INSTRUCTIONS FOR
PETITION FOR TEMPORARY EX PARTE RISK PROTECTION ORDER
AND RISK PROTECTION ORDER
When should this form be used?
This form should be used to obtain an order that will require a person who is at high risk of
harming himself/herself or others to immediately surrender all firearms and ammunition in
his/her custody, control, or possession and any license to carry a concealed weapon or firearm.
Who may file this form?
A petition must be filed by a law enforcement officer or law enforcement agency.
Where should this form be filed?
A petition must be filed in the county where the petitioner’s law enforcement office is located or
the county where the respondent resides.
What must be shown?
The petition and accompanying affidavit must allege specific statements, actions, or facts based
on personal knowledge that give rise to a reasonable fear of significant dangerous acts by the
Respondent, and that Respondent poses a significant danger of injury to himself/herself or others
by having in his/her control, or by purchasing, possessing, or receiving, a firearm or ammunition.
IN THE CIRCUIT COURT OF THE SEVENTH JUDICIAL CIRCUIT,
IN AND FOR ________________________ COUNTY, FLORIDA
_________________________________,
Petitioner
v. Case No.: _____________________
Division: _____________________
_________________________________,
Respondent
PETITION FOR TEMPORARY EX PARTE RISK PROTECTION ORDER
AND RISK PROTECTION ORDER
SECTION I. PETITIONER
1. Petitioner’s full legal name or name of petitioning agency: ________________________
2. Petitioner’s law enforcement office/agency is located at {street address, city, state and zip
code}: __________________________________________________________________
SECTION II. RESPONDENT
1. Respondent’s full legal name: ______________________________________________
2. Respondent’s current address: {street address, city, state, and zip code}
____________________________________________________________________
3. Physical description of Respondent:
Race: Sex: Male Female Date of Birth:
Height: Weight: Eye Color: Hair Color:
4. Distinguishing marks or scars:
5. Vehicle: {make/model} Color: Tag Number:
6. Other names Respondent goes by: {aliases or nicknames}
7. Respondent’s email address: {if known}
8. Respondent’s Driver’s License number: {if known}
9. Respondent’s attorney’s name, address, and telephone number: {if known}
SECTION III. BASIS FOR PETITION
In support of this Petition the undersigned Law Enforcement Officer/Agency alleges:
1. Respondent poses a significant danger of causing personal injury to himself/herself or
others by having a firearm or any ammunition in his/her custody or control or by
purchasing, possessing, or receiving a firearm or any ammunition.
2. A sworn affidavit alleging specific statements, actions, or facts based on personal
knowledge that give rise to a reasonable fear of significant dangerous acts by the
Respondent is attached to this petition and incorporated by reference.
3. The attached sworn affidavit includes a list of the quantities, types, and locations of all
firearms and ammunition believed to be in the Respondent’s ownership, possession,
custody, or control.
4. Respondent poses a significant danger of injury to himself/herself or others by having in
his/her control, or by purchasing, possessing, or receiving, a firearm or ammunition.
______ [Required for Temporary Ex Parte Risk Protection Order] Respondent poses
this significant risk of injury in the near future.
5. Relevant evidence for the Court’s consideration is detailed in the attached affidavit and
shows that the Respondent:
was involved in a recent act or threat of violence against himself/herself or others;
engaged in an act or threat of violence, including but not limited to acts or threats of
violence against himself/herself, within the past 12 months;
is seriously mentally ill or has recurring mental health issues;
has violated a risk protection order or no contact order issued under sections 741.30,
784.046, or 784.0485, Fla. Stat.;
is the subject of a previous or existing risk protection order;
has violated a previous or existing risk protection order;
has been convicted of, had adjudication withheld on, or pled nolo contendere in Florida
or in any other state to a crime that constitutes domestic violence as defined in s. 741.28,
Fla. Stat.;
has used, or threatened to use, against himself/herself or others, any weapons;
has unlawfully or recklessly used, displayed or brandished a firearm;
has used or threatened to use on a recurring basis physical force against another person
or has stalked another person;
has been arrested for, convicted of, had adjudication withheld, or pled nolo contendere to
a crime involving violence or a threat of violence in Florida or in any other state;
has abused or is abusing controlled substances or alcohol;
has recently acquired firearms or ammunition;
other (Additional relevant information may be attached).
SECTION IV. NOTICE
______ Petitioner has made a good faith effort to provide notice to a family or household
member of the Respondent and to any known third party who may be at risk of violence
in compliance with s. 790.401(2)(f), Fla.Stat.
______ Petitioner will take the following steps to provide notice as required by s. 790.401(2)(f),
Fla.Stat. ______________________________________________________________________
SECTION V. RISK PROTECTION ORDERS
For the foregoing reasons, petitioner requests the Court to enter:
______ A TEMPORARY EX PARTE RISK PROTECTION ORDER in this matter
requiring Respondent to:
1. Immediately surrender all firearms and ammunition in his or her custody, control, or
possession and any license to carry a concealed weapon or firearm to the {name of law
enforcement agency}; _____________________________________________________
2. Not have in his/her custody, control, or possession any firearm or ammunition while this
order is in effect;
3. Not purchase, possess, receive, or attempt to purchase or receive, a firearm or
ammunition while this order is in effect; and
4. Abide by any other lawful relief the Court may order.
Petitioner further requests this Court to schedule a Hearing for a Risk Protection Order to be held
within 14 days.
A RISK PROTECTION ORDER in this matter requiring Respondent to:
1. Immediately surrender all firearms and ammunition in his or her custody, control, or
possession and any license to carry a concealed weapon or firearm to the {name of law
enforcement agency}; _____________________________________________________
2. Not have in his/her custody, control, or possession any firearm or ammunition while this
order is in effect;
3. Not purchase, possess, receive, or attempt to purchase or receive, a firearm or
ammunition while this order is in effect; and
4. Abide by any other lawful relief the Court may.
Petitioner requests the Risk Protection Order to remain in effect for a period the Court
deems appropriate, up to and including but not exceeding 12 months.
Respectfully submitted this _______ day of ____________, ________.
Signature of Petitioner
Law Enforcement Agency
____________________________________
Service Address
