CUMENT State of Alabama Case Number Unified Judicial System PETITION FOR PROTECTION FROM ABUSE Form C-2 (Page 1 of 5) Rev. mono dbl-7" l07 IN THE CIRCUIT COURT OF ?Am b-?h COUNTY, ALABAMA (Name of County) ElTirm v. 3+0th D. INF/dint.) Plaintiff (victim) Defendant (person to be restrained) Cl .. ll?) lbw-Award Dale, Plaintiff tiling on behalf of Victim De'fgndant's A dress (Business o?ome) . 3) Section Code 1975 provides [t]following information shall not be contained on any court City State Zip Code document made available to the public and the defendant by the circuit clerk?s office' The plaintiffs home address and, if 1 I ?63 (a .1, applicable, business address; a plaintiff?s home telephone Defendant's Dim of Birth number and, ifapplicable, business telephone number; the GET 1 9 2017 home or business address or telephone number of any member of the plaintiff? family or household; or an address thatwould . . . . . . reveal the confidential location ofa shelter for victims of .5th Clerk Defendants 306131 Security Number domestic violence as defined in Section 30-6- I Essamhta courtly?labame YOU MUST PROVIDE COMPLETE AND TRUTHFUL INFORMATION. IF YOU DO NOT, THE COURT MAY DISMISS THIS CASE, AND YOU MAY BE SUBJECT TO BEING CHARGED WITH PERJURY FOR KNOWINGLY PROVIDING FALSE INFORMATION. I. ELIGIBLE PLAIN TIFFS (CHECK ALL THAT APPLY): (Note: The word, ?Plaintiff,? is used in this block to describe the victim and/or the personts) ?ling on behalf of the victim): [?r/lam 18 years of age or older and am a victim of abuse or have reasonable cause to believe i am in imminent danger of becoming the victim of any act of abuse. i am a parent; or Da legal guardian; or next friend; or UtheState Department of Human Resources seeking protection from domestic violence on behalfofthe victim who is: El a minor child; or a person prevented by physical or mental incapacity from seeking a protection order El I am under 18 years of age, emancipated, and am a victim of abuse or have reasonable cause to believe I am in imminent danger of becoming the victim of any act of abuse. CHECK THE BOXES WHICH ARE APPLICABLE: {The Defendant is the victim?s El Spouse; or former spouse, or El the Defendant is in or had a common?law marriage with the victim. Date of Marriage: . Date ofDivorce (if applicable): .The Defendant and the victim has or had a dating relationship (A dating relationship means a signi?cant relationship of a romantic or intimate nature characterized by the expectation of affectionate or sexual involvement over a period oftime and on a continuing basis during the course of the relationship; includes the period ot?engagement to be married; and does not include a casual or business relationship or a relationship that ended more than 12 months prior to the filing of the petition for a protection order). D3The Defendant is a current or former household member of the victim (A household member is a person maintaining or having maintained a living arrangement with the Defendant where heishe is in, or was engaged in, a romantic or sexual relationship). D4. The Defendant and the victim have a child in common regardless of whether the victim and Defendant have ever been married and regardless whether they are currently residing or have in the past resided together in the same household. 5. The victim is a relative ofa current or former household member who also lived with the Defendant. 6. The victim is an individual who is a parent, stepparent, child, or Stepchild who is in or has maintained a living arrangement with the Defendant. El 7. The victim is related by marriage, including a common law marriage, to the Defendant. (NOTE: The word "Plaintiff? in the remainder of this form refers to the victim for whom protection is being sought.) I state that the following is true and correct: . The Plaintiffis a resident of ID a mm, The Plaintiff?s age is 49 years old. (Name of County) (Name of State) Is the Plaintiffinvolved in any other ii, domestic relations, child support, or juvenile case (for example, divorce, paternity or custody) with the Defendant? YES NO If YES, please state the County and State in which the case was brought: County, (State). Are there any criminal charges against the Defendant because of abuse to the Plaintiff? El YES if YES, the charges were brought in County, (State). (Note: Ifthere are more