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Petitioner, and Respondent. (Florida)

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Florida Supreme Court Approved Family Law Form 12.941(b), Temporary Injunction to Prevent Removal of Minor
Child(ren) and/or Denial of Passport Services (Ex Parte) (03/15)
IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA
Case No: ________________________
Division: ________________________
_________________________________,
Petitioner,
and
_________________________________,
Respondent.
TEMPORARY INJUNCTION TO PREVENT REMOVAL OF MINOR
CHILD(REN) AND/OR DENIAL OF PASSPORT SERVICES
(EX PARTE)
Upon verified motion of ( ) Petitioner ( ) Respondent, the Court has jurisdiction of the parties and the
subject matter and the Court being fully advised, it is ORDERED and ADJUDGED that:
NOTICE OF HEARING
This Temporary Injunction to Prevent Removal of Child(ren) has been issued without prior notice to
Respondent. Pursuant to Rule 1.610, Florida Rules of Civil Procedure, the other party may file a motion
to dissolve or modify this temporary injunction and a hearing will be scheduled within 5 days of that
motion.
If no motion to dissolve is filed, Petitioner and Respondent are instructed that they are scheduled to
appear and testify at a hearing regarding this matter on {date}___________, at _______ a.m./p.m.,
when the Court will consider whether the Court should continue, modify, or dissolve this Temporary
Injunction to Prevent Removal of Child(ren) and/or Denial of Passport Services, which would remain in
effect until modified or dissolved by the Court, and whether other things should be ordered, including
who should pay the filing fees and costs. The hearing will be before The Honorable {name }
_____________________________________________, at {room name/number, location, address, city}
_____________________________________________________________________________, Florida.
IF PETITIONER AND/OR RESPONDENT DO (DOES) NOT APPEAR, THIS TEMPORARY INJUNCTION MAY
BE CONTINUED IN FORCE, EXTENDED, OR DISMISSED, AND/OR OTHER ADDITIONAL ORDERS MAY BE
ISSUED, INCLUDING THE IMPOSITION OF COURT COSTS.
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:
Florida Supreme Court Approved Family Law Form 12.941(b), Temporary Injunction to Prevent Removal of Minor
Child(ren) and/or Denial of Passport Services (Ex Parte) (03/15)
__________________________________________________________________
{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.
FINDINGS
1. It appears from specific facts shown by verified motion that immediate and irreparable injury, loss,
or damage will result to the minor child(ren) if a temporary injunction is not issued without notice to
the other party.
2. _____ Petitioner’s _____ Respondent’s attorney has certified in writing any efforts made to give
notice.
3. The reasons why notice should not be given are: __________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
TEMPORARY INJUNCTION
{indicate all that apply}
1. _____The following child(ren) shall not be removed from the jurisdiction of this Court during the
pendency of this proceeding, or until further order of this Court:
Name Birth date
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
2. _____ Petitioner _____Respondent shall not apply for any passports or passport services on behalf
of the child(ren).
3. _____ Petitioner _____ Respondent shall immediately deliver any existing passports for the
child(ren) to {name} ____________________________________________________.
4. The Court may enforce compliance with the terms of this injunction through civil and/or indirect
criminal contempt proceedings, which may include arrest, incarceration, and/or the imposition of a
fine.
5. Violation of this injunction may constitute criminal contempt of court.
Florida Supreme Court Approved Family Law Form 12.941(b), Temporary Injunction to Prevent Removal of Minor
Child(ren) and/or Denial of Passport Services (Ex Parte) (03/15)
6. Bond.
a. _____ Bond is waived because this injunction is issued solely to prevent physical injury or abuse
of a natural person.
b. _____ This order is conditioned upon _____ Petitioner _____ Respondent posting bond in the
sum of $ _________ with the clerk of this Court.
EXPIRATION.
This injunction shall remain in effect until the minor child(ren) reach(es) the age of 18, until the
hearing scheduled herein, if any, or {date}_______________________, whichever occurs first,
unless modified by further order of this Court.
DONE AND ORDERED at _________________________, Florida on {date} _________________ .
__________________________________________
CIRCUIT JUDGE
I certify that a copy of the {name of document(s)} ________________________________________ was
( ) mailed ( ) faxed and mailed ( ) e-mailed ( ) hand-delivered to the parties and any other
person(s) or entities listed below on {date}____________________________.
________________________________________
By: Clerk of Court, Designee, or Judicial Assistant
Petitioner (or his or her attorney)
Respondent (or his or her attorney)
U.S. Department of State
Office of Children’s Issues
2201 “C” Street NW
CA/OCS/CI
Washington, D.C. 20520
Fax (202) 736-9133
preventabduction@state.gov
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Petitioner, and Respondent. (Florida)

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Completed 10 January 2021

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