WCJC FORM 17.0: HOW TO COMPLETE A PETITION FOR A JUVENILE CIVIL PROTECTION ORDER OR A JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER These instructions are intended to assist you in preparing the Petition for a Juvenile Civil Protection Order or Juvenile Domestic Violence Civil Protection Order, which can be heard only by the juvenile division of the court of common pleas in the county where you reside. Throughout the Petition, you (the party to be protected) are called Petitioner and the person you are filing this petition against is called Respondent. SOME HINTS BEFORE YOU BEGIN • Read these instructions carefully. • The types of offenses for which a juvenile civil protection order or juvenile domestic violence civil protection order can be obtained are explained in the last section of this Form. • A juvenile civil protection order or a juvenile domestic violence civil protection order should ONLY be requested if the Respondent is less than 18 years old. • If the Respondent is 18 years old or older, then you must file another petition for a civil protection order in the appropriate court of common pleas. • Fill out the Petition as completely and accurately as possible. • All forms must be typed or printed. • When you write your name on the Petition, use the same name you use when you write your signature. • Write your name and Respondent's name the same way throughout the Petition. • Under federal and state law, no fees may be charged to obtain a protection order. FILLING OUT THE PETITION On the front page, leave the “Case No.” line blank. The Clerk will fill in this information. On the top left-hand side of the front page, fill in the requested information about yourself or minor for whom you are filing. If you do not want your present address or that of the minor for whom you are filing to be known, write in the space provided someone else’s address where you can receive notices from the Court. Also on the top left-hand side of the front page, fill in the requested information about Respondent as best as you can. You may use Respondent’s work or school address if you do not know Respondent’s home address. If you do not know Respondent’s date of birth, try to estimate at least year of birth. Do not attempt to obtain this information unless it is safe to do so. Paragraph 1: Mark the first box if you are filing the Petition on your own behalf. Paragraph 2: If you are filing the Petition on behalf of a minor who is not your family or household member, mark the box and write the minor’s name. Paragraph 3: If you are filing the Petition on behalf of a family or household member, mark the box and fill in their names and the other information requested in the chart. You may attach additional pages if you need more room. Paragraph 4: Mark this box if you are NOT related to the Respondent by blood or marriage. WCJC FORM 17.0 Eff. 04/04/11 American LegalNet, Inc. www.FormsWorkFlow.com [Page 2 of WCJC Form 17.0] Paragraph 5: Mark this box if you ARE related to the Respondent in one of the three ways shown in the Petition. Please mark the appropriate box to show your relation to the Respondent and indicate your relationship. Paragraph 6: Mark this box if you or a family or household member of yours has a child with the Respondent. Paragraph 7: Provide a description of the Respondent’s action(s) that caused you to believe that the Respondent caused or will cause physical or emotional harm to you or another family or household member. State the date(s) of the incident(s) that caused you to file the Petition. An exact date(s) is not necessary; approximate timeframe may be sufficient. You may attach additional pages if you need more room. Paragraph 8: Provide a description of the impact of the Respondent’s actions have had on you or your family or household members. You may attach additional pages if you need more room to complete your description. Paragraph 9: Mark this box if you, your family or household members, or the person for whom you are filing attends the same school or are transported in the same school bus as the Respondent. Please write the name and address of the school AND the school bus number, route, district or any other information which can be helpful to the Court. Paragraph 10: Complete as much of the chart as you are able by listing all relevant open, pending, or closed court cases involving the Respondent, your family or household members, or you (or the person for whom you are filing). Paragraph 11(a)–(h): Indicate the action you want the Court to take by marking the boxes next to the lettered paragraphs that apply to your situation. If you do NOT want the Respondent to come to a specific location, tell the Court in Paragraph 11(b) of these locations and their addresses. If you do NOT want to the Respondent to contact you or your family or household members at all by landline, cordless, or cellular telephone; text; instant message; fax; e-mail; voice mail; delivery service; social network media (like Twitter, My