Petition For Order Of Child Protection
Petition For Order Of Child Protection Form. This is a Missouri form and can be use in Circuit Court Statewide.
Tags: Petition For Order Of Child Protection, CP40, Missouri Statewide, Circuit Court
IN THE _____ JUDICIAL CIRCUIT COURT, ____________________________, MISSOURI Judge or Division: Case Number: Court ORI Number: Respondent’s Home Address: Petitioner: Protected Child: DOB/Age of Protected Child: Sex: F M Race: vs. Respondent: Alias/Nicknames: Respondent’s DOB: SSN (if known): Race: Sex: F Skin Complexion: Age: Hair Color: Height: Eye Color: Weight: Hair Length/Style: (Identifying Information for use by Law Enforcement) Home Phone Number: Respondent’s Work Address: (Date File Stamp) Work Phone Number: Work Hours: Other Locations Where Respondent May Be Served: M Protected Child’s Relationship to Respondent: Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify): Visible Identifying Marks (e.g., tattoos, birthmarks, braces, mustache, beard, pierced ear, glasses) ___________________________________________________________________________________________________________ Petition for Order of Child Protection 1. I am Petitioner and the: (check appropriate boxes) parent or guardian of the child. guardian ad litem for the child. court appointed special advocate for the child. juvenile officer. 2. Respondent is: an adult household member who is residing with the child. an adult household member who resided with the child in the past. an emancipated child who is residing with the child. an emancipated child who resided with the child in the past an adult stalking the child. 3. The act(s) of abuse occurred at ______________________________________ (address) ________________________ (city) ___________________________________ (County/City of St. Louis), Missouri. 3.a. The county in which this petition is being filed is where the protected child lives respondent may be served act(s) of abuse occurred. (check appropriate boxes) 4. The family home of the child is: (check appropriate boxes) owned By: leased Respondent rented Petitioner Other (name)____________________________________ Occupied by: (include name only if different from above) __________________________________________________ OSCA (2-19-08) CP40 1 of 4 455.503, 455.505, 455.510, 455.510.3, 455.520 RSMo American LegalNet, Inc. www.FormsWorkflow.com 5. Respondent has knowingly and intentionally: (check at least one) caused physical injury to the child. stalked the child. sexually abused the child. inflicted emotional abuse on the child. by the following acts: (Include the most recent date(s) of the acts described.) 6. An immediate and present danger of abuse to the child exists because: (describe) 7. It is in the best interest of the child(ren) that custody be awarded as follows: Child’s Name Relationship to Parties Person to Receive Custody ______________________ _________________________ _______________________ ______________________ _________________________ Full _______________________ ______________________ 8. _________________________ Temporary _______________________ 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. c. 9. Respondent:_________________________________________________________________________ Child(ren) (identified in item 7):_________________________________________________________ Pursuant to Sections 455.510 to 455.520 RSMo, it is requested that the court issue an Ex Parte Order of Protection restraining Respondent from: (check boxes that apply) Abusing, threatening to abuse, stalking, molesting, or disturbing the peace of the child victim. Having any contact with the child victim, except as specifically authorized by this Order. 10. It is further requested that the Ex Parte Order of Protection exclude Respondent from the family home of the child victim(s) because: • It is in the best interest of the child(ren) remaining in the home; • A substantial risk to the child(ren) exists unless Respondent is excluded; • A remaining adult family or household member is able to care adequately for the child(ren) in the absence of Respondent; and • A commitment has been obtained from the Children’s Division to provide appropriate social services to the family or household members during the period of time during which an Order of Protection is in effect. 11. Exclusion of the Respondent from the family home of the child victim is not being requested. OSCA (2-19-08) CP40 2 of 4 455.503, 455.505, 455.510, 455.510.3, 455.520 RSMo American LegalNet, Inc. www.FormsWorkflow.com 12. It is further requested that, upon the hearing of this cause, the court issue a Full Order of Child Protection and: (check boxes that apply). Order Respondent not to stalk, abuse, threaten to abuse, molest, or disturb the peace of the child victim. Order Respondent not to have any contact with the child victim, except as specifically authorized by this order. Order Respondent not to enter the family home of the child victim, except as specifically authorized by this order. Award custody of the child(ren) to ___________________________________________________________________ Award visitation with the child(ren) as follows: _________________________________________________________ _____________________________________________________________________________________________ Order Respondent to pay child support to Petitioner in the amount of $ ____________ per week per month. Order Respondent to pay maintenance to Petitioner in the amount of $ ____________ per week per month. Order Respondent to make an assignment of periodic earnings or other income. Order Respondent to participate in a court approved counseling program to help child abusers stop violent behavior. Order Respondent to participate in a court approved counseling program to treat substance abuse. Order Respondent to pay the costs of his or her treatment and of the treatment of the child victim. Order Respondent to pay or to continue to pay the rent or mortgage payments on the residence occupied by the child victim in the amount of $ ___________ per _____________________. Order Respondent to pay a reasonable sum for housing and other services provided to the child victim by a shelter for victims of domestic violence. Order Respondent to pay court costs. Order Respondent to pay Petitioner’s attorney fees. I believe that revealing my address will endanger myself or the protected child. (Note: If checked, complete the Child Protection Petitioner and Protected Child Information (Confidential Record) form.) I swear/affirm under penalty of perjury that these facts are true according to my best knowledge and belief. ____________________________________________ Date NOTICE: Section 455.510.3 RSMo provides that a Petitioner seeking protection under the Child Protection Orders Act is not required to reveal any current address or place of residence of the child on this petition. Do not provide this information if doing so will endanger the child. ____________________________________________ Petitioner’s Signature ____________________________________________ Address (Optional) ____________________________________________ City, State and Zip ____________________________________________ Telephone ____________________________________________ Attorney’s Name, Missouri Bar No., if Applicable ____________________________________________ Address ____________________________________________ City, State and Zip ____________________________________________ Telephone OSCA (2-19-08) CP40 3 of 4 455.503, 455.505, 455.510, 455.510.3, 455.520 RSMo American LegalNet, Inc. www.FormsWorkflow.com Definition of Abuse You are notified that, under Section 455.501(1) RSMo, the term “abuse” includes any physical injury, sexual abuse, or emotional abuse inflicted on a child, other than by accidental means, by an adult household member or the stalking of a child. Discipline, including spanking, administered in a reasonable manner shall not be construed to be abuse. Definition of Stalking You are notified that, under Section 455.501(10) RSMo, “stalking” occurs when an adult purposely and repeatedly engages in an unwanted course of conduct that would 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 cause alarm. “Alarm” means fear of physical harm. OSCA (2-19-08) CP40 4 of 4 455.503, 455.505, 455.510, 455.510.3, 455.520 RSMo American LegalNet, Inc. www.FormsWorkflow.com