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Carlos Slay Documents
Carlos Slay Documents
Petitioner,
and
C,Qr\DS Respontlent.
1.
2. Respondent is:
-I
,-
[ ,./ all that apply] -o
__ a. the spouse of Petitioner. Date of Marriage: _ _ _ _ _ _ _ _ __
::;c ITl
Florida Supreme Court Approved Family law Ftmn 12.980(b). Pelitkin fo, lnJunclion ro, Protection Against Domestic Violence (03/04)
N
CJ)
0
b. the former spouse! Petitioner.
( Date of Marriage: _ _ _ _ _ _ _ __
Date of Divorce: -,-----=-..,.,,,,........----
_2.Q C. re~ated bX bloo~ or m~iag~ to Ptitioner.
Specify relationship: d,od... c:..@116/Q
__ d. a person who is or was living in one home with Petitioner, as if a family.
__ e. a person with whom Petitioner has a child in common, even if Petitioner and
Respondent never were married or living together.
SECTION Ill. CASE HISTORY AND REASON FOR SEEKING PETITION (This
section must be completed.)
1. Has Petitioner ever received or tried to get an injunction for protection against
domestic violence against Respondent in this or any other court?
--.-Yes )C No If yes, what happened in that case? (include case
number, if known)
2. Has Respondent ever received or tried to get an injunction for protection against
domestic viol~e against Petitioner in this or any other court?
_ _ Yes . No If yes, what happened in that case? (include case
number, if kn wn)
Ftorklo sup,eme Court Approved Family l.aw farm 12.980(b), Pelltlon for Jnjunclion for P,olecllon Against Domestic Violence (03IOII)
(
3. Describe any other co!t case that Is either going on or that happened
in the past, including a dissolution of marriage, paternity action, or child support
!w
enforcement action, between Petitioner and Respondent {include city, state,
and case number; if known): _______________
~~~~~ti~~~-~4-~~~~~tl~~~~~~~ro~
( + 'i 6 pr , so "-l:e~
0 Check here if you are attaching additional pages to continue these facts.
5. Additional Information
Florida Supretne Gour! App,oved Family Law forl!l 12.980(b), Petlllon for lnjuricUon for Prolection Against Domestic Violence (03/04)
(
Is Resp<;ingef\t suppo:!d fo take medication for mentfhealth problems?
( )Yes(,v)'No
( If yes., 'is Respondent currently taking his/her medication? ( ) Yes ( ) No
SECTION IV. TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME
(Complete Ihis section only if you want the Court to gra:nt you temporary exclusive use
and possession of the home that you share With the Respondent.)
1. Petitioner claims thI::i following about the home that Petitioner and Respondent
share or that Petitioner lefl because of domestic violence:
[ ,J aU that apply]
__ a. Petitioner needs the exclusive use and possession of the home that the
parties share at {street address} _ _ _ _ _ _ _ _ _ _ _ __
{city, state, zip cocle} - - , - - . . . , , . - - - c - " - - - , - - - c - - ~ - , . - - - - - - -
.b. Petitioner cannot get an<:>fher safe place to live because: _ __
c. If kep.t out of the home, Respondent has the m:oney t6 get other housing or
may live. without rno:ney at {street address}- _ _ _ _ _ _ _ _ _,
{city; sf.ate, zip code} _ __c__ _ _ _ _ _ _ _ _ _ _ _ __
Note, lf'the f)aternity of th:e minor child(ren) listed below has not been
estap"lis"hecl "through either marriage or court order, the Court may deny
temporary oustody, visitatio:n, andlor support.
f=lor!da Sup'rema Cotirt Approved family Low ro,m 12.9BO(b)., PoUtion 1o1 lnjunct1on for Protection Against Dome$IIC Violence (03/04}
1. Petitioner is the naturfparent, adoptive parent, or gu.dian by court order of the
minor child(ren) whose name(s) and age(s) is (are) listed below.
Name Place of Birth Birth date Sex
2. The minor child (ren) whom Petitioner is seeking temporary custody of:
[ ./ one only]
_ a. saw the domestic violence described In this petition happen.
__ b. were at the place where the domestic violence happened but did not see it.
c. were not there when the domestic violence happened this time but have seen
previous acts of domestic violence by Respondent.
d. have not witnessed domestic violence by Respondent.
3. Name any other minor child (ren) who were there when the domestic violence
happened. Include child (ren)'s name, age, sex, and parents' names. _
C 4. Visitation
[ ..J all that apply] . .
a. Petitioner requests that the Court order reasonable visitation by Respondent
with the minor child(ren), as follows:
b. Petitioner requests that the Court order supervised exchange of the minor
child(ren) or exchange through a responsible person designated by the Court.
The following person is suggested as a responsible person for purposes of such
exchange. Explain: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
c. Petitioner requests that the Court limit visitation by Respondent with the minor
child (ren). Explain: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
d. Petitioner requests that the Court prohibit v.isitation by Respondent with the
minor child (ren) because Petitioner genuinely fears that Respondent imminently
will abuse, remove, or hide the minor child(ren) from Petitioner. Explain:
r:10,lda supreme Court Approved f{)mi!y Law Form 12.960(b), Pellllon for lnJunclion for Prolecllon Against Oomestic Violence {03/04)
( ..
( SECT.ION VI.
TEM'.PORARY SUPPORT (Complete this section only if you are
seeking financial support from the Respondent. You must also complete and file a
Family Law Fi'rrnncial Affidavit, _Cl Florida Family Law Rules of Procedure Form
t2.902(b) or (c}, and Notice of $0<:ial Security Number, _Cl Florida Supreme Court
Approved Family Law Form 12.9020), If yow are seeking child spport. A Child
Supp_t>.rt Guicf~lines Worksheet, _l'.J Florida Family Law Rules of ProcecJure Form
12.902(e), must be filed with the court a'! or prior to a hearing to establish or modify
child support.)
__ 2.. Petitioner requests that the Court order Respondent to pay the following
temporary alimony to Petitioner. (Petitioner must be married to Respondent to
a.sf< for temporary alimi;iny.) Temporary Alimony Requested$.___ every
( ) week ( ) otherweel< ( ) month.
3. Petitioner requests that the Court order Resporident to pay the following
temporary child support to Petitioner. (The respondent must be the natural
pareht, adoptive parent, or guardian by court order o.f the minor child(ren) for the
court to order the respondent to pay child support.) Temporary child support is
requested in the amount of $_ _ _ _ every ( ) week ( ) other week ( )
( month.
SECTION VII. INJUNCTION (This section summarizes what you are asking the
Court to include in the injunctiGn. This section must be completed.)
1. Petitioner asks the Court to enter a TEMPORARY INJUNCTION for protection
against domestic violence that will be in place from now until the scheduled
hearing in this matter.
2. Petiti0oer asks the Court to .enter, after a hearing has been held on this petit1oh,
a final Judgment .on injuncti.on prohibiting Respondent from oommitting any acts
of domestic violence against Petitioner and:
/a) pro.hibiting Respondent from going io or within 500 feet of any place the
)ietitioner 11ves.;
() prohibiting Respondent from going to or within 500 feet of the Petitioner's
place{s) of employment or sch ol; the . dress of Petitioner's place(s) of
ernpk1yment .r sch:ool is: . ::::-. ~ 'C
c prohfbi.ting Respondent from contacting Petitioner by mail, by telephone,
,tl;)roUgh another person, or in any other manner;
(g:) prohibiting Respondent from knowingly and intentionally going to or within 1oo
feet of Petitioner's motor vehicle.
