Tennessee > Local County > Shelby > Chancery Court
Petition For Orders Of Protection - Tennessee
| Petition For Orders Of Protection Form. This is a Tennessee form and can be used in Chancery Court Shelby Local County . |
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Petition for Orders of Protection PETITIONER/PLAINTIFF First Middle Last Case No. Court _____________________________ County Tennessee PETITIONER/PLAINTIFF IDENTIFIERS Date of Birth of Petitioner Minor Children Protected Under this Order: ________________________________________________ ________________________________________________ V. RESPONDENT SEX First Middle Last HAIR SOCIAL SECURITY # RESPONDENT IDENTIFIERS RACE DOB HT WT EYES Relationship to Petitioner _________________________________ Respondent's Address ______________________________________ ________________________________________________________ Respondent's Employer __________________________________ Distinguishing Features _____________________________ ________________________ CAUTION: Weapon Involved Relationship Identifiers (Mark all that apply): Parents of Child in Common Child of Respondent Respondent owns/possesses a firearm Current or Former Spouses Child of Respondent's Intimate Partner Live Together or Have Lived Together Other (Explain): _____________________________ Petitioner, __________________________, pursuant to Tennessee Code Annotated, Section 36-3-601 et seq., states: 1. Petitioner and respondent are: Adults or minors who are current or former spouses; (A) (B) Adults or minors who live together or who have lived together; (C) Adults or minors who are dating or who have dated or who have or had a sexual relationship, [as used herein "dating" and "dated" do not include fraternization between two (2) individuals in a business or social context]; (D) Adults or minors related by blood or adoption; (E) Adults or minors who are related or where formerly related by marriage; or (F) Adult or minor children of a person in a relationship that is described in subdivisions (A)-(E); or (G) Respondent has stalked Petitioner; or (H) Respondent has sexually assaulted the Petitioner Revised 7-1-05 Page 1 of 4 American LegalNet, Inc. www.USCourtForms.com 2. The Parties have _______ minor child(ren). (Write name and age of each child below.) ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 3. (Check ONE of the following if custody of minor child(ren) is involved:) _______ The health, safety, or liberty of the petitioner and/or the parties' minor child(ren) would be jeopardized by disclosure of identifying information. OR _______ The child(ren)'s present address is _____________________________________________. The child(ren) has/have lived at the following address(es) for the past five years: ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ AND _______ The names and addresses of the persons with whom the parties' minor child(ren) has/have lived during the last five years are: ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 4. (Check ONE of the following if custody of minor child(ren) is involved:) _______ Petitioner is not aware of any prior pending actions concerning the custody of the parties' minor child(ren) in this or any other State. OR _______ Petitioner is aware of the following prior or pending actions concerning the custody of the parties' minor child(ren) in this or any other State: ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 5. (Check ONE of the following if custody of minor child(ren) is involved:) _______ Peitioner does not know of any person not a party to this proceeding who has physical custody of the parties' minor child(ren) or claims rights of custody or visitation with the parties' minor child(ren). OR _______ Petitioner knows of the following person(s) who have physical custody of the parties' minor child(ren) or claim rights of custody or visitation with the parties' minor child(ren): ________________________________________________________________________________________________ ________________________________________________________________________________________________ 6. Petitioner has been subject to threatened with or placed in fear of domestic abuse, stalking or sexual assault by respondent. Specifically, respondent has: (Write what happened, when it happened, and where it happened on the following lines; attach additional pages if necessary.) ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Revised 7-1-05 Page 2 of 4 American LegalNet, Inc. www.USCourtForms.com 7. Petitioner is in an immediate and present danger of abuse by respondent. 8. Petitioner's minor child(ren) is/are in immediate and present danger of abuse by respondent. (For Paragraphs 9 through 14, check ONLY the paragraphs that apply.) _______ 9. Petitioner need support for the parties' minor child(ren). _______ 10. Petitioner needs support for the petitioner. _______ 11. Respondent refuses to leave the parties' resident. (If you check paragraph 11, plea
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