CIRCUIT COURT DISTRICT COURT OF MARYLAND FOR Located at Case No. Court Address vs. Petitioner City/County Street Address, Apt No. Respondent Street Address, Apt No. Home: Home: Work: Telephone Number(s) City, State, Zip Code Work: Telephone Number(s) City, State, Zip Code PETITION FOR PERMANENT PROTECTION FROM DOMESTIC VIOLENCE (Family Law 4-506(h)) (NOTE: Fill in the following, checking the appropriate boxes. Petitioners need not give an address if doing so risks further abuse or reveals the confidential address of a shelter. If this is the case, check here . If you need additional paper, ask the clerk.) 1. I want relief for myself minor child vulnerable adult, from abuse by . 2. I was a victim of the abuse and a person eligible for relief under this statute in Case No. , and granted a Final Protection Order in said case. 3. The person(s) I want protected are persons who were protected under the Final Protection Order in Case No. (include yourself if you are a victim): Names(s) 4. Birthdate Relationship to Respondent , the Respondent in this petition, was the respondent in Case No. . 5. The respondent was convicted in Criminal Case No. served a term of imprisonment of at least five years for and . Crime for which Sentence was served 6. The acts of abuse for which the Respondent was incarcerated led to the issuance of the Final Protection Order in Case No. . I solemnly affirm under penalties of perjury that the contents of the foregoing are true to the best of my knowledge, information and belief. Date I have filled in the Addendum (Description of Respondent), CC-DC/DV 1A. CC-DC/DV 18 (4/2009) Petitioner American LegalNet, Inc. www.FormsWorkflow.com