civil or other cases with the Defendant or more criminal charges against the Defendant, please attach additional 8? x1 sheets of paper, ifnecessary, stating the case number(s), and States(s) in which these cases are being handled). Original-Court Record Copy-Law Enforcement Copy-Plaintiff Copy-Defendant DOCUMENT 1 State of Alabama Case Number Um?edmmial System PETITION FOR PROTECTION FROM ABUSE DR- so]? I07 (Check the box if the following statement applies to the Plaintiff): Plaintiff left his or her residence to avoid further abuse or threat of abuse, and the Plaintiff is temporarily located in County, Alabama. CI The Defendant lives in County, (State). The abuse occurred in County, Alabama, The Defendant is 5 cars old. Mr requesting Wection order; El a change in a. current protection order; Dan emergency order; a change in an emergency order II. To Get a Protection Order, the Defendant Must Have Done One or More of the Following (Check all that apply): yeatened to con?ne the Plaintiff Exposed the Plaintiffs chi]d(ren) to drugs Made the Plaintiffafraid that the Plaintiff would be seriously injured Made the El Injured the Plaintiff Plaintiff have sex by force or threat 0f force Tried to do one or more of the acts in this section Kidnapped the Plaintiff or his or her child(ren) Thre tened to injure/hurt the Plaintiff El Trespassed on the Plaintiff?s property add the Plaintiff Tortured or willfully abused the Plaintiff's child(ren) Set tire to the Plaintiffs house El 31015 from the Plaintiff El Restrained the Plaintiff Recklessly engaged in conduct which risked serious injury to the Plaintiff El Other (please specify): El Tortured or willfully abused the Plaintiffs child.(ren) multiple times Explain the Abuse That Has Happened (Begin With the Most Recent Act. You May Add Additional 8? 11? Sheets of Paper, If Necessary): Date and place where the abuse occurred: never?.1, pert) \Oliorlran. Drawing Jar-lea an +0 l?d mad ?Iminmmd Descr' . how the Defendant urt or threatened the Plaintiff or how the Plaintiff is in imminent danger of becoming a victim: 12. ad?? 0hr ?Pl Fonds m- WW *0 an as burl. Q-?jowseot ammo; are [gmdelg?fe I. Dem?quse?m? :1 0p Wind: inc, (1m, (in. (NOTE: lfa parent, legal guardian, or next friend is seeking a protection order on behalf ofa minor child who is living at home, the parent, legal guardian, or next friend must have been an eyewitness to. or have direct evidence or af?davits of eyewitnesses of, the speci?c facts and circumstances that form the basis upon which the rcliefis sought, OR have reasonable cause to believe that the minor child is a victim of abuse to form the basis upon which reliefis sought, if the party against whom the protection order is sought is also a parent. stepparent, or legal guardian of the minor child.) IV. Legal Information Required (Check all that apply): There is a current rest ing or protection order against the Defendant: ?lmed: N0. the County and State where it was issued: County, (State). The Defendant has a current restraining or protection order against the Plaintiff: If YES, the County and State where it was issued: County, (State). (Note: If there are more current restraining or protection orders against the Defendant or against the Plaintiff, please attach additional 8? 11? sheets of paper, if necessary, stating the case number(s), County?es), and Statets) in which these Orders were issued). Original-Court Record Copy-Law Enforcement Copy-Plaintiff Copy-Defendant State of Alabama USE Case Number Uni?ed Judidal 53"? TITI PROTECTION FROM Child(ren) A.The name(s) and age[s'} of any child(ren) ofthe Defendant and the Plaintiff. who are under 19 years old. Name: Age: Name: Age: Name: Age: Name: Age: B. Is there a custody order concerning any of the above children? YES NO C. For the last six months, the child(ren) (has) have lived (in what State with whom): Child: Lived with: State: Child. Lived ??lth: State: Child: Lived with: State: Child: Lived with: State: VI. Residence THE DEFENDANT MAY BE REQUIRED TO MOVE FROM THE RESIDENCE IF THE RESIDENCE IS IN THE SOLE NAME OF THE PLAINTIFF, IF IT IS JOINTLY OWNED OR RENTED BY THE PLAINTIFF AND THE DEFENDANT, OR IF THE PARTIES ARE MARRIED TO EACH OTHER. The place where the Plaintiff lives is: Owned by: Elthe Plaintiff; or Elthe Defendant; or both the Plaintiff and the Defendant. Rented by: