Fill and Sign the In the Judicial Circuit Missouri Petition for Order of Form

OSCA (02-16) AA40 (ASPO) Bosnian 1 od 7 455.010, 455.030, 455.030.3, 455.550 RSMo IN THE ______ JUDICIAL CIRCUIT, ____________________ ____________, MISSOURI Petition for Order of Protection - Adult U _____ PRAVOSUDNOM OKRUGU, ____________________________ , MIZURI Podnesak za nalog za zaštitu – odrasli Notice to Petitioner: Respondent will recei ve a copy of this petition with service. Obavijest podnosiocu: Tuženik će primiti kopiju ovog podneska uru čenjem. Judge or Division: Sudija ili odjel: Case Number: Broj predmeta: (Date File Stamp) (Pe čat s datumom podnošenja) Court ORI Number: ORI broj suda: Petitioner: Podnosilac: MSHP number: MSHP broj: Responsible Law En forcement ORI: ORI odgovornih za provedbu zakona: Vs. naspram Related Cases: Povezani predmeti: Respondent: Tuženik: Alias/Nicknames: Pseudonim/nadimci: Respondent’s Home Address: Adresa prebivališta tuženika: Home Phone Number: Broj telefona ku ći: Respondent’s DOB: Datum ro đenja tuženika: Age: Dob: Respondent’s Work Address: Adresa tuženika na poslu: Work Phone Number: Broj telefona na poslu: Work Hours: Radno vrijeme: SSN (if known, last four digits): SSN (ako je poznato, zadnje četiri cifre): Race: Rasa: Sex: F M Spol: Ž M Hair Color: Boja kose: Height: Visina: Eye Color: Boja o čiju: Weight: Težina: Other Locations Where Respondent May Be Served:: Druge lokacije gdje se može izvršiti uru čenje tuženiku: (Identifying information for use by Law Enforcement) (Identifikacijske informacije za upotrebu od institucija za provedbu zakona) Visible Identifying Marks (e .g. tattoos, birthmarks, braces, mustache, beard, pierced ear, glasses): Vidljivi identifikacijski znakovi (npr. tetovaže, mladeži, proteze, brkovi, brada, probušeno uho, nao čale): Petitioner’s Relationship to Responde nt pursuant to 18 U.S.C. §§ 921(a)(32) and 922(g)(8) determination: Veza izme đu podnosioca i tuženika u skladu sa odredbom 18 U.S.C. §§ 921(a)(32) i 922(g)(8): Spouse Child(ren) in common Supružnik Zajedni čko/a dijete(djeca) Former spouse Intimate residing/resided together Bivši supružnik Intimni zajednički boravak Are/were in a continuing social re lationship of a romantic/intimate nature Jesu/bili su u kontinuiranoj društvenoj vezi romanti čne/intimne prirode Related by blood. Define relationship: Krvno srodstvo. Definišite vezu: Related by marriage. Define relationship: Bračna veza. Definišite vezu: Residing/resided together; no intimacy Stanuju/stanovali zajedno; bez intimne povezanosti Stalking/Sexual Assault. Define relationship: Uho đenje/seksualno zlostavljanje. Definišite vezu: OSCA (02-16) AA40 (ASPO) Bosnian 2 od 7 455.010, 455.030, 455.030.3, 455.550 RSMo I. PETITIONER INFORMATION INFORMACIJE O PODNOSIOCU 1. I am Petitioner and at least 17 years of age under 17 but emancipated Ja sam podnosilac i imam najmanje 17 godina manje od 17 godina ali sam emancipiran/a 2. I reside in _______________________________________________ (city), ______________________________ (state), in the County of _____________________________. Moje prebivalište je u ____________________________________________ (grad), __________________________ (država), u regiji _____________________________. II. RESPONDENT INFORMATION INFORMACIJE O TUŽENIKU 3. Respondent is at least 17 years of age or emancipated under 17 Tuženik ima najmanje 17 godina ili je emancipiran/a manje od 17 godina 4. Respondent may be found in ________________________________________ (city), ________________________ (state), in the County of _____________________________. Tuženik se može prona ći u ________________________________________ (grad), ________________________ (država), u regiji _____________________________. III. LOCATION WHERE DOMESTIC VIOLENCE, STALKING, OR SEXUAL ASSAULT OCCURRED LOKACIJA GDJE SE DESILO NASILJE U PORODICI, UHO ĐENJE ILI SEKSUALNO ZLOSTAVLJANJE 5. An act of domestic violence , stalking, or sexual assault occurred at ___________________________________________________ (address), _______________________________ (city), _____________ (state), in the County of __________________________. Č in nasilja u porodici, uho đenja ili seksualnog zlostavljanja se desio u ______________________________________ (adresa), _______________________________ (grad), _____________ (država), u regiji ____________________________. IV. COMPLETE FOR DOMESTIC VIOLENCE PETITION ONLY POPUNITE SAMO ZA PODNESAK ZA NASILJE U PORODICI Relationship with Respondent Veza s tuženikom 6. Respondent and I: (check one or more) Tuženik i ja: (ozna či jedno ili više) reside together. stanujemo zajedno. previously resided together at ________________________________________________________________ (address), _________________________________________________ (city), _____________________________ (state),in the County of _______________________________________. ranije smo stanovali zajedno u ________________________________________________________________ (adresa), _________________________________________________ (grad), _____________________________ (država), u regiji _______________________________________. never resided together. nikada nismo stanovali zajedno. Residency Stanovanje 7. The residence in which I live is: (check one or more) Prebivalište u kojem ja živim je: (ozna či jedno ili više) jointly owned, leased or rented or jointly occupied by Respondent and me. u zajedni čkom vlasništvu, pod zakupom ili iznajmljeno ili zajedni čki zauzimamo tuženik i ja. owned, leased, rented or occupied by me. u mom vlasništvu, ja ga zakupljujem, unajmljujem ili zauzimam. jointly owned, leased, rented or occupied by me and someone other than Respondent. u zajedni čkom vlasništvu, ja i neko drugi ko nije tuženik ga zakupljujemo, unajmljujemo ili zauzimamo. owned, leased, rented or occupied by someone else, and Respondent is my spouse . neko drugi je vlasnik, zakupljuje, unajmljuje ili zauzima, a tuženik je moj supružnik . jointly occupied by me and another person, and Respondent has no property interest therein. ja i druga osoba smo zajedni čki vlasnici, a tuženik nema vlasni čki interes u tome. OSCA (02-16) AA40 (ASPO) Bosnian 3 od 7 455.010, 455.030, 455.030.3, 455.550 RSMo Custody Starateljstvo List only the children that the Petitioner and Respondent have in common. The cour t cannot change custody if a prior order regarding custody is pending or has been made. Navedite samo zajedni čku djecu koju podnosilac i tuženik imaju. Sud ne može mijenjati starateljstvo ako je raniji nalog u vezi starateljstva u toku ili je ve ć sa činjen. 8. It is in the best interest of the minor ch ildren that custody be awarded as follows: U najboljem interesu maloljetne djece je da starateljstvo bude dodijeljeno kako slijedi: Child’s Name Ime i prezime djeteta SSN (last 4 digits only) SSN (samo zadnje 4 cifre) Age Dob Address (If other than Petitioner) Adresa (ako nije ista kao kod podnosioca) 1. ______________________________________ _______________ _____ ________________________ 2. ______________________________________ _______________ _____ ________________________ 3. ______________________________________ _______________ _____ ________________________ 4. ______________________________________ _______________ _____ ________________________ 5. ______________________________________ _______________ _____ ________________________ Who did each Child reside with during last six months S kim svako od djece boravi tokom zadnjih šest mjeseci Persons to Receive Custody Osobe koje trebaju dobiti Starateljstvo Custody (check one or both) Starateljstvo (ozna čite jedno ili oboje) Temporary Privremeno Full Potpuno 1. ______________________ _____________________________ 2. ______________________ _____________________________ 3. ______________________ _____________________________ 4. ______________________ _____________________________ 5. ______________________ _____________________________ (If necessary, attach additional sheets.) (ako je potrebno, priložite dodatne listove.) V. COMPLETE FOR STALKING OR SEXUAL ASSAULT PETITION ONLY POPUNITE SAMO ZA PODNESAK ZA UHO ĐENJE ILI SEKSUALNO ZLOSTAVLJANJE 9. Respondent is stalking or sexually assaulting me. Ex plain relationship (example: co-workers, neighbors, etc.) Tuženik me uhodi ili me seksualno zlostavlja. Objasn ite vezu (na primjer: saradnici, komšije itd.) _________________________________________________________________________________________________ _________________________________________________________________________________________________ VI. COMPLETE FOR ALL CASES POPUNITE