Fill and Sign the Sworn Petition for Form

Petition for Temporary Order of P rotection and Request for Hearing - AGO Form OVS 3 – Revised 02/11 Page 1 of 9 Name Address City, State, Zip Telephone No. IN THE _________________________________ COURT STATE OF MONTANA COUNTY OF ____________________________________ ) _________________________________, ) No. _______________ ) Petitioner, ) ) SWORN PETITION FOR v. ) TEMPORARY ) ORDER OF PROTECTION ) AND REQUEST FOR HEARING _________________________________, ) ) Respondent. ) The law requires that Respondent be given a copy of this completed form and all attachments. 1. Request for Temporary Order of Protection. Under oath and as provided by Mont. Code Ann. § 40 -15 -201, I request that the Court issue a Temporary Order of Protection against Respondent. I believe I am in danger of harm if the court does not issue a Temporary Order of Protection immediately. 2. Protected Person/s. I am seeking a n Order of Protection for (check all that apply): Myself The following minor child/ren: Child /ren Age How child is rel ated to: You Respondent Who does child live with? Petition for Temporary Order of P rotection and Request for Hearing - AGO Form OVS 3 – Revised 02/11 Page 2 of 9 Other people you would like to be protected (first and last names and relationship to both you and Respondent) : 3. Residence. I live or am staying in the City of , County of ______________________________, State of . The Respondent lives in the City of , County of ________ ______________________, State of __ _________________. The abuse happened in the City of , County of ________ ______________________, State of . (Check all that apply). The Respondent does not live with me. I live with the Respondent at I have left a residence where I lived with the Respondent. I want to return: to live at that residence to get personal belongings other (describe) : A business is run from the home. Type of business (describe) : The business is run by: me Respondent both me and Respondent 4. Relationship. (Please check all that apply to the relationship between the Respondent (the person you want restrained) and you or the person(s) for whom you are s eeking protection ) I (or the person I want protected) have/has a relationship with Respondent as follows: Married Were married, but are now separated Divorced Are cu rrently dating or having an ongoing intimate relationship Live together Lived together in the past Have a child and/or children together Is a family member or a former family member of Respondent Dated or had an ongoing intimate relationship in the past Petition for Temporary Order of P rotection and Request for Hearing - AGO Form OVS 3 – Revised 02/11 Page 3 of 9 If a dating relationship please describe: Nature of relationship Length of time of the dating relationship How often saw each other Time since relationship en ded Victim of Sexual Assault/ Stalking/ Other: (describe how you know Respondent) I am the parent, guardian or other person supervising the welfare of a child less than 16 years of age and request that Respondent, who is a person over 18 years of age and who has no legal right of supervision or control over the child , to stop contacting the child because I believe that the contact is not in the child's best interests as set forth in MCA § 45 -5- 622 (4) . 5. Information about the violence. Please explain what the Respondent did to you (and/or the person you want protected). Be specific. Write down places and dates as well as you can remember. It does not matter when the abuse happened or whether you re ported it to the police. But you must tell the judge why you are afraid now. A. RECENT ABUSE Date of the most recent abuse: Who was there? Where did it take place? What did the Respondent do or say that made you (and/or the person you want p rotected) afraid? Did the Respondent use or threaten to use a gun or other weapon? If yes, list how: Describe any injuries: Did the police come? Yes No Petition for Temporary Order of P rotection and Request for Hearing - AGO Form OVS 3 – Revised 02/11 Page 4 of 9 B. PAST ABUSE Desc ribe any past abuse. Explain what happened in past situations. Be sure to explain when the abuse occurred , where it happened , and who was there. Explain why you (and/or the person you want protected) are afraid now. Check here if you need more space to write. Attach a sheet of 8 ½ x 11 paper and write: “Explanation of What Happened” at the top. Do NOT use the back of this form. 6. Firearms (Check all that apply) To the best of your knowledge, does Respondent currently possess firearms? Petition for Temporary Order of P rotection and Request for Hearing - AGO Form OVS 3 – Revised 02/11 Page 5 of 9 No Yes Where are the firearms located? 