STATE OF SOUTH CAROLINA COUNTY OF SOUTH CAROLINA ) ) ) __________________________________ ) Petitioner ) VS. ) ) __________________________________ ) Respondent ) IN THE FAMILY COURT NINTH JUDICIAL CIRCUIT FILE #: 20_____DR-10- _________ RESPONDENTS SSN: _______________________ DOB/RACE/SEX:__________/________/________ PETITION FOR ORDER OF PROTECTION I ask this court to issue an Order of Protection, because: 1. This is the county where this case should be handled, since (check all that apply): a. The alleged act of abuse occurred in this county; or, b. The person who caused the abuse lives in this county; or, c. The person who caused the abuse and I last lived together in this county. 2. The person who caused the abuse lives at _____________________________________ in or near the town or city of ______________________________________ which is in __________________________ County, and the State of ________________________. 3. The person who was abused was (check one or both and supply information): ______ a. ___________________________, who is the person asking for an Order of Protection; or, ______ b. ___________________________, who is a child under 18 years old who lives with me. 4. That the abuser and the victim (check all that apply): ______ are husband and wife ______ were formerly husband and wife ______ are living together ______ were formerly living together ______ have a child/children in common, who is/are___________________________ 5. The abuse happened at (address) _____________________________________________ on ________________________, 20______, at ____________o clock, _____m when _______________________________________ did this: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 6. Have there been any prior convictions of domestic violence or prior orders of protection? ______ yes ______ no. If yes, please state date ________________________________. 7. I ask this court to grant the following temporary relief (check as many as apply and supply information) ______ a. issue an Order of Protection which prohibits and forbids ______________________________ from abusing threatening to abuse, or molesting, or engaging in any other conduct that would place Petitioner in reasonable fear of bodily injury. ______ b. issue an Order of Protection which restrains and prohibits _____________________________ from using, attempting to use, or threatening to use physical force against Petitioner that would reasonably be expected to cause bodily injury. ______ c. issue an Order of Protection which restrains, prohibits, and forbids ______________________ ______________ from communicating or attempting to communicate with petitioner in any way, and from entering or attempting to enter the home of the victim, place of employment, education, or other location as American LegalNet, Inc. www.USCourtForms.com the Court may order. ______ d. issue an order granting _____________________________ temporary custody of the following minor child(ren): Name DOB Address ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ______ grant reasonable visitation or ______ deny visitation. ______ e. issue an order granting Petitioner temporary child support (Financial declaration must be completed and attached). ______ f. issue an order granting Petitioner temporary alimony (Financial declaration must be completed and attached). ______ g. issue and order granting Petitioner temporary exclusive use and possession of the home and furnishings. ______ h. issue and order which forbids ______________________ from transferring, selling, destroying, encumbering, or otherwise disposing of real or personal property belonging to petitioner or jointly owned. ______ i. issue an order which gives the petitioner assistance from law enforcment in that petitioner will be accompined: ______ (1) in removing personal property from _______________________________________________ (Street address) in ___________________________(city) ____________________________(county), SC. ______ (2) in placing the petitioner in possession of the home and furnishings at ____________________________________(Street address) _________________________(city)________________(county), SC. ______ j. issue an order reimbursing petitioner for costs and attorney s fees. ______ k. hold a hearing within 15 days of the date of filing these papers. ______ l. hold an emergency hearing within 24 hours. ______ m. issue an order granting petitioner the following additional requests: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Sworn to and Subscribed before me this _______ day of _____________, 200____ ______________________________________ Notary Public for South Carolina My Commission expires: __________________ ___________________________________ Signature of Petitioner or Person on behalf of Petitioner under 18 years old NOTICE TO RESPONDENT: YOU HAVE THE RIGHT TO EMPLOY COUNSEL TO REPRESENT YOU. American LegalNet, Inc. www.USCourtForms.com PETITIONER RESPONDENT NAME ____________________________ NAME _____________________________ ADDRESS _________________________ ADDRESS __________________________ CITY, ZIP CODE ____________________ CITY, ZIP CODE ____________________ SEX_______RACE_______DOB________ SEX_______RACE_______DOB________ SSN_______________________________ SSN________________________________ HGT___________ WGT______________ HGT_____________WGT______________ EYES__________HAIR_______________ EYES_____________HAIR_____________ EMPLOYMENT_____________________ EMPLOYMENT _____________________ ___________________________________ ____________________________________ HOME # ___________________________ HOME #____________________________ WORK # ___________________________ WORK #____________________________ CELL # ____________________________ CELL # _____________________________ VEHICLE MAKE & MODEL __________ VEHICLE MAKE & MODEL __________ ___________________________________ ____________________________________ TAG # ____________STATE___________ TAG # ______________STATE _________ DO YOU HAVE ANY PENDING CASES IN FAMILY COURT? ____ YES ____ NO *FOR COURT USE ONLY* FILE # _______________________________ MUTUAL ORDER YES / NO DATE GRANTED ______________________ EXPIRATION DATE ____________________ ISSUING JUDGE________________________ American LegalNet, Inc. www.USCourtForms.com