Kansas > Local District Court > 4th Judicial District > Domestic
Petition For Protective Order (Protection From Abuse) - Kansas
| Petition For Protective Order (Protection From Abuse) Form. This is a Kansas form and can be used in Domestic 4th Judicial District Local District Court . |
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IN THE DISTRICT COURT OF _____________________ COUNTY, KANSAS ______________________________, Plaintiff vs. Case No. _____________________________________________, Defendant PETITION FOR PROTECTIVE ORDER (Pursuant to K.S.A. 60-3101, et seq.) 1. I live in the City of _________________, in the County of __________________, Kansas. 2. I have filed __________ (give number) petitions for protection from abuse in the past twelve months. The dates of these petitions are _________________________________. These petitions were filed in the counties of . (State which petitions, if any, involved abuse of a minor child) .3. I am seeking protection for: (check all that apply) _____ myself _____ my minor children (under age 18) _____ minor children who live with me 4. The defendant and I: (answer all that apply if you are asking for protection for yourself) _____ are currently in a dating relationship _____ were formerly in a dating relationship _____ currently live together in the same residence _____ formerly lived together in the same residence _____ have never lived together in the same residence _____ have had a child in common (If you are alleging that you and the defendant are or were in a dating relationship, briefly describe that relationship): The residence is: (answer if you want the judge to order the defendant to move) _____ a) jointly owned, or rented and jointly occupied by defendant and me _____ b) owned, or rented by me _____ c) owned, or rented by someone else (explain) _____ d) owned, or rented by me and someone else _____ e) a home in which I have no property interest, but the defendant is my spouse _____ f) not applicable because the defendant and I do not live together. Page 1 <<<<<<<<<********>>>>>>>>>>>>> 25. The minor child(ren): (check all that apply if you are asking for protection for minor child(ren)) _____ is currently in a dating relationship with the defendant _____ was formerly in a dating relationship with the defendant _____ currently lives with the defendant _____ currently lives with me _____ formerly lived with the defendant _____ has never lived with the defendant _____ has had a child in common with the defendant (If you are alleging that the minor child and the defendant are or were in a dating relationship, briefly describe that relationship): 6. The following legal actions have been filed between me and the defendant or involving the minor children: (check case type, give county filed in, and give case number and date filed, if known) _____ divorce/custody _____ paternity _____ child in need of care _____ action seeking protective order _____ other 7. These minor children are involved in this matter: (give full names and ages) 8. I am seeking protection from abuse because the defendant, (name of person you are seeking protection from) has: (check all that apply) _____ caused me bodily injury or attempted to cause me bodily injury _____ placed me in fear of imminent bodily injury by threatening me _____ caused the minor children bodily injury or attempted to cause them bodily injury _____ placed the minor children in fear of imminent bodily injury _____ engaged in any of the following acts with a minor under 16 years of age who is not the spouse of the defendant: sexual intercourse or lewd fondling or touching of the person of either the minor or the defendant9. The acts complained of occurred on these dates: 10. (Briefly describe the facts about why you are seeking a protection from abuse order): Page 2<<<<<<<<<********>>>>>>>>>>>>> 311. The defendant can be found at: (give all available addresses) HOME: Street City State Zip Code Phone Number Times when defendant is usually there WORK: Street City State Zip Code Phone Number Times when defendant is usually there OTHER: Please explain: Street City State Zip Code Phone Number Times when defendant is usually there WHEREFORE, plaintiff requests that the Court issue an order of protection restraining defendant from: _____ a) abusing, molesting or interfering with the privacy or rights of the plaintiff and the minor child(ren) _____ b) entering or coming on or around the premises or the residence of the plaintiff located at: (Give address or other description of residence from which defendant is to be excluded.)I am requesting that my ____ address and ____ telephone number remain confidential for the following reason: (complete if appropriate) FURTHER, plaintiff requests that the Court also issue the following order(s): (check if appropriate) _____ c) defendant immediately move from and not return to the residence located at: (You must include your address if defendant is ordered to be removed from the residence) _____ d) law enforcement officers be directed to evict the defendant from the residence located at: ____________________________________________ _____ e) law enforcement officers be directed to grant any assistance necessary to protect plaintiff and child(ren) from abuse Plaintiff further requests that copies of orders be given to the appropriate law enforcementagencies; that the Court issue an ex parte order of temporary custody of the minor child(ren), ifappropriate; that a date, time and place for a hearing on this matter be set; and that summons beissued to defendant, notifying the defendant of this action and the relief requested. Page 3 <<<<<<<<<********>>>>>>>>>>>>> 4 Plaintiff further requests that upon hearing of this cause, the Court issue a final order ofprotection, enjoining defendant from any acts of abuse against the plaintiff and the plaintiffschild(ren), and that the Court award to plaintiff the following additional relief:_____ a) suitable alternative housing for plaintiff and minor child(ren) _____ b) custody of the minor child(ren) _____ c) child support _____ d) support of spouse _____ e) possession of personal property, and the assistance of a law enforcement officer in securing that property, if necessary _____ f) attorneys fees, if represented by counsel; and costs _____ g) counseling for defendant _____ h) other, please specify: and for such other and further relief, all as appropriate and as the Court deems necessary. Plaintiffs signature(If attorney represents the plaintiff, the attorneys address and phone number must be provided.) VERIFICATION STATE OF KANSAS ) ) ss: COUNTY OF __________ ) _____________________________, of lawful age, being first duly sworn states that(she)(he) is the plaintiff in the above action; that (she)(he) has read the foregoing Petition an
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