Space, Facebook, etc.); writings; or communications by any other means regardless if directly or through another person, mark Paragraph 11(c). If you want the Respondent to be electronically monitored, make sure you mark Paragraph 11(f) and provide a description of the Respondent’s conduct that puts your and/or your family or household members’ health, welfare, and safety at risk. Write any special court orders you believe would help protect you and your family or household members in Paragraph 11(h). Paragraph 12: Mark this box if you want to request the Court grant you an emergency (Ex Parte) protection order because you and/or your family and household members are in immediate and present danger. SIGNING THE PETITION Try to fill out the Petition before you go to the courthouse. AFTER YOU HAVE FILLED OUT THE PETITION, TAKE IT TO A NOTARY PUBLIC OR DEPUTY CLERK OF COURT TO HAVE YOUR SIGNATURE NOTARIZED. DO NOT SIGN THE PETITION UNLESS YOU ARE IN FRONT OF A NOTARY PUBLIC OR DEPUTY CLERK OF COURT. WCJC FORM 17.0 Eff. 04/04/11 American LegalNet, Inc. www.FormsWorkFlow.com [Page 3 of WCJC Form 17.0] FILING THE PETITION After you have your signature notarized, file your Petition at Warren County Juvenile Court Clerk’s office, 570 Justice Drive, Lebanon, Ohio. If you have requested an emergency protection order, the Clerk of Court’s office will tell you when and where your Ex Parte hearing will take place. FEES Under federal and state law, you cannot be charged any costs or fees for filing or obtaining a protection order. [R.C. 2151.34(J) and 3113.31(J)] RENEWAL A juvenile civil protection order and juvenile domestic violence civil protection order can be renewed in the same manner as the initial protection order was issued. [R.C. 2151.34(E)(2)(b) and 3113.31(E)(3)(c)] EXPIRATION OF CIVIL PROTECTION ORDER A juvenile civil protection order and juvenile domestic violence civil protection order will terminate on a specific date as determined by the Court, but no later than the Respondent’s 19th birthday. [R.C. 2151.34(E)(2)(a) and 3113.31(E)(3)(a)] SEALING OF RECORDS The Court will automatically seal all of the records of the juvenile civil protection order or juvenile domestic violence civil protection order proceeding if a full hearing or consent agreement civil protection order is not granted. The Court will automatically seal all of the records of the juvenile civil protection order or juvenile domestic violence civil protection order proceeding on the Respondent’s 19th birthday, unless you provide the Court information that the Respondent did not comply with the order. If the Respondent did not comply with all the terms of the juvenile civil protection order or juvenile domestic violence civil protection order, the Court may consider sealing the records two years after the order expires. The Court must provide you notice of the hearing to seal the juvenile civil protection order or juvenile domestic violence civil protection order records. APPOINTMENT OF COUNSEL The Court may appoint a lawyer for the Respondent. NOTICE TO PARENT, GUARDIAN, OR LEGAL CUSTODIAN The Court may provide your parent, guardian, or legal custodian notice that you (if you are a minor) or someone else on your behalf has filed a petition for a juvenile civil protection order or a juvenile domestic violence civil protection order. The Court must provide the parent, guardian, or legal custodian of the Respondent notice of the full hearing on a petition to obtain a juvenile civil protection order or juvenile domestic violence civil protection order. WCJC FORM 17.0 Eff. 04/04/11 American LegalNet, Inc. www.FormsWorkFlow.com [Page 4 of WCJC Form 17.0] OFFENSES A juvenile civil protection order or juvenile domestic violence civil protection order can ONLY be issued for specific behavior under R.C. 2151.34 and 3113.31. Below is a summary of the specific behaviors identified in the law. Aggravated Assault No person, while under the influence of sudden passion or in a sudden fit of rage, either of which is brought on by serious provocation occasioned by the victim that is reasonably sufficient to incite the person into using deadly force, shall knowingly cause serious physical harm to another or to another’s unborn. [R.C. 2903.12(A)(1)] No person, while under the influence of sudden passion or in a sudden fit of rage, either of which is brought on by serious provocation occasioned by the victim that is reasonably sufficient to incite the person into using deadly force, shall knowingly cause or attempt to cause physical harm to another or to another’s unborn by means of a deadly weapon or dangerous ordnance, as defined in section 2923.11 of the Revised Code. [R.C. 2093.12(A)(2)] Aggravated Menacing No person shall knowingly cause another to believe that the offender will cause serious physical harm to the person or property of the other person, the other person’s unborn, or a member of the other person’s immediate family. [R.C. 2903.21(A)] Aggravated Trespass No person shall