SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, COUNTY COURTHOUSE, 220 W. BROADWAY, SAN DIEGO, CA 92101 EAST COUNTY DIVISION, 250 E. MAIN ST., EL CAJON, CA 92020 NORTH COUNTY DIVISION, 325 S. MELROSE DR., VISTA, CA 92081 SOUTH COUNTY DIVISION, 500 3RD AVE., CHULA VISTA, CA 91910 PEOPLE OF THE STATE OF CALIFORNIA DEFENDANT FOR COURT USE ONLY SUPERIOR COURT CASE NUMBER DA PETITION TO MODIFY A DOMESTIC VIOLENCE PROTECTIVE ORDER Protected Party's Name: Note: The protected party must appear in person on the date set for this hearing. If the protected party fails to appear in person, the request will not be granted. Background Information. What is your relationship to the defendant? ________________________________________________ Do you and the defendant have children together? Yes No (If yes, you must complete the information sheet on page two.) Are there any children in the home under age 16? Yes No (If yes, you must complete the information sheet on page two.) Do you have family members in this area? Yes No Are you employed outside of the home? Yes No If yes, Explain: Does the defendant abuse drugs/alcohol? Yes No If yes, explain: Prior Abuse. Describe all prior abuse (physical and/or verbal) that has occurred between you and the defendant. Advocacy/Counseling: Have you seen a victim advocate to discuss domestic violence and your safety? Would you like to see an advocate to discuss domestic violence and your safety? What counseling or education have you had specific to domestic violence, if any? Yes Yes No No What are you asking this court to do? (Note: Per Pen. Code § 1203.097, as long as a defendant remains on probation, there must be at least a Limited Protective Order in place. Therefore, Limited Protective Orders cannot and will not be deleted by the court.) Other Orders. Are there any other Family, Juvenile, or Civil court orders presently in effect regarding you and the defendant? Yes No If yes, please provide details, including issuing court, case number, and conditions of order. (Note: Modifying the criminal order at issue here may not affect the terms of other orders. Your Safety. Does the defendant own or have access to firearms? Yes No Justification. What are your reasons for wanting the defendant to be allowed to have contact with you? Additional Information. What other information would you like the court to consider? Date: SDSC CRM-248 (New 4/11) Signature of Protected Party: PETITION TO MODIFY A DOMESTIC VIOLENCE PROTECTIVE ORDER Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com INFORMATION SHEET Protected Party's Name: (LAST, FIRST, MIDDLE) Defendant's Name: (LAST, FIRST, MIDDLE) Children the parties share: Name: (LAST, FIRST, MIDDLE) Name: (LAST, FIRST, MIDDLE) Name: (LAST, FIRST, MIDDLE) Name: (LAST, FIRST, MIDDLE) DOB: DOB: DOB: DOB: Other children in the home under age 16: Name: (LAST, FIRST, MIDDLE) Name: (LAST, FIRST, MIDDLE) Name: (LAST, FIRST, MIDDLE) DOB: DOB: DOB: SDSC CRM-248 (New 4/11) PETITION TO MODIFY A DOMESTIC VIOLENCE PROTECTIVE ORDER Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com