Florida Supreme Courl App,oved Fam!ly t..S\v Foiln 12.980(b), Petlllm1 for Injunction for Proloolion Against Domestic Viblehee {03/04)
(
e. prohibiting Respor!nt from defacing or destroyin~etitioner;s personal
( property..
June 7, 2016
Carlos Slay
54161 Jerra Road
Callahan, FL 32011
The Nassau County School Board examined the propriety of the contract for
services awarded to Dr. Catherine Drew and Florida Psychological Associates.
The School Board found no impropriety. Dr. Drew is not prohibited from bidding
for a government contract merely because her husband is the current Tax
Collector. Dr. Drew and Tax Collector Drew's marriage is known within the
community. Your effort to "link" claims of School Board campaign contributions to
violations of Florida's Sunshine law is little more than a circuitous impermissible
stacking of inferences and innuendo.
Similarly, John Drew, nor his wife, are prohibited from advocating funding
from the Florida Legislature for local and community programs which are of
interest or benefit to the citizens of Nassau County. Neither Tax Collector Drew,
nor his wife, are "lobbyists" as that term is defined in section 11.045, F.S., and
have committed no such associated lobbying violations as you allege.
The Nassau County Tax Collector's Office has been independently audited
for the last seven years by certified public accountants. On each occasion the
auditing firm concluded the Tax Collector complied with his statutory
In your letter you claim Tax Collector Drew failed to take due care in
protecting public records. As for alleged public records violations, Chapter 119,
F.S., sets forth the various remedies relating to such claims. If you believe you
have been aggrieved by the Tax Collector regarding Florida's Public Records law
you have a civil remedy. I am satisfied with the explanation provided by the Tax
Collector's IT Director regarding the Tax Collector's IT storage and retention and
do not believe there is any evidence of a civil or criminal public records violation.
The sexual harassment claim is known within the County. The matter was
handled by the County Attorney and settled through the appropriate civil or
administrative employment process. To my knowledge, there is no underlying
criminal conduct for my Office to review related to this settled matter.
Finally, and most disturbingly, you accuse the Tax Collector of improperly
storing his personal property on County property. In particular, you allege
vessels are improperly stored on the property. Having worked in Nassau County
the last several years I have driven past those vessels on countless occasions. I
recognized them immediately to be the property of the Florida Fish and Wildlife
Conservation Commission. The Executive Director of the Commission prepared
an affidavit acknowledging ownership of the vessels and you are aware of the
ownership of the vessels.
In closing, you are a declared candidate for Nassau County Tax Collector
and such a candidacy carries with it a responsibility to remain informed of not
only Florida's campaign laws, but of basic facts regarding your opponent. I
caution you that Florida law imposes such a responsibility and sets for a
punishment for ignoring its admonition. Section 104.271, F.S., provides in
relevant part:
Sincerely,
/ ,fl~ta1Sri1r,l
Stephen Siegel 1
Sr. Division Chief
Nassau County
Incident lnfor/llfltion
Dny/Date/lim, of lnci,IWFrom: Tuesday 6/28/2002 22:65 Dlzy/Date/Tlm of lnc/1/ent-To: Tuesday 6/28/2002 23:30
l.ocatlon oflncld,nr: 3033 MONUMENT RD Apt.1/.ot II: 20 Sul1-S,ctor: F1
City: JACKSONVILLE State: FLORIDA Zip: 32277
Tnt: Cro5sstrett: Day/Dare/T/11r, lncl1len1 Reponeil: Tuesday 6/28/2002 23:00
Drue Acll,lty: NOT APPLICABLE Dmg 1yp,: NOT APPLICABLE /I Of Offenses: 3
Alcolrol Related: UNKNOWN (OR NIA) Dnrg R,lated: UNKNOWN (OR NIA) // OfVicltmi: 3
M.C,/, Case: Yes Fol/01VIIP hf: Patrol Office Wa, Hate Crime Involved: NIA Datlnc Violence 1,,.,0/vtd: NIA II OfSu,pects: 1
Offense#1
Statute No: S784.021(1)(B) Degree: F3 UCR Coile: 130A At1,111p1 Code: Commit
AS9AUL'l' / AGO / WIW AN :tmaw.r TO COMMrl' A FELONY
Offense#2
Statute No: S784,021(1)(B) Degne: F3 I/CR Co,/,: 130A At1emp1 c.,,,, Commit
MISA'Ulll' / AGG / WXfi I\N EtnBNT TO COMMX'T' A i'ELONY
Offen&e#3
c S/Qtute No: S784,07(2)(C)
ASSAVL'l' 1 Aaa, r..a.oA I
Dtgrte: F2
l"lRBP-:tOll'J:'JIR I DR, nc
I/CR Code: 130A At1empt Cude: Commit
SUP Pase I of 4 Dnte Prlntttl: 5119/20/6 MIKE WILLIAMS, SHERIFF 20024$6007 SUP
M,lrm: 6124 LAURANHA LN Aw.11.o, U: ,"i11h,\'c,1on
C/1y: CALLAHAN s1111e: FLORIDA z111: 32011
'Jim Cnms1ru1:
( 11879.. 0317 IJ11s. Nwm #765 3300 H:d,
/Jame Pltollt! 00
11s.J>lw111:-i;1,
w11e Proirftfer Ii-mull
( ls V11gra111? NO
Altenmte 1\1/clrtJs: Mt /\111,/l.,Q( H: ,\Ir S1thSerwr:
1\11 Ci(>: t\ll Stare: Alt Zi11:
,\II rm:: All c,vssstrectt
SUP 1'11,:tl of .J /)11/t' l'rillf11J: 51/1)/2()/6 MIKE WILLIAMS, SHERIFF 21/02456007 SUP
Helgl,t range ls from to Welgl,t(lbs> mn,:e is from to
Eye Color: BROWN Hair Color: BLACK Hair length: MEDIUM
HalrSryle: DREADLOCKS comp/,xlo11: DARK Vole,: LOUD Facial Hair: NONE
Dls1lngul$ll(ng Marks:
( c1011,1nglD"crlp11on: BLUE RUNNING PANTS, BLACK JACKET, BEIGE STOCKING ON HEAD
.Nlckn'1me(s):
Aliases:
9mw.u
#1 ASSAVVJ: / AIJG / WX.WH AN ltflEN'l' TO COMMIT A l'BLONY
ff2 ASSAvtn! / AGIJ / Wl~JI 11'1 %ll'>B!T1' N COlllllW A FBLONY
#3 USA't1Im / AGG, L.m.o. / l'JREFIOJITU / tlO, I.TC
Jail Booking# NIA 08711 No, Juv,n//,: Unk /,1/mn,la llllmlngs Given: No Su,pI Co1/[esst<I?
Eal U5uge:
RTR. wrllltn reltUed to this incltlt11t? NO RTR lnclt/ellt Yr: RTR lnctlfent #:
ADDITIONAL INFORMATION
On 05-2802 an attempted armed robbery occurred at the Blockbuster Video on 3033 Monument Road. One of
the euspects fled on foot and a second was detained by Pllm. Garcia.
Ae the euspeot fled on foot, he pulled out a handgun and pointed It at victims #1 1 #2, and #3.
The suspect detained by Pllm. Garcia provided Information as to the Identity of tha suspect who fled on foot.