enter or remain on the land or premises of another with purpose to commit on that land or those premises a misdemeanor, the elements of which involve causing physical harm to another person or causing another person to believe that the offender will cause physical harm to the person. [R.C. 2911.211 (A)] Assault No person shall knowingly cause or attempt to cause physical harm to another or to another’s unborn. [R.C. 2903.13(A)] No person shall recklessly cause serious physical harm to another or to another’s unborn. [R.C. 2903.13(B)] Domestic Violence Family or Household Member “Domestic violence” means the occurrence of one or more of the following acts against a family or household member: attempting to cause or recklessly causing bodily injury; placing another person by the threat of force in fear of imminent serious physical harm or committing a violation of section 2903.211 or 2911.211 of the Revised Code; committing any act with respect to a child that would result in the child being an abused child, as defined in section 2151.031 of the Revised Code; committing a sexually oriented offense. [R.C. 3113.31(A)(1)(a)-(d)] "Family or household member” means any of the following: (a) Any of the following who is residing with or has resided with the respondent, such as a spouse, a person living as a spouse, or a former spouse of the respondent; a parent, a foster parent, or a child of the respondent, or another person related by consanguinity or affinity (blood or marriage) to the respondent; a parent or a child of a spouse, person living as a spouse, or former spouse of the respondent, or another person related by consanguinity or affinity (blood of marriage) to a spouse, person living as a spouse, or former spouse of the respondent. [R.C. 3113.31(A)(3)(a)] (b) The natural parent of any child of whom the respondent is the other natural parent or is the putative other natural parent. [R.C. 3113.31(A)(3)(a)-(b)] “Person living as a spouse” means a person who is living or has lived with the respondent in a common law marital relationship, who otherwise is cohabiting with the respondent, or who otherwise has cohabited with the respondent within five years prior to the date of the alleged occurrence of the act in question. [R.C. 3113.31(A)(4)] WCJC FORM 17.0 Eff. 04/04/11 American LegalNet, Inc. www.FormsWorkFlow.com [Page 5 of WCJC Form 17.0] Felonious Assault No person shall knowingly cause serious physical harm to another or to another’s unborn. [R.C. 2903.11(A)(1)] No person shall knowingly cause or attempt to cause physical harm to another or to another’s unborn by means of a deadly weapon or dangerous ordnance. [R.C. 2903.11(A)(2)] No person, with knowledge that the person has tested positive as a carrier of a virus that causes AIDS, shall knowingly do any of the following: (1) engage in sexual conduct with another person without disclosing that knowledge to the other person prior to engaging in the sexual conduct; (2) engage in sexual conduct with a person whom the offender knows or has reasonable cause to believe lacks the mental capacity to appreciate the significance of the knowledge that the offender has tested positive as a carrier of a virus that causes AIDS; or (3) engage in sexual conduct with a person under eighteen years of age who is not the spouse of the offender.[R.C. 2903.11(B)] Menacing No person shall knowingly cause another to believe that the offender will cause physical harm to the person or property of the other person, the other person’s unborn, or a member of the other person’s immediate family. [R.C. 2903.22(A)] Menacing by Stalking No person by engaging in a pattern of conduct shall knowingly cause another person to believe that the offender will cause physical harm to the other person or cause mental distress to the other person. [R.C. 2903.211(A)(1)] No person, through the use of any electronic method of remotely transferring information, including, but not limited to, any computer, computer network, computer program, or computer system, shall post a message with purpose to urge or incite another to commit a violation of division (A)(1) of this section. [R.C. 2903.211(A)(2)] Sexually Oriented Offense WCJC FORM 17.0 Eff. 04/04/11 Sexually oriented offenses are defined in R.C. 2950.01. American LegalNet, Inc. www.FormsWorkFlow.com Page 6 of Form 17.0 IN THE COURT OF COMMON PLEAS, JUVENILE WARREN DIVISION COUNTY, OHIO Petitioner : Case No. Address : Judge Mike Powell Magistrate City, State, Zip Code : Date of Birth: / / : PETITION FOR JUVENILE CIVIL PROTECTION ORDER OR JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (R.C. 2151.34 and 3113.31) : v. : Respondent : DO NOT WRITE YOUR ADDRESS ON THIS FORM IF YOU ARE REQUESTING CONFIDENTIALITY. PLEASE PROVIDE ANOTHER ADDRESS WHERE YOU CAN RECEIVE NOTICES FROM THE COURT. Address : City, State, Zip Code : Date of Birth: / Notice to Petitioner: Throughout this form, check every that applies. / 1. Petitioner seeks relief on his or her own behalf. 