DOMESTIC VIOLENCE ORDERS PACKET AND INSTRUCTIONS

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1 DOMESTIC VIOLENCE ORDERS PACKET AND INSTRUCTIONS 1. Fill out these forms. Please print neatly with dark ink (not red). The Court must be able to read them clearly. 2. Correct Addresses on the Law Enforcement Information Sheet are very important. LAW ENFORCEMENT WILL NOT SERVE DOCUMENTS ON RESPONDENT WITHOUT AN ADDRESS. 3. Please include the correct birth dates and correct spelling of names for all parties named. AGAIN, LAW ENFORCEMENT WILL NOT SERVE ANY DOCUMENTS WITHOUT THIS INFORMATION. 4. Bring completed forms back to the clerk s office Monday through Friday by 12:00 pm (noon). It is important to not be late, as court starts promptly at 1:15 pm. You may have to return the next day if you are late. Fill out the following forms COMPLETELY: 1) The Petition: Fill out all statement areas on the petition completely with as much information about what is happening and why you are petitioning for an order. This is what the court uses to determine if a temporary order is necessary. 2) LEI Sheet: Correct addresses and birthdates if possible. 3) Child Custody Info Sheet (If children are involved) Only the HEADING of the following documents need to be filled out: 1) The Temporary Order of Protection (Judge/Commissioner will fill out the order) 2) The Permanent Order of Protection (Judge/Commissioner will fill out the order) 3) Return of Service (Law enforcement will fill this out after service on respondent) If there is clear and convincing evidence that a party has used, displayed, or threatened to use a firearm or other dangerous weapon you may fill out the motion for surrender of weapons. The court will then consider issuing an order to have the respondent surrender their weapons to their local law enforcement agency. PLEASE DO NOT FOLD, MUTILATE, TEAR, STAIN OR CRUMPLE THESE FORMS. Once court is done, you will be directed back down to the Clerk s Office to obtain copies. We will give you 3 certified copies of the temporary order. Keep a copy of the order on you at all times. Law enforcement will attempt to serve the respondent with the petition and temporary order. If respondent has not been served yet and is at your residence, please call 911 to have an officer come to your house. They can use one of your copies to serve on respondent at that time and do a civil standby (if court orders this) to allow respondent to get personal belongings. If the respondent violates the order, please call 911 to make a report. SKAGIT COUNTY CLERK S OFFICE 205 WEST KINCAID ROOM 103 MOUNT VERNON WA (360) Updated 6/2016

2 What is domestic violence? Washington State law defines Domestic violence as physical harm, bodily injury, assault, the infliction of fear of imminent physical harm, sexual assault, or stalking. (RCW ) This includes a wide variety of abusive behavior. Pushing, shoving, hitting, slapping, biting, choking or other conduct which causes harm or puts you in fear of being hurt are considered domestic violence if these actions occur between family or household members or people involved in a dating relationship. Domestic violence is a pattern of physically and/or emotionally abusive behavior used to control another person with whom the abusive person has an intimate or family relationship. Is a Domestic Violence Protection Order Right For Me? Deciding whether to file for a protection order is an important and personal decision. Studies have shown that a protection order can be a useful tool for stopping physical domestic violence, but it may not work as planned for everyone. Some abusers may continue to contact or abuse their partners even when a court order is in place. There are many questions to think about when weighing the pros and cons of filing for a protection order. Some questions to ask yourself may be: Does your partner think they are "above the law" or that rules don't apply to them? Has your partner been arrested for domestic violence and/or court order violations? Has your partner threatened to harm or kill you if you were to file a protection order? Are you concerned with how your partner might react when they are served with your petition and read the statement you wrote that describes the abuse? If you answered "yes" to any of these questions, or have concerns about how your partner will respond to your petition, you may want to talk to a domestic violence (DV) advocate about safety options before you file because your abuser may be more likely to violate the terms of the order. A DV advocate is someone who has special training in domestic violence and can help with safety planning, support and connecting you to resources. DV advocates most often work for communitybased agencies or within the criminal justice system. Skagit Domestic Violence & Sexual Assault Services can be reached at REMEMBER: You know the most about your own situation. Always trust your own instincts about how your abuser might react and about what you need to do to keep yourself and your children safe. Please keep in mind that a protection order is only one part of your safety plan. Talking to an advocate may help you decide how to best plan for your safety. What is a Protection Order? A protection order is a civil court order that you, the petitioner, can request from a judge to protect you from your abuser, the respondent. It is free to file for a protection order. Protections can range from absolutely no contact to some allowed contact, depending on your needs. While it can prohibit contact, it is NOT a criminal No Contact Order. A No Contact Order is another kind of court order but can only be in place when there is a domestic violence criminal charge or conviction. A protection order can: Order the abuser/respondent to stop hurting you, harassing you, and/or stalking you or your minor children 1