A photo spread was prepared by tha Support Center, containing a photo of the suapect's State of Florida ID card,
as well as five other photos.
The photo spread was shown to each of the victims lndMdually.
Victim #1 positlvely Identified the suspeot In the photo spread.
Victim #2 did not Identify the suspect, stating that he did not feel confident about Identifying any of tha photos as
the suspect.
( Victim #3 did not correctly Identify the suspect during the photo spread.
On 06-2002 I spoke with Assistant State Attorney Monica Henschel, who Instructed ms to contact the subject
detained by Pllm, Garcia and conduct a controlled phone call between be and the suspacl,
Patrol efforts continuing.
Supplemental CCR# 4669112,
Nelg/1borhood Canvass: #1
Namt:
Atltlress: Apt/Lot II: Btlildlng NamdNumber: Sub-Settor:
City: Stale: Zip:
Taz: CroJSSlfetl:
Home Phone# Bus, Phone# Ext,
Cell Pho1tf!! # Cell fl,one Pn.wltltr E-mail
Race: Etlmlc/ty: Sex:
c1,ara11ce Slatus: CASE NOT CLEARED Clearance Coile: NOT APPLICABLE 0a1e case was <ltaretl: Numb6r (J/Cases C(eanttl
CaseNotCltaredType: CASE NOT CLEARED (PATROL FOLLOW-UP)
CRIME ANALYSIS
Aggmvottd AssaultJMurtl,r: ASSAULT ON LAW ENFORCEMENT OFFICER
Type of Weapon: HANDGUN
Force,/ En11y:NOT APPLICABLE S1ra,1uro occ11pancy Co,le: NOT APPLICABLE
(. Nrm1htrof Premises Entered:
(
SOP Pag,4 of 4 Dat, Printe,/:5/19/l0/6 MIKE WILLIAMS, SHERIFF 2002456007 SUP
NCICIFC/C
6tllere1l: _ _ __
MCI Patrol Follow Up
Ro111e To: Robbery
Clttck,ih _ _ __
Fife Purged:. _ _ __
NIA: _ _ __
Incident Informatio11
Jacksonville Sheriff's Office
Supplement Incident Report
ll
Day/Dor,/l'im, of /ncldenlFrom: Tuesday 6/28/2002 22:56 Dny!Da1tll'lme oflnci<l,m-Th: Tuesday 5/28/2002 23:30
Location of lnc/,/enr: 3033 MONUMENT RD Ap1JLo1 Ii: 20 Suh-Sector:, F1
City: JACKSONVILLE Stott, FLORIDA Zip: 32277
Tat: CroJmrteu Day!Dmtll'im, lncld,m R,poTteil: Tuesday 5/28/2002 23:00
Drug Ae1Mty: NOT APPLICABLE Dn,g Typt, NOT APPLICABLE! #OJO/fenm: 3
Alro/101 R,101,il: UNKNOWN (OR N/A) Drug Relotedt UNKNOWN (OR NIA) # OJ Vier/ms: 3
M,C,/, Cam Yes Folloiv-up hy: Patrol Offloe Wit.f Hate Crimtr Involved: N/A Dallng V/olem:e Involved: NIA Ii Of Su,p,cr,: 1
Offen11e#1
Srarure No: 9784.021 (1 )(B) Degr,e: F3 UCR Code: 130A A11,mp1 C,x/,: Commit
ASSAUf./ll / AM / WH'B AN XNTBRl' TO COMXUT- A J'Br.omt
0.ffense#2
Stnlut< No: 8784.021 (1 )(B) Dtgree: F3 UCR Cod,: 130A All'111/}I Code: Commit
ASSAULT I AGO I WXWll .Mo! IN'l'~ WO OOMM:(,;t A, PZLONY
Offense#S
S784.07(2)(C) D,grm F2 UCRCtHle: 130A Commit
( Statutt No,
ASSAU'Ill' / AGGr L,S.o. / l'l1Ui:P%GHTBR / EM'l'_, BWC
A11emp1Code:
Ci Victim1"formation #2
Nam,: HOWELL KNEWLON ROBERT
VICTIM TYPE: ADULT
C /,f Vt1gnmti' NO
AIMwlll! Ai/dress: Alt Apt/l..iJI fl: t\/1 S11h-Se11m:
Mt Ci1y: Alt ,fltllc: J\11 ZI/>:
Aft 'Hu.: All CnJJ'1strtet:
All llome Phmlt' IJ /\Ir D1ts. l'hone HAlt l~w.
DOI...,
All Cd/ /'fume# All Cell I'll ,ltlcr Ali
llosplwl Wltt'lt' Vktim rnk
I'iltrc~\'('/1 ool:
Rim.- Etlmklry
Age:.
11,;y/11: ....l'ds/tl(llu/:
t(w CtJIVI Ir Colr,r.
lll)III)' l~xlc'JII. hijrlly . 1 ,'
oncm1c.-. Ykthn o :
U3 ASB11.UUl' / J\GGI L,E,0, / FIREli'IGHTER / EM'l', l'l'C
Viflim IMatfrmsl1i{} 'fo Offi11t/er:
STRANGER #1 UK,
... . ' '
Suspect I11fomwtio11 #1 Suspect Locatio11: At Large
Ntm11: UK
A,Mrt.m ,1,,1.ll..nr H: S11h-S1,wr:
Clly,JACKSONVILLE smt,: FLORIDA ,1,,:
'fm:.: Cro.1Mtn't'f:
llmne /1/ume II /J11s. Plwm H lfrt,
Cdt Plwni: # CHI l 1lw1w Providt'r .mail
l.r Vt1$l'WU '! NO.
N,,r, ,!f H11111ft1)' l.'ll'lwol: UK
tlilri, BLACK 1w11,;,;,y: NOT OF HISPANIC ORIGIN sa: Male /)OIi:
(. Age mnge isfrom lo
SUP /'01.,l 11/ I /J11/1 Pri11Ml:."ill9/1016 MIKE WILLIAMS, SHERIFF 2002 456007 SUP
Helglir m11ge ls.from 10 Wt/Jlhl (lbs) rana~ ls from ro
ey,ector: BROWN HokColor: BLACK Hairt,sh: MEDIUM
Hatrsryte: DREADLOCKS <:cmp/..,/om DARK Vole,: LOUD Faclnl Hair: NONE
( D/,tlg11lshlg Marlis:
c101hlslDmrlptlom BLUE RUNNING PANTS, BLACK JACKET, BEIGE STOCKING ON HEAD
Nickname/,):
ltllas,s:
~
#1 ASSI\UL'.1' I I\GG / w.t'l'II ... JN'l'l!NT TO CO!IMl:T II FIOLOm<
ffa ASIIJ\lnll ' JIQG / Wl'l'II ... JN'1'l!NT oro COIIMZT II l!'BLON1'
13 ASSA'1t.T I AaG1 L.B.O. I PJRBPXfflllllBR I Btft, B~O
Jail Booking II NIA OBTS No. Jul'dtll/t: Unk Mlmnda Warnlnas OJvin: No Suspet:1 ConfeJStd?
Brd Uiagt:
RTR wrlrten related to this incident? NO RTR lncltlenl Yr: RTR lncitlent (I:
ADDITIONAL INFORMATION
On 06-28-02 an attempted armed robbery occurred at the Blockbuster Video on 3038 Monument Road. One of
the suspects fled on foot and a eeoond was detained by Pllm. Garcia.
