FAPA Restraining Order - Petition Page 1 of 7 (Aug 2019) IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF Case No: Petitioner v. PETITION FOR RESTRAINING ORDER TO PREVENT ABUSE Respondent (Person to be restrained) (Family Abuse Prevention Act) I need an interpreter: Spanish Russian other: NOTICE TO PETITIONER You must provide complete and truthful information. If you do not, the court may cancel the restraining order. The court may also hold you in contempt. Contact Address and Telephone Number: If you don222t want Respondent to know your residential address or phone number, use a contact address and telephone number so the court and the sheriff can reach you if necessary. I am the Petitioner. I declare that the following information is true: 1. Residency I live in the county of , state of Respondent lives in the county of , state of 2. Age of Parties Petitioner: Respondent (must be 18 or older): 3. Relationship Respondent: (check all that apply) is or was my spouse or Registered Domestic Partner (RDP) is related to me by blood, marriage, or adoption (explain) lives or has lived with me in a sexually intimate relationship (dates, from - to) has a sexually intimate relationship with me (or did within the past 2 years) is the parent of my child 4. Abuse within past 180 days (about 6 months)226 Within the past 180 days* Respondent has (check all that apply): caused me physical injury tried to cause me physical injury made me fear that I was about to be physically injured made me have sexual relations against my will by force or threat of force *The 180-day period is increased by any time Respondent was in jail or prison, or lived more than 100 miles from your home Respondent was in jail or prison Dates (from 226 to) Respondent lived more than 100 miles from my home Dates (from 226 to) American LegalNet, Inc. www.FormsWorkFlow.com FAPA Restraining Order - Petition Page 2 of 7 (Aug 2019) 5. Incidents of Abuse A. Describe the incidents of abuse that happened within the past 180 days, starting with the most recent incident Date: County, State: Additional details about this incident: I was injured I sought medical care (describe): Respondent had a weapon was using drugs or alcohol (describe): The police were called (name): was arrested Date: County, State: Additional details about this incident: I was injured I sought medical care (describe): Respondent had a weapon was using drugs or alcohol (describe): The police were called (name): was arrested Date: County, State: American LegalNet, Inc. www.FormsWorkFlow.com FAPA Restraining Order - Petition Page 3 of 7 (Aug 2019) Additional details about this incident: I was injured I sought medical care (describe): Respondent had a weapon was using drugs or alcohol (describe): The police were called (name): was arrested Additional page attached labeled 223Incidents of Abuse 226 180 Days224 B. There are other incidents of abuse that happened more than 180 days ago (describe): Date: County, State: Date: County, State: Date: County, State: Additional page attached labeled 223Additional Incidents of Abuse224 Describe any injuries, medical treatment, weapons, drug or alcohol use, and police involvement (including arrests) related to any of these incidents: 6. I am in imminent danger of future abuse by Respondent Explain how or why Respondent presents a threat to your physical safety in the near future: 7. Firearms I want the order to prohibit Respondent from possession or purchase of firearms or ammunition. Because of the abuse and danger detailed in this Petition, Respondent222s having firearms affects my or my children222s safety and welfare. American LegalNet, Inc. www.FormsWorkFlow.com FAPA Restraining Order - Petition Page 4 of 7 (Aug 2019) Additional information: Respondent has firearms (or has easy access to firearms) Respondent is already prohibited from possession or purchase of firearms or ammunition 8. Existing Restraining and Stalking Orders There is a current restraining order or stalking order between Respondent and me County and state: Case #: County and state: Case #: 9. Other Family Cases There is another court case between Respondent and me for divorce (dissolution), annulment, separation, paternity, or custody and parenting time (include pending or finished cases) County and state: Case #: County and state: Case #: 10. Move-out Order I want Respondent ordered to move out of the residence (check all that apply): the residence is solely in my name Respondent and I jointly own (or) lease or rent the residence Respondent is my spouse or Registered Domestic Partner 11. Emergency Money I want an order for emergency monetary assistance. I want a one-time payment of $ from Respondent because (explain): JOINT CHILDREN Minor Children of the Parties (under the age of 18 and not married or emancipated) 12. Name and Age Name Age Additional page attached labeled 223Additional Children224 American LegalNet, Inc. www.FormsWorkFlow.com FAPA Restraining Order - Petition Page 5 of 7 (Aug 2019) 13. Current Residence The children live with: me or (name and address): For how long? 14. Children222s Residences 226 5 years List everywhere the children have lived in the past 5 years (starting with the most recent address) and a current contact address for each caretaker. Dates From/To County, State Name of Parent/Caretaker Contact Address of Parent/Caretaker Which Children Additional page attached 15. My children have continuously lived in Oregon for the six months before the filing of this Petition My children have not lived in Oregon continuously for six months, but my children and I live in Oregon now and I want the court to award me custody because of an emergency (describe): 16. Unmarried Parents 226 Parentage (complete all that apply) Parentage (who the legal parents are) has been established for both parties by: petitioner respondent giving birth to (names): filing a Birth Certificate or Voluntary Acknowledgment of Paternity form listing petitioner respondent as the parent of children (names): judicial order or administrative/agency order (court/agency name): case number located in (county/state) re: petitioner respondent for children (list names): other method (explain): re: petitioner respondent for children (list names): American LegalNet, Inc. www.FormsWorkFlow.com FAPA Restraining Order - Petition Page 6 of 7 (Aug 2019) 17. Prior Cases (if you have a copy of existing judgments or orders, bring them with you to your hearing) a. There are no other court orders (besides child support) currently in effect regarding any of the children listed (include juvenile cases) except (list information for all cases): Case #: County and state: b. I have not participated as a party, witness, or in any other capacity in any other case concerning custody or parenting time (visitation) of the children except: c. I do not know of any other legal proceeding that could affect this case (for example: custody/parenting time enforcement, domestic violence, protective orders, termination of parental rights, or adoption cases) in any state except: d. I do not know of anyone other than Respondent who has physical custody of the children or who claims custody or parenting time (visitation) rights except: 18. Custody Assistance I believe that I will need the help of a peace officer to regain custody of my children from Respondent. The addresses where the children can most likely be found are listed on the proposed Order. I believe the children are most likely to be found there because (explain): 19. Department of Human Services 226 Child Welfare (DHS) DHS is involved with my children because (explain): 20. A Confidential Information Form (CIF) has been completed and filed with the court clerk containing all required information that is identified as confidential by UTCR 2.130 for: Petitioner Respondent American LegalNet, Inc. www.FormsWorkFlow.com FAPA Restraining Order - Petition Page 7 of 7 (Aug 2019) I ask the court to order my requests as marked on the Restraining Order to Prevent Abuse I hereby declare that the above statements are true to the best of my knowledge and belief. I understand they are made for use as evi