3 Order the abuser/respondent to stop having contact with you (either directly or indirectly, in person, by phone, , texting, mail, through a third party or via the internet or other electronic means (e.g. cyberstalking) Order the abuser/respondent to move out of the home you live in together Order the abuser/respondent to stay away from you, your home, your work, your school, or your children s school or daycare Give you temporary custody of your children and can set up a visitation schedule with the respondent (if safe) Give you use of essential personal items (i.e. tools of the trade, toiletries, medications, legal documents, etc.) Give you custody and protection of pets Give you use of a specific vehicle A protection order cannot: Order the respondent to pay child or spousal support Determine who "owns" or gets to keep property or personal belongings Make final child custody decisions (i.e. which parent the child should live with until the age of 18) Although a protection order is a civil order, if the abuser violates it, he or she can be arrested and or charged with a crime. A NOTE ABOUT FIREARMS...You have the right to ask the court to order the respondent to turn his/her firearms (or other dangerous weapons) in to law enforcement as part of the court's order. For your safety, please try to talk to a DV Advocate about the removal of firearms before filing for your protection order. How Do I Get a Protection Order? The protection order process requires appearing in court at least two different times to: 1) Request a temporary or "emergency order", and if granted, 2) Attend the full or "permanent order" hearing (this hearing may be scheduled at a different court). Step 1: Thoroughly complete all paperwork. Be prepared to write a descriptive statement about all acts of physical violence, threats of violence, stalking, sexual assault, or fear of immediate harm, including approximate dates when these acts occurred. In your protection order paperwork, you will find a one-page sheet called the Law Enforcement Information Sheet (LEIS). The police use this form to "serve" -- or deliver in person -- your order on the respondent. They also use it to "enter" your order into the statewide law enforcement database. PLEASE NOTE: The LEIS will NOT be served on the respondent. The LEIS must be as complete as possible, including the abuser's full name, date of birth, address (work or home), and other identifying information (e.g. height, weight, eye color, driver's license #, etc.). You may still file for a protection order even if you do not have an address for the respondent, but the police may not be able to serve it without an address. You can talk with a domestic violence advocate about other ways to have the respondent served if you do not have an address for the respondent. Step 2: Turn in your paperwork to the clerk Monday through Friday by noon. The Clerk will tell you where the courtroom is. Court is at 1:15 daily. It may take time to be seen by the judge. Please allow plenty of time. Step 3: Once your order has been signed by the judge, go back to the clerk s office and get at least three "certified" copies. ALWAYS keep a copy of your order with you (and if necessary, 2

4 at your child(ren)'s school or daycare). The clerk will send a copy of your signed order and your petition to the police to be served on the respondent. Step 4: Appear at your full order hearing at the time and location listed on your temporary order. Be ready to speak to the judge about the domestic violence you described in your petition. Be aware that the respondent will likely be at this hearing but may choose not to attend. REMINDER: If you do not show up for your full order hearing, your case and temporary order will be dismissed. NOTE: Please give yourself plenty of time to go to court and complete the protection order process. It may take a couple of hours to complete paperwork and see the judge. If you have children, it is best to make childcare plans so that your children do not have to come to court with you. Service of the Protection Order The abuser, or "respondent", must be given or "served" a copy of the paperwork you filled out to get the protection order. This paperwork includes the Temporary Order for Protection (and Notice of Hearing) and the Petition for Order for Protection. Most orders are served by the police, but anyone over the age of 18 can serve the respondent (except you). Please keep in mind that this may be the first time the respondent finds out that you filed an order and have told people about the domestic violence. Because of this, you may want to think of ways to stay safe during the service time. Most orders are served by the police and can take a few days to be served. If you need the order served immediately, you may want to hire a process server (someone who is paid to serve legal papers) or a person over the age of 18 who would be willing to serve the respondent. The person serving the order must sign a court form (Return of Service) saying that they "swear under penalty of perjury" that they served the respondent. The respondent DOES NOT need to sign anything. A Return of Service sheet must be filed with the court once the respondent is served. Please be sure to bring a copy of your Return of Service with you to your full protection order hearing. How will you know when your protection order is served? SAVIN Protective Order is a free telephone service where petitioners can easily register to be contacted by phone when a protection order is served or is about to expire. Please call the Washington SAVIN Protective Order Line at or go to to register. If you asked for police to serve the order, you can also check with that police agency to find out if the order has been served. Preparing for the Full Order Hearing Please file original statements/evidence at the Clerk s Office at least 3 days prior to your court hearing. Be aware that the respondent has a right to come to this hearing and respond to your petition. An advocate can attend court with you. Please call Bring copies all of your protection order paperwork to court with you, including: Your Temporary Order for Protection 3

