Petition Restraining Order

Petition for Restraining Order Due to Domestic Violence

IN THE COURT OF (County), (State)

(Name of Petitioner)

V. CAUSE NO.

(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

2. (Name of Respondent), Respondent herein, the person who has harmed me, last resided at

3. The name and address of Respondent's last known place of employment is ,

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

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:

10. Petitioner is the custodian of the minor children of the parties, whose names and ages are as follows:

11. Petitioner needs the exclusive use and possession of the dwelling that the parties share located at for the following reasons:

12. Petitioner is unable to obtain safe alternative housing because:

13. Petitioner genuinely fears that Respondent will abuse, remove, or hide the minor children from Petitioner because:

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 , 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 .

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,

STATE OF

COUNTY OF

Personally appeared before me, the undersigned authority in and for the aforesaid jurisdiction, the within named 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.

________________________________

(Signature of Petitioner)

SWORN to and subscribed before me, this the .