Massachusetts > Statewide > State District Court > Abuse Or Harrasment Prevention Orders
Defendent Information Form FA-HA-5 - Massachusetts
| Defendent Information Form Form. This is a Massachusetts form and can be used in Abuse Or Harrasment Prevention Orders State District Court Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
DEFENDANT INFORMATION FORM AS PROVIDED BY PLAINTIFF DOCKET NO. (for court use only) Massachusetts Trial Court G.L. c. 209A or G.L. c. 258E This information is requested to help police to identify and locate the Defendant in order to serve the Defendant with a copy of any restraining Order that is issued. Please provide as much information as possible. DEFENDANT'S NAME DATE OF BIRTH OTHER NAMES USED BY DEFENDANT, IF ANY PLACE OF BIRTH MOTHER'S MAIDEN NAME (FIRST & LAST) FATHER'S NAME (FIRST & LAST) SOCIAL SECURITY NO. SEX RACE EYES HAIR HEIGHT WEIGHT PHOTO AVAILABLE? (very helpful for ID) G MALE G FEMALE BUILD OTHER PHYSICAL CHARACTERISTICS (beard, glasses, scars, tattoos, complexion, hairstyle) G YES G NO DEFENDANT'S HOME ADDRESS (NO., STREET, CITY, STATE, ZIP) DEFENDANT'S HOME TELEPHONE NO. APT NO. FLOOR NO. NAME ON DOOR/MAILBOX DOES DEFENDANT UNDERSTAND ENGLISH? IF NOT, WHAT LANGUAGES? G YES G NO DEFENDANT'S EMPLOYER/WORKPLACE WORK TELEPHONE NO. WORK ADDRESS (NO., STREET, CITY, STATE, ZIP) TITLE DEPARTMENT WORK HOURS OTHER PLACES DEFENDANT MAY BE FOUND (friends, bars, relatives, hangouts) BEST PLACE TO FIND DEFENDANT MOTOR VEHICLE LICENSE PLATE YEAR MAKE MODEL COLOR BEST TIMES TO FIND DEFENDANT DOES DEFENDANT HAVE: (describe very briefly) A history of violence toward police officers? A history of using/abusing drugs or alcohol? Access to guns, a license to carry, or possess a gun? Psychiatric/emotional problems? G NO G YES G NO G YES G NO G YES G NO G YES What kind? What kind? What kind? ANY OTHER INFORMATION WHICH MIGHT BE HELPFUL IN LOCATING THE DEFENDANT DATE SIGNED PRINT PLAINTIFF'S NAME PLAINTIFF'S SIGNATURE x FA/HA-5 (5/10) American LegalNet, Inc. www.FormsWorkFlow.com
|
|||||||
