Rev. 7/2019 KSJC Page 1 of 7 IN THE DISTRICT COURT OF COUNTY, KANSAS Plaintiff Case No. vs. Defendant Petition Pursuant to K.S.A. Chapter 60 PETITION FOR PROTECTION FROM ABUSE ORDER (K.S.A. 60-3101 et seq.) 1.Plaintiff seeks an order for protection from abuse:(check and fill out either a, b, or c) a. For Plaintiff Only (Kansas law requires a former or current relationship which may be establishedby any one of the following options.) Plaintiff and Defendant: are in a dating relationship were formerly in a dating relationship reside together in the same residence formerly resided together in the same residence have a child in common OR b. For Plaintiff and minor child(ren) Plaintiff is: the parent of the child(ren) an adult who resides with the child(ren) the child(ren)222s court appointed legal custodian the child(ren)222s court-appointed legal guardian. American LegalNet, Inc. www.FormsWorkFlow.com Rev. 7/2019 KSJC Page 2 of 7 (Kansas law requires a former or current relationship which may be established by any one of the following options.) Plaintiff and Defendant: are in a dating relationship were formerly in a dating relationship reside together in the same residence formerly resided together in the same residence have a child in common The minor child(ren) and Defendant: reside together in the same residence formerly resided together in the same residence Plaintiff asks for protection for the following minor child(ren): (give full names and year of birth) NAME YOB PARENT222S NAME PARENT222S NAME OR c. Only for the minor child(ren) Plaintiff is: the parent of the child(ren) an adult who resides with the child(ren) the child(ren)222s court appointed legal custodian the child(ren)222s court-appointed legal guardian. (Kansas law requires a former or current relationship which may be established by any one of the following options.) Minor child(ren) and Defendant: are in a dating relationship were formerly in a dating relationship reside together in the same residence formerly resided together in the same residence have a child in common American LegalNet, Inc. www.FormsWorkFlow.com Rev. 7/2019 KSJC Page 3 of 7 Plaintiff asks for protection for the following minor child(ren): (give full names and year of birth) NAME YOB PARENT222S NAME PARENT222S NAME 2. Defendant can be served at: (please provide all available addresses) HOME: street city state zip code phone number times when defendant is usually there WORK: street city state zip code phone number times when defendant is usually there OTHER: street city state zip code phone number times when defendant is usually there 3. If the defendant is a minor, a Minor Defendant Addendum is attached. 4. Plaintiff needs a protection from abuse because Defendant: (check all that apply) caused Plaintiff bodily injury or attempted to cause Plaintiff bodily injury placed Plaintiff in fear of imminent bodily injury by threatening Plaintiff caused the minor child(ren) bodily injury or attempted to cause the minor child(ren) bodily injury placed the minor child(ren) in fear of imminent bodily injury engaged in any sexual contact or attempted sexual contact with the Plaintiff without consent or when the Plaintiff was incapable of giving consent. engaged in any sexual contact or attempted sexual contact with the minor child(ren) without consent or when the minor child(ren) was incapable of giving consent. engaged in any of the following acts with a minor under 16 years of age who is not the spouse of Defendant: sexual intercourse or lewd fondling or touching on the person of either the minor or Defendant. American LegalNet, Inc. www.FormsWorkFlow.com Rev. 7/2019 KSJC Page 4 of 7 5.Describe why you are asking for a protection from abuse order and include specificfacts: (Attach more pages as needed.) 6.Plaintiff requests that Plaintiff222s address and/or telephone number remain confidential for the following reason(s): (complete if applicable) (If Plaintiff requests that Plaintiff222s address remain confidential, Plaintiff must complete the Protection from Abuse Confidential Address Form and include it with this petition.) 7.Plaintiff requests that the court issue an ex parte Temporary Order of Protection and FinalOrder of Protection restraining defendant from: abusing, molesting or interfering with the privacy or rights of the protected person(s) entering or coming on or around the premises or the residence of the protected person(s) located at: , and the workplace located at: . (Give address or other description of residence and workplace from which Defendant is to be excluded. DO NOT include the residential address if Plaintiff is requesting that Plaintiff222s residential address is to remain confidential.) American LegalNet, Inc. www.FormsWorkFlow.com Rev. 7/2019 KSJC Page 5 of 7 8.Plaintiff states the residence is: jointly owned or rented and jointly occupied by Plaintiff and Defendant owned or rented by Plaintiff owned or rented by Defendant only owned or rented by someone else (explain) not applicable because Plaintiff and Defendant do not live together. Plaintiff requests the court order that the defendant immediately move from and not return to the residence, and that law enforcement officers be directed to remove Defendant from the residence, located at: 9.Plaintiff requests that the court issue an ex parte order of temporary custody of the minorchild(ren) and has attached a completed UCCJEA form. a. Defendant222s parentage of the following child(ren) has NOT been established andDefendant has no right to custody or parenting time with the following child(ren): b. Defendant222s parentage of the following child(ren) has been established and thePlaintiff requests the following custody and parenting time orders concerning thefollowing child(ren): Plaintiff requests the following orders: i.Temporary legal custody (decision-making) and residency of the minorchild(ren) be: Joint legal custody (decision-making) between Plaintiff and Defendant until this order expires. OR Sole legal custody (decision-making) granted to Plaintiff Defendant until this order expires. ii.Rights of temporary parenting time as follows: Defendant shall have no parenting time. American LegalNet, Inc. www.FormsWorkFlow.com Rev. 7/2019 KSJC Page 6 of 7 OR Defendant shall have supervised parenting time as follows: . OR Plaintiff and Defendant shall have parenting time as described in the attached parenting plan. iii. Plaintiff and Defendant shall exchange the minor child(ren) forparenting time at: . 10.The court should give copies of orders to the appropriate law enforcement agencies; set adate, time and hearing on this matter; and issue summons to Defendant notifyingDefendant of this action and the relief requested. 11.After a hearing, the court should issue a Final Order of Protection from Abuse prohibitingDefendant from committing any acts of abuse against the protected person(s), and orderthe following additional relief: (check all that apply) suitable alternate housing for Plaintiff and minor child(ren) custody of the minor child(ren) (UCCJEA form completed) child support support of spouse possession of personal property, and the assistance of law enforcement officers in securing that property, if necessary attorney222s fees, if represented by counsel, and costs counseling for Defendant the transfer of the rights to and billing responsibility for the wireless telephone number of Plaintiff and/or minor child(ren) in the care of Plaintiff other, please specify: 12.The following legal actions have been filed between Plaintiff and Defendant or involvingthe minor child(ren): (check case type, give county filed in, and give case number anddate filed, if known) American LegalNet, Inc. www.FormsWorkFlow.com Rev. 7/2019 KSJC Page 7 of 7 divorce/custody parentage child in need of care action seeking protective order other VERIFICATION I verify under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct. Executed on , 20 . Plaintiff222s Signature Plaintiff222s Name: Address 1: Address 2: City, State, Zip: Telephone Number: (DO NOT include the residential address or telephone number if Plaintiff is re