Application_for_Protective_Order

INSTRUCTIONS: APPLYING FOR A PROTECTIVE ORDER

YOU NEED TO READ THE FOLLOWING INFORMATION BEFORE YOU FILL OUT THE INTAKE FORM.

What is a Protective Order?

A protective order is a civil court order issued to prevent continuing acts of family violence.

HOW CAN A PROTECTIVE ORDER HELP?

A protective order may prohibit the offender from:

committing further acts of family violence
harassing or threatening the victim, either directly or indirectly by communicating the threat through another person
going to or near a school or day-care center that a child protected under the order attends

The offender may or may not be immediately arrested for violating these orders!

A protective Order cannot award custody of children and this office cannot help you get custody of children. You must contact a private attorney or Northwest Texas Legal Aid Services if getting custody of children is your

WHAT DO YOU HAVE PROVE TO BE ABLE TO GET A PROTECTIVE ORDER?

In order to get a Protective Order, you will have to prove two things to the judge: (1) That family violence has occurred and (2) That family violence is likely to happen again in the near future.

WHO MAY NOT FILE FOR A PROTECTIVE ORDER?

(1) If you are married and going thru a divorce, the application for a Protective Order must be filed through the divorce.

(2) If you have a criminal case pending in Randall County a conflict of interest exists and our office cannot file a Protective Order on your behalf. You may still be able to get a Protective Order through a private attorney or Northwest Texas Legal Aid Services.

(3) If you were the respondent (the abuser) in a previous order and our office represented the applicant, we have a conflict of interest and cannot apply for a protective order on your behalf. You must contact a private attorney or Northwest Texas Legal Aid Services.

(4) If CPS has custody of your children and the case is pending in Randall County, a conflict of interest exists and our office cannot file a Protective Order on your behalf. You may still be able to get a Protective Order through a private attorney or Northwest Texas Legal Aid Services.

STEPS IN APPLYING FOR A PROTECTIVE ORDER:

(1) Submit information packet online, which includes an Affidavit (a sworn statement

(2) Screening process in our office and meeting with an attorney.

(3) Our office takes the Affidavit to the Judge who decides if a Temporary Ex-Parte order should be granted. The temporary order only lasts 20 days.

(4) The hearing on the permanent protective order will be within 14 days. The Judge will decide if a permanent protective order should be granted. The respondent is entitled to be present at the hearing.

(5) You may be required to gather records and/or information to complete the application for the protective order or for use during the hearing.

(6) THE LAW REQUIRES YOU TO TESTIFY AT THE HEARING FOR THE PERMANENT PROTECTIVE ORDER, EVEN IF THE RESPONDENT DOES NOT SHOW UP.

WHAT HAPPENS IF THE PERMANENT PROTECTIVE ORDER IS VIOLATED?

Call the police immediately!! Remember, protective orders do not offer complete protection. No piece of paper can protect you from all instances of violence.

If a person violates the permanent protective order IN THE PRESENCE of law enforcement, the offender must be arrested immediately.

If the person violates the permanent protective order outside the presence of law enforcement, a police report needs to be made SO law enforcement can conduct an investigation for the offense of violation of a protective order. This may or may not result in an arrest.

IF YOU ARE NOT ELIGIBLE TO APPLY FOR A PROTECTIVE ORDER YOU MAY BE ABLE TO:

You may be able to issue a A TRESPASS WARNING against the person. You must give the person notice to stay away from your home (your employer can issue a trespass warning for the place where you work). You must send the person a trespass warning that simply states I AM NOTIFYING YOU THAT YOU DO NOT HAVE MY PERMISSION TO COME TO MY RESIDENCE LOCATED AT _____________ , ________________TEXAS. Sign you name on the warning and send it Certified Mail return receipt requested. Keep a copy of the warning and the GREEN CARD the post office sends back to you showing that the person received the warning.

IF YOU ARE CURRENTLY MARRIED TO THE PERSON AND YOU SHARE A HOME YOU CANNOT ISSUE A TRESPASS WARNING FOR THE RESIDENCE YOU SHARE TOGETHER!

After the person has notice and IF you have a copy of the warning and the green card receipt, the police may be able to file a criminal trespass charge if the person returns to your property.

EVEN IF YOU ARE NOT ELIGIBLE FOR A PROTECTIVE ORDER, call 911 when any violenceoccursandmake a police report. If the person is harassing you over the phone or otherwise contact the police and harassment charges may be filed. Record telephone calls if possible and take pictures of the caller I.D. logs, texts, and other social media contact, as some proof that the person is harassing you.

PLEASE PROVIDE AS MUCH INFORMATION AS POSSIBLE. WE UNDERSTAND THAT THIS IS TIME CONSUMING, BUT IT IS NECESSARY TO MAKE SURE YOU GET THE BEST HELP AND ADVICE THAT WE CAN GIVE YOU.

1. APPLICANT'S INFORMATION: (You are the applicant)

Your Name*

WHAT IS THE RELATIONSHIP BETWEEN YOU AND THE RESPONDENT?*

DL#:

State:

Date of Birth:

Date

SS#:

Race:

Sex:

What county have you lived in for the last 30 days?*

Home Address:*

City:

Zip:

Home Phone:*

Cell Phone:*

Email address:*

example@example.com

Mailing Address if different from home address:

Place of Employment & Work Address:

Work Phone#:

It is important that we always be able to contact you with information regarding your case. Please list name, address, phone number, and relationship of someone who will always be able to reach you and will always know where you are:

Do you currently live with Respondent?

YesNo

Does the Respondent know your Phone Number, Home address, or Work Address?

YesNo

If yes please specify which or all

Do you have any pending felony or misdemeanor criminal charges against you in Randall County?

YesNo

Are you currently on probation in Randall County at this time?

YesNo

Does CPS thru Randall County have custody of your children?

YesNo

If yes please explain:

2. RESPONDENTS INFORMATION: (this is the person you want ordered to stay away from you)

Respondents Name:*

Alias (Nicknames):

DL#:

State:

Date of Birth:

Date

Age:

SS#:

Race:

Sex:

What county has this person lived in for the last 30 days?

Home Address:

City:

Zip:

Home Phone:

Cell Phone:

Email address:*

example@example.com

Mailing Address if Different from home address:

Place of Employment & Work Address:

Work Phone#:

Hours/Dept:

Supervisor:

Height: blanks feetblank inches

Weight: blank pounds

Eye Color:

Hair Color:

Skin Color:

Other contacts who may have information to help find Respondent:

Name:

Phone:

Address:

Relationship:

Respondent's Vehicle:

Year:

Make/Model:

Color:

License Plate:

State:

Other addresses to where we might find the respondent:

Does the respondent have outstanding warrants?

YesNo

If yes for what offenses?

Is respondent on probation or parole?

YesNo

If yes, name of Probation/Parole officer:

Phone # of Probation/Parole officer:

For what offense is the respondent on probation/parole?

Other Known arrests convictions:

3. INFORMATION REGARDING CHILDREN OF THE MARRIAGE/RELATIONSHIP

A. List the names of your minor children of THIS marriage/relationship, including their dates of birth:

List the names of schools and addresses that each child attends:

Do these children live with you?

YesNo

If not, who do they live with?

B. List the names of your minor children of OTHER marriage/relationship(s), including their dates of birth:

Do these children live with you?

YesNo

If not who do they live with?

Has Child Protective Services ever removed a child from your custody or from the custody of the Respondent?

YesNo

4. MARITAL STATUS AND DIVORCE PROCEEDINGS

Are you married legally or by common-law to the respondent NOW?

YesNo

Has a divorce been filed?

YesNo

If yes, what is the cause number and county?

Who is/was your attorney in the Divorce case?

If you were married to the respondent IN THE PAST, when and in what county was the divorce finalized?

5. COURT ORDERS OR PROCEEDINGS REGARDING CHILDREN:

Are there any court orders or court proceedings regarding your children (for example, child support/visitation, Attorney General Case, paternity suit, Child Protective Services case)?

YesNo

If yes what is the cause number and county?

*** YOU MAY BE ASKED TO PROVIDE COPIES OF ANY COURT ORDERS AFFECTING YOU, THE CHILDREN, OR THE RESPONDENT- IT WILL BE YOUR RESPONSIBILITY TO OBTAIN COPIES OF THESE RECORDS IF THE RECORDS ARE NOT MAINTAINED IN POTTER OR RANDALL COUNTY, TEXAS***

6. HOUSEHOLD RESIDENCY

Are you asking that the respondent be excluded from the home until the day of the hearing on the permanent two year protective order?

YesNo

Has the respondent committed family violence against you within the last 30 days?

YesNo

Do you Own, Lease, or Rent the home?

Whose names is on the lease/deed/rental agreement?

7. FAMILY VIOLENCE HISTORY

Was there a weapon involved in the most recent incident of abuse?

YesNo

If yes, what type of weapon?

Was Respondent under the influence of drugs, alcohol, or chemical intoxicants when abuse occurred?

YesNo

If yes, what kind?

Is Respondent active Military?

YesNo

If yes, name and telephone number of Unit Commander.

Was medical treatment received as a result of this incident?

YesNo

If so, was it:

EMSHospitalDoctor

EMS Date of treatment

Date

Hospital Date of treatment

Date

Doctor Date of treatment

Date

Have you ever received medical treatment as a result of Respondent's violence?

YesNo

If yes where and when?

Was law enforcement called as a result of this incident of violence?

YesNo

If yes, what department responded?

If yes, what is the report number

Have charges ever been filed against the respondent as a result of family violence to you or anyone?

Have you ever been involved in a Protective Order before?

YesNo

If yes, when and explain what happened

Do you believe Respondent has a drug or alcohol problem?

