*****THIS FORM IS NOT A PROTECTIVE ORDER APPLICATION OR A PROTECTIVE ORDER*****
|
|
- Benedict Morgan
- 8 years ago
- Views:
Transcription
1 SHAREN WILSON CRIMINAL DISTRICT ATTORNEY OF TARRANT COUNTY, TEXAS PROTECTIVE ORDERS Family Law Center Phone Number East Weatherford Street # 3040 Fax Number Fort Worth, Texas poqintake@tarrantcountytx.gov 1. WHAT IS A PROTECTIVE ORDER? A final protective order is a civil court order issued by a District Court to prevent continuing acts of family violence, dating violence, stalking or sexual assault against the victim and the victim s household members. It is not the same as a restraining order. Violation of a protective order may result in criminal prosecution, and includes the potential for jail/prison time and/or fine for the offender. A protective order may order the abuser to: stay a specified distance, such as 200 yards or more, away from the addresses listed in the order, generally your home, school and work addresses; not commit or threaten to commit violence against you or members of your family; not communicate with you in a threatening or harassing manner - directly or through someone else; not communicate with you at all, except through attorneys and court-appointed persons; not follow you (for Stalking Protective Orders only); not possess any weapons unless that person is a peace officer; not remove or harm your pets or companion animals; and not remove children from your care. The Criminal District Attorney s Office does not issue protective orders. Only a judge can grant a protective order. After one or multiple court hearings, if the judge grants the protective order, your local police or sheriff s department will be sent a copy of the order. If the person complained against commits any of the prohibited acts listed in the Protective Order, criminal charges can be filed by law enforcement if there is sufficient proof of a violation. Page 1 of 13
2 2. THE PROTECTIVE ORDER PROCESS How do I get started? Complete this questionnaire. USE BLACK INK ONLY If you print this form and fill it out by hand, do not use other ink colors, including blue. Do not use pencil. WRITE LEGIBLY - Printing or typing is preferred. Return the completed questionnaire to this office: By poqintake@tarrantcountytx.gov By fax: By mail***: Tarrant County Criminal District Attorney Protective Orders Family Law Center 200 East Weatherford Street, Suite 3040 Fort Worth, Texas ***This usually requires at least two stamps. In person: Between the hours of 7:45 a.m. to 5:00 p.m., Monday through Friday, at the Tarrant County Criminal District Attorney Protective Order office. If you have any questions, you may call this office at between the hours of 7:45 a.m. and 5:30 p.m., Monday through Friday. You ve completed and submitted the questionnaire. What s next? Typically, within 2-3 business days after your questionnaire is received, you will receive a call from a Protective Order support staff person to obtain any missing or incomplete information. After that, an Assistant Criminal District Attorney will call you to discuss your questionnaire and determine if the Criminal District Attorney s Office may file an Application for a Protective Order for you. You may contact this office to check on the status of your questionnaire at any time. If we are unable to assist you, we will provide you with referrals as may be appropriate. You must attend at least one in-person appointment at our offices. Generally, a court date will be set for within 14 days of your in-person appointment. If your case is accepted, an Assistant Criminal District Attorney will obtain an affidavit from you detailing relevant facts of the case, file the protective order lawsuit and represent you in court. Depending on the circumstances, a final protective order may take 4 weeks or more to obtain. Our staff and attorneys will work to accommodate your schedule as much as Page 2 of 13
3 possible. However, there are certain aspects of the court process that we do not control. Court appearances are always during the week, Monday through Thursday. You must be present for court at 8:00 a.m. on your designated court day. 3. WILL I GET A PROTECTIVE ORDER? Based on the information you provide to us, we will assess your request and determine whether the necessary relationship requirements are met, and whether the bad acts you describe meet the code requirements to support filing a Protective Order Application on your behalf. If your primary issue is divorce, child custody, visitation, child support or a property dispute, this office will not file an Application for a Protective Order. You may consult a private attorney for advice on those issues. If you would like the Protective Order to review the facts of your situation to determine whether we may assist you, please complete and submit this questionnaire. It is the policy of the Criminal District Attorney that all services and activities of the office are accessible to all qualified persons without regard to disability. If you have a disability that will require an accommodation, please notify us. If you are hearing impaired, blind or visually-impaired, you may call Relay Texas at 711 from any phone or visit Page 3 of 13
4 Today s date: SECTION I: NAMES OF PARTIES Your name: ( ) First Middle Last Other last names used Full name of the person you want a protective order against (List only one person): ( ) First Middle Last Other last names used What is your current relationship to this person? (Check ONLY one.) Married - living together Married - not living together Divorced Living together - not married Used to live together - never married Related by marriage Biological parents of the same child - never married Dating or used to date Other - please specify: Related by blood please specify: SECTION II: YOUR PERSONAL INFORMATION Your race or ethnicity: White African American Asian American Pacific Islander Hispanic Native American Other - specify: Sex: Male Female Date of Birth: Age: Place of Birth: *If you are female, are you pregnant? Maybe/don t know *If you are female, has this person ever abused you while you were pregnant? Do you have any handicaps or disabilities? If yes, what is your handicap or disability? Visual impairment Hearing impairment Mobility or functional impairment Emotional or mental disorders Cardiac and circulatory diseases Respiratory diseases Other physical handicap or disabling condition - please specify: Have you ever been arrested, convicted, put on probation, or given a ticket for an act you committed against ANY PERSON? If yes, please briefly explain, include dates: Has anyone ever applied for or gotten a protective order against you? If yes, please explain: How did you find out about this office? Law enforcement agency - please specify: Judge or justice of the peace Mental health services Hospital/Doctor/Nurse/Medical Professional Social service agency - please specify: Page 4 of 13
