Iowa > Statewide > District Court > Domestic Violence
Petition For Relief From Domestic Abuse (To Be Filled Out By Parent Or Guardian) - Iowa
| Petition For Relief From Domestic Abuse (To Be Filled Out By Parent Or Guardian) Form. This is a Iowa form and can be used in Domestic Violence District Court Statewide . |
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Print neatly. Use dark ink. You may want to write your answers on scratch paper and then transfer them IN THE IOWA DISTRICT COURT FOR ____________________COUNTY (name of the county where you are filing this petition) _____________________________________________________________________ : : _________________________ : Civil No. ______________________ Plaintiff, :(leave blank - Clerk of Court will fill in) (parent or guardian of : person desiring domestic : abuse protective order) : on behalf of child/ward : : _________________________ : (person desiring domestic abuse order) : PETITION : : FOR RELIEF FROM vs. : : DOMESTIC ABUSE : _________________________ : Defendant. : (alleged domestic abuser) : : Code Ch. 236____________________________________________________________________________ The Plaintiff states: 1. This action is being filed under Iowa Code chapter 236. 2. My child/ward now lives in _______________ County, Iowa. 3. My child/ward is ______ years of age. 4a. I (Plaintiff) can receive mail at the following address: ____________________________________________________________________________ Number, Street City, State Zip Code County4b. My child/ward can receive mail at the following address: (any of the following addresses may be used: your mailing address, the mailing address of a shelter or other agency, a public or private post office box, any other mailing address, with permission of the resident of that address) ____________________________________________________________________________ Number, Street City, State Zip Code County5a. Defendant lives at the following address (if known): ____________________________________________________________________________ Number, Street City, State Zip Code County 5b. Defendant works at the following (if known): ____________________________________________________________________ Employer ____________________________________________________________________________ Number, Street City, State Zip Code County6. Is defendant 17 years of age or younger (if known)? No _____ Yes _____ 1 <<<<<<<<<********>>>>>>>>>>>>> 2 If yes, what is defendants date of birth? / / 7. Give the name and age of each child under age 18 whose welfare may be affected by thecontroversy. Name Birthdate Name Birthdate _________________ __________ _________________ ____________ _________________ __________ _________________ ____________8. Relationship of plaintiff and defendant at the time of the abuse or threat of abuse:(mark only one box) [ ] Married [ ] Lived together within one year [ ] Separated of the assault, but not at the [ ] Divorced time of the assault [ ] Parents of the same minor [ ] Intimate relationship* (under 18) child or children [ ] Have been in an intimate relationship [ ] Living together and have had contact within one year of the assault * * An intimate relationship means a significant romantic involvement that need not include sexual involvement. An intimate relationship does not include casual social relationships or associations in a business or professional capacity. (NOTE: If none of these boxes accurately describes your relationship, do not completethis form. Contact an attorney and/or call the police about your abuse.) 9. Nature of the alleged domestic abuse: (mark all that apply) [ ] Defendant has physically abused my child/ward [ ] Defendant has sexually abused my child/ward [ ] Defendant has threatened her/him and she/he fears for her/his physical safety10a. Describe the most recent injury, and/or nonconsensual (against the will of your child/ward)sexual experience, and/or threats. Please include how it happened, where it happened, andwhen your child/ward were hurt or threatened: (Please note: If child/ward is present at thepreparation of this petition and able to write, she/he may also describe recent injuries or threatsat the end of this petition.) ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ b. Describe any other injuries or threats your child/ward has received from the defendant.Please include how you were hurt or threatened, where it happened and when it happened:____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Mark this box [ ] if additional 8 x 11 sheets are attached. If your child/ward and defendant have no children in common (biological or adopted) 2 <<<<<<<<<********>>>>>>>>>>>>> 3under age 18, skip questions 11 through 18. Questions 11-18 relate to the Uniform Child-CustodyJurisdiction Act and to the courts duty under Iowa Code 236.5(2)(d) (1993). If you are unsure how to answer thesequestions, contact a lawyer for advice. 11. Who should have temporary custody of the minor children your child/ward has in common with the defendant?___ My child/ward ___ Defendant ___ Other (please specify) _____________________12. How will the safety of your child/ward and their children be affected by the courts decision about temporarycustody or temporary visitation? (please explain) ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________13. If your child/ward wants custody of the children in common, provide suggestions for how the defendant could visitthe children without contacting your child/ward -- for example, through friends, relatives, or baby-sitters. List concernsyou have about visitation: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________14. List the minor children (under age 18) your child/ward has in common with the defendant (your grandchildren).(Give each childs name, address and birthdate. If children are living in a shelter or other safe place, give only thecounty and state where they are living.) Name Present Address (or county/state) Birthd
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