New York Family Offense Petition

FAMILY OFFENSE PETITION

F.C.A. §§ 812, 818, 821    Form 8-2 (Family Offense Petition) (12/2013)

FAMILY COURT OF THE STATE OF NEW YORK

COUNTY OF

TO THE FAMILY COURT:

The undersigned Petitioner respectfully states that:

1. a. I reside at [specify address unless confidential]:

b. The Respondent resides at [specify address unless confidential]:

2. a. The Respondent and I are related as follows [check all applicable box(es)]:

b. Petitioner is a duly authorized agency, association, society or institution and is filing this petition pursuant to F.C.A. §822(b).

c. I am a peace officer and am filing this petition pursuant to F.C.A. §822(c).

3. The Respondent committed the following family offense(s) against me and/or my children, which constitute(s):

[Describe each incident; starting with the most recent incident; state date, time and location of each incident; specify all injuries and if any weapons were used. Use additional sheets where necessary]:

4. I have have not filed a criminal complaint concerning these incident(s)

[If so, please indicate court, county, date, charge(s) and status, if known]:

5. [Check applicable box(es)]:

a. I have no children and there are no other children living in my home.

b. The following children live with me [include children who are not yours]:

c. The following children are mine but do not live with me.

d. The Respondent committed family offenses against the above child or children as follows [describe including name(s) of child or children, nature of offense(s) and date(s)]:

[Check boxes and complete any of the following paragraphs 6-13 that apply to you. Skip any that do not apply to you.]

6. The Respondent has acted in a way I consider dangerous or threatening to me, my children, a member of my family or household or person with whom I have or had an intimate relationship, in addition to the incident(s) described in question 3, as follows [describe]:

7. The Respondent was found to have violated an Order of Protection issued on behalf of me, my children, a member of my family or household or person with whom I have or had an intimate relationship as follows [describe]:

8. The Respondent owns or has access to guns as follows [describe]:

9. a. The Respondent has a gun license or pistol permit for the following gun(s) as follows [describe]:

b. The Respondent has a gun license or permit application pending as follows [describe]:

c. The Respondent carries a gun on his or her job as follows [describe]:

10. a. The Respondent threatened [check applicable box(es)]:

b. There is a substantial risk that Respondent would use or threaten to use a firearm or dangerous instrument or object against me, my child(ren), a member of my household or person with whom I have or had an intimate relationship on the basis of the following facts and for the following reasons [describe]:

11. The following court cases are pending between me and the Respondent [specify court, county, docket or index number, nature of action and status, if known]:

12. The Respondent has the following criminal convictions [specify, including date, crime, sentence and court, if known]:

13. [Applicable where protection is sought for pet(s)]:

a. The following pets live in my house [specify name(s) and type(s)]:

b. The Respondent injured or tried or threatened to injure pets in my household as follows [describe]:

14. I have not made any previous application to any court or judge for the relief requested in this petition, (except [specify the relief, if any, granted and the date of such relief; delete if inapplicable]: ).

WHEREFORE, Petitioner respectfully requests this Court to:

a. adjudge the Respondent to have committed the family offense(s) alleged;

b. enter an order of protection, specifying conditions of behavior to be observed by the Respondent in accordance with Section 842 of the Family Court Act;

c. enter a finding of aggravated circumstances [delete if inapplicable];

d. enter a temporary order of child support in accordance with Family Court Act §828(4) [delete if inapplicable];

e. order such other and further relief as to the Court seems just and proper.