5 Other - please specify: Where do you live today? SECTION III: YOUR HOUSEHOLD INFORMATION Street Address Apartment # City State Zip Code When you call 911 from this address, which police department responds? **Does the abuser know where you live today? Yes No Names and contact information for any other ADULTS currently living in your household. Please explain your relationship with these adults: What is YOUR mailing address? (if different from above): Street Address Apartment # City State Zip Code Home Phone # Cell Phone # address: Does our office have permission to leave messages at the above phone numbers? **This office will not leave messages at any number provided if you are still living with your abuser. You will need to contact our office to find out the status of your questionnaire. If you have any minor children, please provide the following information: Child s Name Age Date of Birth Sex Live with you M F M F M F M F M F M F M F Page 5 of 13
6 If you have minor children NOT living with you, briefly explain why: Do any of your children have any handicaps or disabilities? If yes, please indicate type of handicap or disability after that child s name in the space above. Is the abuser the parent of any of these children? If yes, which children? Are there any court orders [temporary or final] that include any of your children? If known, what court issued the order? Cause# Has the abuser ever harmed any of your children? If yes, complete the following: Date(s) of abuse: Name of child/children: Briefly describe the incident(s): Has Texas Department of Family and Protective Services (TDFPS formerly CPS) ever been notified?** If yes, provide the following information: Date City/State Name of case worker Phone # and extension Have the police ever been notified of child abuse? If yes, provide the following information: Date City/State Name of Officer/Detective Phone # Case # Have criminal charges ever been filed against this person for child abuse? If yes, please list the date, county, and case # (if known): **This office may make a report to TDFPS if we believe a child has been harmed and no report has been filed. Page 6 of 13
7 SECTION IV: YOUR EMPLOYMENT/SCHOOL AND OTHER CONTACT INFORMATION Are you currently employed? If yes, what is your current job? If you are currently employed, please list: Employer Phone # Street Address City State Zip Code List the days and hours that you work: When you call 911 from this address, which police department responds?: Does the abuser know where you work? Are you currently attending school? If you are currently attending school, please list: School Phone # Street Address City State Zip Code List the days and hours that you attend class: When you call 911 from this address, which police department responds?: Does the abuser know where you attend school? Friend or Relative (not living with you) who will always be able to locate you: Name: Relationship: Address: Street Address Apartment # City State Zip Code Home Phone Cell Phone Work Phone In the event we cannot find you, may we call the above named person(s)? Does this office have permission to leave a message with the above named person(s)? Page 7 of 13
8 SECTION V: INFORMATION ABOUT THE ALLEGED ABUSER Name: ( ) First Middle Last Maiden, if applicable What other names does this person use? Sex: Male Female Age: Date of birth: Social Security No.: Place of birth: Driver s License No. and State: Home address: Street Address Apartment # City State Zip Code Home Phone No. Cell Phone No. When is the best time to find this person at home? Is he/she currently employed? If yes, please complete the following: Occupation: Employer Work Phone No. Street Address City Zip Code Days and hours at work: Is there any other address where this person can be found? If yes, please complete the following: Person who lives at address: Phone #: Street Address Apartment # City Texas Zip Code Physical Description: Height: Weight: Race/ethnicity: Complexion: Hair color: Eye color: Glasses? Contacts? Color of contacts? Facial hair? Page 8 of 13
9 Tattoos? If any, describe: Scars? If any, describe: Body piercing? If any, describe: Other identifying characteristics: What kind of vehicle does this person drive? Year: Make: Model: Color: License plate no.: Does he/she have any weapons? If yes, please list: Is this person currently on parole or probation? If yes, provide the following information: Parole/Probation Officer s Name: Phone # Reason this person is currently on parole or probation: SECTION VI: RELATIONSHIP INFORMATION When did you meet this person? When did you start dating this person? When did you stop dating this person? Did you ever live with this person? If yes, when did you start living together? Were you ever married to this person? If yes, where and when were you married? Are you currently living with this person? When did you stop living together? While you were living together, did you ever separate from this person? If yes, how many times? For how long? Have either one of you filed for a divorce from each other? If yes, when? What county and state? If you are DIVORCED from this person: When was your divorce final? What county and state? Have you ever been granted a protective order against this person before? If yes, when and where (county and state)? Do you currently have an emergency protective order? If yes, through which police department? Page 9 of 13
