Petition And Affidavit For Civil Protection Order printable pdf download

Petition And Affidavit For Civil Protection Order

SUPERIOR COURT OF THE DISTRICT OF COLUMBIA

DOMESTIC VIOLENCE UNIT (202) 879-0157

Petitioner

Your Name

Your Address (If confidential, request a Confidential Address Form)

CPO No:__________________

vs.

Respondent

Name of Individual Against Whom You Are Filing

Individual’s Address

PETITION AND AFFIDAVIT FOR CIVIL PROTECTION ORDER

Pursuant to D.C. Code Section 16-1001 et seq.; Petitioner respectfully requests that the court issue a 12-month Civil Protection

Order against Respondent. In support of this request, Petitioner states:

1. Respondent is related to Petitioner

By Blood;

Legal Custody;

Marriage;

Having a Child in Common;

Now or Previously Shared the Same Residence;

Romantic /Dating Relationship;

Stalking;

§16-1001(6)(B)

Sexual Assault

2. Do you reside, live, work or attend school in the District of Columbia?

Yes

3. Did any incident described below occur in the District of Columbia?

Yes

4. Respondent committed or threatened to commit an act punishable as a criminal offense against Petitioner within the

meaning of D.C. Code Section 16-1001 et seq., by: (Please describe any such acts, including physical assaults like hitting,

punching, shoving or kicking; threats to do harm, or destruction of property).

On or about

at approximately

a.m./p.m.,

At (location):

Respondent

On or about

at approximately

a.m./p.m.,

At (location):

Respondent

On or about

at approximately

a.m./p.m.,

At (location):

Respondent

On or about

at approximately

a.m./p.m.,

At (location):

Respondent

Rev. July 2015

Petition And Affidavit For Civil Protection Order

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