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Form preview Texas order form Notary Public in and for the State of Texas My Commission expires Check one or both the Court to order the Respondent to pay support in an amount set by the Court. And the Applicant asks for these Orders in the best interest of the people named on page 1 of this form. Look at the top of your Order and copy the same information here. Order is check one Attached or Not available now but will be filed before the hearing on this Application. Sample Only Do Not File Form Approved by the Supreme Court of Texas by order in Misc. Docket No. 05-9059 April 12 2005 Page 1 of 4 Check all the orders you The Applicant requests a Protective Order and asks the Court to make all Orders marked with a check want the judge to make Orders to Prevent Family Violence Not commit family violence against any person named on page 1 of this form. Not communicate in a threatening or harassing manner with any person named on page 1 of this form. Children Other Adults named on page 1 of this form. Good cause exists for prohibiting the Respondent s direct communications. Sign Here Applicant Pro se Address where Applicant may be contacted List your address/phone or another address/phone Phone where Applicant may be contacted Fax confidential. if you want yours kept List another address/phone if you want yours kept confidential Affidavit Write the name of County of your county here State of Texas My name is. I am years old and otherwise competent to make this Affidavit. The information and events described in this Affidavit are true and correct. Describe the most recent time the Respondent hurt you or threatened to hurt you Answer every question on this form. If it happened in the last 30 days the judge What date did this happen / / can order the Respondent to move out. Or get it from the court clerk or from www. texaslawhelp.org/protectiveorderkit How will the other person know about the protective order You must have the other person served before the court hearing. This means someone not you will serve the other person a copy of your The clerk can arrange for law enforcement to serve Need help There is an instruction sheet for each form. But if you need more help contact Family Violence Legal Line 800-374-HOPE Or go to Although you may file these forms without having a lawyer you are encouraged to get a lawyer to help you in this process. Your county or district attorney or legal aid office may be able to help for free. The State Bar of Texas may also be able to refer you to a lawyer if you call 800-252-9690. This means someone not you will serve the other person a copy of your The clerk can arrange for law enforcement to serve Need help There is an instruction sheet for each form. But if you need more help contact Family Violence Legal Line 800-374-HOPE Or go to Although you may file these forms without having a lawyer you are encouraged to get a lawyer to help you in this process. Your county or district attorney or legal aid office may be able to help for free. The State Bar of Texas may also be able to refer you to a lawyer if you call 800-252-9690. Get Ready for Court Don t miss your hearing What if I am afraid If you miss it your Temporary Ex Parte Protective Order may end and you will have to start from the beginning. R. Civ. P. 21a. Copies Forwarded The Clerk is ORDERED to forward copies of this Protective Order and accompanying Respondent Information Form to Check all that apply Sheriff and Constable of County Texas Police Chief of the City of Any law enforcement agency receiving a copy of this Protective Order MUST within 10 days enter all required information into the Department of Public Safety s statewide law enforcement information system. that the Protective Order may last for two years after the date it is signed. If the Respondent is confined or imprisoned on the date this Protective Order is scheduled to expire the Protective Order will expire one year after the date of the Respondent s release.

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