YesNo

If yes, why do you believe this?

Has the Respondent ever been abusive to your children?

YesNo

If yes, when and in what way?

Was the abuse reported to Child Protective Services?

YesNo

Has the Respondent ever been abusive to animals?

YesNo

If yes, when and in what way?

Do you believe Respondent has mental problems?

YesNo

If yes, why do you believe this?

9. PHOTO DOCUMENTATION

Were photos ever taken of any of your injuries?

YesNo

If yes, who took them and when?

11. FIREARMS

Does the respondent have a license to carry a concealed handgun?

YesNo

Does the respondent have any firearms?

WITNESS INFORMATION

Please provide the name, relationship, addresses, and phone number of each person who witnessed or has witnessed any incident of violence or who has knowledge about any of your injuries. This may include people like your children, family members, friends, neighbors, police officers, medical care professionals, or co-workers. These people will possibly be subpoenaed to testify on your behalf at the final protective order hearing.

INSTRUCTIONS: AFFIDAVIT IN SUPPORT OF PROTECTIVE ORDER

YOU NEED TO READ THE FOLLOWING INFORMATION BEFORE YOU FILL OUT THE AFFIDAVIT FORM.

In order to get an order that will last for 20 days while you wait to go to court on the final protective order that lasts for two years, you need to explain to the Judge why you need protection right now.

Your affidavit in support of the protective order should be short and to-the- point.

You need to briefly, and clearly, describe the most recent event of family violence and explain why you are afraid of the respondent RIGHT NOW.

For example, when describing what happened and why you need protection right now - 1. My husband slapped me in the face and busted my lip. He grabbed my hair and slammed my face into the wall. Then he pushed me down to the ground and kicked me. He did this in front of our children. I tried to call the police but he took my cell phone and threw it against the wall and broke it. I ran to my neighbor's house and called 911. My husband has told me if I ever try to leave him, he's going to kill me and take our child away. When he finds out about this, he is going to be very mad and I am afraid of how he will react.

For example, when describing what happened and why you need protection right now - 2. My boyfriend told me he was going to kill me and put me where no one would ever find me. This isn't the first time he has threatened to kill me. He has a gun and I am afraid he will really do it. When he finds out I'm trying to get him to stay away from me, he is going to be very mad and I am afraid of how he will react.

For example, when describing what led up to the violence - Last night, my husband was mad because I was not home when he got off work. When I got home he was still mad and accusing me of being a bad wife. We started yelling at each other.

You need to briefly, and clearly, describe the history of violence.

For example - 1. My husband has beat me up many times. Last Christmas he got mad so he slammed my head into the wall. Then he choked me until I almost passed out. For example - 2. When I was pregnant last year, he grabbed my arm and twisted it behind my back. He threw me to the ground and kicked me in my side.

You will sign the affidavit in our office in front of a notary.

County of Randall

State of Texas

My Name is:

Age

My relationship with Respondent is:

2 Describe the most recent time the Respondent hurt or threatened to hurt you including any conduct involving sexual assault stalking or trafficking:*

In what county did this happen?

On what date did this happen?

Date

Was a weapon involved?

YesNo

If yes, what kind?

Does Respondent possess or have access to firearms?

YesNo

Were any of the children present?

YesNo

If yes, who?

Did anyone call the police?

YesNo

If yes, what happened?

Were you injured?

YesNo

If yes, describe your injuries?

Did you seek medical care?

YesNo

Has the Respondent threatened or hurt you before?

YesNo

If so describe below how the Respondent threatened or hurt you including dates if possible

Were weapons ever involved?

YesNo

If yes, what kind?

Were the children present?

YesNo

If yes, who?

Did anyone report the conduct to the police?

YesNo

Were you injured?

YesNo

If yes, describe your injuries:

Did you seek medical care?

YesNo

Has the Respondent ever been convicted of family violence?

YesNo

If yes list when and in which county and state the conviction(s) occurred"

5.Has the Respondent ever been convicted or placed on deferred adjudication community supervision for any of the following:

Trafficking of Persons Continuous Trafficking of Persons

Sexual Assault Indecent Assault

Aggravated Sexual Assault Stalking Compelling Prostitution

Unknown Unknown Unknown Unknown Unknown Unknown Unknown

Trafficking of Persons

YesNoUnknown

Continuous Trafficking of Persons

YesNoUnknown

Sexual Assault

YesNoUnknown

Indecent Assault

YesNoUnknown

Aggravated Sexual Assault

YesNoUnknown

Stalking

YesNoUnknown

Compelling Prostitution

YesNoUnknown

If yes, list when and in which county and state the convictions occurred:

Are you Requesting exclusive possession of a residence and to have the Respondent excluded from the residence?

YesNo

What is the location of the residence

Do you currently reside at the residence or have resided there within the last 30 days?

YesNo

Please describe the facts and circumstances that require the Respondent to be excluded from the residence

NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA

AFFIDAVIT