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 County, Washoe, District Court.

Alternate TextLast updated: 4/13/2015

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1 2 3 4 5 6 7 8 9 Code: 1255 IN THE FAMILY DIVISION OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNT OF WASHOE _______________________________________, 10 Applicant, 11 Dept No. 12 13 14 15 16 17 18 19 20 21 22 23 ________________________________________, Adverse Party. APPLICATION FOR A TEMPORARY AND/OR EXTENDED ORDER FOR PROTECTION AGAINST DOMESTIC VIOLENCE vs. Case No. Please write or print clearly. Use black or dark blue ink. Complete this Application to the best of your knowledge. Applicant states the following facts under penalty of perjury: 1. Applicant's Date of Birth: _____________ Adverse Party's Date of Birth: ___________ Relationship: I am the __________________(for example, wife, ex-husband, girlfriend, father, sister, etc.) of the Adverse Party. (a) (b) Length of relationship: _____________________. Have you ever lived together? Yes Are you living together now? Yes No No If so, how long? _____________ 24 25 26 27 28 (c) (d) (e) Date of Separation: __________________________. We have child(ren) TOGETHER: Yes or No If yes, where and with whom are these child(ren) living? _____________________________________ 2. My address is: CONFIDENTIAL. (If confidential, do not write address here) If address is not confidential, write below: 1 Address__________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 4 5 City______________________________ State__________ Zip Code_________________ I own rent this residence. Lease/title is held in all the following name(s): _________________________________________________________________________ How long have you been living in this residence? _________________________________. 3. 6 7 8 9 10 11 Adverse Party's address is: Address________________________________________________________________ City______________________________ State_________ Zip Code________________ How long has the Adverse Party been living in this residence?_____________________. 4. My place of employment is CONFIDENTIAL. (If confidential, do not write address here) If not confidential, state place(s) of employment: Name of employer_________________________________________________________ 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Address: _________________________________________Phone__________________ City _____________________________ County ____________________State________ Name of employer_________________________________________________________ Address: _________________________________________Phone__________________ City _____________________________ County ____________________State________ Name of employer_________________________________________________________ Address: _________________________________________Phone__________________ City _____________________________ County ____________________State________ 5. Adverse Party's employer is:________________________________________________ Address: ________________________________________________Phone __________ City _____________________________County ____________________State________ 6. (a) The name(s) and date(s) of birth of the minor child(ren) of whom I am the parent, appointed guardian, or who live in my home, are as follows: NAME (first and last) DATE OF BIRTH APPLICANT'S CHILD (Yes/No) ADVERSE PARTY'S CHILD (Yes/No) Circle one Yes Circle one Yes WHO CHILD LIVES WITH 1. 28 2. Circle one Yes Circle one Yes 2 No No No No American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 4 5 6 7 8 NAME (first and last) DATE OF BIRTH APPLICANT'S CHILD (Yes/No) ADVERSE PARTY'S CHILD (Yes/No) Circle one Yes Circle one Yes Circle one Yes Circle one Yes WHO CHILD LIVES WITH 3. Circle one Yes Circle one Yes Circle one Yes Circle one Yes No No No No 4. 5. 6. No No No No 9 10 (b) Have you or the Adverse Party ever been awarded custody/guardianship of the minor 11 child(ren) by Court Order? 12 13 14 15 16 17 Yes No Applicant Adverse Party Who was awarded custody/guardianship? By what Court? __________________________________________________________ Court Case No. (if known) __________________________________________________ 7. Please check the appropriate box, IF YOU or the ADVERSE PARTY have ever filed a case in any court for a Divorce, Custody, Paternity, Child Support, Guardianship, Order for Protection Against Domestic Violence, or 18 19 20 21 22 23 Stalking/Harassment Order. Please indicate when and where the case(s) was filed, and list the case number(s) if known. ______________________________________________________________________________ ______________________________________________________________________________. 8. (a) Has CHILD PROTECTIVE SERVICES (CPS) ever been contacted regarding any member of the household in the past year? Yes No Yes No (b) Is CPS currently involved with your family? 24 25 26 27 28 If yes, give details, including the caseworker's name: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________. 3 American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 4 5 9. (a) Does the Adverse Party possess a firearm, or does the Adverse Party have a firearm under his or her custody or control? Yes No I don't know (b) Has the Adverse Party ever threatened, harassed, or injured you, the minor child(ren), or anyone else with a firearm or any other weapon? If yes, give details: ______________________________________________________________________________ Yes No I don't know 6 7 8 9 10 11 ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________. 10. (a) I have been or reasonably believe I will become a victim of domestic violence committed by the Adverse Party. (b) 12 13 14 15 The child(ren) have been or are in danger of becoming a victim of domestic violence committed by the Adverse Party. In the following space, state the facts that support your Application. Be as specific as you can, starting with the most recent incident. Include the approximate dates and locations, and whether law enforcement or medical personnel have been involved. THIS APPLICATION IS A PUBLIC RECORD 16 17 18 19 20 21 2

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