9/1:1 I Oen 8c nt t r nyA Va Respondent. Cy: :7 1V '1:1 "1•• E PETITION FOR INJUNCTION FOR PROTECTION AGAINST DATING VIOLENC LR N being sworn, certifythat the I, (full legalname)ea, following statements are true: SECTION I. PETITIONER (This section is about you. It must be corn • leted. 1. Date ofBirth ofPetitioner: [4. if applies] 1,1 Petitioner seeks an Injunction for protection on beim Petitioner is the parent or legal guardian of (full legal name a minor child who is living at home. Filing Fees 2. [ d one only) a. Petitioner is paying the filing fee and sheriffs (or other authorized law enforcement agency's) service fees. b. Petitioner does not have enough money to pay the filing fee or service fees and is filing an Affidavit and Motion for Waiver of Fees for Petition for Injunction for Protection, %O Florida Supreme Court Approved Family Law Form 12.980(a), and a Family Law Financial Affidavit, grba Florida Family Law Rules of Procedure Fonn 12.902(b) or (c). Petitioner asks that hefsbe not have to pay the fees necessary to process the petition and serve the injunction and any motions or orders needed to enforce the injunction, subject to later order(s) of the Court about the payment of such fees. Petitioner's attorney's name, address, and telephone number is: • 3. (Ifyou do not have an attorney, write "none.") Florida Supreme Court Approved Furth. Low Form 12.980(o). Petition ibr Injunction for Protection Again% Dating Page lot 5 sly Violence (05/03) EFTA02746639