Nevada > Statewide > Harm To Minors
Application For Order For Protection Of Children C-3 - Nevada
| Application For Order For Protection Of Children Form. This is a Nevada form and can be used in Harm To Minors Statewide . |
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Case No. ___________________ Dept. No. ___________________ IN THE JUSTICE COURT OF _____________ TOWNSHIP COUNTY OF __________________, STATE OF NEVADA APPLICATION FOR ORDER FOR _____________________________________ PROTECTION OF CHILDREN ) (NRS 33.400) Applicant(s) ) ) vs. ) _____________________________________ ) Adverse Party(s)) (must be Age 18 or older).) ORDER FOR PROTECTION OF CHILDREN - In addition to any other remedy provided by law, the parent or guardian of a child may petition any court of competent jurisdiction on behalf of the child for a temporary or extended Order against a person who is 18 years of age or older and who the parent or guardian reasonably believes has committed or is committing a crime involving: (a) Physical or mental injury to the child of a nonaccidental nature; or (b) Sexual abuse or sexual exploitation of the child. (NRS 33.400) PLEASE TYPE OR PRINT CLEARLY. 18 19 20 21 22 23 24 25 COMPLETE THE APPLICATION TO THE BEST OF YOUR KNOWLEDGE. I am applying for protection (check all that apply): For my minor child For my ward For my minor child and other person(s) For my ward and for other person(s) Form C3 Application for Order for Protection of Children (NRS 33.400) Page 1 of 7 ©2007 Nevada Supreme Court June 30, 2007 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Applicant states the following facts under penalty of perjury: I reasonably believe that the Adverse Party has committed and/or is committing a crime against a child as defined above. The acts occurred as follows: (NOTE: BE SPECIFIC AS TO WHO COMMITTED WHAT ACTS, AGAINST WHOM, WHEN, WHERE, WHETHER COMMITTED OR THREATENED; INDICATE APPROXIMATE DATE(S) AND LOCATION(S).) THIS FORM IS A PUBLIC RECORD ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 21 ______________________________________________________________________________ 22 23 24 25 NOTE: PLEASE DO NOT WRITE ON THE BACKS OF ANY PAGES; CHECK BOX IF YOU ARE USING ADDITIONAL PAGES. Check if you use a continuation page (to be incorporated by reference) Form C3 Application for Order for Protection of Children (NRS 33.400) Page 2 of 7 ©2007 Nevada Supreme Court June 30, 2007 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Has this matter been reported to law enforcement or child protective services? Yes No If yes, approximate date(s): _____________________________________________________________________ Name of agency: _____________________________________________________________________ Case/Event number if known: _____________________________________________________________________ (IF YOU HAVE A REPORT AVAILABLE, PLEASE ATTACH A COPY OR BRING IT TO THE COURT HEARING.) For purposes of this form, a "TPO Action" is defined to include the following Justice Court actions: (1) An Order for Protection Against Stalking and Harassment (NRS 200.591); (2) An Order for Protection of Children (NRS 33.400); (3) An Order for Protection Against Harassment in the Workplace (NRS 33.270). A "TPO Action" is also defined to include the following Justice/Family/District Court action: (a) An Order for Protection Against Domestic Violence (NRS 33.020) Please Check the Appropriate Box Below: In the last 2 years, Applicant or any party seeking protection has not filed a TPO action against the Adverse Party anywhere in the State of Nevada, and the Adverse Party has not filed a TPO action against Applicant or any party seeking protection anywhere in the State of Nevada. In the last 2 years, the following TPO action(s) in the State of Nevada have been filed involving Applicant and the Adverse Party: Case # (if known) Court Place of (Justice/Family) Filing Approx. Date Filed Outcome (TPO granted, denied, rescinded, etc.) Form C3 Application for Order for Protection of Children (NRS 33.400) Page 3 of 7 ©2007 Nevada Supreme Court June 30, 2007 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Has the Adverse Party ever been involved in any other relevant Court actions (e.g., eviction, divorce, custody, criminal, etc.)? Yes If yes, please explain: ________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Applicant must be at least 18 years of age. If not 18 years of age, consult with the Clerk. 1. a) Applicant's Name ____________________________________________ (Last) (First) (Middle) b) Protected Minor's Name No Age _______ Age ____________________________________________ (Last) (First) (Middle) _______ c) Protected Minor's relationship to Applicant: _______________________________ Protected Minor's relationship to Adverse Party: ___________________________ d) Applicant's relationship to Adverse Party: _________________________________ e) Provide names below of those for whom you are additionally seeking protection, including family and household members that need this protection. Indicate the relationships of all persons listed to the minor and to the Adverse Party (i.e., spouse, intimate partner, friend, roommate, neighbor, relative, acquaintance, co-worker, stranger): NAME OF OTHERS SEEKING PROTECTION AGE RELATIONSHIP TO PROTECTED MINOR RELATIONSHIP TO ADVERSE PARTY Form C3 Application for Order for Protection of Children (NRS 33.400) Page 4 of 7 ©2007 Nevada Supreme Court June 30, 2007 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
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