El?e Plaintiff; or Elthe Defendant; or Elboth the Plaintiff and the Defendant. The Plaintiff must notify the Court of any change(s) in address. VII. Ex Parte Relief Requested (Please Check the Boxes To Show What is Requested): I am asking the Court for the following for myself and/or the person(s) for whom I am applying:- E?njoin the Defendant from threatening to commit or committing acts of abuse, as defined in the Protection from Abuse Act, against the laintiff; andi?or El child(ren) of the Plaintiff; andfor any designated person to wit: MResh?ain and enjoin the Defendant from: mnnoying; Ma?s-sing; mug: mtening; ngaging in conduct that would place the following in reasonable fear of bodily injury: E/The Plaintiff; andfor El Any designated person, to wit: El Minor(s); andi?or ChildIren) ofthe Plaintiff; andx?or Or [3 restrain and enjoin the Defendant from contacting he Plaintiff andlor children of the Plaintiff ?9 "Contacting" includes, but is not limited to, communicating with the victim verbally or in any written form. either in person, telephonically. electronically, or in any other manner. either directly or indirectly through a third persoii. Original-Court Record Copy-Law Enforcement Copy-Plaintiff Copy-Defendant MENT .. State of Alabama Case Number Uni?ed Judicial System Form (3?2 (Page 4 of 5) PETITION FOR PROTECTION FROM ABUSE 80W - 0?1 Rev. .li?2016 WRestrain and enjoin the Defendant from having physical or violent contact with Plaintiff or the Plaintiff? wiperty; Mof employment; school; andfor Elthe csidence;E place of employment; school; and/or any other designated person?s [to wit: 1 residence; place of employment; school or, order the Defendant to stay away from any specified place; which the court determines the Defendant has no legitimate reason to frequent, as designated below; frequented by the Plaintiff; andfor child(ren); and or any designated person. Name(s) and location(s} of the other specified place(s): The Defendant shall not go within feet (a minimum of 300 feet) ofthe Plaintiffs residence even ifthe residence is shared with the Plaintiff, (4) Award temporary custody of the chi]d(ren) to (Please specify the name of the person to whom custody should by given) (5)13njoin the Defendant from interfering with the Plaintiff's efforts to remove any ofthe Plaintiffs child(ren) or from removing any children from the juris- diction of the court and direct the appropriate law enforcement of?cer to accompany the Plaintiff during the effort to remove any ofthe Plaintiffs child(ren) as necessary to protect the Plaintiff or any children from abuse or child abuse. i:i the Defendant from removing any child(ren) from [the individual having legal custody of the except as subsequently authorized by a custody or visitation order issued by a court of competent urisdiction. (7")Rernove and exclude the Defendant from the residence of the Plaintiff, regardless of ownership of the residence. (8)0rder possession and use of an automobile; andfor other essential personal effects regardless of ownership, and direct the appropriate law en- forcement officer to accompany the Pl aintilf to the residence of the parties or to other speci?ed locations as necessary to protect the Plaintiff or any children from abuse. (9)1?rohibit the Defendant from transferring; concealing; encumbering; or otherwise disposing of specified property mutually owned or E/ie'ased by the parties, (Please describe property) (10) Order other relief deemed necessary to provide for the safety and welfare of the Maintiff: and/or any child(ren); and/or any designated person as follows: Additional relief requested for final hearing (permanent order): In addition to the relief requested above in Ex Parte Relief Requested," I request the following relief for myself andfor the person(s) for whom I am applying: (I Order the Defendant to comply with the following visitation arrangements of any child(ren): Visitation; Deny visitation; Require supervision by a third party (Please specify visitation arrangements of any chiid(ren) below giving primary consideration to the safety of the Plaintiffor any child(ren) or both): IE4) Order the Defendant to pay attorney?s fees and court costs. Grant possession of the residence or household to the Plaintiff to the exclusion ofthe Defendant by evicting the Defendant; restoring posses- sions to