IN THE DISTRICT COURT OF THE ___________JUDICIAL DISTRICT OF THE STATE OF IDAHO, IN AND FOR THE COUNTY OF ____________ MAGISTRATE DIVISION ______________________________________________, ) Petitioner (Person Seeking Protection Order), ) ) vs. ) ) ______________________________________________, ) Respondent (Person You Want Restrained). ) _______________________________________________ ) Case No. SWORN PETITION FOR PROTECTION ORDER THE LAW REQUIRES THAT THE RESPONDENT BE GIVEN A COPY OF THIS COMPLETED FORM. 1. Protected Person(s) I am seeking a protection order for: Myself. The following minor child/ren (first and last names): My relationship to the child/ren is: Custodial Parent Non-Custodial parent Guardian 2. Relationships Please check all that apply to the relationship between the Respondent (person you want restrained) and you or, if you are filing for a minor, the relationship between the Respondent and the minor. Are married. Used to be married. State and county where divorced Are related by blood, marriage or adoption. How? Live together. Used to live together. Last date lived together Are dating. Used to have a dating relationship. Date relationship ended Have a child together. If a dating relationship please describe: (complete for adult or minor in a dating relationship): Nature of relationship Length of time of the dating relationship How often saw each other Time since the relationship ended 3. Residence I live or am staying in County, State of The Respondent does not live with me. SWORN PETITION FOR PROTECTION ORDER County, Idaho. Respondent lives in . Page 1 CAO DV 1-1 Revised 03/12/04 American LegalNet, Inc. www.FormsWorkflow.com I live with the Respondent at . Our home is rented or owned by both of us by me by the Respondent. I have left a residence where I lived with the Respondent. I want to return yes no to get personal belongings Other A business is run from the home. Type of business: The business is run by me by the Respondent If yes, to live by both of us. 4. Child/ren affected by the protection order I am the natural/adoptive parent or legal guardian of the following child/ren: Name (First, Middle Initial, Last) Birth Date Sex How Child is Related to Petitioner Respondent State(s) where child lived last 6 months During the last six (6) months the child/ren have lived with 5. Other court cases List any other court cases relating to the minor child/ren who will be affected by this protection order (divorce, child protection, guardianship, adoption, other protection order, etc.) I have applied for a protection order(s) before in the county of on (date) , against (name) The Respondent has applied for a protection order(s) before in the county of on (date) , against (name) The Respondent has been involved in crimes involving violence, child abuse, weapons, drugs or alcohol. (If checked, please describe what the charges were, when and where they were filed and convictions) I have been involved in crimes involving violence, child abuse, weapons, drugs or alcohol. (If checked, please describe what the charges were, when and where they were filed and convictions) SWORN PETITION FOR PROTECTION ORDER Page 2 CAO DV 1-1 Revised 03/12/04 American LegalNet, Inc. www.FormsWorkflow.com 6. Information about the violence Domestic violence means physical injury, sexual abuse or forced imprisonment or threat thereof. a. Please describe the most recent acts or threats of domestic violence committed by the Respondent against you or the minor child/ren. When? (date and time) Where? (address or general location) Who was present? (minor children, friends, family, etc) What happened? Do not write on the back of this page. Include a separate sheet if you need more room. SWORN PETITION FOR PROTECTION ORDER Page 3 CAO DV 1-1 Revised 03/12/04 American LegalNet, Inc. www.FormsWorkflow.com Was a weapon involved? No Yes How? Describe any injuries. Is there anything else you want the judge to know about what happened? b. Please describe past acts or threats of domestic violence: Do not write on the back of this page. Include a separate sheet if you need more room. 7: I ask the Court to order the following: A. Personal Conduct Order. The Respondent shall not harass, annoy, disturb the peace of, telephone, contact, or otherwise communicate with (either directly or indirectly, in person or through any other person) the Petitioner minor on whose behalf the petition is brought minor child/ren residing in the Petitioner’s household. B. Stay Away Order. The Respondent shall at all times stay away from: My residence at No address is given because I do not want my address on this petition. Protected Minor’s residence at: My workplace and/or school at: Protected Minor’s workplace and/or school at: My child/ren’s school and/or childcare at: Other: C. Move-out Order. The Respondent shall move from the residence at and take from the dwelling only items needed for employment and necessary personal effects (at peace officer’s discretion). SWORN PETITION FOR PROTECTION ORDER Page 4 CAO DV 1-1 Revised 03/12/04 American LegalNet, Inc. www.FormsWorkflow.com D. Child Custody. Temporary custody of the minor child/ren named in Section 4 above, be awarded to: me Respondent. The other parent should have: Visitation as follows (list specific days and times) Neutral drop off and pick up location at Transportation provided by Supervised visitation, why and supervised by whom No visitation. E. Treatment/Counseling. That the Respondent be ordered to participate in treatment or counseling services for (purpose) F. Other relief requested: I SWEAR UNDER OATH OR AFFIRM I HAVE READ THIS APPLICATION, OR HAVE HAD IT READ TO ME, AND THE FACTS STATED IN THIS APPLICATION ARE TRUE. INTENTIONALLY PROVIDING FALSE INFORMATION IS A CRIME. Date: Signed: Petitioner Subscribed and sworn to before me this day of , 20 . Clerk of the District Court By Deputy Clerk SWORN PETITION FOR PROTECTION ORDER Page 5 CAO DV 1-1 Revised 03/12/04 American LegalNet, Inc. www.FormsWorkflow.com