5 Petition for Order for Protection Copies of any divorce, parenting plan, paternity, or other related cases. Copies of evidence to support the abuse described in your petition; for example: Witness statements (see below for how to submit statements), police reports, photos, medical records, journals documenting the abuse, other evidence of the domestic violence you may have (e.g. text messages, s, etc. The court cannot look at your phone, please have these message printed out). ALERT: Please be aware that any paperwork you file with the court becomes public record. At this hearing you will need to tell the judge how and when the respondent physically hurt, threatened, stalked you or why you have fear that these things will happen to you. If the respondent is at the hearing, he or she will have the chance to tell the judge why a full order should not be entered. After listening to both of you, the judge will decide whether to give you a longer protection order (called a full order ). Some people bring friends or family with them for support at this hearing. Skagit County has advocates who can attend the hearing with you. Submitting Witness Statements: If other people have witnessed the domestic violence you experienced, you can ask them to fill out a court form called a declaration form describing what they saw or heard. All statements from witnesses must be signed, dated and include the following sentence above the signature: "I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct." The person signing the declaration must state where they signed (city) and when (date). Please file original statements and/or evidence at least 3 days before your final hearing so the Court has time to review them. Cover sheets for evidence are available at the Clerk s Office at no cost. Enforcement of the Protection Order It is best to keep a copy of your protection order with you at all times. If the respondent violates any of the protections listed on your order, call Be ready to give police a copy of your order, and tell them how the order was violated. If possible, call for each violation. Your "Temporary Order for Protection" and "Order for Protection" are in effect as soon as they are signed by a judge or commissioner. It is important to know that the respondent cannot be arrested or charged for violating the order until there is proof that the respondent knew about the order. Once the Return of Service sheet is filed with the court after respondent is served, it is used as proof that the respondent knew about the order. If possible, please try to keep a copy of the Return of Service form with your order to show that respondent has been served. Whether or not you have a protection order, and whether or not the abuser has been served, you can always call if the abuser hurts, threatens, or harasses you. The police may be able to charge the abuser with other crimes even if you do not have a served protection order. 4

6 Do you have questions about Domestic Violence Protection Orders or other legal issues? Are you unsure of your next steps or wondering how you will support yourself after separating from your partner? You are not alone, and the violence is not your fault. There are experienced advocates available to help you free and confidentially: 24-hour hotline: An advocate can: Talk to you about your unique safety concerns and the reliefs available in a Domestic Violence Protection Order (DVPO). Print out DVPO forms and help you fill them out properly. A judge may deny your request or ask you to refile if your petition is incomplete or filled out incorrectly. Explain how to file and serve your order, and where to go for your hearings. Attend court hearings with you for support. Support your decision making, and provide you with additional resources and referrals to assist you in keeping you and your children safe. Skagit Domestic Violence and Sexual Assault Services is a local agency that provides free and confidential support to survivors of domestic abuse and sexual assault. Their services include: Crisis Hotline available 24 hours per day, 7 days per week ( ) Legal advocacy Counseling and safety planning Support groups Emergency confidential shelter Immigration assistance Skagit DVSAS services are voluntary and always judgment-free B Leigh Way, Mount Vernon WA P: , F:

7 Planning for Your Safety Do not depend solely on the WA Protective Order service, or any other single program, for your safety. If you feel you may be at risk, contact your local law enforcement agency. Keep a copy of your protective order with you at all times. Give copies to trusted family members and friends so they will be aware of the conditions and protections. Having a copy of the order on hand may be critical if the respondent violates the order at a location away from your home. Keep copies of important documents for you and your child/children in a safe place or with a trusted person (i.e. Social Security card, driver's license, birth certificates, bank statements, paycheck receipts, medicines, medical equipment, etc.) If You Travel or Move Out of State If you travel in the U.S., your protective order should be enforced by law enforcement agencies and courts in other states and jurisdictions. If you move out of the state in which your order was issued, check with an advocate, local law enforcement agency or the court about whether or not you need to register the protective order in your new location. Carry a certified copy of the protective order with you at all times to show to officials who can help protect you. Do not rely solely on the WA Protective Order service for your safety. Make this service a part of your overall safety plan. WILL YOU KNOW WHEN YOUR PROTECTIVE ORDER IS SERVED? If your order is violated, call 911 or contact your local law enforcement agency. The police may file a criminal complaint for a violation of a protective order. Other Resources National Domestic Violence Hotline: SAFE (7233) or (TTY) State Domestic Violence Hotline: (v/tty) Local Domestic Violence Hotline: Local Sexual Assault Center Hotline: Local Law Enforcement Phone Number: WASPC The mission of WASPC is to provide support services which enhance public safety. For more information regarding this program, contact: Dawn Larsen Director of Projects dlarsen@waspc.org WASPC 3060 Willamette Ave., NE Lacey, WA This project is provided by the Washington Association of Sheriffs and Police Chiefs (WASPC) and is supported by Grant No VN-CX-0004 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, and the Office for Victims of Crime. Points of view or opinions in this document are those of the author and do not represent the official position or policies of the United States Department of Justice. Revised 07/12 Washington Protective Order Service Access to Information & Notification for Protective Order Status A service provided by the Washington Association of Sheriffs and Police Chiefs