On 082002 I spoke with Assistant State Attorney Monica Henschel regarding this case. ASA Henschel advised
that baaed on the evidence, the State Attorney's Office would not file charges against the suspect, Sha
suggested that I attempt to oontaot the subject detained by Pllm. Garcia and oonduot a controlled phone call
between ha and the auepeot.
I attempted to contact the sublect at the telephone number provided, but wee unsuccessful,
Case excepllonally cleared, proaecutfon decllnad,
Supplemental CCR# 612857.
Neighborhood Canvass: #1
Nanm
( Atldrtss:
City: St01e1 Zip:
AptJUJt #t Bufltllng Namt/Num'1er: Sub.Sector:
Tov Crosss1ree1:
Hom, Pl,one # Bus. Plume# Ext.
Cell Plione # Cell Phone Provider E-mail
Race, 811lnlclty: Sex:
Clearo1tSrmus: EXCEPTIONALLY CLEARED CltaranceCode, NOT APPLICABLE Dorecasewnsclear,d: Nmtther of Cases Cit
lixceptlon Type: PROSECUTION DECLINED
CRIME ANALYSIS
Aaero,n1t1/Asroult1Mmder: ASSAULT ON LAW ENFORCEMENT OFFICER
Typeofweapom HANDGUN
Forc,il Entl)I, NOT APPLICABLE S1ruc111re Occupancy Cotle: NOT APPLICABLE
Number of Pr,mlsts E11tere1l:
wc1ion Type: Parking Lot (Not specified)
/nr:11/ent Occ11Tlld In the Parkl,1g lol at tlds lncallom
Numl,er Qj Vehicles Recoveud: Numbdr ofArrtsred:
Sc/1001 Name: Scltool Number
MISCELLANEOUS:
Is Offense Related to Domestic Violence; No If yes, were Clrlldrtn unde1 18 Presem: I/ No Is II Domestic Rdated:
/s t11ere acltlldonal iltfontlatlon lnclutfetl on a co11tlm1ation report: Yes Are tl1trt olher P~rJlnem Reporm Vea
In your opl,ilon Is 1l1ere slgnUJc:~m ritason to btlieve tlmt tl,~trime can be so/Petl hy o patrolfoJlow~uv Investigation? No
Nelgt1t,or/JM1f CtinvaJt c"mfucre1h Yes Cast /llformmlon Cor,l Left Will,~ Victim
!f 01/,er(Name Ad,tres,):
NO
( Is Vogmnt1
Investigative Time:
#1 /fours: 3 Minutts: 0 <:ost Amount, $43.38
#2 Hour,: 0 Minutes: 30 COSJ Amoun1: $7,23
#3 /four,: 1 Minutes: 0 <:ost Amounr: $14.46
#4 Hours: 1 Minutes: 0 Cost Amount, $14,46
Incident Information
Day/Do1e/Tim< qf lncld<nlFrom: Friday 4/28/200617:50 Doy/Dote/lime of Tn,1,t,ntTo: Friday 4/28/2006 16:00
l.ocatlon of Tnct1t,n1: 4555 EMERSON ST Ap1J1.o1 N: Sub-Stc1or: G1
c111: JACKSONVILLE Srai,: FLORIDA 7ip: 32207
Taz:: Crossslreel: Day/Dotenime /ncltltnt Reportttl: Friday 4/26/2006 16:03
Drug Activity: NOT APPLICABLE Drug 'fype: NOT APPLICABLI:! # OfOJ(,nm: 1
Alcohol Rela1td: UNKNOWN (OR NIA) Drug Rtlat<d: UNKNOWN
(OR NIA) #O/Vlc1ln~:
M.C.l. Case: No Follow-11p by: Wa, Haro Cr/me /nvolvtd: NIA Dating Vlo/,nce Involved: NIA
0.[fense or Incident:
#1 Slalute No: 999 Degre,: NfA UCR Code: 9999 A11,111p1 Code: Commit
!HPOlttmT.tOM
ADDITIONAL INFORMATION
On 042806, at 1808, I was dispatched to a disturbance at 4555 Emerson St., (University of Florida Shands
Medloal Diagnostic Center),
Upon arrival, I met with potential victim Arthur Alphonso DIK Ill, Mr, DIK stated ha arrived at 4555 Emerson St., to
collect a paycheck from the potentlal suspect, Mr. Dix stated he worked for the potantlal auspeot for
approximately ten days and was terminated from employment on 042606. The potential suspect owns a
cleaning service, The University of Florida Shands Is a client of the potential auspect. Mr. DIK explained he
approached the potential suspeot In the parking lot of the business and asked for his oheok, The potential
suspect and Mr. Dix became Involved In an argument, The potentlal auspeot then grabbed Mr. Dix, pulled a
eman anver handgun from his pocket, stuck the handgun under Mr. Dix's neck, and told him to leave the
property. Mr. Dix called the police from his cell phone and reported the Incident,
I spoke to potential suspect Cerloe Slav at the scene. I asked Mr. Slav II I could search his person for weapona.
Mr. Slay agreed to a search of his person. I did not find a handgun on Mr. Slav's person. Mr. Slav stated he did
possess a handgun, but he explained II wee not a small sliver handgun, but a Gieck .40 caliber. Mr. Slav told me
he keeps the gun In the center console of his vehlcle, Mr. Slay gave me permlsalon to search hla vehicle, and I
located the Glock handgun, but I did not locate a small sliver handgun.
Mr. Slav explained the potential victim arrived at the business to collect his check. However, Mr. Slav did not
have a check prepared for the potential victim because Mr. slay did not have all of the potentlal victim's
Information. Mr. Slay asked the potential victim to come back on Monday, 05..01-0G, to collect the money. At this
point, the potentlal victim became Irate and began arguing with Mr. Slay. Mr. Slay asked the potentlal victim to
calm down and return on Monday for Is paycheck. Mr, Dix refueed to leave and continued to argue with Mr. Slay.
The potential victim then got very close to Mr. Slay In an aggressive posture. Mr. Slay elated ha balleved the
potential victim was going to start fighting him, Mr. Slay elated he grabbed the potential victim, took a key from
his pocket, held the kev to the potential victim's neck, and told the potenthil victim to leave. The potential victim
broke free and called the police. The potenllal victim did not leave the property.
I apoke with witness Dvnlaha Blount. Ms, Blount explained ehe Is also a former employee of Mr. Slay. Ms.
Blount stated ehe was also terminated on 04-2508, the aame day as Mr. Dix. Ma. Blount stated she and the
potentlal vlottm are cousins, On the listed data and time, Ms, Blount took the potential victim to get his
payoheok from Ms. Slav. Ms. Blount stated she observed the argument between the potential victim and the
potential suspect. Ms, Blount explained that during the argument, aha observed the potential euapect take a
small sliver handgun from hie right pocket and point the gun at the potential victim. Ms, Blount stated the
handgun the potential suspect had In his hand was a var!,' emall silver handgun.
As there were no other Independent wltneasea to this Incident It Is undetermined If the potential suspect
produced a weapon. The potential victim la a termer employee of the potential suspect, The witness la II ooualn
of the potent111I victim. There were no other wllneesaa to this Incident.
