Family Offense Petition Form 8-2

Case Information and Addresses

County Petitioner Name Respondent Name File Number Docket Number

1. Petitioner Address

Should your address be kept confidential? Physical Address Mailing Address

2. Respondent Address

Physical Address Mailing Address

3. Relationship to Respondent

We are married We were married We have a child in common We are parent and child We are related by blood or marriage Specify Blood or Marriage Relationship

We are in an intimate relationship Specify Relationship We were in an intimate relationship Specify Relationship I am related by blood or marriage to a person who is in an intimate relationship with the respondent Specify Relationship I am related by blood or marriage to a person who was in an intimate relationship with the respondent Specify Relationship

Living Arrangement We live together We lived together in the past We never lived together Petitioner is an agency, association, society, or institution I am a peace officer

4. Offense Details

Describe the family offense(s) alleged and what happened.

Date

Time

AM / PM Location Who Was Injured Injuries Suffered Weapons Used, if any Briefly Describe What Happened

5. Criminal Complaints

Have you filed a criminal complaint concerning these incidents? Court Name Docket Number Date Filed Charges Status of Case

6. Household Members

I have no children and there are no children living in my household The following children live with me

Children Living With Me

Child 1 Name Date of Birth Relationship to Respondent Relationship to Me Child 2 Name Date of Birth Relationship to Respondent Relationship to Me Child 3 Name Date of Birth Relationship to Respondent Relationship to Me Child 4 Name Date of Birth Relationship to Respondent Relationship to Me

The following children are mine but DO NOT live with me

Children Not Living With Me

Child 1 Name Date of Birth Relationship to Respondent Child Lives With Child 2 Name Date of Birth Relationship to Respondent Child Lives With Child 3 Name Date of Birth Relationship to Respondent Child Lives With Child 4 Name Date of Birth Relationship to Respondent Child Lives With

7. Family Offenses Against Children

Did the respondent commit a family offense against any child listed above? Child 1 Name Alleged Offense Child 2 Name Alleged Offense Child 3 Name Alleged Offense Child 4 Name Alleged Offense Child 5 Name Alleged Offense

8. Safety of Petitioner, Children, and Family

Has respondent acted in a way you consider dangerous or threatening? If Yes, Explain Has respondent violated an Order of Protection? If Yes, Explain Does respondent own or have access to firearms? If Yes, Explain Does respondent have a firearms license? License or Permit Number Issuing County Guns / Pistols Listed Does respondent have a pending application for a firearms license? Does respondent carry a firearm on their job? If Yes, Explain Did respondent use a firearm or dangerous instrument to threaten anyone? Me My child(ren) Member(s) of my household Household Member Names Describe the Incident Is there a substantial risk respondent would use or threaten to use a firearm or dangerous object? If Yes, Explain

Pending Court Cases

Case 1 Docket / Index Number Court Name Court Location Case Type Case 2 Docket / Index Number Court Name Court Location Case Type Case 3 Docket / Index Number Court Name Court Location Case Type Case 4 Docket / Index Number Court Name Court Location Case Type

Respondent Criminal Convictions

Conviction 1 Docket Number Court Name and Location Conviction Charge Conviction Date Sentence Conviction 2 Docket Number Court Name and Location Conviction Charge Conviction Date Sentence Conviction 3 Docket Number Court Name and Location Conviction Charge Conviction Date Sentence Conviction 4 Docket Number Court Name and Location Conviction Charge Conviction Date Sentence

Protection for Pets

Are you seeking protection for pets? Pet 1 Name Type of Pet Was the Pet Threatened or Injured? Explain Pet 2 Name Type of Pet Was the Pet Threatened or Injured? Explain Pet 3 Name Type of Pet Was the Pet Threatened or Injured? Explain Pet 4 Name Type of Pet Was the Pet Threatened or Injured? Explain

9. Previous Application for Relief

Have you previously applied for the relief requested in this petition? Application 1 Date Court Name and Location Relief Granted Application 2 Date Court Name and Location Relief Granted Application 3 Date Court Name and Location Relief Granted Application 4 Date Court Name and Location Relief Granted

10. Petitioner Request for Relief

Determine that respondent committed one or more family offenses alleged Enter an Order of Protection Stay away from petitioner Stay away from petitioner's home Stay away from petitioner's workplace Do not menace, harass, assault, or commit family offenses No communication or contact through social media No third-party contact Surrender firearms Enter a finding of aggravated circumstances Enter a temporary order of child support Consider temporary spousal support

11. Petitioner Name and Signature

Print or Type Petitioner's Name Upload Petitioner's Signature Date

12. Lawyer Information

Did the lawyer assist the petitioner with the paperwork? Will the lawyer represent the petitioner in court? Print Lawyer Name Upload Lawyer Signature Lawyer Signature Date Lawyer Address Lawyer Phone Lawyer Email