10 Has this person ever applied for or gotten a protective order against you? If yes, please explain: Have you ever hit, slapped, pushed, bitten, kicked, spit at, or otherwise physically hurt, threatened, or used a weapon against this person? If yes, please explain: Have you ever received any kind of health care because of abuse in this relationship? If yes, please briefly specify reason and dates. Emergency room Hospitalization Counseling or psychotherapy Doctor s care Dental care SECTION VII: DETAILS ABOUT DOMESTIC VIOLENCE/SEXUAL ASSAULT/STALKING The information provided will help us make a determination whether our office can assist you. Please use the space provided to list three (3) recent incidents where the abuser has physically harmed you, threatened physical harm, or has caused bodily injury, assault or sexual assault. If the abuser has been harassing or stalking you, list incidents of that behavior or the incidents that have placed you in fear of IMMINENT physical harm, bodily injury, assault or sexual assault. If you need additional space to answer any question in this section, please attach separate sheets of paper. Date of the MOST RECENT incident: Briefly describe what happened: Were weapons or objects used on you? If yes, what kind? Were you injured? Page 10 of 13
11 If yes, describe your injuries: Are there photos of your injuries? Any witnesses? If yes, please provide names and contact information: Were the police called? If yes, which police department responded? What did the police do? Report number Date of INCIDENT #2: Briefly describe what happened: Were weapons or objects used on you? If yes, what kind? Were you injured? If yes, describe your injuries: Page 11 of 13
12 Are there photos of your injuries? Any witnesses? If yes, please provide names and contact information: Were the police called? If yes, which police department responded? What did the police do? Report number Date of INCIDENT #3: Briefly describe happened: Were weapons or objects used on you? If yes, what kind? Were you injured? If yes, describe your injuries: Are there photos of your injuries? Any witnesses? If yes, please provide names and contact information: Were the police called? If yes, which police department responded? What did the police do? Page 12 of 13
13 Report number I have read and understand the following: The information that is provided in this questionnaire is for the use of the Tarrant County Criminal District Attorney s Office only and will be kept confidential unless we are required by law to release or report any information. This office receives federal grant funds, so it is necessary to request some statistical information from you. This information is used only to prepare reports to show compliance with federal nondiscrimination requirements. This information has no bearing on whether or not you qualify for services through this office. A protective order is not a criminal charge. Criminal acts must be reported to a law enforcement agency in order to be prosecuted. If you have suffered personal injury as a result of a criminal act, you may qualify for crime victims compensation benefits. To be eligible for consideration, you must report the crime to law enforcement within a reasonable period of time, but not so late as to interfere with or hamper the investigation and prosecution of the crime. For more information you may contact the victim assistance liaison at the appropriate law enforcement agency. I,, affirm that the incidents and the information contained herein are true and correct to the best of my knowledge. Signature Date Page 13 of 13
*****THIS FORM IS NOT A PROTECTIVE ORDER APPLICATION OR A PROTECTIVE ORDER*****
SHAREN WILSON CRIMINAL DISTRICT ATTORNEY OF TARRANT COUNTY, TEXAS PROTECTIVE ORDER UNIT Family Law Center Phone Number 817-884-1623 200 East Weatherford Street # 3040 Fax Number 817-212-7393 Fort Worth,
More informationPROTECTIVE ORDER UNIT QUESTIONNAIRE FANNIN COUNTY CRIMINAL DISTRICT ATTORNEY S OFFICE
PROTECTIVE ORDER UNIT QUESTIONNAIRE FANNIN COUNTY CRIMINAL DISTRICT ATTORNEY S OFFICE HOW TO USE THE QUESTIONNAIRE USE BLACK INK ONLY blue ink and other colors of ink are difficult to read, especially
More informationDomestic Violence: Can the Legal System Help Protect Me?
Domestic Violence: Can the Legal System Help Protect Me? What is domestic violence? Domestic violence is a pattern of physically and/or emotionally abusive behavior used to control another person with
More informationUnderstanding Nebraska's Protection Orders
Understanding Nebraska's Protection Orders A guide for victims, law enforcement and service providers. What is a Protection Order? A protection order is a special type of order issued by a Judge which
More informationINSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(a), PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE (06/12)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(a), PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE (06/12) When should this form be used? If you are a victim of
More informationVICTIM COMPENSATION APPLICATION
OFFICE OF THE ATTORNEY GENERAL Crime Prevention & Victim Services Crime Victim Compensation Division Post Office Box 220 Jackson, Mississippi 39205-0220 1-800-829-6766 or 601-359-6766 601-576-4445 (FAX)
More informationWhat is DOMESTIC VIOLENCE?
What is DOMESTIC VIOLENCE? Domestic violence is a pattern of control used by one person to exert power over another. Verbal abuse, threats, physical, and sexual abuse are the methods used to maintain power
More informationOhio Victims of Crime Compensation Program
Ohio Victims of Crime Compensation Program Application for Compensation If you or your family members are innocent victims of a violent crime, financial assistance may be available. The Ohio Victims of
More informationINSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(f), PETITION FOR INJUNCTION FOR PROTECTION AGAINST REPEAT VIOLENCE
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12980(f), PETITION FOR INJUNCTION FOR PROTECTION AGAINST REPEAT VIOLENCE When should this form be used? If you or a member of your immediate
More informationCrime Victim Compensation
Crime Victim Compensation Eighth Judicial District Crime Victim Compensation 201 LaPorte Avenue Ste 200 Fort Collins CO 80521 970-498-7290 www.larimer.org/da/vicwit/compensation.htm APPLICATION The Victim
More informationCounty Court Restraining Orders
Answers to Your Questions About County Court Restraining Orders Excellence in Customer Service Colorado Judicial Branch http://www.courts.state.co.us June 2002 CIVIL LAW In a civil case, the person seeking
More informationProtective Orders. What if the other person and I live together or have children together? What is a protective order?
