Fill and Sign the Petition Domestic Abuse Form

FORM 450 Rev 09/07 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                   Apt. or P.O. Box Number Apt. or P.O. Box Number             Petition Number City State Zip Code City State Zip Code                                       Attorney Name and Phone Number Attorney Name and Phone Number                         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 address of my place of residence, school and/or employment the address of my child(ren)’s school or child care Not be disclosed because the disclosure of this information would place me and/or my child(ren) in danger. (DO NOT LIST ADDRESS ON PETITION IF REQUESTING CONFIDENTIAL ADDRESS) 2. The Respondent's relationship to the Petitioner is: family:       child in common custodian of child former spouses living together Child/Adult Protective Agency Dating Relationship marriage 3. The Respondent has committed the following act(s) of abuse ( Please describe all the acts of abuse you wish the Court to consider, including dates if known. Continue on back if additional space is needed) :                               4. Petitioner has reason to believe that the Respondent is in possession of the following firearm(s):       WHEREFORE , Petitioner asks this Court to: 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 :       1 of 3 FORM 450 Rev 09/07 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. 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. Award custody and/or residency of the parties minor child(ren) to the Petitioner (please specify names and ages of the child(ren)): Order the Respondent to pay support for child(ren). Order the Respondent to pay $       support for Petitioner. Order the Respondent to pay or reimburse fees and costs. Award the Petitioner temporary possession of the following personal property (including bank accounts, check books, credit cards, automobiles, etc.): Order the Respondent to enroll in the following counseling program(s): Substance Abuse Domestic Violence Mental Health 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. Subscribed and sworn before me on this date, Petitioner 2 of 3                                          FORM 450 Rev 09/07 Date Notary Public 3 of 3