Application For A Temporary And Or Extended Order for Protection Against Domestic Violence | Pdf Fpdf Doc Docx | Nevada

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Application For A Temporary And Or Extended Order for Protection Against Domestic Violence | Pdf Fpdf Doc Docx | Nevada

Application For A Temporary And Or Extended Order for Protection Against Domestic Violence

This is a Nevada form that can be used for Domestic Violence within Statewide, District Court.

Alternate TextLast updated: 5/16/2006

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1 Case No. __________________ Dept. No. __________________ 2 IN THE JUSTICE COURT OF ________________________ TOWNSHIP 3 COUNTY OF _____________________, STATE OF NEVADA 4 _______________________________________, 5 Applica nt, 6 v s. APPLICAT ION FOR A TEMPORARY AND/OR EXTEN DED ORDER FOR PROTECTION 7 _______________________________________, AGAINST DOMESTIC VIOLENCE Advers e Party, 8 9 Applicant states the following facts under penalty of perjury: Applicant Date of Birth: _____________ Adverse Party Date of Birth: ________________ 10 1. My relationship to the Adverse Party is (for example, current/former husband, current/former wife, 11 current/former boyfriend, current/former girlfriend, father, mother, brother sister, etc.): 12 ___________________________________________________. 13 ? Length of relationship: _____________________. 14 ? Have you ever lived together? Yes or No _________. If so, how long? _________. ? Are you living together now? Yes or No __________. 15 ? Date of Separation: __________________________. 16 ? We have child(ren) TOGETHER: Yes or No ___________. If yes, where and with whom are these child(ren) living? 17 ______________________________________________________. 18 2. My address is : CONFIDENTIAL, (If confidential do not write address here) 19 or, if not confidential list 20 _____________________________________________________________________________ 21 City______________________________ State______________ Zip Code__________ 22 Phone_____________ I own rent this residence. Lease/title is held in all the following name(s): 23 _______________________________________________________________________________ 24 _______________________________________________________________________________ I have been living in this residence for ________________________________. 25 3. Adverse Partys address is: 26 ______________________________________________________________________________ 27 City______________________________ State_______________ Zip Code__________ 28 Phone_____________ 1 <<<<<<<<<********>>>>>>>>>>>>> 2 1 Adverse Party has been living in this residence for ____________________________________. 4. My employment is CONFIDENTIAL, (if confidential do not write address here) 2 or, if not confidential, state place of employment ______________________________________ 3 Address: _______________________________________________________________________ 4 City ________________________ County _____________________ State __________________ 5 5. Adverse Partys employment is: _____________________________________________________ 6 7 Address: ________________________________________________ Phone _________________ City __________________________ County ____________________ State _________________ 8 6. (a) The name(s) and dates of birth of minor child(ren) who I am the parent of, or who live in my 9 home, are as follows. 10 NAME (first and last) Date of APPLICANTS CHILD ADVERSE WHO CHILD Birth (Yes/No) PARTYS LIVES WITH CHILD (Yes/No) 11 Circle one Circle one 12 1. Yes No Yes No Circle one Circle one 2. Yes No Yes No 13 Circle one Circle one 14 3. Yes No Yes No Circle one Circle one 4. Yes No Yes No 15 Circle one Circle one 5. Yes No Yes No 16 17 (b) Have you or the Adverse Party ever been awarded custody of the minor child(ren) that 18 you have in common by Court Order? Yes No 19 Who was awarded custody? Applicant Adverse Party By what Court? _____________________________________ Case No. _____________________ 20 7. Please check the appropriate box, IF YOU or the ADVERSE PARTY has ever filed a case in any 21 Court for a Divorce, Custody, Paternity, Child Support, Guardianship, Order for 22 Protection, Stalking/Harassment Order. Please indicate when and where the case was filed, 23 and list the case numbers. _________________________________________________________ _______________________________________________________________________________ 24 8. Has CHILD PROTECTIVE SERVICES (CPS) ever been contacted regarding any member of the 25 household in the past year? Yes No. Is CPS currently involved with this family? 26 Yes No. If yes to the question, give details, including the caseworkers name: ____________ _______________________________________________________________________________ 27 _______________________________________________________________________________ 28 _______________________________________________________________________________ 2 <<<<<<<<<********>>>>>>>>>>>>> 3 1 9. I have been or reasonably believe I will become a victim of domestic violence committed 2 by the Adverse Party. My child(ren) have been or are in danger of being a victim of domestic violence 3 committed by the Adverse Party. 4 5 In the following space, state the facts which support your application. Be as specific as you can, starting with the most recent incident. Include the approximate dates , how long it has gone on, and 6 whether law enforcement or medical personnel have been involved. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Please do not write on the backs of any pages. 3 <<<<<<<<<********>>>>>>>>>>>>> 4 1 10. Have YOU ever been arrested or charged with domestic violence, or any other crime committed against your spouse, partner, or child(ren)? Yes No. If yes, WHEN and where? 2 3 _______________________________________________________________________________ 11. To your knowledge, has the ADVERSE PARTY ever been arrested or charged with domestic 4 violence, or any other crime committed against his/her spouse, partner, or child(ren)? Yes 5 No. If yes, WHEN and where?___________________________________________________ 6 _______________________________________________________________________________ _______________________________________________________________________________ 7 12. An emergency exists, and I need a TEMPORARY ORDER FOR PROTECTION AGAINST 8 DOMESTIC VIOLENCE issued immediately without notice to the Adverse party to avoid 9 irreparable injury or harm. I request that it include the following relief (please check all the 10 choice(s) that apply to you): (a) Prohibit the Adverse Party, either directly or through an agent, from threatening, 11 physically injuring or harassing me and/or my minor child(ren). 12 (b) Prohibit the Adverse Party from any contact with me whatsoever. 13 (c) Exclude the Adverse Party from my residence and order the Adverse Party to stay 14 at least 100 yards away from my residence. (d) Obtain law enforcement assistance t

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