Protective Orders What is a protective order? It is a court order that protects you from someone who has been violent or threatened to be violent. How can a protective order help me? It can order the other
More informationVictim Information. Other Information. How did you find out about the CVCP? Check the box that applies: Police/Law Enforcement
Department of Labor and Industries Crime Victims Compensation Program PO Box 44520 Olympia WA 98504-4520 Email: CrimeVictimsProgramM@LNI.WA.GOV Fax: (360) 902-5333 Crime Victim s Application for Benefits
More informationProtective Orders Including: Order of Protection and Injunction Against Harassment
Things You Should Know About Protective Orders Including: Order of Protection and Injunction Against Harassment This booklet is designed to provide general information about protective orders for domestic
More informationClaim Form. Before you fill out this application, please read the information below. Before you complete this application:
Claim Form Before you fill out this application, please read the information below. You may qualify to receive payment if: Before you complete this application: The victim suffered physical injury or was
More informationCommunity Legal Information Association of PEI, Inc. Sexual Assault
Community Legal Information Association of PEI, Inc. Sexual Assault As an adult in Canada, you have the right to choose when or if you engage in sexual activity. Sexual activity without your consent is
More informationOhio Victims of Crime Compensation Program Application for Crime Victim Compensation
Ohio Victims of Crime Compensation Program Application for Crime Victim Compensation Please type or print using blue or black ink After an application has been filed, the law may provide for payment of
More informationCherokee Nation Child Support Services Post Office Box 557 Tahlequah, OK 74465 918-453-5444
Cherokee Nation Child Support Services Post Office Box 557 Tahlequah, OK 74465 918-453-5444 It s more than money It s about healthy, happy children with a positive future The following pages include an
More informationThe application must include the signature of the victim or of the claimant if the victim is under the age of 18 years old.
Denver Crime Victim Compensation Application Check List In order to ensure that your application is processed as quickly as possible, please review the following checklist: The incident must have been
More informationDomestic Violence and Protective Orders
Domestic Violence and Protective Orders Domestic violence (also called family violence) is a pattern of behavior and a method of control which results in physical injury or places one in reasonable apprehension
More informationDomestic Violence Case Management Plan
Domestic Violence Case Management Plan From the commencement of litigation to its resolution, whether by trial or settlement, it is the goal of this Court to reduce delay and enable just and efficient
More informationHow To Protect Yourself From Violence
FAMILY VIOLENCE Violence takes many forms. It is unacceptable whenever it happens. Violence by a family member who is loved and trusted can be particularly devastating. Family violence happens where the
More informationInstructions for Pistol Permit Applicants. If you have any questions call 845 291-7942
Instructions for Pistol Permit Applicants. If you have any questions call 845 291-7942 Description of forms in this Packet: Form PPS-19: This form is a checklist of all the documents you will need to provide
More informationDomestic Violence Laws and the Illinois Domestic Violence Act
CHAPTER 8 Domestic Violence Laws and the Illinois Domestic Violence Act Although clergy and other spiritual leaders may not be directly involved in the legal procedures described below, it is important
More informationTarrant County College Police Department
Tarrant County College Police Department VICTIM ASSISTANCE An Assistance Program for Victims and Family Survivors of Violent Crimes Tarrant County College The Tarrant County College District Police Department
More informationCRIME VICTIM COMPENSATION APPLICATION
CRIME VICTIM COMPENSATION APPLICATION Weld County District Attorney s Office Kenneth R. Buck-District Attorney Post Office Box 1167 915 Tenth Street Greeley, CO 80632 (970) 356-4010 Fax (970) 336-7224
More informationCompensation. Financial Assistance. Resources. Office of Attorney General. for Victims of Crime in the Commonwealth of Massachusetts
Resources If you are a crime victim, you have certain rights under Massachusetts Law, and you are eligible for certain services. For further information about victim rights and victim services, contact
More informationPro Se Protection From Abuse Order Packet
Huntingdon County, Pennsylvania Pro Se Protection From Abuse Order Packet Disclaimer Please note that court staff is not able to give you legal advice nor help you fill out or complete these forms. If
More informationGuide For Advocates Working With Immigrant Victims of Domestic Violence
Guide For Advocates Working With Immigrant Victims of Domestic Violence Created by the Domestic Violence Coordinating Council October 2009 This guide is intended to provide information to advocates working
More informationDOMESTIC VIOLENCE RESTRAINING ORDER RESPONDENT PACKET
SUPERIOR COURT OF CALIFORNIA COUNTY OF SAN DIEGO DOMESTIC VIOLENCE RESTRAINING ORDER RESPONDENT PACKET FORMS INCLUDED IN THIS PACKET How Can I Respond to a Request for Domestic Violence Restraining Order?