8 WASHINGTON PROTECTIVE ORDER SERVICE or WA Protective Order service is a free, automated service that lets you, the petitioner, track the status of a protective order over the phone or Internet. You can also register to be notified by phone and about changes in the status of a protective order. How to Search and Register Information Call or visit or to access protective order information. Before you call, be ready with your protective order case number. You can find this information on your petition or protective order. To search online, you will need your protective case number, the respondent's name as it appears on the order, and the county of issuance. Registration If the protective order has been filed, you can register to receive notifications. If registering a phone number, you will be asked to create a four-digit personal identification number (PIN) that will be used to confirm that the call was received. Make sure your PIN is easy to remember. Notification You will be notified about the following events: When the order has been served on the respondent As a reminder when your order is about to expire (you may want to extend your order at that time) When the service calls, you will be asked to enter your PIN followed by the pound (#) key. Entering your PIN lets the service know that you received the call and will stop the service from calling you again Important Things to Know What is a protective order? This is a court order issued by a judge to protect a victim (the petitioner) from someone who has been abusive or threatened violence (the respondent). This order requires the respondent to stop the abuse and stay away from the petitioner. It also authorizes the arrest of the person who violates provisions of the order. Who is the petitioner? The petitioner is the person who asks the court to issue the order and needs protection. Who is the respondent? The respondent is the person who has been abusive or threatened violence. Who can register for notifications? Any petitioner may register for notification. You can also choose to share the toll-free number and the case number, but not your PIN, with family members or friends. They can register for notification using their own PIN. How do I protect my PIN? What if I forget my PIN or want to stop notifications? Protecting your PIN is the key to receiving notification. Choose a PIN that only you know. Your victim advocate can help you reset your PIN or cancel notification. Operators are also available around-theclock for assistance. What if the respondent tries to get information about me through WA Protective Order? The respondent will not know you are registered with the WA Protective Order service. Other questions? Call the WA Protective Order service toll-free at Wait on the line to speak with an operator. Write down the following information, tear off this panel, and keep in a safe place: My case number My four-digit PIN My victim advocate Contact number If you feel you are in danger, call 911 immediately. Since the service calls automatically when a protective order is served, you may get a call from the service in the middle of the night. If there is no answer, or if the call goes to an answering machine, the system will continue to call for up to 24 hours or until a correct PIN is entered. A short message will be left on your answering machine. However, because of safety concerns, the message will not state who is calling, nor provide information about your case. Do not register a phone number that rings to a switchboard. You can register multiple phone numbers and addresses for notifications. Operators are available 24 hours a day, seven days a week to assist you. If you have registered but have not heard that the order has been served after three to four days, contact your victim advocate.

9 Instructions for Petition for Order for Protection This form is used to start a domestic violence protection order case. Ask the court clerk for advocate services to help you fill out this form. This form will be: Filed as a public court record and will start a civil court case. Served (personal delivery) to the person from whom you need protection. The information in the petition is used by the court to determine if: The court has authority to enter an order on your behalf. If the relationship between you and the other party meets the legal definition of family or household member. If the respondent s behavior towards you meets the legal definition of domestic violence. This is a two step process. This form is used to request both immediate temporary protection And full protection. If you need immediate protection, and the court finds an emergency exists, the court may immediately issue a temporary order that will last until the court holds a hearing, usually within 14 days. During the 14 days, you must arrange for service on the respondent of the petition, temporary order and notice of hearing, and any other declarations or documents, if any, presented to the court. Service may be done by a law enforcement agency where the respondent lives or works, a hired professional process server, or a person 18 or over who is not a party to this action. The person completing service on the respondent must file an affidavit, declaration, or certificate of service with the court or the hearing cannot go forward. At the hearing, the court will determine if it should issue a full Order for Protection. The respondent has a right to attend that hearing. Please Print Clearly Using Black or Blue Ink! Top of the form (Page 1) Fill in your name (first, middle initial, last) as the Petitioner. The person you want protection from is the Respondent. Fill in the respondent's name (first, middle initial, last). Who Needs Protection (Question 1) The court must know who needs protection. Check the first box if you need protection. Check the second box if someone in your family or household needs protection. You may check both boxes. Check the third box if you are the guardian, guardian ad litem or next friend of a minor years of age who is a victim of domestic violence in a dating relationship with a person 16 years of age or older, who needs protection. Include the minor s name in the space provided within the third check box and provide additional identifying information for the minor in paragraph 5. A next friend is a competent person, over 18 years of age, chosen by the minor who is capable of pursuing the minor s stated interest in the petition for order for protection action. DVI (6/2010) Page 1 of 6 Petition