C/epra11ce Sta1tu: Cleanmce Cot/e,. Dalt. case wa.s clear,<l: Number of C(lses Clenrlll
c,m: Nol Cleared Tjpt:
CRIME ANALYSIS
Aggmattd A,roulr!Mu~ler: NOT APPLICABLE
Typ, oJW,apon: NOT APPLICABLE
Fomdl?mry:NOT APPLICABLE Str11cturtOcc11pmtcyC:01te: NOT APPLICABLE
Number of Pl'emises &tend:
local/on Type: Commerclal/Olfloe Bldg
Incident Occurred Outside this Location lncidem Occ11rml 111 ,1,, Parking to, a, 11,1, location: Yes
Num/Jer of Vehicles Rtcovered: Nhml,er of Artttltd:
S,:l,ool Name: School Number
( MISCEUANEOUS:
Is Offense Relared to Domestic Violence: No Ifyes, were Cllll1lrtn ~ntler 18 Present: UNo is l1 Dome1tlc Related: NO
J$0 Pnge2 of J Da/6 Printe,/:S/19120/6 MIKE WILLIAMS, SHERIFF 2006,369909 JSO
Is 1/lere a1/1U,lonal Information lnclutled on a continuario,i rt port: No A~ 1t,ere other Pt11lnen1 Reports: No
/11 your opinion is ,t,ert .slgnlflcant reason to hefiel't 11ta1 tllecrlmt can be solve,/ by a patrolfolloWllp ln1,1estlga1lon? No
Nelghl,orlwod Cariva.u Contlucttdt No Case /'l{omuuion Ca,'d uJi With: N.A.
/f Otl11r (Nam, Addrm):
Add,eSJ1 Ap1.llot#: Sub-Sec1or:
Cl~: Stare: Zip:
Taz: Crosntrett:
Home Pho11e# Bus. Phone II &1.
Cell Pirone# Cell Pltone Provider Email
Is Vagmnt? NO
Investigative Time:
#1 Hour,: 1 Minut,s: 0 Cast Amou1111 $14.46
(
JSO Page3 of J Date Prime,/: 5/19/2016 MIKE WILLIAMS, SHERIFF 2006-369909 JSO
NCIC!FCIC
Entem4---- Ro 11te To: lntelllgence
CJ:ecked: _ _ __ Det. Sherman lntelllgence
Flit Purge,I:,_ _ __
NIA: _ __
Incident Information
Jacksonville Sheriff's Office
General Offense / Incident Report
ll
Day!Da1,mm, of lncid,nr-From; Friday 3/26/2006 20:30 Day/DattHime of lncltl,m-To: Friday 3/25/2006 20:36
1.o<at1onoflnclllent: 8274 BAYBERRY RD AptJLo1II, Sub-Sector: 12
City: JACKSONVILLE State: FLORIDA ?Jp: 32257
Tai: Crossslfeet: Dny/Dat<lf/111, Incident Reporttd: Saturday 3/26/2005 16:45
o,.g Actlvlly: NOT APPLICABLE Dn,g Type: NOT APPLICABLE 110/0fl,nm: 1
UNKNOWN (OR NIA)
Alcohol Relnted: Dn1g Related: UNKNOWN (OR NIA) # OJ Victims:
M,C.l. Cam No Follow-up by, Wa.r Hate Crtme Jnvolvetlt NIA Da1l,1g Vlolen" lnvolvt,I: NIA HO/Suspttl$:
O,{fense or Incident:
#1 ,Warut No: 999 Degr,e: NIA UCR Code: 999E A11empt Cm/,: Commit
PROPBRW - FOUND
Upon arrival, I met with the complainant, Mr. Slay. The complainant stated that he owns a company that oleans
the Shands ollnlc satellite locations. The complainant found the Hated Items on a picnic table behind the listed
address. The complainant got home, looked through the listed Items and found what appeared to be a reolpe for
a bomb, a swastika, and a comic strip relating to the KKK (Ku Klux Klan). The oomplalnant notified the FOLE
andtheJSO,
I recovered the Items from the complainant and saw the recipe for a bomb. I also found documents that Hated
the name Kelvin Traylor (2845 Sack Dr. E. 32216), LT G.W. Grant #6304 contacted me and aclvlsed me that FDLE
Agent Mike Cervellera (237-4075) located some other Information about KeMn Traylor. Kelvln Traylor uses the
following detes of birth: 4/8/1971 and 4/5/1971 11nd aleo uses the following soclal s11curlty numbers: 446-71-9638
and 455-71 9638. I was also Informed that Kelvln Traylor is wantsd In Colorado for a violation of probation.
Per LT Grant, Intelligence was notified and Sgt. D.L Brannan contacted me and advised me to place the Items
Into the property room. I also obtained a set of elimination prints from the complainant and entered them into
the property room.
I11cidenlin/QrmatiQ11
Jacksonville Sheriff's Office
General Offense / Incident Report
II
Day!Datt/f'/m, oflncldenr-From: Tuesday 6128/2002 22:66 f)ay/DaJe!flme oflncl,lent-To: Tuesday 612812002 23:30
wcarlon oflncld,nt: 3033 MONUMENT RD Apt/Lor #120 Sub-Sector: F1
City: JACKSONVILLE Sta1<1 FLORIDA Zip: 32277
Tat: Croswreet: Day/Da1elf/me lncl,lent Rtponed: T!leaday 6/28/2002 23:00
Drug Activity: NOT APPLICABLE {)mg Type: NOT APPLICABLE u OJOfftnm: 3
Alco!tot Related: UNKNOWN (OR NIA) Drug Relat,i/: UNKNOWN (OR NIA) # Of Viet/ms, 3
M,C.I. Ca,e: Vue Follow-upily: Patrol Office Was Hare Crime lnvolv,d: NIA Daring V/olt11c lnvolv,d: NIA #0/Su,pects: 1
0.ffenae or Incident:
#1 s1a1u1e No: S784.021 (1 )(B) Dtgre,: F3 UCR Code: 130A Al/empt Cotlt: Commit
ASSAtfM' / AGG / WXTH 11N :EtflBN"J: 'i'O COMMX'l' A nLOfflr
#2 StatuNo: S784.021(1)(B) Dtgrw F3 UCR Co,le: 130A Allempl Codd/ Commit
I AGG / WlTR J\N lN'l'BN'l' 'l'O COMMX'l' A FBLONY
ASSAUL'l'
#3 Statute No: S784.07(2)(C) Dt8"" F2 UCR Code: 130A Attempt COIie: Commit
A S ~ I .ai.aa, t..B.o. I i'XRD'XGH'RBll / EMT, B'l'O
Chy: 1,-Zlp:-
1in.: Cm.usu- _...
llmnt! /J/1(111, U IJ11s. Plum,_.-,.
C,11 J'lume IJ Cdl Pho11e P,vvlt/er HJl/(lll .
ls Vt1gnmt? NO
Altmmttt Atltlr,m: J\lr AJ1r.ll..l1t lh
Alt City: Ml Sime, Alt Zip:
,\It 'lht: Crossstreet:
( 1\11
,\It 1/0111,.- /'Imm! ti All nus. P/io11e II Ah E.u.
,\It Cell /llwm. H Alt Cdl 1'11
llospilat \V/u>r(' Victim ta -
l'"1rv ~Sdwol:
R11rl':~tlmki1y:
Age:.
JMgl/1.' lYeJ.qllt ( f b s ) : -
Hye Color Jt1IrCofor:
}11)11,y ., ltl'sitle1trt '/)'Jh!:. .
( Tn~c. Jt1.r"11mt Stallls:
lt3 ASSAUL':C / AGO/ r.,,s.o. / F3:REJ1'IGH'1'BR. / ~f.1T, ETC
lli1'1im Ut'l"lim1sJ1I/I 'rt, Offindfr.'
