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612112010

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Petition

or Pr te ti

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een Plaintiff and Defendant is:

) spouse or ormer pou 0 V n nt [X] pa.IQ11t of a child v i De I.: dant I 1 current or former sexual Or in irnatc partner ith Defendant r Ichild of PI imiff ( ) child of 0 fendant (consanguinit ,) to cndan I Ifamil mcm r rei by mama 'C r ffinity to 0 fendam I ] amity m m I ] i lin (per parcnth 00) of Ieodant Defi ad
t

i.an adult. court actions:

6. Plainriff and Defe t ha been involved in the followin Proteetio From Abu e Other d tail of til court at ion are:
r~ ney PF fi in C nt r County 201 •

7.

een

volved in a crimm»l court action. probation l
Ie minor child/ren:

• Defendant is 01 currentt
8. Plaintiff'and
3.

efendant are th parent ofthe followin
andu

Age:7

Child's addr
b. _ Agc:6 and

is: _

Pert Mali da P

16810

hild' address is: _
and~'ky

P r1

tild,

P

1 70

c.•

Child' addre. is: _Port
9. N inliff i
0110

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P

16870

C' ing an

r er of child cu

t

in i a li:t

I the children and hild

s re th

art

ha

of this petition. lived fOT the past 5 years:

ived \ ith: d with both p 'oliff and dde daD( n Centre

ounty

in

b. _

nd • thi. hild has lived ith: d itb both pLaintiff add fe dan11n
Mtn

or th past )' Minor plajntiff

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61211201

P~g 306 since c. _

irth.
nd this hild . lived with: resided Itb both plaintiff

For the past 5 '
iour p intiff h

d d rendant

entre

ounty

ee HI. ~~
1'1 fth

rIb.
rno 1 recent in iden of abuse

I have Panic D' order and am o OK to do . omething.

av

g fn nd

tay

ilb me orne

i

t bees

e I am

fraid he

committed

ains; Plaintiff or thc minor child/ten,

or incid n of stal ing)

c

folio

and II

Odoberthro On oin: d

'0

ember 200:

fend nt .:rabbed

plaintiffforcdu

ot up d.

thr: ubi to "beat tb property ( h.«ercd pril201 taot :,

ide, made threat to kill p intlfI' fatber m de bit out or' the p opt elpill2 I e phi in tirr oufand made (breats b. d magin , tbrow cbai. punch d Irom door). over. deli ndJtnt ha ... sed plaintiff

COD

ie" "boo

he

plaintiff and ided it call and ~ 1 messages, on f e ook, threat

Defendant • out 00 dat s,

up fake profil

ning plainrifI

fr

n . and

IU'

plai tiff

minor chi I reo'?

l2. (a) Has Defend

I

used or

1

atened

lO

use an, firearm

r othe weapons

8

ainst Plaintl

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6121 010

I' mi n For Prot

Fr m Abuse

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e fa earms, 01 r weapon or ammuniti n Defendant used or threat '1lI.-d to u p ti ioner or th min r hild/ren, cfcnda .10 the be t of 'Y ur n wi cor ny additional firearm other weapon. ammunition firearm Ii n 'e?

o
n or arnmuniti n owned c) IfOl an wer to (b) a VI: i "Y ". li any additi n firearm.oth r we y r In Ih po sion of Defen ani on A1I om nt A to Petition which i i rporatcd by rcfcre into I is pctiti n. (d) Plaintif

DO requ t that the cou order Defendant to re inquis firearms, other weapons or ammunition Ii 'ted n Auechmem A to P 'lion, e Au bent A lO Petition. for a Ii of firearm ' other weapons and ammunition Plaintl re u I the court to 0 er Defe I'll to inqui 13, The sheriff, police epartmen or law enfo nl ft: enc that should be pro ided with a cop oft prot lion ord rare: 11 .enter un a Enrorl':C!ment age tie ~' chldin An Ch01 nt A ihpplicab • 14, re i an immediate and prese
t danger

of fu

r buse from Defendant.
nt fr m

IS, Plaintiff is li 2%. ith Rd
Purt rtf .tilda,

e court to cvi Ide

lud Defen

th

0110\ 'Dg

idence:

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SET FORTH BO ,I R , and AFTER JlEARlN , A R strain Defendant f m abusing. threat
Ih mi child/ren in any pl

THATWO

LD DOTHF.