10 Residency (Question 2) Check the box that applies. Age (Question 3) The court needs to know the ages of the petitioner/victim and the respondent. Check One of the boxes for the petitioner s/victim s age. Check One of the boxes for the respondent's age. Relationship (Question 4) The court must know the relationship between the petitioner/victim and the respondent. Check all the boxes that describe your situation. If you are petitioning on behalf of a minor, the minor s relationship to the respondent is addressed in question 5. Identification of Minors (Question 5) If there are no children, check the box indicating No Minors Involved. If there are children, list each child's name, age, race and sex. Fill in how that child is related to you (for example, son, stepdaughter). Fill in how that child is related to the respondent. Fill in with whom that child lives (for example: me, grandparent, respondent). If you have questions about safety for your children, ask for advocate resources for help in filling out this section. Court Cases (Question 6) This may not be the first court proceeding involving you, or the minors, and the respondent. The court will need to know about other cases, such as divorce, parentage or criminal, or other restraining, protection or no-contact orders so the court does not issue an order that might conflict with an order from another court. If there are other cases or orders involving you, or the minors, and the respondent, list the case title (the parties' names), the case number (if you know it), and the court (district, municipal, or superior) and the county in the columns provided. Request for Protection (Page 2) In this section, you must tell the court what you want the court to order now and after the hearing (the relief requested). The court can only grant the relief you request in the petition. To request relief beginning today and lasting until the hearing, check the boxes on the left under Temp. To request relief you want in the full order issued at the hearing, check the boxes on the left under Full. Some provisions allow you to ask the court to protect you, all the minors listed in paragraph 5 or only minors you name. Some provisions allow you to specify which locations you want included in the protection. Be sure to check the boxes to specify which people and places you want protected within each restraint provision. DVI (6/2010) Page 2 of 6 Petition

11 1. The first provision asks the court to restrain the respondent from causing physical harm, or from stalking or harassing you and/or the children you name. 2. The second provision asks the court to restrain the respondent from harassing, following, keeping under surveillance, including cyberstalking, or from using telephonic, audiovisual or other electronic means to monitor the actions, locations or communications of you and/or the minors listed in paragraph 5, only the minors you name in this provision. You may also ask for protection in this provision for the victim s adult children and/or any of the victim s household members. Write in the names of the adult children or household members in the space provided. 3. The third provision asks the court to restrain the respondent from contacting you and/or the children you name. 4. The fourth provision asks the court to exclude the respondent from your home, workplace, school or the minor s day care or school. If there is someplace else you want to include, add it to the box called other. You have a right to keep your residential address confidential (secret). This restraint provision in the temporary order and in the full order has a space for you to write in your residential address. You are not required to write in your residential address if you are concerned with your safety or with identity theft. However, enforcement of the order may be easier if your address is included. If you decide to include your address, please list the complete address, including the city. 5. The fifth provision asks the court to order the respondent to vacate the home the two of you share and to give you exclusive rights to the home. 6. The sixth provision asks the court to prohibit the respondent from knowingly coming within or knowingly remaining within a specified distance (e.g. 100 feet, 2 blocks) of your home, workplace or school; or the minor s day care or school. If there is someplace else you want to include, add it to the box called other. 7. The seventh provision asks the court to grant you possession of essential personal belongings. Please list the personal belongings. ( Essential personal belongings means those items necessary for a person's immediate health, welfare, and livelihood. Essential personal belongings includes but is not limited to clothing, cribs, bedding, documents, medications, and personal hygiene items. (RCW (7).) 8. The eighth provision asks the court to grant you use of a vehicle (i.e., blue 1994 Ford Taurus, License Number XYZ123). 9. The ninth provision, Other, is where you may list something not mentioned in the above provisions. Provisions 10, 11, 12, 13, 14, and 15 are only available as part of the Full Order: 10. The tenth provision asks the court to direct the respondent to get treatment or counseling. 11. The eleventh provision asks the court to require the respondent to pay the fees and costs of this action. (Fees and costs may include court costs, service fees and reasonable attorney's fees.) DVI (6/2010) Page 3 of 6 Petition