More informationVictim Services Program:
Victim Services Program: Mission Statement: To provide crisis intervention, emotional and judicial support and critical services referrals to aid victims and their children, and to promote community awareness
More informationRESTRAINING ORDERS IN MASSACHUSETTS Your rights whether you are a Plaintiff or a Defendant
RESTRAINING ORDERS IN MASSACHUSETTS Your rights whether you are a Plaintiff or a Defendant Prepared by the Mental Health Legal Advisors Committee October 2012 What is a restraining order? A restraining
More informationDomestic Violence Resource Guide for Mecklenburg County Including Information about Domestic Violence Protective Orders
Domestic Violence Resource Guide for Mecklenburg County Including Information about Domestic Violence Protective Orders Qualifications for a DV Protective Order (50B) 1. Must be a resident of Mecklenburg
More informationObtaining Protective Orders and Peace Orders
Domestic Violence Programs in Maryland Allegany County Hotline: 301-759-9244 TTY: 301-759-9244 Family Crisis Resource Center: 301-759-9246 Anne Arundel County Hotline: 410-222-6800 YWCA Domestic Violence
More informationORDER OF PROTECTION FREQUENTLY ASKED QUESTIONS BY PLAINTIFFS
ORDER OF PROTECTION FREQUENTLY ASKED QUESTIONS BY PLAINTIFFS Q. Who can get an order of protection? A. An order of protection (OP) may be issued against a spouse, an ex spouse, a person with whom you have
More informationCRIME VICTIM S REPARATION CLAIM FORM INSTRUCTIONS
CRIME VICTIM S REPARATION CLAIM FORM INSTRUCTIONS In order to process your claim for compensation, the following information is needed: 1. The claim for compensation must be thoroughly and accurately completed.
More informationThe Nuts & Bolts of Orders of Protection and other relief for Victims of Domestic Violence
The Nuts & Bolts of Orders of Protection and other relief for Victims of Domestic Violence Training for Victim Advocates Sponsored by South Carolina Legal Services Orders of Protection: The Basics What?
More informationNj Victims of Crime Compensation Office
Nj Victims of Crime Compensation Office Claim Information and Application Instructions New Jersey has a Crime Victim s Compensation Fund to help with costs related to injuries received in a violent crime.
More information9 TH Judicial District CRIME VICTIM COMPENSATION FUND 109 Eighth Street, Suite 308 Glenwood Springs, Colorado 81601 (970) 945-8635
9 TH Judicial District CRIME VICTIM COMPENSATION FUND 109 Eighth Street, Suite 308 Glenwood Springs, Colorado 81601 (970) 945-8635 The 9 th Judicial District Crime Victim Compensation Board can provide
More informationCRIMINAL LAW AND VICTIMS RIGHTS
Chapter Five CRIMINAL LAW AND VICTIMS RIGHTS In a criminal case, a prosecuting attorney (working for the city, state, or federal government) decides if charges should be brought against the perpetrator.
More informationIf you qualify for a protective order, you have four options:
Are you in need of a protective order? Please review the attached information from the law library to determine if your circumstances qualify you for a protective order. If you qualify for a protective
More informationRelationship to Victim. Mailing Address City/State/Zip. SSN Date of Birth. Home Telephone Cell phone Other. Email address
State of Alaska Violent Crimes Compensation Board Application for Crime Victim Compensation Application for Crime Victim Compensation Section 1 Claimant A separate application must be completed for each
More informationHOW DO I GET A RESTRAINING ORDER?
HOW DO I GET A RESTRAINING ORDER? A ARestraining Order@ is unusual because it orders someone to stop doing something BEFORE it happens. So, the law has very strict requirements. First: Is the HARM that
More informationCRIME VICTIM COMPENSATION FUND APPLICATION
Office Use Only Claim No. Crime Victim Compensation Board Office of the District Attorney, 20 th Judicial District 1035 Kimbark Street, Longmont, CO 80501 Phone (303) 682-6801 Fax (303) 682-6711 CRIME
More informationSeeking Protection from Domestic Violence in New York s. Information for Immigrant Victims with Limited English Proficiency
Seeking Protection from Domestic Violence in New York s Family Court: Information for Immigrant Victims with Limited English Proficiency What is domestic violence? If your current or former intimate partner
More informationSUPERIOR COURT OF THE DISTRICT OF COLUMBIA CRIME VICTIMS COMPENSATION PROGRAM 515 Fifth Street, N.W., Suite 109 Washington, D.C.
SUPERIOR COURT OF THE DISTRICT OF COLUMBIA CRIME VICTIMS COMPENSATION PROGRAM 515 Fifth Street, N.W., Suite 109 Washington, D.C. 20001 APPLICATION FOR CRIME VICTIMS COMPENSATION DATE RECEIVED: CLAIM NUMBER:
More informationYurok Child Support Services 427 F Street, Ste. 236 P.O. Box 45 Eureka, CA 95502 Phone: (707) 269-0695 Fax: (707) 269-0645
Yurok Child Support Services 427 F Street, Ste. 236 P.O. Box 45 Eureka, CA 95502 Phone: (707) 269-0695 Fax: (707) 269-0645 APPLICATION FOR CHILD SUPPORT SERVICES OFFICE USE ONLY: Date Requested: Date received:
More informationVolunteer Intern/Clerk Applications. Academic Status. Undergrad Graduate Student Law Student (1L) (2L) (3L) (Circle One) Application Term
OFFICE OF THE STATE S ATTORNEY COOK COUNTY, ILLINOIS ANITA ALVAREZ 69 W. Washington, Suite 3200 STATE S ATTORNEY Chicago, Illinois 60602 Volunteer Intern/Clerk Applications Academic Status Undergrad Graduate
More informationOHIO VICTIMS OF CRIME COMPENSATION PROGRAM
OHIO VICTIMS OF CRIME COMPENSATION PROGRAM Application for Supplemental Compensation If you or your family members are innocent victims of a violent crime, financial assistance may be available. For more
More informationChild Abduction Unit Request for Investigation Summary
JESUS RODRIGUEZ ASSISTANT DISTRICT ATTORNEY OFFICE OF THE DISTRICT ATTORNEY COUNTY OF SAN DIEGO BONNIE M. DUMANIS DISTRICT ATTORNEY Child Abduction Unit Request for Investigation Summary San Diego 330
More informationDOMESTIC VIOLENCE. Do the right thing see your lawyer first
DOMESTIC VIOLENCE Do the right thing see your lawyer first Contents 1. What is domestic violence? 2. What protection does the law offer? 3. Who can apply for protection? 4. What is a protection order?
