Adult Abuse-Stalking Petition For Order Of Protection
Adult Abuse-Stalking Petition For Order Of Protection Form. This is a Missouri form and can be use in Circuit Court Statewide.
Tags: Adult Abuse-Stalking Petition For Order Of Protection, AA40, Missouri Statewide, Circuit Court
IN THE CIRCUIT COURT OF COUNTY, MISSOURI Judge or Division: Petitioner: Petitioner's DOB: Sex F M Case Number: Court ORI Number: Respondent's Home Address: Race: vs. Home Phone Number: Respondent's Work Address: Respondent: (Date File Stamp) Alias/Nicknames: Work Phone Number: Work Hours: Other Locations Where Respondent May Be Served: Respondent's DOB: SSN (if known): Race: Hair Color: Eye Color: Hair Length/Style: F M Petitioner's Relationship to Respondent: Spouse Unmarried with Child(ren) in Common Ex-Spouse Unmarried, Intimate Residing/Resided Together Related by Blood/Marriage Other (specify) Age: Height: Weight: (Identifying Information for use by Law Enforcement) Visible Identifying Marks (e.g. tattoos, birthmarks, braces, mustache, beard, pierced ear, glasses) Adult Abuse/Stalking Petition for Order of Protection 1. 2. I am Petitioner and Respondent is I reside in in the County of at least 18 years of age at least 18 years of age (city), (city), An act of abuse or stalking occurred at (address), (state), in the County of Respondent and I: (check one or more) are related by blood. are spouses. were spouses. have child(ren) in common. are or were residing together. . were related by marriage. are related by marriage. have no relationship other than Respondent has stalked me. are in a continuing romantic or intimate social relationship. were in a continuing romantic or intimate social relationship. Complete for Adult Abuse Petition Only. 5. Respondent and I: (check one or more) reside together. previously resided together at (address), (city), of (state), . (city), 4. (state), . Respondent may be found in in the County of 3. under 18 but emancipated under 18 but emancipated (state), in the County . never resided together. Complete for Stalking Petition Only. 6. Respondent is stalking me. Explain relationship (example: co-workers, neighbors, etc.) OSCA (12-04) AA40 (ASPO) 1 of 4 455.010, 455.030, 455.030.3, 455.085 RSMo American LegalNet, Inc. www.USCourtForms.com Complete for Adult Abuse Petition Only. 7. The residence in which I live is: (check one or more) jointly owned, leased or rented or jointly occupied by Respondent and me. owned, leased, rented or occupied by me. jointly owned, leased, rented or occupied by me and someone other than Respondent. owned, leased, rented or occupied by someone else, and Respondent is my spouse. jointly occupied by me and another person, and Respondent has no property interest therein. 8. Respondent has knowingly and intentionally: (check at least one) coerced me stalked me harassed me sexually assaulted me unlawfully imprisoned me followed me from place to place caused or attempted to cause me physical harm placed or attempted to place me in apprehension of immediate physical harm. threatened to do any of the above by the following act(s): (Include the most recent date(s) of each act described.) 9. I am afraid of Respondent, and there is an immediate and present danger of abuse or stalking of me because: (describe) 10. Photographs/Exhibits are filed as evidence of my injuries. Complete for Adult Abuse Petition Only. 11. It is in the best interest of the minor children that custody be awarded as follows: Child's Name DOB SSN Age Address (If other than Petitioner) 1. 2. 3. 4. 5. Who did each Child reside with during last six months Relationship to Parties (Explain if not Respondent's Child) Custody Persons to Receive Custody (check one or both) Temporary Full 1. 2. 3. 4. 5. (If necessary, attach additional sheets.) 12. Indicate any prior or pending custody court cases before, or orders entered by, this court or any other court involving the following parties. (If none, so state): a. Petitioner b. Respondent c. Children (identified in item 11) 13. Order Petitioner's residential address on voter's registration records to be closed to the public. OSCA (12-04) AA40 (ASPO) 2 of 4 455.010, 455.030, 455.030.3, 455.085 RSMo American LegalNet, Inc. www.USCourtForms.com 14. Pursuant to Section 455.010 to Section 455.085 RSMo, it is requested that the court issue an Ex Parte Order of Protection restraining Respondent from: (check all that apply) abusing, threatening to abuse, molesting or disturbing the peace of Petitioner wherever Petitioner may