the Plaintiff; orEl both; or agreeing to allow the Defendant to provide suitable alternate housing. i (14} Order the Defendant to pay temporary reasonable child support for the Plaintiff andfor any child(ren) in the Plaintiff?s custody; or both; in accordance i with the Child Support Guidelines. (If this relief is sought; you must Attach COMPLETED copies of Form Child Support Obligation Income - Statementhf?davit; Form ?3-42, Child Support Guidelines; and Form (TS-47, Child Support Information Sheet); Original-Court Record Copy-Law Enforcement Copy-Plaintiff Copy-Defendant I State of Alabama I: Case Number i Uni?ed Judicial System PETITION FOR PROTECTION FROM ABUSE Form 02 (Page Rev. 1,0016 El (I S) Order the Defendant to provide temporary possession ofthe vehicle (description): to the Plaintiff because the Plaintiff has no other means of transportation of his or her own and the Defendant El has control of" more than one vehicle; or Cl has alternate means of transportation. (16) Incorporate another El custody order (Case Number, County, State: l; or visitation order (Case Number, County, State: andror support order (Case Number, County, State: into this Order. (I 7) Order the Defendant to surrender all ?rearms. (18) Direct the appropriate law enforcement office to accompany the Plaintiff ml] the residence of the parties; andfor another location, (description of location), as necessary to enforce any of the terms of this Order. (19] Order other relief not requested above (describe): Before me, the undersigned authority, personally appeared the Plaintiff, who is known to me or presented an identi?cation card to me, and who being duly sworn, deposes and says that her?she has read the foregoing Petition for Protection from Abuse and that the facts herein are true and correct. tin Sworn to and subscribed before this, the day of 0 (fl-0 EEK .10] .7 ?Km Cerdumj PI ntiff (Please print] amtiff ignature) a. if?Ni-l TUSRQ Judger?Clerk eff Court/Notary Pub A (NolaryMy commission expires 33/? Business Address and Telephone Number ofJudger?Clerk ofCourthotary Public NOTICE TO DEFENDANT The Defendant is advised that (1) he or she has the right to counsel at his or her own expense at the final hearing on this Petition but not counsel appointed by the courtright to request a final hearing prior to 10 days of perfection of Service ofthis Petition. Original-Court Record Copy- Law Enforcement Copy-Plaintiff Copy-Defendant DOCUMENT 1 State of Alabama Uni?ed Judicial System Form C-4 (Page 1 of 3] Rev. li?2016 EX PARTE PROTECTION ORDER (Protection from Abuse Act) .- l-I - seq. Ala. Code 1975 Case NO- 343 107 El Amended Order In the Circuit Court of EIUKM 05 County, Alabama For Cases Filed on or After January 1, 2016 PLAINTIFF (Victim) First Middle Last and any minor(s) on whose behalf the Petition for Protection from Abuse was filed [List Name(s) and ?1 ?3g~la~ til? I Date of Birth (DOB) of Plaintiff (Victim) . Other Protected Persons(s} [List Name(s) and V. DEF EN DANT i -- DEFENDANT IDENTIFIERS First Middle Last SEX RACE DOB HT Relationship to Victim: DSpouscDFormcr-Spouse La 3 a a . .ommon-LawMarriage DFormer Common-Law Marriage EYES HAIR. DISTINGUISHING FEATURES hi1 Common Wk] urrent or Former Dating Relationship LICENSE STATE EXP. DATE Current or Former Household Member Relative of Current or Former Household Member: are 1 web Parent Stepparent Child Stepchild 51 ?13ch Defendant?s Home Address&Teleplione EMT Nib? D: one ten, 1% 37.5458 DFirearm EKnife DHands, Feet, Fist Other: Weapon Present on the Property THE COURT HEREBY FINDS (Check all that apply]: Pursuant to the sworn AffidavitfPetition andfor testimony of the Plaintiff seeking protection from abuse, the Court finds that it has jurisdiction over the parties and matter under the law of the State and the Defendant is being provided with sufficient notice, including notice of his right to request a hearing within 10 days of service, in order to protect his or her rights to due process. temporary order is necessary to prevent abuse. Defendant represents a credible threat to the physical safety of the: Plaintiff; and/or child(ren}; andi'or any designated person to wit: . THE COURT HEREBY ORDERS (Check all that apply): That the above-named Defendant be enjoined from threatening to commit or committing acts of abuse as de?ned in the Protection from Abuse