Intimate Partner Sexual Abuse: Adjudicating This Hidden Dimension of Domestic Violence Cases
National Judicial Education Program, Legal Momentum
© 2011 National Judicial Education Program
2like you keep the children” and that the family “would be better off dead than broken.”4.
The following are the names, ages and relationships to the Petitioner and/orRespondent of each and every child in the family household:a)
Name of child:
Age 6 Relationship to Petitioner and Respondent:
Name of child:
Age 3 Relationship to Petitioner and Respondent:
The following aggravating circumstances, if any, are present in this case["Aggravating circumstances" shall mean physical injury or serious physical injury tothe petitioner caused by the respondent, the use of a dangerous instrument againstpetitioner by the respondent, a history of repeated violations of orders of protection bythe respondent, prior convictions for crimes against the petitioner by the respondent orthe exposure of any family or household member to physical injury by the respondentand like incidents, behavior and occurrences which constitute an immediate andongoing danger to the petitioner or any member of the petitioner's family orhousehold]:
Respondent threatened to kill himself, petitioner and their children
(Upon information and belief) The following criminal, matrimonial or FamilyCourt proceeding(s) involving the respondent (has) (have) been filed [indicate thecourt, date and status]:
Indicate whether a previous application has been made to any court or judge forthe relief requested herein and, if so, the relief, if any, granted and the date of suchrelief.
(Upon information and belief) Respondent is licensed or has a license applicationpending to carry, possess, repair, sell or otherwise dispose of the followingfirearms [if known, specify type of firearms, type of license(s), date of issuance of license(s) and expiration date(s), whether license has been suspended or revokedand, if so, the date of such action and, if not currently licensed, whether licenseapplication is pending]:
Respondent is licensed to possess a hunting rifle.