Petition For Protection From Abuse Page 2
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7Paragraph 4
This Court is the proper venue for this action because:
The marital domicile is located in
Parish.
____ The household is located in __________________ Parish.
The defendant resides or is domiciled in
Parish.
____ The abuse occurred in __________________ Parish.
____ The petitioner resides or is domiciled in _________________ Parish. (Do not fill this out if address is to
remain confidential.)
Paragraph 5
The protected person(s) is related to the defendant as: (check all that apply)
___
Current or former spouse
___
Current or former dating partner
___
Current or former unmarried intimate cohabitant
___
Parent, stepparent, or foster parent
___
Child, stepchild, or foster child
___
Grandparent or grandchild
___
Child of defendant’s current or former intimate partner
___
Other:
_______________________________________
Paragraph 6
____ A suit for divorce between the parties is not pending.
____ A suit for divorce between the parties is pending (fill out page 7 of this form, “Addendum”)
NOTE: If you were NOT the petitioner in the divorce suit, use form LPOR B-R entitled “Petition for
Protection From Abuse, (Filed by the Defendant in the Pending Action as Petitioner-in-reconvention)”
instead of this one.
____ There is a suit for custody pending involving children named in this petition (fill out page 7 of this form,
“Addendum”).
____ There is a custody order in effect involving children named in this petition (fill out page 7 of this form,
“Addendum”, or attach a copy of the order if available).
Paragraph 7
____ The protected person(s) and defendant have child(ren) in common.
Paragraph 8
a.
Defendant abused protected person(s) in the following manner:
___
Slapped protected person(s)
___
Threatened protected person(s) with bodily harm
___
Punched protected person(s)
___
Threatened protected person(s)’ life
___
Choked protected person(s)
___
Threatened protected person(s) with a weapon
___
Shoved protected person(s)
___
Sexually abused protected person(s)
___
Kicked protected person(s)
___
Abused petitioner’s child(ren) or alleged incompetent
___
Stalked protected person(s)
___
Other:______________________________________
The facts and circumstances of this abuse are as follows:
b.
The most recent incident of abuse which caused petitioner to file this petition happened on or about the
day of
,
, at which time the defendant did
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
LPOR B
v.7
Page 2 of 7
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