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Adult Abuse-Stalking Petition For Order Of Protection AA40 - Missouri
| Adult Abuse-Stalking Petition For Order Of Protection Form. This is a Missouri form and can be used in Adult Abuse Circuit Court Statewide . |
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IN THE _______ JUDICIAL CIRCUIT COURT, _____________________________, MISSOURI Judge or Division: Petitioner: Case Number: Court ORI Number: MSHP Number: Responsible Law Enforcement ORI: vs. Related Cases: Respondent: Alias/Nicknames: Respondent's DOB: Age: SSN (if known, last four digits): Race: Hair Color: Eye Color: Respondent's Home Address: (Date File Stamp) Home Phone Number: Respondent's Work Address: Sex: F Height: Weight: M Work phone Number Work Hours Other Locations Where Respondent May Be Served: (Identifying Information for use by Law Enforcement) Visible Identifying Marks (e.g. tattoos, birthmarks, braces, mustache, beard, pierced ear, glasses): Petitioner's Relationship to Respondent pursuant to 18 U.S.C. ยงยง 921(a)(32) and 922(g)(8) determination: Spouse Adults with child(ren) in common Former spouse Adults, intimate residing/resided together Adults are/were in a continuing social relationship of a romantic/intimate nature Adults related by blood. Define relationship: Adults related by marriage. Define relationship: Adults residing/resided together; no intimacy Stalking. Define relationship: Adult Abuse/Stalking Petition for Order of Protection 1. 2. I am Petitioner and at least 17 years of age under 17 but emancipated Respondent is at least 17 years of age under 17 but emancipated under 17 I reside in _______________________________________________ (city), __________________________________ (state), in the County of _____________________________. Respondent may be found in ________________________________________ (city), __________________________ (state), in the County of _____________________________. 3. An act of abuse or stalking occurred at ________________________________________________________________ (address), _______________________________ (city), ___________________ (state), in the County of ______________________________. Respondent and I: (check one or more) are related by blood. are spouses. were spouses. have child(ren) in common. are or were residing together. 4. were related by marriage. are related by marriage. have no relationship other than Respondent has stalked me. are in a continuing romantic or intimate social relationship. were in a continuing romantic or intimate social relationship. Complete for Adult Abuse Petition Only. 5. Respondent and I: (check one or more) reside together. previously resided together at _____________________________________________________________________ (address), _________________________________________________ (city), _____________________________ (state), in the County of _______________________________________. never resided together. Complete for Stalking Petition Only. 6. Respondent is stalking me. Explain relationship (example: co-workers, neighbors, etc.) OSCA (08-11) AA40 (ASPO) 1 of 4 455.010, 455.030, 455.030.3, 455.085 RSMo American LegalNet, Inc. www.FormsWorkFlow.com Complete for Adult Abuse Petition Only. 7. The residence in which I live is: (check one or more) jointly owned, leased or rented or jointly occupied by Respondent and me. owned, leased, rented or occupied by me. jointly owned, leased, rented or occupied by me and someone other than Respondent. owned, leased, rented or occupied by someone else, and Respondent is my spouse. jointly occupied by me and another person, and Respondent has no property interest therein. Respondent has knowingly and intentionally: (check at least one) coerced me stalked me harassed me sexually assaulted me unlawfully imprisoned me followed me from place to place caused or attempted to cause me physical harm placed or attempted to place me in apprehension of immediate physical harm threatened to do any of the above 8. by the following act(s): (Include the most recent date(s) of each act described.) 9. I am afraid of Respondent, and there is an immediate and present danger of abuse or stalking of me because: (describe) 10. Photographs/Exhibits are filed as evidence of my injuries. Complete for Adult Abuse Petition Only. 11. It is in the best interest of the minor children that custody be awarded as follows: Child's Name 1. 2. 3. 4. 5. ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ SSN (last 4 digits only) _______________ _______________ _______________ _______________ _______________ Age _____ _____ _____ _____ _____ Address (If other than Petitioner) _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ Custody Who did each Child reside with during last six months 1. 2. 3. 4. 5. ______________________ ______________________ ______________________ ______________________ ______________________ Relationship to Parties (Explain if not Respondent's Child) Persons to Receive Custody ______________________ ______________________ ______________________ ______________________ ______________________ (check one or both) Temporary Full ________________________ ________________________ ________________________ ________________________ ________________________ (If necessary, attach additional sheets.) 12. Indicate any prior or pending custody court cases before, or orders entered by, this court or any other court involving the following parties. (If none, so state): a. Petitioner______________________________________________________________________________________ b. Respondent ______________________________________________________________________________________________ c. Children (identified in item 11) _______________________________________________________________________________ 13. Order Petitioner's residential address on voter's registration record to be closed to the public. OSCA (08-11) AA40 (ASPO) 2 of 4 455.010, 455.030, 455.030.3, 455.085 RSMo American LegalNet, Inc. www.FormsWorkFlow.com 14. Pursuant to section 455.010 to Section 455.085, RSMo, it is requested that the court issue an Ex Parte Order of Protection restraining Respondent from: (check all that apply) abusing, threatening to abuse, molesting or disturbing the peace of Petitioner wherever Petitioner may be found. stalking Petitioner. entering the family home, place of employment or school of Petitioner located at (see notice below) _________________________________________________, except as specifically authorized by the court. communicating with Petitio
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