STRANGER 111 UK,
s;,specl 1;,f~l'IIU1lio11 #1 Sr1.1pect Locat/1111: At Large
Nmm: UK
1\1/drt'sS.' A/it.lLOI II:
City:JACKSONVILLE sw,,, FLORIDA z;,,,
1r1.:: Cm.u.flrel'I:
llm11i> Plimu JI JJru. Pll1me H 1~:,1.
c,ll l'/Jo11t II C,JI /111m1e l'nwitla ti-moil
t.1 Vagmm? NO
Plm1o{Hmplo}'ISl'lumt: UK
11,,,-,., BLACK i:tl111iri1y: NOT OF HISPANIC ORIGIN s.ct: Male oon,
Age range is.fmm to
lli'lghl 11111,:c Is {n>m w Wt'ighr (lh,f) nmg1 i.f/mm u,
/:)'10,1,m BROWN llt1irC.'ril11r: BLACK llolr1t11u1h: MEDIUM
( J111irS1)'k: DREADLOCKS c,,,,,,,1,.111111: DARK \lnki: LOUD f'twitil l!t,ir: NONE
JSQ /l1fK1,:! of./ l>ml-' l'rill1t,l:)/19/1016 MIKE WILLIAMS, SHERIFF 20()2,156007 JSO
Db1/ngu/shh1g Marks:
c1.,1,1nglDtscrlp1ion: BLUE RUNNING PANTS, BLACK JACKET, BEIGE STOCKING ON HEAD
Nlckname(s}:
Allam:
(' . Chnrggi;
D1 l\SSJ\UIR I AGO I Wl'ffl AN ltrrSll'l' '>O ClOlllll'J A nr.<>m'
82 l\SSAUVJ! I AOa I Wl'ffl AN lN'l'BN'J.' '>O ,"""o, A &'llt.ON11
#3 .ASSAULT / AGC11 L.a.o. / HRBi"XGJlN:R / EM't, E'tC
Jnll 8ooklng # NIA OB'l'S No. Juvenlli: Unk Mimmla Wamfngs 0/~en: No Susp~ct Confused?
E(dUsag6:
RTR wrluen relate,/ tu d1IJ Incident? NO R1'R Incltltnt Yr: RTR Incident II:
ADDITIONAL INFORMATION
On 062802 at approximately 2300 hours, I responded to 3033 Monument Road, In reference to an attempted
armed robbery to the Blockbuster Video. Ptlm. J,R. Garola #7406 and Ptlm. M,P. Gibson #6334 were the first
officers to arrive at the scene. Upon their arrlval, Pllm. Garcia observed two black males standing an the south
west corner of the Blockbuster Video. One of the black malea took off on fool through the parking lat of the
shopping plaza, Pllm. Gibson gave chaea with his marked patrol vehicle through the parking lot after the
suspeot. Ptlm. Garcia detained the second black male.
Upon my arrival, I spoke with the victims, Mr. Carlos Slay and Mr. Robert Knewlon. Mr, Slay advised that at
approximately 2300 hours, he a_nd Mr. Knewlon had arrived at 3033 Monument Road, Suite 20, ta perform
housekeeping earvlces. As he was unlocking the door to the business, he observed an unknown black male
running toward them through the parking lot of the shopping plaza at a brisk pace. Mr. Slay advised that the
suspect was wearing dark running pants and a black jacket. He had a dark ball cap, which fell off as he ran. The
suspect was wearing a beige stocking over the top of his head, He then observad a polloe vehlole (M. P. Gibson
#8223) driving through the parking lot after the suspect. Mr. Slay ran toward the suspect In an attempt to detain
him for the pollce. As Mr. Slay ran toward the suspect, he observed the suspect reaoh under his jacket and pull
a handgun from his waistband, The suspect Yelled "back off" as he racked the chamber. Mr. Slav advised that
the suspect then spun around and pointed the gun toward Pllm. Gibson. The suspect continued running
through the parking lot as ha was pointing the gun. He then Jumped over the chain llnk fence and fled lhto the
apartment complex to the northeast of the shopping plaza.
( Mr. Knewlon advised that as he and Mr. Slay were about to enter the office bulldlng, ha observed the suspect
running toward them and a police car followlng him, As Mr. Slay attempted to tackle the suspect, the suspect
pulled s gun and spun around toward the approaohlng pollce car. As the suspect spun around, he racked the
chamber and shouted "back off" to him and Mr. Slay. Mr. Knewlon advised that the suspect Pointed the gun
toward him as he wes turning toward the police officer, The suspect eontlnued running toward the northeast
corner of the shopping plaza, jumped a fence and fled Into the adjoining apartment compJex to the rear of the
plaza.
A perimeter was lmmedlatelv established with several officers. Sgt. D.R. Schoenfeld, #6637, the air unit and K-9
officers J.J. Thurne #6436 and E.R. Sulllvan #6808 responded, A canvass of the surrounding area was
conducted with no success In locating the suspect.
Neighborhood Canvass:
#1 Nnme:
At1"tts.s: Ap/Jlo1 II: Building Name/Number: S11/J.Seclon
Clly: $/ale; Zip:
raz: Crossslreeh
Home Phone# Bus, P/1one H E..tt.
Cell Plione n Cell Phone Proviller Bmail
Race: Ethnicity: Stx:
Clearate s,a,us: CASE NOT CLEARED Cleamnce Corte: NOT APPLICABLE Da1t ca was cleared: M,mher qf Cates Clearetl
JSO Pngd I 4 Dn,e Primed: 5//9/Z0/6 MIKE WILLIAMS, SHERIFF 2002456007 JSO
Case Not Cleared Typ,: CASE NOT CLEARED (PATROL FOLLOWUP)
CRIME ANALYSIS
Atsmvote11 AssnulrtM,mlsri ASSAULT ON LAW ENFORCEMENT OFFICER
(' Type of Weapon: HANDGUN
Forct1/.En1t)l,NOT APPLICABLE S1rticrureoccupancyCode: NOT APPLICABLE
Numbtrof Premises Entelld:
wcation Type: Parking Lot (Not specified)
lnci,ten, Occurred In tlltt Parking U)t ol lhfs l,Qcatlon:
Numbtro/Vtlilclts Rtcovere,I.' Numh~ro/Arrested:
Sc:hool Name: Sc/root NPml1tr
MISCELLANEOUS:
Is Offense Rela1t1l to Domes!lc Vlolened: No Uyes, were C/dltlren under 18 Pnsttnr: If No Is It Domesllc Related:
Is thtre a,lJltlonal lttfonnatlcm lnclutled on a comlnualion repon: Yes Au tlltrl! other Ptninrmt Repons: Ves
In your opinion fs there stgniflcont reason to believe tl,at thecrlme can be solved by a patrolfollow-11p lnvestlgulion? Yes
Neighborhood Canvass Conduc1t<I: Yes Ca,e lnfom1nt/on Card l,efr With: Victim
U Other (Name Address):
Ad,lress: AptJUJt #: SubSeclor.
City: State: Zip:
Taz: Cro.sssJreet:
Home Phone H lhu. Phon1 II Ext.