More informationSection A Victim/Applicant Information (A separate application must be completed for each victim.)
Application For Crime Victim Compensation Claim No. Arkansas Crime Victims Reparations Board 323 Center Street, Suite 200 Little Rock, Arkansas 72201 Office of the (501) 682-1020 or 1-800-448-3014 This
More informationComplete all pages of the application, especially the signature page.
Dear Applicant: Thank you for your interest in filing for Crime Victims Compensation benefits. Our goal is to assist victims of crime in accessing financial assistance to help them recover from the traumatic
More informationA Summary of Virginia s Crime Victim and Witness Rights Act
A Summary of Virginia s Crime Victim and Witness Rights Act Your Rights and Responsibilities Department of Criminal Justice Services Victims Services Section December 2008 www.dcjs.virginia.gov Table of
More informationOriginal Petition for Divorce
NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA. Cause Number: (The Clerk s office will fill in the Cause Number and Court Number when you file this form.) IN THE MATTER OF THE MARRIAGE OF Petitioner: Print
More informationANSWERS TO COMMON LEGAL QUESTIONS AND RESOURCES FOR VICTIMS OF DOMESTIC VIOLENCE
ANSWERS TO COMMON LEGAL QUESTIONS AND RESOURCES FOR VICTIMS OF DOMESTIC VIOLENCE WHAT IS DOMESTIC VIOLENCE? Domestic Violence or family violence is the abuse of power or control. It is behavior used by
More informationLandlord/Tenant Issues for Survivors of Domestic Violence, Sexual Assault, and/or Stalking
Landlord/Tenant Issues for Survivors of Domestic Violence, Sexual Assault, and/or Stalking Introduction Tenants who are victims of domestic violence, sexual assault, unlawful harassment or stalking now
More informationAPPLICATION FOR COMPENSATION FORM FOR A PERSONAL INJURY (Do not use this form for claims relating to fatal injuries)
Compensation Services 6th Floor Millennium House 17-25 Great Victoria Street Belfast BT2 7AQ Telephone: 0300 200 7887 Criminal Injuries Compensation Scheme (2009) Made under the Criminal Injuries Compensation
More informationOFFICE OF THE ATTOR GENERAL ELIGIBILITY REQUIREMENTS
OFFICE OF THE ATTOR YGENERAL CRIME VICTIM COMPENSATION DIVISION POST OFFICE BOX 22 JACKSON, MS 3925 22 1-8-829-6766 OR 61-359-6766 61-576-4445 (FAX) If you or a family member have been a victim of a violent
More informationAMENDMENTS TO THE RULES OF SUPERINTENDENCE FOR THE COURTS OF OHIO. Final adoption by conference. Effective date of proposed amendments
AMENDMENTS TO THE RULES OF SUPERINTENDENCE FOR THE COURTS OF OHIO Amendments to Rules 10, 10.01 and 10.03 and Domestic Violence Forms of the Rules of Superintendence for the Courts of Ohio were adopted
More informationProtective Orders in Virginia A Guide for Victims
Protective Orders in Virginia A Guide for Victims Virginia Department of Criminal Justice Services www.dcjs.virginia.gov This brochure is intended to provide summary information regarding family abuse
More informationAMENDMENTS TO THE RULES OF SUPERINTENDENCE FOR THE COURTS OF OHIO
AMENDMENTS TO THE RULES OF SUPERINTENDENCE FOR THE COURTS OF OHIO Amendments to Rule 10.05 of the Rules of Superintendence for the Courts of Ohio and related forms were adopted by the Court and become
More informationSUPERIOR COURT OF CALIFORNIA COUNTY OF SUTTER
SUPERIOR COURT OF CALIFORNIA COUNTY OF SUTTER M. B. Todd Court Executive Officer 463 Second Street, Yuba City, CA 95991 Civil Division CHILD CUSTODY INVESTIGATION QUESTIONNAIRE This questionnaire will
More informationWhere can I get help after a sexual assault?
Sexual Assault What is assault? Assault is when someone uses force to hurt you. Slapping, kicking and pushing can be assault. Sometimes touching can be an assault. Threatening or trying to hurt someone
More informationWhen should this form be used?
