Fill and Sign the Petition Restraining Form

IN THE ___________ COURT OF _______________ (County), __________________ (State) ________________________ PETITIONER (Name of Petitioner) V. CAUSE NO. _______,_______ ________________________ RESPONDENT (Name of Respondent) Petition to for Restraining Order due to Domestic Violence Comes now ___________________ (Name of Petitioner) , Petitioner herein, an adult resident citizen of the State of _________________ (Name of State) , and files this, her verified Petition, and would show unto this Honorable Court the following matters and facts, to-wit: 1. Petitioner resides at ______________________________________________________ _________________________ (street address, city, state, zip code) . 2. ____________________ (Name of Respondent) , Respondent herein, the person who has harmed me, last resided at ___________________________________________________ _____________________________ (street address, city, state, zip code) . 3. The name and address of Respondent 's last known place of employment is ________________________ (Name of Employer) , __________________________________ ___________________________________________ (street address, city, state, zip code) . 4. The following is a physical description of Respondent : A. Race: ________________________ B. Sex: ________________________ C. Age: ________________________ D. Height: ________________________ E. Weight: ________________________ F. Eye color: ________________________ G. Natural hair color: ________________________ H. Distinguishing physical marks or scars: ________________________ 5. Aliases Respondent uses or has used: ________________________ 6. Respondent is the spouse of Petitioner , having been married on _________________ (date) . 7. There are no court cases currently pending between Petitioner and Respondent , other than the above-entitled action. 8. Petitioner has made no previous applications for an injunction enjoining domestic violence. 9. Petitioner has suffered or has reasonable cause to fear domestic violence because Respondent has (description of each act of actual physical violence and each threat of physical violence, including date, place, and whether the act or threat was made in front of witnesses, especially any Petitioner’s children) _________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________. 10. Petitioner is the custodian of the minor children of the parties, whose names and ages are as follows: (names and ages of minor children) _________________________________ ____________________________________________________________________________ ____________________________________________________________________________ . 11. Petitioner needs the exclusive use and possession of the dwelling that the parties share located at ____________________________________________________________________ __________ (street address, city, state, zip code) for the following reasons: (State Reasons) ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________. 12. Petitioner is unable to obtain safe alternative housing because: (State Reasons) ______ ____________________________________________________________________________ ____________________________________________________________________________. 13. Petitioner genuinely fears that Respondent will abuse, remove, or hide the minor children from Petitioner because: (State Reasons) ___________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___________________________________________________________________________. 14. Petitioner genuinely fears domestic violence by Respondent . WHEREFORE, Petitioner requests that this Court: 1. Immediately restrain Respondent from committing any acts of domestic violence against Petitioner and the minor children of the parties. 2. Award Petitioner the temporary exclusive use and possession of the dwelling that the parties share located at _________________________________________________________ ______________________ (street address, city, state, zip code) , and excluding Respondent from the said residence. 3. Award Petitioner temporary custody of the minor children of the parties. 4. Award temporary alimony and support for Petitioner and the minor children. 5. Direct Respondent to participate in a batterer's intervention program or other treatment pursuant to (citation of state statute) __________________________. 6. Provide such other terms or conditions which the Court deems necessary for the protection of Petitioner and the minor children as victims of domestic violence, including directives to law enforcement agencies. 7. Grant such other and further relief that the Court deems just and proper. Dated: _____________________ Respectfully submitted, By: _______________________________ (Printed Name of Plaintiff) _______________________________ (Signature of Plaintiff) STATE OF __________________ COUNTY OF __________________ Personally appeared before me, the undersigned authority in and for the aforesaid jurisdiction, the within named __________________ (Name of Petitioner) who, after having been first duly sworn, stated on oath that the matters and facts set forth in the above and foregoing Petition are true and correct as therein stated. ________________________________ (Printed Name of Petitioner) ________________________________ (Signature of Petitioner) SWORN to and subscribed before me, this the __________________ (date) . __________________________________ Notary Public My Commission Expires: ________________________