TO THE PETITIONER: Please provide your information on form DC-621, NON-DISCLOSURE ADDENDUM. Complaint and Request for Injunction. Download.This article defines preliminary injunction, details its elements and the hearing process, and includes a sample motion to download. Step 1: Go to the courthouse and get the necessary forms. Every circuit court shall have jurisdiction to award injunctions, including cases involving violations of the Uniform Statewide Building Code. The form will ask you to give a detailed description of the facts and circumstances about the family violence and your reasons for seeking protection. If a child is being abused or neglected, a family member can intervene and petition the court for a temporary, safe home. Figure 2: Motion to dissolve temporary injunction. Court-Approved Model Documents. As described in the accompanying opinion, E.O. 2 and S.B. 739 are the law in Virginia.