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(j), MOTION FOR MODIFICATION OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE, REPEAT VIOLENCE, DATING VIOLENCE, OR SEXUAL VIOLENCE
More informationIN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT, IN AND FOR MARTIN COUNTY, FLORIDA
IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT, IN AND FOR MARTIN COUNTY, FLORIDA IN RE: / CASE NO: Petition and Affidavit Seeking Involuntary Substance Abuse Assessment and Stabilization I, Being
More informationHOW TO GET A DOMESTIC VIOLENCE PROTECTIVE ORDER
FIRST THINGS FIRST Do you need to report a crime to the police? If you need to report a crime, contact the police or Alaska State Troopers directly and tell them what happened. If you are in immediate
More informationDOMESTIC VIOLENCE IN FLORIDA
DOMESTIC VIOLENCE IN FLORIDA The Petitioner may go to court on his/her own (without an attorney) to petition for an injunction to protect him/her against domestic violence (assault or battery by your spouse
More informationClaim Form. Before you fill out this application, please read the information below. You may qualify for payment if:
Claim Form Before you fill out this application, please read the information below. This claim form should be submitted within one year of the crime. Please include a letter explaining the delay, if more
More informationAPPLICATION FOR COMPENSATION FORM FOR A PERSONAL INJURY (Do not use this form for claims relating to fatal injuries)
The Compensation Agency Royston House 34 Upper Queen Street Belfast BT1 6FD www.compensationni.gov.uk THE COMPENSATION Agency Reference number For official use only T4 Criminal Injuries Compensation Scheme
More informationSUPREME COURT OF PENNSYLVANIA DOMESTIC RELATIONS PROCEDURAL RULES COMMITTEE RECOMMENDATION 140
SUPREME COURT OF PENNSYLVANIA DOMESTIC RELATIONS PROCEDURAL RULES COMMITTEE RECOMMENDATION 140 CHAPTER 1950. ACTIONS PURSUANT TO THE PROTECTION OF VICTIMS OF SEXUAL VIOLENCE OR INTIMIDATION ACT Rule 1951.
More informationAbout DCJS. table of ContentS. ACknowleDgmentS. Introduction...2. Domestic Violence Defined...3. Plan for Your Safety...3
About DCJS The Virginia Department of Criminal Justice Services (DCJS) is a state agency whose mission is to improve the criminal justice system in Virginia s communities through effective training, partnerships,
More informationAPPLICATION FORM - PERSONAL INJURY (Do not use for fatal injuries)
The Compensation Agency Royston House 34 Upper Queen Street Belfast BT1 6FD www.compensationni.gov.uk THE COMPENSATION Agency Reference number For official use only T1 Criminal Injuries Compensation Scheme
More informationDomestic Violence Victims in Virginia
An Informational Guide for Domestic Violence Victims in Virginia Understanding The Legal Process Department of Criminal Justice Services Victims Services Section June 2004 THE AGENCY The Department of
More informationParent s Guide. to Child Protective Services (CPS) Children s. Administration. Division. of Children. and Family. Services
Parent s Guide to Child Protective Services (CPS) Children s Administration Division of Children and Family Services Table Of Contents Topic Page What Is Child Protective Services (CPS)?... What Is Child
More informationADULT ABUSE INFORMATION QUALIFICATIONS FOR FILING AN ADULT ABUSE ORDER OF PROTECTION:
FAMILY COURT OF ST. LOUIS COUNTY, MISSOURI 105 South Central Avenue Room S16 Clayton, Missouri 63105 (314) 615-4725 ADULT ABUSE INFORMATION Missouri s Adult Abuse and Child Abuse Act provides protective
More informationALASKA DRIVING WHILE INTOXICATED (DWI)
ALASKA DRIVING WHILE INTOXICATED (DWI) Alaska DWI arrests trigger two separate cases, and each of these cases must be defended following a drunk driving arrest. First, there is the court case, which can
More informationDomestic Violence/Sexual Assault/Stalking Leave
1 Code: GCBDC/GDBDC Adopted: 2/11/08 Domestic Violence/Sexual Assault/Stalking Leave Definitions: 1. Covered employer means an employer who employs six or more individuals in the state of Oregon for each
More informationKansas Department for Children and Families Grandparents as Caregivers Cash Assistance Application
Kansas Department for Children and amilies Grandparents as Caregivers Cash Assistance Application ollow These Steps to Apply Agency Use Only Initial Review ES-3100.9 Rev. 7-12 Complete this form or go
More informationPlease note: We are accepting applications for 1-4 bedroom apartments only.