12 12. The twelfth provision asks the court to make the order remain effective (last longer) than one year. Check this box only if there is reason to believe the respondent would resume the acts of domestic violence against you if the order expired in one year. 13. The thirteenth provision asks the court to grant you exclusive custody and control of pet(s). You can only ask for custody and control of a pet if it is owned, possessed, leased, kept, or held by you, the respondent, or a minor child residing with either you or the respondent. 14. The fourteenth provision asks the court to prohibit the respondent from interfering with your efforts to remove the pet(s). 15. The fifteenth provision asks the court to prohibit the respondent from knowingly coming within or knowingly remaining within a specified distance (e.g. 100 feet, 2 blocks) from the location(s) you list where the pet(s) may regularly be found. Remember, you have a right to keep your residential address confidential. If There Are No Minors Involved Do Not Check Provisions 16, 17, and 18. If You Are Requesting Restraint Provisions Involving Minors Check the Boxes in 16, 17 and The sixteenth provision asks the court to grant (give) you the temporary care, custody and control of the children you name. 17. The seventeenth provision asks the court to restrain the respondent from interfering with your custody of the children you name. 18. The eighteenth provision asks the court to restrain the respondent from removing the listed children from the state. Please review the section you just completed to ensure that you checked the boxes to show which provisions you want in temporary, full or both orders. In each provision, be sure you checked the boxes to identify the people and places you want protected. Request for Special Assistance From Law Enforcement Agencies You might need special help from the police. Check off everything that you think you may need the police to assist you in obtaining. 1. The first item asks the court to order the police to help you get back into your home. For your safety, ask for a police escort back into your home. 2. The second item asks the court to order the police to help you get use of the vehicle. 3. The third item asks the court to order the police to help you get your personal belongings (Civil Standby). Check the box if you want the police to help you get your belongings from the shared residence, the respondent s residence or another location. Because of time limitations, availability of DVI (6/2010) Page 4 of 6 Petition

13 officers and safety, contact law enforcement to schedule a civil standby (when they will meet you and how long they can stay). 4. The fourth item asks the court to order the police to help you get custody of the children you list. There may be additional steps that you have to take for this request to be enforced. 5. The last item lets you ask for other help you might need from the police. Statement of Petitioner The statement of petitioner is to describe to the court why a protection order is needed. This document will be filed in the court file, which is a public record, and shall be served on the respondent. If you do not include a particular incident of domestic violence in your statement, you may not have an opportunity to tell the court at the hearing. Domestic violence means physical harm, bodily injury, assault, including sexual assault, stalking, Or inflicting fear of imminent physical harm, bodily injury or assault between family or household members. First read through the statement section in the petition before you start writing. There are several places for you to describe what happened. Describe exactly what happened when you were threatened or hurt. Provide as much detail as you can such as dates, times, witnesses, injuries, if any, medical treatment, if any. The more details you can provide the more helpful it is to the judge. If there is an emergency, explain why so the court can issue an immediate temporary order before the hearing. In addition to the information requested in the statement you may want to include: If the respondent has hurt other people. If the respondent has been arrested. If police responded even if no arrests were made. Examples: It is better to say On Sunday, January 12, at 2:00 a.m., Terry slapped my face. Rather than On Sunday Terry assaulted me. It is better to say Terry threatened to kill me if I left the house. He said You leave and I will kill you. Rather than Terry threatened me. It is better to say Terry drives by me while I m waiting at the bus stop after work every Monday evening. Rather than Terry is stalking me. It is better to say Terry sends me s or text messages [include number] times a day. I texted Terry to stop; but Terry keeps sending the messages. Rather than Terry cyber stalks me. Try to use the respondent s exact words when you were threatened with physical harm. DVI (6/2010) Page 5 of 6 Petition

14 If any of the information requested does not apply, write, does not apply in that section. Choose the appropriate box if substance abuse is involved. Out of State Service If the respondent cannot be personally served in Washington State, check the box. Note: The respondent will still have to be personally served, unless the court orders otherwise. Sign the Form When you are done with your statement, put today s date in the date line and fill in the city where you are completing this form. Sign the form. The respondent has a right to have you served with documents in response to this petition. You have a right to keep your residential address confidential. If you want to keep your address confidential, you must list an address that is not your residential address where you agree to accept legal documents. Law Enforcement Information Sheet (LEIS) You must complete a Law Enforcement Information Sheet (LEIS), form WPF All Cases This form is confidential and it does not go in the public court file and is not served on the respondent. It is used by Law Enforcement to locate and identify the respondent when serving documents. It is also used by Law Enforcement when entering the order in the state-wide data base. Complete as much information as possible, especially, first name, middle initial, last name, and date of birth. If the respondent has a disability, brain injury, or other impairment, you may know of special assistance that law enforcement could provide when serving the documents. For example: Respondent has a brain injury. If respondent is rushed, respondent may freeze up and may not respond quickly, or may become verbally aggressive. Remind respondent to contact a friend. Respondent has epilepsy and diabetes and may have seizures when stressed. Respondent doesn t respond well to being rushed and will need time to get meds and supplies. DVI (6/2010) Page 6 of 6 Petition