ZA SVE SLU ČAJEVE 10. Indicate any prior or pending custody c ourt cases before, or orders entered by, this court or any other court involving the following parties. Indicate the case numbers. (If none, so state): Nazna čite sve ranije predmete, ili sudske predmete koji su u toku pred, ili naloge koji su uneseni od strane ovog suda, ovim sudom ili bilo kojim drugim sudom koji uklju čuju sljede će stranke. Nazna čite brojeve predmeta. (ako ih nema, tako i navedite): a. Petitioner _______________________________________________________________________________________ Podnosilac _____________________________________________________________________________________ b. Respondent _____________________________________________________________________________________ Tuženik ____________________________________________________________________________________ c. Children (identified in item 9) _______________________________________________________________________ Djeca (identificirana pod stavkom 9) ____________ ______________________________________________________ OSCA (02-16) AA40 (ASPO) Bosnian 4 od 7 455.010, 455.030, 455.030.3, 455.550 RSMo Acts Committed by Respondent: Č in po činjen od strane tuženika: 11. Respondent has knowingly and int entionally: (check at least one) Tuženik je svjesno i namjerno: (ozna čite barem jedno) caused or attempted to cause me physical harm meni uzrokovao ili pokušao uzrokovati fizi čku ozljedu placed or attempted to place me in apprehension of immediate physical harm ostavio ili me pokušao ostaviti u strahovanju od neposredne fizi čke ozljede coerced me prisiljavao me stalked me uhodio me harassed me uznemiravao me sexually assaulted me seksualno me napastvovao unlawfully imprisoned me nezakonito me zato čio followed me from place to place pratio me od mjesta do mjesta threatened to do any of the above prijetio da će u činiti bilo što od gore navedenog by the following act(s): (Include the mo st recent date(s) of each act described.) č ine ći sljede će: (uklju čite najnovije datume svakog opisanog djela.) _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________. 12. I am afraid of Respondent and there is an immediate and present danger of domestic violence to me or other good cause for an emergency temporary order of protection because: (describe) Ja se plašim tuženika i postoji neposredna i prisutna opasnost od nasilja u porodici prema meni ili drugi dobar razlog za hitan privremeni nalog za zaštitu jer: (opišite) _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________. 13. Photographs/Exhibits are filed as evidence of my injuries. Fotografije/prikazi su podneseni kao dokaz mojih ozljeda. VII. PETITIONER’S REQUESTS ZAHTJEVI PODNOSIOCA 14. Order Petitioner’s residential address on voter’s regi stration record to be closed to the public. Naložiti da se adresa podnosioca u bira čkoj registracijskoj evidenciji zatvori za javnost. OSCA (02-16) AA40 (ASPO) Bosnian 5 od 7 455.010, 455.030, 455.030.3, 455.550 RSMo 15. Pursuant to sections 455.010 - 455.085 RSMo, it is r equested that the court issue an Ex Parte Order of Protection restraining Respondent from: (check all that apply) U skladu sa odjeljcima 455.010 - 455.085 RSMo, traži se da sud izda Ex Parte nalog za zaštitu koji će sprje čavati tuženika da: (ozna čite sve što je primjenjivo) committing or threatening to commit domestic violence, sexual assault, molesting or disturbing the peace of Petitioner wherever Petitioner may be found. po čini ili prijeti da će po činiti nasilje u porodici,seksualno zlostavljanje, maltretiranje ili ometanje mira podnosioca gdje god da se podnosilac nalazi. stalking Petitioner. uhodi podnosioca. entering the dwelling of Petitioner located at (see notice below) ___________________________________________ _____________________________________________________________________________________________. ulazi u mjesto stanovanja podnosioca locirano u (vidi obavijest u nastavku) _ _________________________________ ______________________________________________________________________________________________ entering the premises of the Petitioner’s school, located at _______________________________________________ ulazi u prostorije škole podnosioca, locirane u _______________________ entering onto the premises