STATE OF SOUTH CAROLINA COUNTY OF vs. ) ) ) ) ) Petitioner ) ) ) ) ) Respondent. ) IN THE FAMILY COURT JUDICIAL CIRCUIT PETITION FOR ORDER OF PROTECTION (For Use in Family Court) Docket No. Respondent's SSN: Respondent's Date of Birth: Respondent's Race: Respondent's Sex: I ask this court to issue an Order of Protection, because: 1. This is the county where this case should be handled, since (check one): a. The alleged act of abuse occurred in this county. b. The person who caused the abuse lives in this county. c. The person who caused the abuse and I last lived together in this county. The person who caused the abuse lives at which is in County, and the State of (street address) in or near the town or city of . , 2. 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; ( and/ or), b. , who is a child under 18 years old who lives with me. That the abuser and the victim (check one or more): are husband and wife were formerly husband and wife have a child/children in common, who is/are: are living together were formerly living together are household or family members pursuant to S.C. Code Section 20-4-20(a)(2) 4. 5. The abuse happened at (address/location) on (date), at ( a.m./ p.m.), ( when (Name of person causing abuse) did this: . 6. Have there been 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 SCCA 425 (2/2016) American LegalNet, Inc. www.FormsWorkFlow.com d. Name 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 the Court may order. issue an order granting temporary custody of the following minor child(ren). Date of Birth Address grant reasonable visitation or e. deny visitation. issue an order granting Petitioner temporary child support (Financial Declaration [Form SCCA 430 or 430S Short Form Financial Declaration] MUST be completed and attached). issue an order granting Petitioner temporary financial support (Financial Declaration [Form SCCA 430 or 430S Short Form Financial Declaration] MUST be completed and attached). issue an order granting Petitioner temporary exclusive use and possession of the home and f. g. furnishings. h. issue an 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 Petitioner assistance from law enforcement in that Petitioner will be accompanied: (1) in removing Personal property from (Street Address) in (City) (County), South Carolina. (2) in placing Petitioner in possession of the home and furnishings at Address) in j. k. l. m. (City) (County), South Carolina. (Street issue an order reimbursing Petitioner for costs and attorney's fees. hold a hearing within 15 days of the date of filing these papers. hold an emergency hearing within 24 hours. issue an order granting Petitioner the following additional requests: Sworn to and Subscribed before me this day of , Notary Public for South Carolina Signature of Petitioner or Person on Behalf of Petitioner under 18 years old My Commission expires NOTICE TO RESPONDENT: YOU HAVE THE RIGHT TO EMPLOY COUNSEL TO REPRESENT YOU. SCCA 425 (2/2016) American LegalNet, Inc. www.FormsWorkFlow.com