Washington > Statewide > Domestic Violence
Petition For Order For Protection DV 1.015 - Washington
| Petition For Order For Protection Form. This is a Washington form and can be used in Domestic Violence Statewide . |
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Court of Washington For No. Petitioner vs. Respondent I am a victim of domestic violence committed by the respondent. A member of my family or household is a victim of domestic violence committed by the respondent. I am a guardian guardian ad litem next friend of a minor who is 13 to 15 years of age and is a victim of domestic violence in a dating relationship with a person age 16 or older. The name of the minor victim is _________________________________________. This person's identifying information is provided in paragraph 5 below. 2. The victim lives in this county. The victim left their residence because of abuse and this is the county of their new or former residence. 3. The victim's age is: Respondent's age is: Under 16 16 or 17 18 or over Under 16 16 or 17 18 or over 4. The victim's relationship with the respondent is: spouse or former spouse parent of a common child current or former cohabitant as intimate partner, including current or former registered domestic partner current or former dating relationship stepparent or stepchild current or former cohabitant as roommate in-law parent or child blood relation other than parent or child 1. Petition for Order for Protection (PTORPRT) Petition for Order for Protection (PTORPRT) - Page 1 of 6 WPF DV-1.015 Mandatory (06/2012) - RCW 26.50.030 American LegalNet, Inc. www.FormsWorkFlow.com 5. Identification of Minors (if applicable) Name (First, Middle Initial, Last) Age No Minors involved. Race Sex How Related to Petitioner Respondent Resides with 6. Other court cases or other restraining, protection or no-contact orders involving me, the minors and the respondent: Case Name Case Number Court/County Check the box for each type of relief you are requesting, for each type of order you need. Temp: I Request a Temporary Order for Protection, effective until the hearing, because an Emergency Exists as described in the statement below. A temporary protection order should be issued immediately without notice to the respondent, to avoid irreparable injury. Full: I Request a "full" Order for Protection, following a hearing. Temp Full 1 Restrain respondent from causing any physical harm, bodily injury, assault, including sexual assault, and from molesting, harassing, threatening, or stalking me the minors named in paragraph 5 above these minors only: (If the court orders this relief, and the respondent is your spouse or former spouse, the parent of a common child, or a current or former cohabitant as intimate partner, including a current or former registered domestic partner, the respondent will be prohibited from possessing a firearm or ammunition under federal law for the duration of this order. An exception exists for law enforcement officers and military personnel when carrying department/government-issued firearms. 18 U.S.C. ยง 925(a)(1).) 2 Restrain respondent from harassing, following, keeping under physical or electronic surveillance, cyberstalking as defined in RCW 9.61.260, and using telephonic, audiovisual, or other electronic means to monitor the actions, locations, or wire or electronic communication of me the minors named in paragraph 5 above only the minors listed below; members of the victim's household listed below the victim's adult children listed below: Petition for Order for Protection (PTORPRT) - Page 2 of 6 WPF DV-1.015 Mandatory (06/2012) - RCW 26.50.030 American LegalNet, Inc. www.FormsWorkFlow.com Temp Full Temporary Order, effective until a hearing. Full Order, effective following a hearing. Restrain respondent from coming near and from having any contact whatsoever, in person or through others, by phone, mail, or any means, directly or indirectly, the minors named in paragraph except for mailing of court documents, with me these minors only, subject to any 5 above, subject to any court-ordered visitation court-ordered visitation: Exclude respondent from our shared residence my residence my workplace my school the residence, day care, or school of named in paragraph 5 above these minors only: other: You have a right to keep your residential address confidential. 5 6 4 3 the minors Direct respondent to vacate our shared residence and restore it to me. Prohibit respondent from knowingly coming within, or knowingly remaining within __________________ (distance) of our shared residence my residence my workplace my school the day care or school of the minors named in paragraph 5 above. these minors only: other: 7 Grant me possession of essential personal belongings, including the following: 8 Grant me use of the following vehicle: Year, Make & Model _____________________________ License No. Other: 9 N/A N/A N/A 10 Direct the respondent to participate in appropriate treatment or counseling services. 11 Require the respondent to pay the fees and costs of this action. 12 Remain Effective longer than one year because respondent is likely to resume acts of domestic violence against me if the order expires in a year. Grant me exclusive custody and control of the following pet(s) owned, possessed, leased, kept, or held by me, respondent, or a minor child residing with either me or the respondent. (Specify name of pet and type of animal.): ___________________________________________________________________. Check the following only if you are requesting protection involving pets. N/A 13 Petition for Order for Protection (PTORPRT) - Page 3 of 6 WPF DV-1.015 Mandatory (06/2012) - RCW 26.50.030 American LegalNet, Inc. www.FormsWorkFlow.com N/A N/A Prohibit respondent from interfering with my efforts to remove the pet(s) named above. 15 Prohibit respondent from knowingly coming within, or knowingly remaining within _______________ (distance) of the following locations where the pet(s) are regularly found: petitioner's residence (You have a right to keep your residential address confidential.) _____________________________________________ Park other:___________________________________________________________ Check the following only if you are requesting protection involving a minor: 16 14 Subject to any court-ordered visitation, Grant me the care, custody and control of the minors named in paragraph 5 above these minors only: 17 Restrain respondent from interfering with my physical or legal custody of the minors named in paragraph 5 above these minors only: 18 Restrain the respondent from removing from the state: paragraph 5 above these minors only: the minors named in Request for Special Assistance From Law Enforcement Agen
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