IN THE IOWA DISTRICT COURT FOR ________________________ COUNTY (name of the county where you are filing this motion) ________________________ Plaintiff, Civil No._________________________ (If you do not know, ask the clerk of court) (person who filed a Petition for Relief From Domestic Abuse ) vs. ________________________ Defendant. AFFIDAVIT TO START CONTEMPT PROCEEDINGS BASED ON A CHAPTER 236 PROTECTIVE ORDER Code ch. 236_________________________ The Court issued a Chapter 236 Temporary Protective Order or Protective Order in this case on the _____ day of ___________________, 20____. I (plaintiff) believe the defendant has willfully violated that Order. I (plaintiff) swear under oath that the following is true and correct: (tell what the defendant did that violated the Protective Order) ______________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________ I REQUEST THAT THE COURT issue a “Show Cause” Order which requires the defendant to appear before the Court and show the Court why he/she should not be held in contempt for not following the Protective Order; direct the sheriff to serve this Affidavit and Order to Show Cause. American LegalNet, Inc. www.FormsWorkflow.com I UNDERSTAND that I must attend the contempt hearing and tell the Court how and when the defendant disobeyed the Protective Order. In addition to my own testimony, I can bring other proof of the violation such as people who saw the defendant violate the order, pictures, medical records, police reports, or anything else that might help to show that judge how the defendant violated the Protective Order. I UNDERSTAND that I may fill out and file this Affidavit by myself or with the help on a lawyer. (Please indicate) [ ] I am receiving no help from a lawyer. I am filing this Affidavit with assistance from: [ ] the County Attorney (Please specify name and address) ______________________________ ____________________________________________________________________________ [ ] another lawyer (Please specify name and address) ___________________________________ ___________________________________________________________________________ STATE OF IOWA COUNTY OF ____________________ ) ) ss: ) (name of county where Notary Public is located) ______________________________________________________ Plaintiff (Sign only in front of a Notary Public) Subscribed and sworn to before me this _________day of ___________________, 20______. __________________________________________________ Notary Public A booklet entitled “How to Protect Yourself from Domestic Abuse Without a Lawyer” is available at http://www.judicial.state.ia.us/Self_Help/Domestic_Violence/index.asp It explains court procedure and gives information about how to contact a lawyer. FOR OTHER GENERAL INFORMATION ABOUT DOMESTIC ABUSE, CALL THE (CONFIDENTIAL) IOWA DOMESTIC ABUSE HOTLINE: 1-800-942-0333 American LegalNet, Inc. www.FormsWorkflow.com