Petition for Relief from Domestic Abuse on Behalf of a Ward Read Protect Yourself from Domestic Violence on the Iowa Judicial Branch website before using this form. The booklet explains court procedures and provides information about how to contact an attorney. You may want to or should see an attorney: If you do not know how to use this form or if you do not understand this form. If you think Defendant will hire an attorney. If you think Defendant will try to get custody of your children. Caution: You must provide any protected or confidential information in full on a separate Protected Information Disclosure form. For other general information about domestic abuse, call the confidential Iowa Domestic Violence Hotline: 1-800-942-0333. In the Iowa District Court for County County where Petition is filed Plaintiff Full name of parent or guardian seeking relief from domestic abuse on behalf of Ward Initials of Ward, if a minor child, in need of relief from domestic abus e vs. Defendant Full name of alleged domestic abuser Civil no. Leave blank 226 Clerk of court will fill in Petition for Relief from Domestic Abuse on Behalf of a Ward Iowa Code ch. 236 If you need assistance to participate in court due to a disability, contact the disability coordinator at: () Persons who are hearing or speech impaired may call Relay Iowa TTY (1-800-735-2942). Disability coordinators cannot provide legal advice. Disability coordinator contact information available at: http://www.iowacourts.gov/Administration/Directories/ADAAccess/ . 1. I understand that this action is being filed under Iowa Code chapter 236. 2. My Ward now lives in County, Iowa. 3. My Ward is years of age. 4. Mailing addresses A. I can receive mail at the following address: Any of the following addresses may be used: a mailing address, the mailing address of a shelter or other agency, a public or private post office box, or any other mailing address with permission of the resident of that address. Plaintiff222s mailing address City State ZIP code County B. My Ward can receive mail at the following address: Any of the following addresses may be used: a mailing address, the mailing address of a shelter or other agency, a public or private post office box, or any other mailing address with permission of the resident of that address. Ward222s mailing address City State ZIP code County 5. Defendant lives at the following address (if known): Defendant222s home address City State ZIP code County 6. Defendant222s employer and work address (if known): Employer Defendant222s work address City State ZIP code County November 2014 Petition for Relief from Domestic Abuse on Behalf of a Ward Page 1 of 8 American LegalNet, Inc. www.FormsWorkFlow.com Petition for Relief from Domestic Abuse on Behalf of a Ward, continued 7. Defendant is 17 years of age or younger (if known) Yes No If yes, provide Defendant's year of birth: yyyy 8. Identification and age of each child under age 18 whose welfare may be affected by this controversy: Use a Protected Information Disclosure form to provide full names and birthdates to the court. First, middle, and las t initials of each child Birth year First, middle, and last initials of each child Birth year A. D. B. E. C. F. Check this box if you have attached sheets with additional information. 9. Relationship of Plaintiff and Defendant at the time of the abuse or threat of abuse: Check only one A. Married B. Separated C. Divorced D. Adult relatives living together E. Parents of the same minor child or children under age 18 F. Living together G. Lived together within one year of the assault, but not at the time of the assault H. Intimate relationship* I. Have been in an intimate relationship and have had contact within one year of the assault* * An 223intimate relationship224 means a significant romantic involvement that need not include sexual involvement. An intimate relationship does not include a casual social relationship or association in a business or professional capacity. Note: If none of these boxes accurately describes your relationship, do not complete this form. Contact an attorney or call the police about your abuse. 10. Nature of the alleged domestic abuse Check all that apply A. Defendant has physically abused my Ward. B. Defendant has sexually abused my Ward. C. Defendant has threatened my Ward and the Ward fears for his or her physical safety. November 2014 Petition for Relief from Domestic Abuse on Behalf of a Ward Page 2 of 8 American LegalNet, Inc. www.FormsWorkFlow.com Petition for Relief from Domestic Abuse on Behalf of a Ward, continued 11. Injuries A. Describe the most recent injury, including threats and any nonconsensual (against the will of your Ward) sexual experience. Please include how the injury or threat happened, where it happened, and when your Ward was injured or threatened. Please note: If the Ward is present during preparation of this Petition and is able to write, the Ward may also describe recent injuries or threats at the end of this Petition. Check this box if you have attached sheets with additional information. B. Describe any other injuries or threats your Ward has received from Defendant. Please include how your Ward was injured or threatened, where it happened, and when it happened. Check this box if you have attached sheets with additional information. Note: If your Ward and Defendant have no children in common (biological or adopted) under age 18, skip questions 12 through 19. Questions 12-19 relate to the Uniform Child Custody Jurisdiction and Enforcement Act and to the court's duty under Iowa Code section 236.5(1)(b)(5) (2013). If you are unsure how to answer these questions, contact a lawyer for advice. 12. Who should have temporary custody of the children the Ward has in common with Defendant? Check one My Ward Defendant Other Identify 13. Explain how the safety of your Ward and the children of the Ward will be affected by the court's decision about temporary custody or temporary visitation. 14. If your Ward wants custody of the children in common, provide suggestions for how Defendant could visit the children without contacting your Ward227for example: through friends, relatives, or baby-sitters. List any concerns you may have about visitation: November 2014 Petition for Relief from Domestic Abuse on Behalf of a Ward Page 3 of 8 American LegalNet, Inc. www.FormsWorkFlow.com Petition for Relief from Domestic Abuse on Behalf of a Ward, continued 15. Identify the minor children (under age 18) your Ward has in common with Defendant. Give each child's initials, address, and birthdate. If children are living in a shelter or other safe place, give only the county and state where they are living. Child222s initials Present address (or county/state) Birth year 16. If your Ward222s minor children have lived with people other than your child or Defendant during the last five years, list those other persons and places: Initials Person(s) lived with Address at that time From when to when in last 5 years to to to to Check this box if you have attached sheets with additional information accounting for each child222s living situations over the last five years. 17. Give the present address of each adult listed in question 16, above: Person(s) Ward lived Present address with (other than you) 18. Has there ever been any court case concerning custody of the minor children that your Ward has in common with Defendant in Iowa or any other state? Yes No If yes, explain: 19. Do you, Plaintiff, know of any other person who has physical custody of the Ward222s children or claims to have custody or visitation rights respect to the children? Yes No If yes, explain: Check this box if you have attached sheets with additional information. November 2014 Petition for Relief from Domestic Abuse on Behalf of a Ward Page 4 of 8 American LegalNet, Inc. www.FormsWorkFlow.com Petition for Relief from Domestic Abuse on Behalf of a Ward, continued 20. Request for Court Order You may get two kinds of orders. A short-term order lasts until a hearing is held (within 15 days). A long-term order lasts up to one year, and is issued only after a full hearing. You can ask