of the Petitioner’s place of employment, located at ________________________________ ulazi u prostorije mjesta zaposlenja podnosioca, locirane u _________________ come within ____________ (feet) of the Petitioner. prilazi na udaljenost od ____________ (stopa) do podnosioca. communicating with Petitioner in any manner or through any medium. komunicira s podnosiocem na bilo koji na čin ili putem bilo kojeg medija. other:________________________________________________________________________________________ _________________________________________________________________________________________________. drugo:________________________________________________________________________________________ _________________________________________________________________________________________________. Additional Requests: Dodatni zahtjevi: It is further requested that, upon the hearing of this cause, the court also issue a Full Order of Protection enjoining Respond ent from the above acts for such time as is necessary to protect Petitioner and that the court: (one or more may be selected) Dalje se traži da, nakon saslušanja o ovom predmetu, sud tako đe izda puni nalog za zaštitu kojim se nalaže tuženiku da ne čini gore navedena djela onoliko vremena koliko je potrebno da se za štiti podnosilac i da sud: (jedno ili više može biti odabrano) Custody Starateljstvo 16. Award custody of the minor child(ren) to Petitioner Respondent. Dodijeliti starateljstvo nad ma loljetnim/om djetetom(djecom) podnosiocu tuženiku. 17. Order visitation with the minor child(ren) to Petitioner Respondent as follows: ______________________________________________________________________________________________ ______________________________________________________________________________________________ Naložiti posjete maloljetnom/oj djetetu(djeci) podnosiocu tuženiku kako slijedi: ______________________________________________________________________________________________ ______________________________________________________________________________________________ Child Support/Maintenance Dje čiji doplatak/izdržavanje 18. Order Petitioer Respondent to pay child support to Petitioner Respondent in the amount of $ ____________ (check one) per week per month. Naložiti podnosiocu tuženiku da pla ća dje čiji doplatak podnosiocu tuženiku u iznosu od ____________ $ (ozna čiti jedno) sedmi čno mjese čno. 19. Order Petitioner Respondent to pay maintenance to Petitioner Respondent in the amount of $ ____________ (check one) per week per month. Naložiti podnosiocu tuženiku da pla ća izdržavanje podnosiocu tuženiku u iznosu od ____________ $ (ozna čiti jedno) sedmi čno mjese čno. OSCA (02-16) AA40 (ASPO) Bosnian 6 od 7 455.010, 455.030, 455.030.3, 455.550 RSMo Other Support Druga podrška 20. Order that Respondent make or continue to make the r ent or mortgage payments in the amount of $ _____________ (check one) per week per month on the residence occupied by Petitioner. Naložiti da tuženik pla ća ili nastavi s pla ćanjem najamnine ili hipoteke u iznosu od ______________ $ (ozna čiti jedno) sedmi čno mjese čno za mjesto stanovanja koje koristi podnosilac. 21. Order that Respondent pay Petitioner’s rent at a residence, other than the residence previously shared with Respondent, in the amount of $ _______________ (check one) per week per month. Naložiti da tuženik pla ća najamninu podnosiocu za mjesto stanovanja, koje nije isto kao mjesto stanovanja ranije dijeljeno sa tuženikom, u iznosu od _______________ $ (ozna čiti jedno) sedmi čno mjese čno. 22. Order Respondent to pay a reasonable fee for housing and ot her services provided to Petitioner by a shelter for victims of domestic violence. Naložiti tuženiku da pla ća razumnu naknadu za stanovanje i druge usluge koje je podnosilac primao u uto čištu za žrtve nasilja u porodici. 