PLAINTIFF’S MOTION TO MODIFY OR TERMINATE ABUSE PREVENTION ORDER DOCKET NO. (FOR COURT USE ONLY) PLAINTIFF’S NAME TRIAL COURT OF MASSACHUSETTS DEFENDANT’S NAME COURT DIVISION ________________________________________, Plaintiff in the above entitled matter, respectfully moves that this court modify or terminate the abuse prevention order issued pursuant to G.L. c. 209A. In support of this request, the Plaintiff states: ______________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ Plaintiff: Please read and check box below. I understand that I can request at any time a new abuse prevention order, if the Defendant harms or attempts to harm me physically; or places me in fear of imminent serious physical harm; or, by using force, threat or duress, makes me engage in sexual relations. Signed under the penalties of perjury. ___________________________________________ Signature of Plaintiff The motion is: ALLOWED ________________ Date DENIED __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ SIGNATURE OF JUDGE PRINT/TYPE NAME OF JUDGE WITNESS - FIRST OR CHIEF JUSTICE FA-13 (1/12) DATE OF ORDER TIME OF ORDER A true copy, attest (Asst.) Clerk-Magistrate/ (Asst.) Register of Probate COURT COPY A.M. P.M. American LegalNet, Inc. www.FormsWorkFlow.com