Ctll Phone II Cell f/,cme Provitler Emall
t, Vagranr1 NO
Investigative Time:
#1 Houm 3 Minutes: 0 Co,t Amount: $43,38
Neighborhood Canvass: #1
Name:
Atldress: AptJUJt II: Building Name/Numf,er: Suh-Secto,:
c11y: Stat,; Zip:
Tat: Crosntrett:
Home Pltone # Bus. PhQ11.e # Exl,
Cefl Phone H Celt Phone Pro1>l1ler E-mail
Race: Etlmlclly: Sa:
Clt0ro11ce Stot,s: CASE NOT CLEARED cr,aronce code: NOT APPLICABLE Date'"""'"' clear,,/: Number of Cases Cleared
CaseNotCltoredTyp,: CASE NOT CLEARED (PATROL FOLLOW-UP)
(
~ .. .
CRIME ANALYSIS
SUP Page4 of 4 Dare Printed: S//9/2016 MIKE WILLIAMS, SHERIFF 2002456007 SUP
10/10/2007 NASSAU COUNTY SHERH"F' S OB"B"ICE PAGE 1
22:58:39 CAD Incident Detail USER 1187
Narratives
..................................... ' .......................................... .
~arrative By: CCARTER 04/10/2012 20:37
~AS 3 YO SON IN HOUSE
< o o o o o o O O O O O I t O > 0 0 I " o O O O O > 0 0 t I O O O O O f O O O f O f I O t > < 0 > o O t o O f O O O O O I O O I o o > > I < 0 t O O O 0
Vehicle Information
........................................... , .. , ................................ .
.................................................................................
JNIT DEPT S'l'ATUS/DSP /CASE LOCATION/REMARK USER DATE 'rIME
[85 114 DSP PSTUA 04/10 20:37:20
[85 114 ENR PSTUA 04/10 20:37:48
105 L14 ENR PSTUA 04/10 20:38:14
[85 L14 97 PSTUA 04/10 20:45:46
105 L14 97 PSTUA 04/10 20:45:49
l85 Ll4 LOG REF' S5 AND S14 THREATS Wfi:RE PSTUA 04/10 20:58:57
l85 L14 LOG MADE IN THE PAS'r - SHE IS PS'J'UA 04/10 20:58:5'/
l85 L14 LOG LEAVING RESI FOR NIGHT PSTUA 04/10 20:58:57
105 LJ. 4CLR K PSTUA 04/10 20:59:28
l85 114 CLR G PS'fUA 04/10 21:01:06
l85 L14 LOG H PSTUA 04/10 21:01:06
l85 Ll 4 LOG p PSTUA 04 /10 21:01:06
,.
(
,-;----
(
(
(
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I n . Circuit Court of the Fourth JudiclArcuit,
( In and For Nassau County, Florida
/\,1-'1/)12 -QVL.,
Case No.: ---.:~::.....,__f,..._,-='..,J'---"----
Division:
Hope- .s .6t~
Petitioner,
and
&1:tos
Respondent.
1. Petitioner currently lives at: {street address} $9o 1 J:e;/2.t,A 12.ocul., Cn...liflh:zll P::::L- 3 ";lo/ I
{city, slate and zip code} '
C Telephone Number: {area code and number} qDI/- <l
Physical description of Pelitione&P
-t,,9.>t/ 19
,1
Race; J'IL Sex: Male ~ Female v Date of Birth: Jo -rT-tt, '1' :;,;
=
.,,..
2. Petitioner's attorney's name, address, and telephone number ls: __,_0,.,0c.:1)--=e,"'-----~
,- _,:r
- - - - - - - - - - - - - - - - - - - - - - - - - - - - ' \.0
(If you do not have an attorney, write "none.") I fr,g
-u iTI
Section II. Respondent (This section Is about the person you want to be protected from. It muil'i be 0
completed,) ~
N
U1
1. Respondent currently lives at: {street address, city, state, and zip code} _ _ __
7,qoq --:{b-f?C..A f2oacL, CoJ.d..aha.o, Fl- 8 QD 11
Respondent's Driver's License number Is: {if known} --'&>=t-"'k"'OJ,ou1.,,J,,_a,______
2. Respondent Is:
{ ,J all that apply] CL.OCt(ED I N ~ _tn,
.__
~ a, the spouse of Petitioner. Date of Marriage: lo~ '}0 -PB .
IN CON>\!'UTER:
Vl:HIHEt,BY: - - - ---
b. the former spouse of Petitioner.
Date of Marriage: _ _ _ _ _ _ _ _ __ FILED BY: _i$..Y.X\~-=
Date of Divorce: _ _ _ _ _ _ _ _ __
c. related by blood or marriage to Petitioner Specify relationship: _ _
d. a person who Is or was living In one home with Petitioner, as if a family.
e. a person with whom Petitioner has a child in common, even If Petitioner and Respondent never
were married or living together.
Florida Supreme Court Approved Family Law Form 12.980(b), PeUU011 for Injunction for Proleclion Against Domestic Violence (05/03)
3. Petitioner has known R.ndent since {date} tqq "I
( 4. Respondent's last known place of employment: ,.,.-,6eoelc::..;'.f'
_ _ _ _ _ _ _ _ _ __
Employment address: ..3Qoq 5.z-llLA k'oo.cf__._
Working hours: eue.n "!'J"::>
.I../ - I
5. Physical description of Respondent:
Race: _ Sex: Male...!::::::. Female _ Date of Birth: b - 1l'/-IP o
Height: l,' J/ 11 Weight: f}Jlo Eye Color:6rot0/1H-:'a'-;'ir""'c=--o-':l-'-or-:,"b-.--r:::----
Dlstlngulshlng marks or scars: '' &u- cJL h I -from 6vr,
Vehicle: (make/model) tow F15b CmJ Color: !ii/uec Tag Number: n Df K,flOWYl .
6. Other names Respondent goes by (aliases or nicknames): _ _ _ _ _ _ _ _ __
7. Respondent's attorney's name, address, and telephone number Is: fl/l(1CC- 1-/a.rrlf,bfy .
(If you do not know whether Respondent has an attorney, write "unknown." If Respondent does not
have an attorney, write "none.")
Section Ill. Case History and Reason for Seeking Petition (This section must be completed,)
1. Has Petitioner ever received or tried to gel an injunction for protection against domestic violence
against Respondent In this or any other court?
Yes......:::::. No If yes, what happened In that case? (include case number, if known)
( 2. Has Respondent ever received or tried to get an injunction for protection against domestic violence
against Petitioner in this or any other court?
Yes t../. Nolf yes, what happened in that case? (include case number, If known)
3. Describe any other court case that is either going on now or that hc1ppened in the past, Including a
dissolution of marriage, paternity action, or child support enforcement action, between Petitioner and
Respondent {include city, state, and case number, If known):
4. Petitioner Is the victim of an act of domestic violence ru: has reasonable cause to believe that he or she
is In Imminent danger of becoming the victim of an act of domestic violence. Below Is a brief
description of the I atest a ct of v lolence or threat of v lolence that causes Petitioner to honestly fear
imminent domestic violence by Respondent. (Use addition al sheets If necessary.)
1/-s/o '/ . I
On {dale}
the Respondent
lne..:toha~n l'rA
;rule:;-z a:; ~hwe.