7. Other Court Cases (Check all that apply) A divorce, legal separation or custody case between me (and/or the person I want protected) and Respondent has been filed in _______ ________ __ County, State of _____________________ Is the family law case listed above still pending ? Ye s No Did the Court issue a parenting plan? Yes No A criminal charge of was filed against me or Respondent in ____________________________ Court in ______________________ __ County, State of _____________________ List any other cases that you (and/or the person you want protected) or Respondent are or have been involved in: I ask the Court to Order the Following: 1. Res pondent shall not commit or threaten to commit acts of violence against me (and/or the person I want protected) and the following people including family members : 2. Respondent shall not harass, annoy, disturb the pe ace of, telephone, email, contact, or otherwise communicate, directly or indirectly, with me (or the person I want protected), and the following family members, other victims of the abuse, or witnesses to the abuse: 3. Re spondent shall not take the following child /ren out of this C ounty or State: Petition for Temporary Order of P rotection and Request for Hearing - AGO Form OVS 3 – Revised 02/11 Page 6 of 9 4. (List the distance, up to 1500 feet, that you want Respondent to stay away from you and/or the person you want protected and the places you c heck below). Respondent shall stay at least _________ feet from: Me (Petitioner) Minor child/ren Other people: My home (if you want the location of your home t o be secret, do not list) My job or workplace: My vehicle: The child/ ren’s school and/or child care: Other places (describe): 5. Resp ondent used or threatened me with firearms. Respondent shall not possess these firearms (describe): 6. Respondent shall not take, hide, sell, damage or dispose of property belonging to me (and/or the person who I want protected) or Re spondent or both of us. 7. Respondent shall give me (or the person I want protected) possession or use of the following items (items may include the residence, automobile and other essential personal property no matter who owns it): 8. I (and/or the person I want protected) need a peace officer to help get possession of the property listed in Number 7, or I request that a peace officer come with Respondent when picking up his/her property or belongings. 9. The Court should order Respondent to complete violence counseling, which may include alcohol or chemical dependency counseling or treatment, if appropriate. 10. The Court should order the following to provide for the safety and welfare of me and/or the person I want protected, and family: Petition for Temporary Order of P rotection and Request for Hearing - AGO Form OVS 3 – Revised 02/11 Page 7 of 9 11. Parenting of Child/ren Note: Justice and City and Municipal Courts can protect minor c hildren by listing them on the Order of P rotection. Althou gh these courts can provide short term visitation plans, they cannot make parenting plans. If you need a parenting plan, you need to file an action in your local District or Tribal Court. (Choose one) Parenting of children does not appl y in this case. The protections I have asked for in Paragraph 2 will keep Respondent away from the children. Therefore a visitation schedule is unnecessary. I want the children listed in Appendix A to have parentin g time with Respondent. I am attaching Appendix A that says what visitation schedule I want. (Fill in and attach Appendix A). 12. Other Relief: The Court should order other protection as it deems just and proper. I SWEAR UNDER OATH OR AFF IRM I HAVE READ THIS APPLICATION, OR HAVE HAD IT READ TO ME, AND THE FACTS STATED IN THIS APPLICATION ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I ALSO UNDERSTAND THAT PROVIDING FALSE INFORMATION IS A CRIME. Date: Signed: Petitioner Petition for Temporary Order of P rotection and Request for Hearing - AGO Form OVS 3 – Revised 02/11 Page 8 of 9 NOTARY SEAL OR JUDGE’S SIGNATURE STATE OF MONTANA ) : ss. County of _____________ ) SUBSCRIBED AND SWORN to before me this ___ day of ________________, 20___ _. JUDGE/CLERK/NOTARY (For use by notary) __________________ __________________ (signed) Name ______________________________ (printed) Notary Public for the State of Montana. Residing at _________________________________ My Commission Expires_______________________ Petition for Temporary Order of P rotection and Request for Hearing - AGO Form OVS 3 – Revised 02/11 Page 9 of 9 APPENDIX A In this form, you will tell the Judge h ow the temporary visitation will take place under safe and peaceful conditions. You must have a very good reason before the Judge will deny the Respondent visitation. The visitation schedule will be temporary. For permanent parenting arrangements, you mu st file an action with your local District or Tribal Court. Parenting schedules generally include: ● visits that take place on a regular basis; ● visits that vary in length depending on the ages and needs of the children. Children (List all children, w hether or not you have asked that they be protected by the Order of Protection): Children Age How child is related to You Respondent Who does child live with? State(s) where child lived in the last 6 months? CHEC K the visitation option that you want. I request the following visitation schedule: Supervised visits (List why, and supervised by whom): Neutral drop off and pick up location: Transportation provided by: I request the Respondent have no visitation with the children because: