Fl412 Form – Fill Out and Use This PDF

Updated: Nov 2, 2026

The FL-412 form is a legal document used in the state of California, designed for individuals to report violations of restraining orders related to domestic violence, custody, and visitation issues. It serves as an attachment to the Order to Show Cause and Affidavit for Contempt, providing a detailed affidavit of facts constituting contempt by the respondent or defendant. If you need to report violations of court-issued restraining or custodial orders, click the button below to fill out the form accurately and securely.

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Fl412 Form PDF Details

Understanding the intricacies of legal forms can be overwhelming for individuals navigating the judicial system, especially in matters as sensitive as protecting oneself from harm. The FL-412 form serves as a vital tool in ensuring that the rights and safety of individuals are upheld in family law situations. This form is primarily used as an attachment to an Order to Show Cause and Affidavit for Contempt, specifically addressing situations of contempt related to domestic violence, custody, and visitation issues. It is meticulously structured to document instances where a respondent or defendant may have violated the terms of a restraining order. Such violations can range from direct contact, harassment, stalking, to less considered actions like failing to adhere to court-ordered moves or mandates, such as relinquishing firearms or attending batterer’s treatment classes. Whether it's detailing forbidden proximity to protected persons or the destruction of personal property, each section allows the petitioner to specify the nature of the violation, providing a clear affidavit of facts. By filing this form, individuals affirm under penalty of perjury that their claims are accurate, striving towards a safer living situation amidst challenging circumstances. This declaration, mandated for use by the Judicial Council of California, embodies the legal system's commitment to addressing and rectifying instances of order violations, thereby protecting those at risk.

Question	Answer
Form Name	Fl412 Form
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	california fl412, fl 330 form, fl 412 contempt, fl 412

How to Fill Out Form FL-412

Form FL-412 at a glance

What it is: Affidavit of Facts Constituting Contempt Domestic Violence/Custody and Visitation.

Who signs: Enter your name at (TYPE OR PRINT NAME) and sign at (SIGNATURE).

A filled-in Form FL-412 example: a parent reports messages sent after a restraining order

Form FL-412 example filled out, example: a parent reports messages sent after a restraining order — Dana Sample, the protected parent, fills out the affidavit about Alex Sample, the Citee. Alex Sample sent messages on March 3, 2026, so box 1 is marked. The picture shows it, and its names and figures are sample values. The restraining order was issued on January 6, 2026. Boxes 2 through 7 stay empty because no other order was violated, and the account fits the space, so no attachment is used. Jordan Sample is the other parent.

How to fill out Form FL-412, box by box

Petitioner, respondent, other parent and case number

Attachment to Order to Show Cause and Affidavit for Contempt (form FL-410).

Enter the PETITIONER/PLAINTIFF, the RESPONDENT/DEFENDANT, the OTHER PARENT and the CASE NUMBER.

The Citee has violated the restraining order

In box 1, the Citee has violated the restraining order issued on (date) by contacting, molesting, harassing, attacking, striking, threatening, sexually assaulting, battering, telephoning, sending any messages to, following, stalking, destroying the personal property of, disturbing the peace of, keeping under surveillance, or blocking movements in public places and thoroughfares of me or any other person protected by the restraining order. Specify which order was violated, how the order was violated, and when the violation occurred. Continued on Attachment 1.

In box 2, the Citee has violated the restraining order issued on (date) by not moving from and staying away from the residence as ordered by the court. Specify how the order was violated and when the violation occurred. Continued on Attachment 2.

In box 3, the Citee has violated the restraining order issued on (date) by not staying (specify) yards away from me, the other protected persons, my residence, my place of work, the children's school or place of child care, my vehicle, or other (specify). Continued on Attachment 3.

In box 4, the Citee has violated the restraining order issued on (date) by not relinquishing his or her firearm(s) as ordered by the court. Continued on Attachment 4.

In box 5, the Citee has violated the restraining order issued on (date) by failure to complete court-ordered batterer's treatment/anger management class (specify how the order was violated). Continued on Attachment 5.

The Citee has violated a custody or visitation order or other orders

In box 6, the Citee has violated order issued on (date) by violating the following custody or visitation order (specify which order was violated, how the order was violated, and when the violation occurred). Continued on Attachment 6.

In box 7, the Citee has violated the order issued on (date) by violating other orders (specify which order was violated and how the order was violated). Continued on Attachment 7.

Declare under penalty of perjury, date and sign

"I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct." Date:

Enter your name at (TYPE OR PRINT NAME) and sign at (SIGNATURE).

Sources

[1] Form FL-412, Affidavit of Facts Constituting Contempt Domestic Violence/Custody and Visitation, Rev. January 1, 2003, Judicial Council of California (the Official source link on this page).