be found. stalking Petitioner. entering the dwelling of Petitioner located at (see notice below) communicating with Petitioner in any manner or through any medium. other: 15. It is further requested that, upon the hearing of this cause, the court issue an Order of Protection enjoining the Respondent from the above acts for such time as is necessary to protect Petitioner and that the court: (one or more may be selected) Award custody of the minor child(ren) to Petitioner Respondent. Order visitation with the minor child(ren) to Petitioner Respondent as follows: Order Petitioner Respondent to pay child support to Petitioner Respondent in the amount of $ (check one) per week per month. Order Petitioner Respondent to pay maintenance to Petitioner Respondent in the amount of $ (check per week per month. one) Order that Respondent make or continue to make the rent or motgage payments in the amount of $ on the residence occupied by Petitioner. Order that Respondent pay Petitioner's rent at a residence, other than the residence previously shared with Respondent, in the amount of $ . Order that Petitioner be given temporary possession of the following personal property: Prohibit Respondent from transferring, encumbering, or otherwise disposing of the following property mutually owned or leased with Petitioner: Order Respondent to participate in a court-approved counseling program designed to help batterers stop violent behavior. Order Respondent to pay a reasonable fee for housing and other services provided to Petitioner by a shelter for victims of domestic violence. Order Respondent to pay the cost of medical treatment or services provided to Petitioner as a result of injuries sustained by an act of domestic violence committed by Respondent. Order Respondent to pay court costs. Order Respondent to pay Petitioner's attorneys fees. Other (specify): I swear/affirm under penalty of perjury that these facts are true according to my best know ledge and belief: Date Petitioner's Signature Address (Optional) City, State and Zip NOTICE: Section 455.030.3 RSMo provides that a Petitioner seeking protection under the Adult Abuse Act is not required to reveal any current address or place of residence on this motion. Do not provide this information if doing so will endanger you. Telephone Attorney's Name, Missouri Bar No., if Applicable Address City, State and Zip Telephone OSCA (12-04) AA40 (ASPO) 3 of 4 455.010, 455.030, 455.030.3, 455.085 RSMo American LegalNet, Inc. www.USCourtForms.com Definition of Abuse You are notified that under Section 455.010 (1) RSMo the term “abuse” includes, but is not limited to: 1. 2. 3. the occurrence of, or attempt to do, or threats to do any of the following acts against Petitioner: (a) purposely or knowingly placing pr attempting to place Petitioner in fear of physical harm; (b) purposely or knowingly causing physical harm to Petitioner with or without a deadly weapon; (c) compelling Petitioner by force or threat of force to engage in conduct from which Petitioner has a right to abstain or to abstain from conduct in which Petitioner has a right to engage; (d) engaging in a purposeful or knowing course of conduct involving more than one incident that alarms or causes distress to Petitioner and serves no legitimate purpose. The course of condoct must be such as would cause a reasonable adult suffer substantial emotional distress and must actually cause substantial emotional distress to Petitioner. Such conduct might include, but is not limited to: a. Following Petitioner about in a public place or places; b. Peering in the window or lingering outside the residence of Petitioner; (e) causing or attempting to cause Petitioner to engage involuntarily in any sexual act by force, threat of force, or duress; or (f) holding, confining, detaining, or abducting Petitioner against Petitioner's will. Definition of Stalking You are notified that, under Section 455.010(10) RSMo, “stalking” occurs when an adult purposely and repeatedly engages in an unwanted course of conduct that could cause alarm to a reasonable person. “An unwanted course of conduct” is behavior that serves no legitimate purpose. Such conduct may include following a person or unwanted communication or contact. “Repeated” means two or more incidents that show a continuity of purpose, in other words, that are intended to acuse alarm. “Alarm” means fear of physical harm. OSCA (12-04) AA40 (ASPO) 4 of 4 455.010, 455.030, 455.030.3, 455.085 RSMo American LegalNet, Inc. www.USCourtForms.com