15 Superior Court of Washington For Skagit County Petitioner Respondent vs. No. Petition for Order for Protection (PTORPRT) 1. I am a victim of domestic violence committed by the respondent. A member of my family or household is a victim of domestic violence committed by the respondent. I am a guardian guardian ad litem next friend of a minor who is 13 to 15 years of age and is a victim of domestic violence in a dating relationship with a person age 16 or older. The name of the minor victim is. This person s identifying information is provided in paragraph 5 below. 2. The victim lives in this county. The victim left their residence because of abuse and this is the county of their new or former residence. 3. The victim s age is: Respondent's age is: Under or or over Under or or over 4. The victim s relationship with the respondent is: spouse or former spouse parent of a child in common current or former domestic partner current or former cohabitant as part of a dating relationship current or former dating relationship stepparent or stepchild current or former cohabitant as roommate in-law parent or child blood relation other than parent or child Petition for Order for Protection (PTORPRT) - Page 1 of 7 WPF DV Mandatory (06/2014) - RCW

16 5. Identification of Minors (if applicable) No Minors involved. Name (First, Middle Initial, Last) Age Race Sex How Related to Petitioner Respondent Resides with 6. Other court cases or other restraining, protection or no-contact orders involving me, the minors and the respondent: Case Name Case Number Court/County I Request an Order for Protection following a hearing that will: 1 Restrain respondent from causing any physical harm, bodily injury, assault, including sexual assault, and from molesting, harassing, threatening, or stalking me the minors named in paragraph 5 above these minors only: (If the court orders this relief, and the respondent is your spouse or former spouse, current or former domestic partner, the parent of a child in common, or a current or former cohabitant as part of a dating relationship, the respondent will not be able to obtain or possess a firearm, other dangerous weapon, ammunition, or concealed pistol license under state or federal law for the duration of the order.) 2 Restrain respondent from harassing, following, keeping under physical or electronic surveillance, cyberstalking as defined in RCW , and using telephonic, audiovisual, or other electronic means to monitor the actions, locations, or wire or electronic communication of me the minors named in paragraph 5 above only the minors listed below; members of the victim s household listed below the victim s adult children listed below: 3 Restrain respondent from coming near and from having any contact whatsoever, in person or through others, by phone, mail, or any means, directly or indirectly, except for mailing of court documents, with me the minors named in paragraph 5 above, subject to any court-ordered visitation these minors only, subject to any court-ordered visitation: Petition for Order for Protection (PTORPRT) - Page 2 of 7 WPF DV Mandatory (06/2014) - RCW

17 4 Exclude respondent from our shared residence my residence my workplace my school the residence, day care, or school of the minors named in paragraph 5 above these minors only: other: You have a right to keep your residential address confidential. 5 6 Direct respondent to vacate our shared residence and restore it to me. Prohibit respondent from knowingly coming within, or knowingly remaining within (distance) of our shared residence my residence my workplace my school the day care or school of the minors named in paragraph 5 above. these minors only: other: 7 Grant me possession of essential personal belongings, including the following: 8 9 Grant me use of the following vehicle: Year, Make & Model License No. Other: Protection involving a minor: 10 Subject to any court-ordered visitation, Grant me the care, custody and control of minors named in paragraph 5 above these minors only: the 11 Restrain respondent from interfering with my physical or legal custody of named in paragraph 5 above these minors only: the minors 12 Restrain the respondent from removing from the state: paragraph 5 above these minors only: the minors named in Additional Requests: Direct the respondent to participate in appropriate treatment or counseling services. Require the respondent to pay the fees and costs of this action. Remain Effective longer than one year because respondent is likely to resume acts of domestic violence against me if the order expires in a year. Petition for Order for Protection (PTORPRT) - Page 3 of 7 WPF DV Mandatory (06/2014) - RCW