Page 1 Gardens at SouthBay Preliminary Application 6720 S. Louis Ave, Tampa, FL 33616 PLEASE RETURN APPLICATION MONDAY THURSDAY 9AM 6PM POR FAVOR DE REGRESAR LA APLICACIÓN DE LUNES A JUEVES DE 9AM A 6PM
More informationWest Virginia Department of Health and Human Resources. Application for Child Care Services
West Virginia Department of Health and Human Resources Application for Child Care Services I. INSTRUCTIONS Please complete this form in order to apply for child care services. Be sure to sign and date
More informationChildren s Advocacy Center for Denton County Community Outreach Coordinator Job Position Duties & Responsibilities Effective 1/1/14
Children s Advocacy Center for Denton County Community Outreach Coordinator Job Position Duties & Responsibilities Effective 1/1/14 Reports To: Position Overview: Development Director CACDC is seeking
More informationCrime Victim Compensation Application 7 th Judicial District 1140 North Grand Ave, Suite #200, Montrose, CO 81401
Crime Victim Compensation Application 7 th Judicial District 1140 North Grand Ave, Suite #200, Montrose, CO 81401 All claims are reviewed by the Crime Victim Compensation Board (CVC). The CVC board meets
More informationHelp for Victims of Hate Crime. California Victim Compensation Program
Help for Victims of Hate Crime California Victim Compensation Program Help for Victims of Hate Crime Hate crimes occur when a criminal act is committed against an individual due to their disability, gender,
More informationMaking our Communities a better place to live
RPM MANAGEMENT, LLC Making our Communities a better place to live 77 Park Street * Montclair, NJ 07042 * PHONE :(973) 744-5410 * FAX: (973) 744-6455 Dear Prospective Resident, Thank you for your interest
More informationNORTHSTAR DERMATOLOGY, PA NOTICE OF PRIVACY PRACTICES
NORTHSTAR DERMATOLOGY, PA NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
More informationFRUITA POLICE DEPARTMENT
FRUITA POLICE DEPARTMENT Personal History Form for Police Officer Applicants Personal Full Legal Last First Middle Name Sex Height Weight Hair Eyes Social Security Number Driver s License No. State Expiration
More informationIt is a court order against someone who has abused or harassed you. That person is ordered either not to abuse you or not to have contact with you.
WHAT IS A RESTRAINING ORDER? WILL IT PROTECT ME? It is a court order against someone who has abused or harassed you. That person is ordered either not to abuse you or not to have contact with you. A restraining
More informationHow To Get An Order Of Protection In A Divorce
THE BASICS Orders of Protection in New York State Sadly, both men and women can, and do, abuse their intimate partners or members of their families. In this booklet, we assume that the abuser is a man
More informationACCESS TO JUSTICE PROGRAM. (Our office will not accept phone, email, or walk-in inquiries about your application or case)
ACCESS TO JUSTICE PROGRAM (Our office will not accept phone, email, or walk-in inquiries about your application or case) Please review the following before completing application: The Center s Legal Program
More informationUnderstanding Consent to Sexual Activity. Public Legal Education and Information Service of New Brunswick
Understanding Consent to Sexual Activity Public Legal Education and Information Service of New Brunswick NO means NO Understanding Consent to Sexual Activity This pamphlet provides information on what
More informationAustin Independent School District Police Department Policy and Procedure Manual
Policy 4.11 Austin Independent School District Police Department Policy and Procedure Manual Domestic Violence I. POLICY (TPCAF 7.08.1) It is the policy of the AISD Police Department to respond to all
More informationName of victim (last, first, middle) Home telephone Work telephone. Name of claimant (last, first, middle) Home telephone Work telephone
Personal injury compensation application JD-VS-8PI Rev. 12/07 section one - Victim information Name of victim (last, first, middle) Home telephone Work telephone Address cell telephone age City State Zip
More informationVictim Services Programs. Core Service Definitions
Victim Services Programs Core Service Definitions EFFECTIVE MAY 2012 1 P a g e Core Services Overview The Criminal Justice Coordinating Council (CJCC) strives to be a responsible and exemplary steward
More informationVictim Services. An Assistance Program for Victims and Family Survivors Of Violent Crimes BRENHAM POLICE DEPARTMENT. Victim Service Program
Victim Services An Assistance Program for Victims and Family Survivors Of Violent Crimes BRENHAM POLICE DEPARTMENT Victim Service Program 1800 Longwood Drive Brenham, Texas 77833 979-337-7340 Cindy Kras
More informationOFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney
OFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney Shawnee County Courthouse Fax: (785) 251-4909 200 SE 7th Street, Suite 214 Family Law Fax: (785)
More informationNew York State Crime Victims Board
New York State Crime Victims Board Claim Application and Instructions 1 Columbia Circle, Suite 200 Albany, NY 12203-6383 (518) 457-8727 55 Hanson Place, Room 1000 Brooklyn, NY 11217-1523 (718) 923-4325
More informationAPPLICATION FOR CRIME VICTIM COMPENSATION (Please print clearly and complete the entire form)
Maryland Criminal Injuries Compensation Board (CICB) Department of Public Safety and Correctional Services 6776 Reisterstown Rd, Ste. 206 Baltimore, MD 21215 410-585-3010 1-888-679-9347 (fax) 410-764-3815
More informationCITY OF SALINA MUNICIPAL COURT DIVERSION INFORMATION AND APPLICATION
CITY OF SALINA MUNICIPAL COURT DIVERSION INFORMATION AND APPLICATION A diversion is a written agreement between the City Prosecutor and the defendant. During the diversion period, the prosecutor agrees
More informationHOUSING RIGHTS FOR DOMESTIC VIOLENCE, SEXUAL ASSAULT AND STALKING SURVIVORS
HOUSING RIGHTS FOR DOMESTIC VIOLENCE, SEXUAL ASSAULT AND STALKING SURVIVORS Your landlord may not discriminate against you because you are a victim of dating or domestic violence, sexual assault or stalking.
More information