8.

ing, h

where PI inti

ing, .La) in Plaintiffsnd/0r and/or the child/ren may found, rom

b.
C,

!

ict/exclud

enrum
t

attempting to enter an

from Plaintiff residence and prohibit Defendant mporary or permanen re ide ee 0 I'laintiff. cu, tody of'thc minor child/ten n Defend t and the child/ren:

\ lard Plainnff'tcmporary rc rictions n contact Def, hou

pI e the following

dant rna ha e pbcn contact wit mi r plaJhtLft twice a day erwee of 9: mad 9: Op with the minor pia' tif[ ca i: from pia· tiff'

" phone. l)efenda
children'
t may

va

n'C

p ried
l!

dpa

Jury and Dorutb

of partial eu od

to be arTllngcd throug .. and

minor

d. Prohibit Deren ant from having an contact with Plaintlff an r the min r hildlren. either in per on. b t lephone, or in iting, pel'S nail or through mird pers includlng but n t limited t n c fila I ill Plaintiff' school. b in" plac of

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612112010

Petitior

F r Proietti

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from Abu

0:

P

e 5 ers

employment. C)(OCpt as the court In y find nee und/or i·itation with th minor child/ren.
e

with rc peel

10

partial c

tody

Prohi it Defendant from having any contact with Plaintiff rel ti children list in thi. petiti n, I! eept s th court rna}' find neces partial custody and/or . itatlon with the minor chiktlren.

and PI intiff ' with respect to

T

pi inti

followia pe believes ReI.
Father

n rom

or family and household mern rs that ing and ham ment by 0 fcndant,

hlp

Add

M ther

r.

der Dcf dant to t mporaril . relinquish some or all ofth firearms, other an or ammunition list d n Atta hment A to Petition and any firearm Ii en .n riff of tho . count)' dlor prohibit Defendant from transferring. acquirin po ing me Or all firearm r tI durati J of II on! T. le finan i re ult 0 the abuse. to be determined at the hearing, oft is action. includin reasona I artorney'
f;

w
t Or

g. Dire t Def ndant to pa Plain iff or th reasona

. ffered as the fe .

h. Order Deli ndant ro pay th co
i. Order Defendant to pay Plaintiff J.
mull

filing and

SCTVlC

such other relief

Plaintiff requc

. and/or the court deems appropriate.

r the police, sheriff r other law enforcement agen y to serve Defendant with a p>, f thi petition. an order is: ed, and the order for hearing. PI intiff 'hill inf rrn the d j al d Iluthority of any addrc e. other than t Defendanrs re iden c, wh Defendant can '1'\'00. ERIFICATlO
I veri t I am th pcuuoner dj ted in lh ion and that the facts and tatem nlS contained in th above • ilion are true and rrect 10 th best of my knowled . I understand lhal any false statements re made: 'Ubjccl to til Penalti of 18 P .. J\. 4904. rel ling 10 unsworn fi sification to autboeiti

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6121 010

ABUSE CWECKUST -ATTACHMENT
ExperJenc;ed by .dc(elufan11
emUS

TO PFA PET1T10N

Type of Abu58

Grabbing, siIovTng or~Tng Slopping (with on open hand) Punching (whfl a dosed fIs1) Kldchg Choking Of' 5 r gllng (any grabbing of the neclc)
BttTng

lYe$) ~o Yes eNol

Indlcotw ollhet 'he datu Ihe lneTdents or frequency of the abuse ()(·i I ...Vi."\ O?_

,h.

of

Indimte physIcal InIv"'." if any ~

Wa. ther police contact?

06

Yes (NO.._ Yes i"Nb,) Yes~ Yes (No\ Yet ~ Y s ~)

Forcing sexual contact Fordtig to stay In closet, room,
~~I

.

Of' location PhyskaRy rfifroTnTngj'holdlng Ves <.t!ClI down the victim (r-Y~) No ReceTvad thntafenlng ~ horass~g.phone calls Yes t-to...J Has the d feMant thrlMltened to SdU'f04J' Vm No Does the det.ndont hove

----

'AO\\ \' 10 ,

~C>
.

Yes -(tbl Throat by displayIng 0( pok1tJng w-eopon Uslng a weapon (rndud1nv but Y= ~ not limited to CI flreonnl y~ No Th~at by CI'\Ielry to anTmab YO$ &) PhY*ally abvslng d1i1dr Tn the hOU50hold Sexualty abusIng c:hIldren In Ves @ hoo~d { Y~ No Threat to InIvto selfLolhon (y~ No Thntot by following Thr.at by damoge to ~No

0CCIeSS

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Nome oaUing/dt~ u of I yeS} No ob$oenJtles HO$ ~ plt'f'lcal vrolence Ves' No ~~ incr'e(1sed· 10V rfty or fi~'''T ever lhe past year9 Have yo.J Ie-It the defendant ( ~No (J r living tog&ther during the past )l90rt Yes (N.JV Is the defendant unemployed' Has 1he defendant avoIded Yes ~ b lng 0 l1'f:Sfed for dome:strc violence? Do yov have a mi or child YM@ that's not tho defe!1odo!"11'$i

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