18 Protection involving pets Grant me exclusive custody and control of the following pet(s) owned, possessed, leased, kept, or held by me, respondent, or a minor child residing with either me or the respondent. (Specify name of pet and type of animal.):. Prohibit respondent from interfering with my efforts to remove the pet(s) named above. Prohibit respondent from knowingly coming within, or knowingly remaining within (distance) of the following locations where the pet(s) are regularly found: petitioner's residence (You have a right to keep your residential address confidential.) Park other: Protection from Firearms and Other Dangerous Weapons 19 Require the respondent to surrender any firearm or other dangerous weapon, or any concealed pistol license, and prohibit the respondent from obtaining or possessing a firearm or other dangerous weapon, or a concealed pistol license. Notice: If you are the respondent s intimate partner, after actual notice and an opportunity to be heard at the hearing, the court may be required to order the respondent to surrender firearms, other dangerous weapons, or concealed pistol license. I want emergency temporary protection effective immediately, that lasts (up to 14 days) until the court hearing: An emergency exists as described below. I request that a Temporary Order for Protection granting the relief requested above in 1) through 12) be issued immediately, without prior notice to the respondent, to be effective until the hearing. I also request temporary surrender of a firearm or other dangerous weapon without notice to the other party because irreparable injury could result if an order is not issued until the hearing. What irreparable harm would result if an order is not issued immediately without prior notice to the respondent? Request for Special Assistance From Law Enforcement Agencies: I request the court order the appropriate law enforcement agency to assist me in obtaining: Possession of my residence. Possession of the vehicle designated above. Possession of my essential personal belongings at the shared residence respondent s residence other location. Petition for Order for Protection (PTORPRT) - Page 4 of 7 WPF DV Mandatory (06/2014) - RCW

19 Custody of the minors named in paragraph 5 above these minors only (if applicable): Other:. Domestic violence means physical harm, bodily injury, assault, including sexual assault, stalking, Or inflicting fear of imminent physical harm, bodily injury or assault between family or household members. Statement: The respondent has committed acts of domestic violence as follows. (Describe specific acts of domestic violence and their approximate dates, beginning with the most recent act. You may want to include police responses.) Describe the most recent violent act, fear or threat of violence, and why the temporary order should be entered today without notice to the respondent:. Describe the past incidents where you experienced violence, where you were afraid of injury or where the respondent threatened to harm or kill you:. Petition for Order for Protection (PTORPRT) - Page 5 of 7 WPF DV Mandatory (06/2014) - RCW

20 Describe any violence or threats towards children:. Describe any stalking behavior by respondent, including use of telephonic, audiovisual or electronic means to harass or monitor:. Describe medical treatment you received and for what:. Describe any threats of suicide or suicidal behavior by the respondent:. Does the respondent own or possess firearms? Yes No. Does the respondent use firearms, weapons or objects to threaten or harm you? Please describe: Has the respondent used, displayed, or threatened to use a firearm or other dangerous weapon in a felony? Please describe:.. Petition for Order for Protection (PTORPRT) - Page 6 of 7 WPF DV Mandatory (06/2014) - RCW

21 Has the respondent previously committed an offense that makes him or her ineligible to possess a firearm under the provisions of RCW ? Please describe: Does possession of a firearm or other dangerous weapon by the respondent present a serious and imminent threat to public health or safety, or to the health or safety of any individual? Please describe:.. If you are requesting that the protection order lasts longer than one year, describe the reasons why: Other:.. (Continue on separate page if necessary.) Check box if substance abuse is involved: alcohol drugs other Personal service cannot be made upon respondent within the state of Washington. I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Dated: at, Washington. Signature of Petitioner You have a right to keep your residential address confidential. If you have one, please provide an address, other than your residence, where you may receive legal documents:. Petition for Order for Protection (PTORPRT) - Page 7 of 7 WPF DV Mandatory (06/2014) - RCW

22 Superior Court of Washington For Skagit County No. Petitioner vs. Respondent DOB DOB Temporary Order for Protection and Notice of Hearing (TMORPRT/ORWPN) (Clerk's Action Required) Next Hearing Date: Time: [ ] 9:30 am [ ] 10:00 am [ ] 1:30 pm At: Skagit County Superior Court 205 W. Kincaid Street, Mount Vernon WA Names of Minors: No Minors Involved Respondent Identifiers First Middle Last Age Sex Race Hair Height Weight Eyes Respondent s Distinguishing Features: Caution: Access to weapons: yes no unknown The Court Finds: The court has jurisdiction over the parties, the minors, and the subject matter. The respondent will be served notice of his or her opportunity to be heard at the scheduled hearing. RCW For good cause shown, the court finds that an emergency exists and that a Temporary Protection Order should be issued without notice to the respondent to avoid irreparable harm or injury. The Court Orders: 1. Respondent is restrained from causing petitioner physical harm, bodily injury, assault, including sexual assault, and from molesting, harassing, threatening, or stalking petitioner the minors named in the table above these minors only: 2. Respondent is restrained from harassing, following, keeping under physical or electronic surveillance, cyberstalking as defined in RCW , and using telephonic, audiovisual, or other electronic means to monitor the actions, locations, or wire or electronic communication of petitioner the minors named in the table above only the minors listed below members of the victim s household listed below the victim s adult children listed below: Additional no contact provisions are on the next page. The terms of this order shall be effective until: the end of the hearing, noted above. Temp Ord for Protection/Nt of Hrg (TMORPRT/ORWPN) - Page 1 of 4 WPF DV Mandatory (12/2014) - RCW , RCW