Fill and Sign the Delaware Protection Form

Form 450 Rev 10/15 The Family Court of the State of Delaware In and For New Castle Kent Sussex County PETITION FOR ORDER OF PROTECTION FROM ABUSE Petitioner v. Respondent Name Name File Number             Street Address ( Refer to Question 1 below before filling in address) Street Address (including Apt)                   P.O. Box Number P.O. Box Number Petition Number             City/State/Zip Code City/State/Zip Code                   Date of Birth Date of Birth             Attorney Name Attorney Name             Interpreter Needed Yes No Interpreter Needed Yes No Language:       Language:       Para asistencia en español llame a: (302) 762-6110 (New Castle County) o (302) 745-9874 (Kent y Sussex Counties). Child(ren) Date of Birth Is this the respondent’s child? Are you alleging the respondent abused this child and you want the child to be a petitioner?             Yes No Yes No             Yes No Yes No             Yes No Yes No             Yes No Yes No             Yes No Yes No             Yes No Yes No             Yes No Yes No The Petitioner respectfully requests that this Court issue an Order of Protection from Abuse against the Respondent, as provided for in 10 Del. C. , § 1041 et seq. In support of this request, the Petitioner states that: 1. I ask that the following addresses be kept confidential because the disclosure of this information will place me and/or my child(ren) in danger: the address of my place of residence, school and/or employment the address of my child(ren)’s residence, school or child care *** DO NOT LIST ADDRESS ON PETITION IF REQUESTING CONFIDENTIAL ADDRESS *** 2. Choose one: Petitioner’s relationship to Respondent is: (select relationship) Current or former spouse Living together Current or former substantive dating relationship Child in common Family member (specify relationship):       Custodian of Children Affidavit of Parentage attached and incorporated herein. 1 of 4 Form 450 Rev 10/15 OR Petitioner is the Division of Family Services acting in the interest of a minor child. OR Petitioner is the Division of Adult Protective Services acting in the interest of an infirm adult. 3a. The Respondent has committed the following act(s) of abuse against the Petitioner ( Please describe all the acts of abuse you wish the Court to consider, including dates if known. If additional space is required please attach the Court Addendum Form, Form 540.) : 3b. The Respondent has committed the following act(s) of abuse against the Child(ren) ( Please describe all the acts of abuse you wish the Court to consider, including dates if known. If additional space is required please attach the Court Addendum Form, Form 540.) : 4. Petitioner has reason to believe that the Respondent is in possession of the following firearm(s): WHEREFORE , Petitioner asks this Court for the following relief(s): 2 of 4                                                                                                                                                      Form 450 Rev 10/15 Prohibit the Respondent from committing any act of abuse against the Petitioner (or his or her minor children). Order the Respondent to stay away from: Petitioner Petitioner’s home Petitioner’s workplace Other:             Prohibit the Respondent from contacting or attempting to contact the Petitioner in any way, including, but not limited to, by phone, by the mail or by any other means. Grant no contact relief for as long as reasonably necessary to prevent further acts of Domestic Violence up to and including a permanent order of Court pursuant to 10 Del C. 1045(f) because of the following aggravating factors: (please use the space provided to date and detail these events) 1. Actions resulting in physical injury or serious physical injury to me (Petitioner) caused by the Respondent. (Describe below.)                   2. The use of a deadly weapon or dangerous instrument against me (Petitioner) by Respondent. (Describe below.)                   3. A history of repeated violations of prior protective orders by the Respondent (Describe below.)                   4. Prior convictions for crimes against me (Petitioner) by the Respondent (Describe below.)                   5. Exposure of any member of the my (Petitioner’s) family or household to physical injury by the Respondent. (Describe below.)                   Order that the Petitioner be given the exclusive use and possession of the parties' residence at: Order the Respondent to pay $       to the Petitioner as compensation for losses Suffered as a direct result of the domestic violence. 3 of 4            Form 450 Rev 10/15 Award custody and/or residency of the parties minor child(ren) to the Petitioner (please specify names and date of birth of the child(ren)) YOU MUST INCLUDE FORM 346 CUSTODY SEPARATE STATEMENT IF THIS BOX IS CHECKED :                         Order the Respondent to pay support for the child(ren). Order the Respondent to pay $       support for the Petitioner. Order the Respondent to pay or reimburse fees and costs. Award the Petitioner temporary possession of the following personal property (including but not limited to motor vehicles, checkbooks, keys and other personal effects listed below):       Order the Respondent to be evaluated by a certified domestic violence treatment agency and follow all recommendations for treatment and counseling. Other:                   The Petitioner also asks the Court for any other such relief that the Court deems appropriate and just. Date Petitioner/Petitioner's Attorney VERIFICATION STATE OF DELAWARE ) ) ss.: COUNTY OF       )       , being duly sworn, says: I am the Petitioner in this action. I have read the above Petition and know to the best of my knowledge that the Facts contained therein are true. Petitioner Subscribed and sworn before me on this date, Date Notary Public 4 of 4