23. Order Respondent to pay the cost of m edical treatment or services provided to Petitioner as a result of injuries sustained by an act of domestic violence committed by Respondent. Naložiti tuženiku da pla ća troškove medicinskog lije čenja ili drugih usluga koje je podnosilac primao kao rezultat povreda pretrpljenih činom nasilja u porodici po činjenog od strane tuženika. Personal Property Lična imovina 24. Order that Petitioner be given temporary po ssession of the following personal property: _____________________________________________________________________________________________ _____________________________________________________________________________________________ Naložiti da podnosiocu bude dato privremeno posjedovanje sljede će li čne imovine: _____________________________________________________________________________________________ _____________________________________________________________________________________________ 25. Prohibit Respondent from transferring, encumbering, or otherwise disposing of the following property mutually owned or leased with Petitioner. _____________________________________________________________________________________________ _____________________________________________________________________________________________ Zabraniti tuženiku da prenosi, optere ćuje ili na drugi na čin raspolaže sljede ćom imovinom koja je u zajedni čkom vlasništvu ili je pod zakupom zajedno sa podnosiocem. _____________________________________________________________________________________________ _____________________________________________________________________________________________ Counseling/Treatment Savjetovanje/lije čenje 26. Order Respondent to participate in a court-approved counseling program designed for batterers and/or substance abuse. Naložiti tuženiku da u čestvuje u programu savjetovanja odobrenom od suda i dizajniranom za nasilnike i/ili zloupotrebu opojnih tvari. Costs/Fees Troškovi/naknade 27. Order Respondent to pay court costs. Naložiti tuženiku da plati sudske troškove. 28. Order Respondent to pay Petitioner’s attorney fees. Naložiti tuženiku da plati advokatske naknade za podnosioca. Other Orders Drugi nalozi 29. Order the full order of protection issued for one year be automatically renewed unless Respondent requests a hearing by 30 days prior to the expiration of the order. Naložiti da puni nalog za zaštitu koji je izdan na jednu godinu bude automatski obnovljen osim ako tuženik traži saslušanje 30 dana prije isteka naloga. 30. Other (specify): _________________________________________________________________________________ ______________________________________________________________________________________________. Drugo (specificirajte): ___________________________________________________________________________ ______________________________________________________________________________________________. OSCA (02-16) AA40 (ASPO) Bosnian 7 od 7 455.010, 455.030, 455.030.3, 455.550 RSMo VIII. PETITIONER’S SIGNATURE POTPIS PODNOSIOCA I swear/affirm under penalty of perjury that these fact s are true according to my best knowledge and belief. I understand that a copy of this petition will be served on the respondent. Zaklinjem se/potvr đujem pod materijalnom i kaznenom odgovornoš ću da su ove činjenice istinite u skladu s mojim najboljim sasznanjima i vjerovanju. Razumijem da će kopija ovog podneska biti uru čena tuženiku. _________________________________________________ Date Datum NOTICE: Section 455.030.3, RSMo, provides that a Petitioner seeking protection under the Domestic Violence Act is not required to reveal any current address or place of residence on this motion. Do not provide this information if doing so will endanger you. NAPOMENA: Odjeljak 455.030.3 RSMo podrazumijeva da podnosilac koji traži zaštitu od č ina nasilja u porodici ne mo ra otkrivati bilo koju trenutnu adresu ili mjesto prebivališta u ovom prijedlogu. Nemojte davati ove informacije ako će vas to ugroziti. __________________________________________________ Petitioner’s Signature Potpis podnosioca __________________________________________________ Address (Optional) Adresa (opcionalno) __________________________________________________ City, State and Zip Grad, država i poštanski broj ________________________________________________ Telephone Telefon __________________________________________________ Attorney’s Name, Missouri Bar No., if Applicable Ime advokata, Mizuri bar broj, ako postoji __________________________________________________ Address Adresa __________________________________________________ City, State and Zip Grad, država i poštanski broj __________________________________________________ Telephone Telefon