2. Petitioner seeks relief on behalf of, , who is a minor. The minor is not a family or household member of the Petitioner pursuant to R.C. 3113.31(A)(3)(a) and (b). 3. Petitioner seeks relief on behalf of the following family or household members: NAME (first, middle initial, and last) DATE OF BIRTH HOW RELATED TO PETITIONER/APPLICANT 4. Petitioner is not a family or household member of Respondent. 5. Petitioner is a family or household member of Respondent and a victim of domestic violence. The relationship of Petitioner to Respondent is that of: Parent of Respondent Foster Parent of Respondent Other relative by blood or marriage of Respondent or Petitioner/ who has lived with Respondent at any time (describe relationship): 6. Petitioner and/or a family or household member of Petitioner has a child in common with the Respondent. WCJC FORM 17.0 Eff. 04/04/11 American LegalNet, Inc. www.FormsWorkFlow.com [Page 7 of Form 17.0] Case No._____________________ 7. Please describe in detail the action(s) of the Respondent that causes you to believe that he/she will cause or has caused you and/or your family or household members physical or emotional harm. Attach additional page if you need more room. This conduct may include domestic violence, felonious assault, aggravated assault, assault, aggravated menacing, stalking, menacing, aggravated trespass, or sexually oriented offense. 8. Please describe how the Respondent’s conduct affected you and/or your family or household members. Attach additional page if you need more room. 9. Petitioner further states that Respondent attends the same school or is transported to school on the same school bus as Petitioner and/or the family or household member of the Petitioner. School Name & Address: School Bus: 10. The following is a list of all past and present court cases, that Petitioner knows of, which involve the parties, their children, or other family or household member and are relevant to this matter: CASE NAME WCJC FORM 17.0 Eff. 04/04/11 CASE NUMBER COURT/COUNTY TYPE OF CASE RESULT OF CASE American LegalNet, Inc. www.FormsWorkFlow.com [Page 8 of Form 17.0] Case No._____________________ 11. Petitioner requests the Court grant relief under R.C. 2151.34 or 3113.31. Check all that apply. a. Require the Respondent not to harm, attempt to harm, threaten, follow, stalk, harass, contact, force sexual relations upon, or commit sexually oriented offenses against the Petitioner and/or the Petitioner’s family or household members named in this Petition. b. Require the Respondent not to enter or have limited access to the following places (include name and address, as applicable) where Petitioner and Petitioner’s family or household members named in this Petition may be found, including the buildings, grounds, and parking lots at these places. Residence: School: Business or Place of Employment: Other (specify): c. Require the Respondent not to have contact with Petitioner and/or Petitioner’s family or household members named in this Petition by any means whatsoever. d. Require the Respondent not to remove, damage, hide, or dispose of any property or pets owned or possessed by the Petitioner and Petitioner’s family or household members named in this Petition. e. Require the Respondent not to possess, use, carry, or obtain any deadly weapon. f. Require the Respondent to be electronically monitored. Please explain why the Respondent’s conduct is a past, present, and future danger to the health, welfare, or safety of the Petitioner and/or the Petitioner’s family or household members. Attach additional page if you need more room. g. Require the Respondent to complete batterer counseling, substance abuse counseling, or other counseling as determined necessary by the Court. WCJC FORM 17.0 Eff. 04/04/11 American LegalNet, Inc. www.FormsWorkFlow.com [Page 9 of Form 17.0] Case No._____________________ h. Includes the following additional provisions: 12. Petitioner further requests that the Court issue an ex parte (emergency) protection order. 13. Petitioner further requests that the Court grant such other relief as the Court considers equitable and fair. I hereby swear or affirm that the answers above are true, complete, and accurate to the best of my knowledge. I understand that falsifying this document may result in a contempt of court finding against me which could result in a jail sentence and fine and that falsifying this document may also subject me to criminal penalties or adjudication of delinquency for perjury under R.C. 2921.11 or falsification under R.C. 2921.13. Sworn to and subscribed before me on this day of . SIGNATURE OF PETITIONER NOTARY/DEPUTY CLERK OF COURT DO NOT WRITE YOUR ADDRESS BELOW IF YOU ARE REQUESTING CONFIDENTIALITY. PLEASE PROVIDE AN ADDRESS WHERE YOU CAN RECEIVE NOTICES FROM THE COURT. Address: Name of Attorney (if applicable): Address: Attorney Registration: Telephone Number: Signature of Attorney for Petitioner (if applicable) WCJC FORM 17.0 Eff. 04/04/11 American LegalNet, Inc. www.FormsWorkFlow.com