04//2018 Form #OP2018-1 Petition for Order of Protection page 1 of 6 Petition for Order of Protection and Order for Hearing In the Court of County, TN Case # (the clerk fills this in) : : (person needing protection) TCA 24736 - 3 - 602) f irst middle last Check if Applicable: Petitioner is under 18 and this Petition is being filed o n behalf of an unemancipated person (someone under 18 years of age) pursuant to TCA 24736 - 3 - 602. This request is being made by who is parent or legal guardian or a caseworker. This request is being made by a law enforcement officer pursuant to TCA 24736 - 3 - 619. Person on whose behalf this Petition is filed consents in writing to the filing and signs here ** P C HILDREN UNDER 18 THA T PETITIONER BELIEVE S ARE I N NEED OF PROTECTION : Name Age Relationship to Respondent Name Age Relationship to Respondent 1. 3 . 2 . 4. (pe rson you want to be protected from): first middle last date of birth (MM/DD/YYYY) street address city state zip Describe Respon dent: Sex Race Hair Eyes Height Weight SSN Other Male Female White Asian Black Hispanic Other: Black Grey Blond Bald Brown Other: Brown Hazel Blue Green Gray Other: Height Weight Social Sec. # Do not list it here. XXXXXXXXXXXXXXXXXXXXX Scars/ Special Feature s Phone Number American LegalNet, Inc. www.FormsWorkFlow.com 04//2018 Form #OP2018-1 Petition for Order of Protection page 2 of 6 Warning! Weapon involved Has or owns a weapon Check all of the following that apply to the Petitioner: a. We are married or used to be married.b. We live together or used to live together.c. We have a child together.d. We are dating, used to date, or have had sex. e. We are relatives, related by adoption, or are/were in-laws. (Specify): f. We are the children of a person whose relationship is described above (Specify): g. The Respondent has stalked me.h. The Respondent has sexually assaulted me. i. Other: List all children under 18 that you have: * Check here if listing addresses would put you or your child in danger. If so, leave any spaces for addressesblank. Name of Child Age Is Respondent the parent of the child? Where else have the children (that you and Respondent have together) lived during the last 6 months? Who did they live with at this address? Other Court Cases Is there any court, other than this court, in which the respondent and petitioner are parties to an action? (including cases in which the parties have children in common) Yes No County and State of other case: Case Number (if you know it): Kind of case (check all that apply): Divorce Domestic Violence Criminal Juvenile Child Support Other (specify): American LegalNet, Inc. www.FormsWorkFlow.com 04//2018 Form #OP2018-1 Petition for Order of Protection page 3 of 6 Custody Rights Does anyone besides you or the Respondent claim to have custody or visitation rights to the children that you and Respondent have together? Yes No N ame Address Describe Abuse (use additional sheets of paper if necessary and attach to Petition) Describe abuse, stalking or assault (include, IF APPLICABLE, inf ormation about abuse or fear of abuse to your child(ren), personal property or animals) Where and when did this happen? Describe any weapons used. I ask the court to make the following Orders after the hearing: (check all that apply) No Contact Please order the Respondent to not contact: me our children under 18, either directly or indirectly, by phone, email, messages, text messages, mail or any other type of communication or contact. Stay Away Please order the Respondent to stay away from my home my workplace or from coming about me for any purpose. American LegalNet, Inc. www.FormsWorkFlow.com 04//2018 Form #OP2018-1 Petition for Order of Protection page 4 of 6 Personal Conduct Please order the Respondent not to: Cause intentional damage to my property or interfere with the utilities at my home. Hurt or threaten to hurt any animals that I/we own or keep. Temporary Custody Please give me temporary custody of our children. Child Support Please order the Respondent to pay reasonable child support. Petitioner Support (if married) Please order the Respondent to pay reasonable spousal support. Move-out / Provide other housing Please order the Respondent to (check one): move out of our family home immediately or provide other suitable housing (if married) Check here if your home only. If the parties share a residence, please allow the Respondent to obtain his/her clothing and personal effects such as medicine and other things he/she may need. Counseling/Substance Abuse Programs Please order the Respondent to go to a certified batterers intervention program if one available in the area or a counseling program. No FirearmsPlease order the Respondent not to have, possess, transport, buy, receive, use or in any otherway get any firearm.List all firearms that you believe the Respondent owns, controls, or has access to: Type of Firearm (Pistol, Rifle, etc.) Location Animals / Pets Please give me custody and control of any animal owned, possessed, leased, kept or held by me, the Respondent, or the children listed above. Costs, fees, and litigation taxesPlease order the Respondent to pay all court costs, lawyer fees, and taxes for this case. Transfer the billing responsibility for and rights to wireless telephone number(s)Please issue an order directing , a wireless telephone serviceprovider, to transfer the billing responsibility for and rights to the wireless telephone number ornumbers of petitioner since petitioner is not the account holder. Current account holder (name): American LegalNet, Inc. www.FormsWorkFlow.com 04//2018 Form #OP2018-1 Petition for Order of Protection page 5 of 6 Billing telephone number: New account holder (name): All telephone numbers to transfer to new account holder: Telephone number (include area code): Telephone number (include area code): Telephone number (include area code): Telephone number (include area code): Check box to include attachment with additional telephone number(s). If the judge makes this order, you will be financially responsible for the transferred wireless telephone number or numbers, including the monthly service costs and costs of any mobile device associated with the wireless telephone number or numbers. You may be responsible for other fees. You must contact the wireless service provider to find out what fees you will be responsible for and whether you are eligible for an account. Other Orders: (General Relief) I also ask the court to: 1.Make an immediate Temporary Order of Protection. (Ex-Parte Order of Protection)2.Notify law enforcement in this county of that Order.3.Serve the Respondent a copy of that Order and Notice of Hearing to take place within 15 daysof service.4.Serve a copy of the Request, Notice of Hearing and Temporary Order on the parents of thePetitioner (if the Petitioner is under 18 years of age) unless the Court finds that this wouldcreate a serious threat of serious harm to the Petitioner. T.C.A. 24736-3-605 (c ) Petitioner (parent/legal guardian/caseworker/law enforcement personnel) signs below in front of a notary public and swears that he/she believes the above information is true: Date: Notary fills out below (TCA 24736-3-602) I declare that the Petitioner has read this Petition, and swears it be true to the best of her/his knowledge. Sworn and subscribed before me, the undersigned authority, By (Print name of notary): On this date: Notary or Court Clerk or Judicial Officer signs here The court finds good cause and will issue a Temporary Order of Protection. American LegalNet, Inc. www.FormsWorkFlow.com 04//2018 Form #OP2018-1 Petition for Order of Protection page 6 of 6 The court does not find good cause and denies a Temporary Order of Protection - Thecourt finds there is no immediate and present danger of abuse to the petitioner and request for a Temporary Order of Protection. The court will set the matter for hearing. ORDER FOR HEARINGThe Petitioner and Respondent must go to court and explain to the judge why the judge should or should not issue an Order of Protection against the Respondent. This hearing will take place on (date): at (time): a.m. p.m. at (location