COURT
PETITIONER
PARISH/CITY OF
V.
STATE OF LOUISIANA
DIVISION:
NUMBER:
DEFENDANT
FILED:
CLERK:
PETITION FOR PROTECTION FROM ABUSE
Pursuant to La. R.S. 46:2131, et seq. or La. R.S. 46:2151
o
o
This petition is:
Initial Petition
Supplemental and Amending Petition
The petition of
, born
your name
month, day, year
a resident of the State of Louisiana, respectfully represents:
Paragraph 1
Petitioner files this petition on behalf of:
a.
____ Petitioner, and/or
b.
____ Minor child(ren) as follows:
Name ___________________________ DOB _________ Relationship to petitioner __________
Name ___________________________ DOB _________ Relationship to petitioner __________
Name
DOB
Relationship to petitioner
Name
DOB
Relationship to petitioner
c.
____ Alleged incompetent:
Name
DOB
Relationship to petitioner
Name ___________________________ DOB _________ Relationship to petitioner __________
Paragraph 2
a.
____ Petitioner requests that his/her address, or that of the minor child(ren) or alleged incompetent, remain
confidential to the court and files the address pursuant to La. R.S. 46:2134(B). (Ask clerk of court for
the Confidential Address Form.)
OR
b.
____ Petitioner’s current address:
No. & Street
Apt. No.
________________________________________________________________________
City
State
Zip Code
c.
____ The minor child’s or alleged incompetent’s current address:
No. & Street
Apt. No.
________________________________________________________________________
City
State
Zip Code
Paragraph 3
______________________________________, defendant, resides in _______________________ Parish
Abuser’s Name
at _________________________________________________________________________________
No. & Street
Apt. No.
City
State
Zip Code
LPOR B
v.7
Page 1 of 7