Maryland > Statewide > Circuit-District Court > Domestic Violence
Petition For Protection From Domestic Violence Or Child Abuse Or Vulnerable Adult Abuse CC-DC DV 1 - Maryland
| Petition For Protection From Domestic Violence Or Child Abuse Or Vulnerable Adult Abuse Form. This is a Maryland form and can be used in Domestic Violence Circuit-District Court Statewide . |
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Judge Time Hours Minutes CIRCUIT COURT DISTRICT COURT OF MARYLAND FOR City/County Located at Court Address Case No. (NOTE: Fill in the following, checking the appropriate boxes. Petitioners need not give an address if doing so risks further abuse or reveals the confidential address of a shelter. If this is the case, check here If you need additional paper, ask the clerk.) Petitioner Street Address, Apt. No. City, State, Zip Code Home: Work: Telephone Number(s) vs. Respondent Street Address, Apt. No. City, State, Zip Code Home: Work: Telephone Number(s) PETITION FOR PROTECTION FROM DOMESTIC VIOLENCE CHILD ABUSE VULNERABLE ADULT ABUSE 1. I want relief for myself minor child vulnerable adult, from abuse by The Respondent committed the following acts of abuse against on or about, slapping shoving other The details of what happened are: (Describe injuries. State when and where these acts occurred. Be as specific as you can.): Date (check all that apply.) kicking punching choking/strangling stabbing biting shooting rape or other sexual offense (or attempt) mental injury of a child hitting with object detaining against will stalking threats of violence 2. (If the victim is a child or vulnerable adult, fill in the following): I am asking for protection for a vulnerable adult whose name is At this time the victim can be found at I am State's Attorney DSS a relative an adult living in the home. 3. The person(s) I want protected are (include yourself if you are a victim): Names(s) Birthdate child Relationship to Respondent CC-DC/DV 1 (Rev. 10/2011) Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Case No. Petitioner vs. Respondent 4. the person(s) I want protected now lives, or has lived, with the Respondent for the following period of time during the past year: There are are not additional persons living in the home. 5. I know of the following court cases involving me, or the person I want protected, and the Respondent. (Examples include: paternity, child support, divorce, custody, domestic violence, juvenile cases, criminal cases) Court Kind of Case Year Filed Result or Status (if you know) 6. I have received a final protective order against the same respondent that expired within one (1) year of the abuse alleged in this petition, and which was issued for a period of at least six (6) months. Date issued Location where issued City/County/State Date expired 7. Describe all past injuries the Respondent has caused the victim, and give date, if known 8. The Respondent owns or has access to the following firearms: 9. I want the court to order the Respondent: (NOTE: Petitioner need not give an address if doing so risks further abuse.) NOT to abuse or threaten to abuse Name(s) NOT to contact, attempt to contact, harass Name(s) NOT to go to the residence(s) at NOT to go to the school(s) at Address Name of school and address NOT to go to the child care provider(s) NOT to go to the work place(s) at Name of child care provider and address Name(s) CC-DC/DV 1 (Rev. 10/2011) Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Case No. Petitioner vs. Respondent To leave the home at and give possession of the home to The name(s) on the deed or lease are: To turn over firearm(s) to a law enforcement agency. To go to counseling domestic violence drug/alcohol Address other To pay money as Emergency Family Maintenance (may be taken from Respondent's paycheck). 10. I also want the Court to order: Custody of be granted to Name Children's names Use and possession of the following jointly-owned vehicle be granted to Description of vehicle Name Temporary possession of the pet(s) be granted to Name Name and Description 11. (Fill in only if you are seeking Emergency Family Maintenance.) The Respondent has the following financial resources: Income from employment in the amount of $ every week 2 weeks month other Source of employment income Name and address of source and amount(s) received Income from other source Name and address of source and amount(s) received Estimated Value The Respondent also owns the following property of value: Automobile(s) $ Home $ Estimated Value Bank Account(s) $ Estimated Value Estimated Value Other: I solemnly affirm under the penalties of perjury that the contents of the foregoing Petition are true to the best of my knowledge, information and belief. Date -------------------------------------------------------------------------------------------------------- Petitioner I have filled in the Addendum (Description of Respondent), CC-DC/DV 1A NOTE If you believe that you have been a victim of abuse and that there is a danger of serious and immediate injury to you, you may request the assistance of a police officer or local law enforcement agency. The law enforcement officer must protect you from harm when responding to your request for assistance and may, if you ask, accompany you to the family home so that you may remove clothing and medicine, medical devices, and other personal effects required for you and your children, regardless of who paid for them. You are entitled to request that address and telephone number of a victim, a complainant, or a witness be considered for shielding at the filing of this application. NOTICE: Remote access to the name, address, telephone number, date of birth, e-mail address, and place of employment of a victim or non-party witness is blocked. (Md Rule 16-1008(a)(3)(B)) CC-DC/DV 1 (Rev. 10/2011) Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com
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