Fill and Sign the Ex Parte Order of Protection Adult Missouri Courts Mogov Form

OSCA (02-16) CP 50 1 of 2 455.523, 455.528, 455.530 RSMo IN THE _______ JUDICIAL CIRCUIT , ________________________________, MISSOURI Affidavit of Changes in Circumstance and Motion to Modify Judgment/Full Order of Protection – Child Use this form when one child is involved with this case. Use CP 56 for two to five child ren and CP53 for six to ten children. Judge or Division: Case Number: (Date File Stamp) Court ORI Number: Petitioner: Protected Child: Age of Protected Child: Sex: F M Race: vs. MSHP Number: Responsible Law Enforcement ORI: Related Cases: Protected Child’s Relationship to Respondent pursuant to 18 U.S.C. §§ 921(a)(32) and 922(g)(8) determination: Protected Child’s Relationship to Respondent : Child Step -Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) ____________________________________________ Respondent: Alias/Nicknames: Respondent’s DOB: SSN (if known, last four digits): Respondent’s Home Address: Home Phone Number: Race: Sex: F M Respondent’s Work Address: Work Phone Number: Work Hours: A Judgment/Full Order of Protection – Child was entered in __________________________________ (County/City of St. Louis), Missouri, on ____________________________ (date). A change has occurred in the circumstances of the child(ren) or his/her custodian and the modification is necessary to serve t he best interests of the child(ren). Below are the specific facts, including dates and times, which petitioner respondent Guardian ad Litem Court Appointed Special Advocate believes forms grounds f or modification of the court’s judgment: I request that the court find grounds for modification of: (check the box that applies) Installments of maintenance or support. Conditions regarding communication. Custody. Conditions regarding contact. Visitation. Other (specify): The specific modification that I am requesting is: OSCA (02-16) CP 50 2 of 2 455.523, 455.528, 455.530 RSMo I swear /affirm under penalty of perjury that these facts are true according to my best knowledge and belief. _______________________________ __________ Date ___________________ ______________________________ Your Signature _________________________________________________ Your Street Address _________________________________________________ City State Zip _________________________________________________ Your Telephone Number NOTICE: Section 455.510.3, RSMo , provides that a Petitioner seeking protection under the Child Protection Orders Act is not required to reveal any current address or place of residenc e of the child(ren) on this petition. Do not provide this information if doing so will endanger the child (ren). In witness thereof: _________________________________________ _________________________________________________ Date Clerk Witnessing Signature (Seal) Subscribed and sworn to before me on this ________________________________ (date). My commission expires: __________________ ____________ ___________________ Date Notary Public Directions for Completing This affidavit must be completed and signature witnessed by a court clerk or notary before filing it with the court.