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Petition For Order Of Child Protection (10 Children) CP41 - Missouri
| Petition For Order Of Child Protection (10 Children) Form. This is a Missouri form and can be used in Child Protection Circuit Court Statewide . |
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IN THE _______ JUDICIAL CIRCUIT COURT, _____________________________, MISSOURI Petition for Order of Child Protection Judge or Division: Petitioner: Case Number: Court ORI Number: Related Cases: MSHP Number: Responsible Law Enforcement ORI: Respondent's Home Address: Race: Home Phone Number: Respondent's Work Address: Work Phone Number: Race: Work Hours: Other Locations Where Respondent May Be Served: Protected Child's Relationship to Respondent pursuant to 18 U.S.C. §§ 921(a)(32) and 922(g)(8) determination: Protected Child's Relationship to Respondent (Child 1): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) __________________________________________________ Protected Child's Relationship to Respondent (Child 2): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) __________________________________________________ Protected Child's Relationship to Respondent (Child 3): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) __________________________________________________ Protected Child's Relationship to Respondent (Child 4): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) __________________________________________________ vs. Respondent: Alias/Nicknames: Respondent's DOB: SSN (if known, last four digits): Race: Skin Complexion: Hair Color: Eye Color: Hair Length/Style: Sex: F Age: Height: Weight: M Protected Child's Relationship to Respondent (Child 5): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) __________________________________________________ Protected Child's Relationship to Respondent (Child 6): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) __________________________________________________ Protected Child's Relationship to Respondent (Child 7): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) __________________________________________________ Protected Child's Relationship to Respondent (Child 8): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) __________________________________________________ Protected Child's Relationship to Respondent (Child 9): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) __________________________________________________ Protected Child's Relationship to Respondent (Child 10): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) __________________________________________________ OSCA (08-11) CP41 1 of 11 455.503, 455.505, 455.510, 455.510.3, 455.520 RSMo American LegalNet, Inc. www.FormsWorkFlow.com Protected Child 1: Age of Protected Child: Sex: F M Protected Child 2: Age of Protected Child: F M Sex: Protected Child 3: Age of Protected Child: F M Sex: Protected Child 4: Age of Protected Child: F M Sex: Protected Child 5: Age of Protected Child: Sex: F M Protected Child 6: Age of Protected Child: F M Sex: Protected Child 7: Age of Protected Child: Sex: F M Protected Child 8: Age of Protected Child: F M Sex: Protected Child 9: Age of Protected Child: Sex: F M Protected Child 10: Age of Protected Child: Sex: F M (Date File Stamp) Race: Race: Race: Race: Race: Race: Race: Race: (Identifying Information for use by Law Enforcement) Visible Identifying Marks (e.g., tattoos, birthmarks, braces, mustache, beard, pierced ear, glasses): Complete questions 1 6 for each protected child. Protected Child 1: 1. I am Petitioner and the: (check appropriate boxes) parent or guardian of the child. guardian ad litem for the child. court appointed special advocate for the child. juvenile officer. 2. Respondent is: an adult household member who is residing with the child. an adult household member who resided with the child in the past. an emancipated child who is residing with the child. an emancipated child who resided with the child in the past. an adult stalking the child. a household member under 17 who is residing with the child. a household member under 17 who resided with the child. a person under 17 stalking the child. 3. The act(s) of abuse occurred at ______________________________________ (address) ________________________ (city) ___________________________________ (County/City of St. Louis), Missouri. protected child lives respondent may be served 3.a. The county in which this petition is being filed is where the act(s) of abuse occurred. (check appropriate boxes) 4. The family home of the child is: (check appropriate boxes) owned leased rented By: Respondent Petitioner Other (name)____________________________________ Occupied by: (include name only if different from above) __________________________________________________ Respondent has knowingly and intentionally: (check at least one) caused physical injury to the child. stalked the child. sexually abused the child. inflicted emotional abuse on the child. by the following acts: (Include the most recent date(s) of the acts described.) 5. 6. An immediate and present danger of abuse to the child exists because: (describe) Protected Child 2: 1. I am Petitioner and the: (check appropriate boxes) parent or guardian of the child. guardian ad litem for the child. court appointed special advocate for the child. juvenile officer. 2. Respondent is: an adult household member who is residing with the child. an adult household member who resided with the child in the past. an emancipated child who is residing with the child. an emancipated child who resided with the child in the past. an adult stalking the child. a household member under 17 who is residing with the child. a household member under 17 who resided with the child. a person under 17 stalking the child. 3. The act(s) of abuse occurred at ______________________________________ (address) ________________________ (city) ___________________________________ (County/City of St. Louis), Missouri. protected child lives respondent may be served 3.a. The county in which this petition is being filed is where the act(s) of abuse occurred. (check appropriate boxes) OSCA (08-11) CP41 2 of 11 4
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