'at {location} hqML (Jf).fJ..CphOM.
fhreafe.1flY?J -(b Jl.jf{Jl{ll -{old
he~ efkc hr.., afvm or 11.L IA/Qu..iof
/4'tL1~ . 11Jb.An ho rf hovu,,e , AR,. waf-, 6tamrnir9 -lh,t09, bv& 1y:,.pl
r:tlllltR d rllFIV/1 6Q&W1<a:i. 'tfu. IU-{f,t @q ~ Ai hu:ra.s~ eel fflL al- IPl?tk__
MjO/o 'ffifeAf(nic'J, fo Ki!S. N 1 .Wil /LL m.a loo<;,"- M<j.:J 4h ,. a.n g#.,,1.(J/ed
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0-1.Wt App,oVid Family Low For \ 12.080(b), Petition for lnJuncUon for Protection Against Domesllc Vlolonco (05/03)
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0 C eek here if you are attaching addition I pages to continue these facts.
5. Additional Information
[~ all that apply]
a. Other acts or threats of domestic violence as described on attached sheet.
b. This or other acts of domestic violence have been previously reported to {person or
agency);,__- - - - - - - - - - - - . , - - - - - - . , - - - - - - - - -
v c. Respondent owns, has, and/or Is known to have guns or other weapons.
Describe weapon(s): - , - - - - - - - - - - - - - - - - - - - - - -
d. Respondent has a drug problem.
e. Respondent has an alcohol problem.
f. Respondent has a history of mental health problems, If checked, answer the following, if known.
Has Respondent ever been Iha subject of a Baker Act proceeding? ( ) Yes ) No
Is Respondent supposed to take medication for mental health problems? ( ) Yes ( ) No
If yes, is Respondent currently taking his/her medication? ( ) Yes ( ) No
( Section IV. Temporary Exclusive Use and Possession of Home (Complete this section only If you want
the Court lo grant you temporary exclusive use and possession of the home that you share with the
Respondent.)
(
7
~. - Florida Supreme Court App,ove<I family Law Fom112.960(b}, Petition for Injunction for Prot,mllon Against Domestic Violence (05/03)
Section V, Temporary Custofof Minor Chlld(ren) (Complete !his .Ion only if you are seeking
temporary custody of any minor child. You must be the natural parent, adoptive parent, or guardian by court
( order of the minor child(ren). If you are asking the court to determine issues of temporary custody with regards
to a minor child, you must also complete and file a Uniform Child Custody Jurisdiction and Enforcement
Act (UCCJEA) Affidavit, _o
Florida Supreme Court Approved Family Law Form 12.902(d).
le: If the paternity of the minor chlld(ren) listed below has not been established through either
ma lage or court order, the Court may deny temporary custody, visitation, and/or support.
1, elitioner is the natural parent, adoptive parent, or guardian by court order of the minor child(ren)
wl se name(s) and age(s) Is (are) listed below.
Name Place of Birth Birth date Sex
3. Name any other minor chlld(ren) who were~ when the domestic violence happened. Include
( chlld(ren)'s name, age, sex, and parents' n a m e s . - - - - - - - - - - - - -
"
4. Visitation[../ all that apply] ~
a. Petitioner requests that the Court order reasonable visitatio~v Respondent with the minor
child(ren), as follows: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _,___ _ _ _ __
b. Petitioner requests that the Court order supervised exchange of the mlno child(ren) or exchange
through a responsible person designated by the Court. The followlng person I uggested as a
responsible person for purposes of such exchange. Explain: - - - - - - - - ' " - - -
c. Petitioner requests that the Court limit visitation by Respondent with the minor chlld(r ). Explain:
d. Petitioner requests that the Court prohibit visitation by Respondent with the minor chlld(ren) ecause
Petitioner genuinely fears that Respondent Imminently will abuse, remove, or hide the minor ch (ren)
from Petitioner. Explain: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
(_ Florida supreme Court Approved Family Law Form 12,900(b), PeliUon for Jnjunctlon for Pfo!octlan Against Domestic Vlolortce (05/03)
Section VI. Temporary suA(Complete this section only if you a.eeklng financial support from the
Respondent. You must also complete and file a Family Law Financial Affidavit, _D Florida Family Law
( Rules of Procedure Form 12.902(b) or (c), and Notice of Social Security Number, _D Florida Supreme Court
Approved Family Law Form 12.902), if you are seeking child support. A Chlld Support Guidelines
Worksheet, _Cl Florida Family Law Rules of Procedure Form 12.902(e), must be flied with the court at or prior
to a hearing to eslabllsh or modify child support.)
[,/ all that apply]
1. Petitioner claims a need for the money he or she Is asking the Court to make Respondent pay, and
that Respondent has the ability to pay that money.
2. Petitioner requests that the Court order Respondent to pay the following temporary allmony to
Petitioner. (Petitioner must be married to Respondent to ask for temporary alimony.) Temporary
Alimony Requested $_ _ _ _ every ( ) week ( ) other weel< (. ) month.
3. Petitioner requests that the Court order Respondent to pay the following temporary chtld support to
Petitioner. (The respondent must be the natural parent, adoptive parent, or guardian by court order of
the minor chtld(ren) for the court to order the respondent to pay child support) Temporary child support
is requested In the amount of$ _ _ _ _ every ( ) week ( ) other week ( ) month.
Section VIL Injunction (This section summarizes what you are asking the Court to Include In the injunction.
This section must be completed.)
1. Petitioner asks the Court to enter a TEMPORARY INJUNCTION tor protection against domestic
violence that will be In place from now until the scheduled hearing In this matter. Petitioner asks the
Court to enter, after a hearing has been held on this petilion, a final judgment on
2. Injunction prohibiting Respondent from committing any acts of domestic violence against Petitioner
( and:
a. prohibiting Respondent from going to or within 500 feet of any place the Petitioner lives;
b. prohibiting Respondent from going to-or within 500 feet of the Petitioner's place(s) of employment or
school; the address of Petitioner's lace(s) of employment or school ls: B/IIR.tl CCL &111 ine._
I <' ::Tbl: I FL -3 CZ:;;) @.'f
c. prohibiting Respondent from contacting titloner by mall, by telephone, through another person, or
ln any other manner;
d. prohibiting Respondent from knowingly and intentionally going to or within 100 feet of Petitioner's
motor vehicle.
e, prohibiting Respondent from defacing or destroying Petitioner's personal property.
I have read every statement made In this Petition, and each statement Is trne and correct.
understand that the statements made in this Petition are being made under penalty of perjury,
punishable as 1:1rovlded In Section 837.02, Florida Statutes. ,,--Jtt;7
/ / '"'~==--- (Initials)
Dated: 7(1,_o <-( J/ 'L _ .J .Jj_ ,..---
'11J- Sigt<aiure~
(_ Flotlda Supreme Court Approved Famlly Law Form 12.980(0}, Pcllllon for loJuncllon for Protection Against Domeslio Vloltmcu (05/03)
10/10/200'/ NASSAU COUN1'Y SHERin' t S OFFICE PAGE 1
22:58:39 CAD Incident Detail USER 1187
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10/10/200'7 NASSAU COUNTY SHERIFF'S OFFICE PAGE 1
22:58:17 CAD Incident Detail USER 1187
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Incoming Call: 11/27/2003 01:34:03
::";all Created : 11/27/2003 01:34:13 created By: MWHI'l'EN Pos:002 DISPATC
:::all Send 1'ime 01:36:07 Sent By : MWJIITEN Action:
:au Dispatch 'Pime: 01:37:07 Event S22IP 1 Language:
~all Enroute Time 01:37:20 Law S22IP 1
:all Arrival Time : 01:45:51 ' Fi.t'e DISPU'l1 2 lR lE
:all Clear Time 02:10:53 EMS S22IP 2
:all Closed : 11/27/2003 02:18:53 Rescue: S22IP 2
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