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SC-28 Petition for Dating Violence Temporary Protective Order SC-28 THE SUPERIOR COURT FOR THE COUNTY OF STATE OF GEORGIA : Petitioner, : Civil Action File : v. : No. : : Respondent. : PETITION FOR DATING VIOLENCE TEMPORARY PROTECTIVE ORDER Petitioner, pursuant to O.C.G.A. § 19-13A-1 et seq., files this Petition for a Dating Violence Temporary Protective Order and in support shows the Court the following: 1. Petitioner is a resident of County, Georgia. Petitioner is over the age of 18. 2. Respondent is a resident of County, Georgia, and may be served at , Georgia. Jurisdiction and venue are proper with this Court. OR 2.1 Respondent is a resident of the State of . Under O.C.G.A. § 19-13A-2 jurisdiction and venue are proper with this Court because the abuse occurred in the State of Georgia in County and/or Petitioner lives in County. Respondent is subject to the jurisdiction of this Court and may be served at . 3. Petitioner and Respondent are currently, or within the last six months were, in a dating relationship as described by O.C.G.A. § 19-13A-1 (check all that apply): [ ] Yes [ ] No Is either party pregnant with the other party’s child? [ ] Yes [ ] No Are you currently in a committed romantic relationship with Respondent? For your convenience, this form has been designed to be completed online. The information typed on the first page will automatically update to the other pages. Please be sure all pertinent information is completed before printing. Once the form is completed, select 'Print' to print the form. Selecting 'Reset' will clear the entire form. Print Reset ---PAGE BREAK--- CIVIL ACTION FILE NO. 2 [ ] Yes [ ] No If you and Respondent are not currently in a committed romantic relationship, were you in a committed romantic relationship within the last six months? Please describe what makes your relationship with the Respondent a romantic or dating relationship, including how long you have dated, how you spend time together, how often you communicate and see each other, how you have represented the relationship to others (such as on social media), and whether you are physically intimate with each other (i.e. do you hold hands, kiss, have sex, sleep together, etc.): 4. On or about Respondent committed the following acts of Dating Violence (simple battery, battery, simple assault, stalking, any felony) against Petitioner (please describe): ---PAGE BREAK--- CIVIL ACTION FILE NO. 3 and Petitioner is in reasonable fear for Petitioner’s own safety. 5. At other times Respondent has committed other such acts/crimes against Petitioner, including but not limited to (approximate dates and what happened): 6. There is a substantial likelihood that Respondent will commit such acts of violence against Petitioner in the immediate future if relief is not granted as provided pursuant to O.C.G.A. § 19-13A-4. Check the paragraphs below that apply to your case. Fill in the information needed by each paragraph you check. 7. Petitioner fears that if Respondent learns of Petitioner's current address that Respondent will hurt or injure Petitioner. Petitioner requests that Respondent not be informed of Petitioner's current residence. 8. Petitioner asks that the Court award possession of the following property to Petitioner (list items specifically including household goods, keys, pets): ---PAGE BREAK--- CIVIL ACTION FILE NO. 4 THEREFORE, Petitioner asks: That the Court set a hearing no later than thirty (30) days from the filing of the Petition and direct Respondent to appear before this Court and show any reasons why the demands of Petitioner should not be granted; That Respondent be served a copy of this Petition and Ex Parte Protective Order as required by law; That this Court direct law enforcement to enforce this Order; That this Court direct Respondent to stop abusing, harassing and intimidating Petitioner; That this Court restrain and enjoin Respondent from having any direct or indirect contact with Petitioner; That this Court order that Respondent be enjoined from approaching within yards of Petitioner; That this Court make findings of fact and conclusions of law concerning the issues in this case; That Petitioner have such other and further relief as the Court may deem just and proper; That this Court issue Dating Violence Ex Parte and Twelve Month Protective Orders to: Check the paragraphs below that apply to your case. Fill in the information needed by each paragraph you check. order Respondent to stay away from Petitioner’s place of residence, place of employment, and/or school, as well as return any and all keys, garage door openers, and other security and access devices to Petitioner; award Petitioner costs and attorney’s fees for having to bring this action; order that Petitioner’s current address be kept confidential; enjoin and restrain Respondent from selling, disposing or encumbering, trading, contracting to sell, or otherwise disposing or removing from the jurisdiction of this Court any of the property of Petitioner or of the parties except in the ordinary course of business; permit Petitioner to remove the following property of Petitioner’s from Respondent’s ---PAGE BREAK--- CIVIL ACTION FILE NO. 5 residence for the exclusive use by Petitioner and law enforcement (sheriff or police department) be ordered to assist Petitioner during this removal; order Respondent to undergo appropriate or educational services an appropriate intervention program); order Respondent to undergo evaluation for drug/alcohol abuse and to follow the recommended treatment; order Respondent to return the following property to Petitioner immediately; order additional relief as follows: Respectfully submitted, Petitioner’s Signature Petitioner’s Address Telephone: (Do not give current address if confidential; give alternative address) ---PAGE BREAK--- CIVIL ACTION FILE NO. 6 THE SUPERIOR COURT FOR THE COUNTY OF STATE OF GEORGIA : Petitioner, : Civil Action File : v. : No. : : Respondent. : VERIFICATION Personally appeared , who being duly sworn states that she/he is the Petitioner in the above styled case and that the facts set forth in the foregoing Petition are true and correct. Petitioner Sworn and subscribed before me this day of , 20 . NOTARY PUBLIC/JUDGE/CLERK My commission expires: ---PAGE BREAK--- CIVIL ACTION FILE NO. 7 Pursuant to O.C.G.A. § 19-13A-3, Petitioner assisted by Name: Address: Phone: ---PAGE BREAK--- CIVIL ACTION FILE NO. 8 *REMOVE THIS PAGE FROM ORDER AND FILE SEPARATELY UNDER SEAL* Rev’d 1/22 CONFIDENTIAL INFORMATION FORM - ATTENTION COURT STAFF: THIS PAGE IS A RESTRICTED-ACCESS DOCUMENT. This document is not accessible to the public or to other parties. RESPONDENT’S IDENTIFYING FACT SHEET (please complete as much as possible; one of these must be provided to have the order placed in the National Crime Information Center registry: Respondent’s date of birth OR social security number) Respondent’s social security number is , date of birth is , sex , color of hair , color of eyes , height , weight . Respondent’s race is , ethnic background . Respondent has distinguishing marks (tattoos, scars, etc.) . Respondent drives a , license tag no: (Expires: ) and has a (state) driver’s license no: (Expires: Respondent’s home address is and is employed by at and works from to on (days) . Respondent has the following known aliases: . Petitioner: Other: Other: Other: Other: PROTECTED PARTIES’ IDENTIFYING INFORMATION DOB sex race DOB sex race DOB sex race DOB sex race DOB sex race