Act. That the above-named Defendant be restrained from any contact with the Plaintiff, andfor Dchild?en): andfor El any designated person, to wit: Additional terms of this order follow on succeeding pages. The terms of this order shall be effective until or I: further order of the Court. THIS ORDER IS VALID AND ENFORCEABLE IN ALL COUNTIES IN THE STATE OF ALABAMA. LAW ENFORCEMENT OFFICERS MAY USE THEIR ARREST POWERS PURSUANT TO SECTION 15-10-3 TO ENFORCE THE TERMS OF THE INJUNCTION. NOTICE TO LAW ENFORCEMENT This Order shall be enforced. even without registration, by courts and any law enforcement of?cer of any state, the District of Columbia, any US. territory, and may be enforced by Tribal lands (18 U.S.C.A. Section 2265). WARNINGS TO DEF ENDANT: This Order shall be enforced, even without registration, by the courts and any law enforcement officer of any State, the District of Columbia, and any U. S. territory, and may be enforced by Tribal Lands (18 U.S.C.A. Section 2265 Crossing state, territorial or tribal boundaries to violate this Order may result in penalties, including federal imprisonment (.18 U.S.C.A. Section 2262), Federal law provides penalties for possessing. transporting, shipping, or receiving any ?rearm or ammunition while subject to a qualified protection order or after being convicted of a misdemeanor crime of domestic violence [18 U.S.C.A. Sections 922(g)(8) and Section l3A-l l-72(a) provides that it is a Class felony for a person convicted in the State of Alabama or elsewhere of a misdemeanor offense of domestic violence or subject to a valid protection order for domestic abuse to own a firearm or have one in his or her possession or under his or her control. This Order is also enforceable on US. Department of Defense installations (10 U.S.C.A. Section 156] A violation oi?this ORDER is aClass A misdemeanor. Section I3A-6- 42, Ala. Code 1975. The Defendant is noti?right to request a final hearing prior to 10 days of perfection of service of the Petition for Protection from Abuse. ONLY THE COURT CAN CHANGE THIS ORDER Origi nal?Court Record Copy-Law Enforcement Copy-Plaintiff Copy-Defendant udge's Initials: State of Alabama Unified Judicial System Form C-4 (Page 2 of 3) Rev. 1/20 l6 EX PARTE PROTECTION ORDER (Protection from Abuse Act) .. 0-) ?30-5-l, et seq, Ala. Code ms Case No. Amended Order In the Circuit Court of E$W?bi County, Alabama THE COURT FURTHER ORDERS THAT (Check all that apply): El The Defendant is enjoined from threatening to commit, or committing acts of abuse, as de?ned in the Protection from Abuse Act, against thea? Plaintiff, andfor EIchild(ren) of the Plaintiff; andi'or any designated person, to wit: The Defendant is restrained and enjoined from harassing, stalking,l:lannoying, Dthreatening engaging in conduct that would place the following in reasonable fear of bodily injury, the: DPlaintiff, andiotEI child(ren) ofthe Plaintiff; andiot [3 any designated per- son, to-wit: or from contacting the Plaintiff andi?or children of the Plaintiff. . The Defendant is restrained and enjoined from having physical or violent contact with: the Plaintiff or the Plantiff' property; Dplace of employment; Dschool; andforDhe of employment? school; andfor any designated person?s to- wrt: Dresidence; place of employment; school. The Defendant is ordered to stay away from any specified place, as designated below which the court determines the Defendant has no legitimate reason to frequent, frequented by the Plaintiff and/or any designated person. Name(s) and location(s) of the other speci?ed place(s): The Defendant is ordered to not within feet (minimum of 300 feet) orl:l the PlaintiffsEl residence (even if the residence is shared with the Plaintif?glj school; andi?orTj place of employment; school; andforElplace of employment; any designated person's, to-wit: school andfor place of employment. Temporary custody of the childt'ren} of the parties is hereby awarded to: he Defendant is enjoined from interfering with the Plaintiffs efforts to remove any of the Plaintiffs childtren) or from removing any children from the jurisdiction of the court, 1 direct the appropriate law enforcement officer to accompany the Plaintiffduring this effort. (6) The Defendant is enjoined from removing any child(ren) from the individual, to wit: having legal custody of the child(ren}, except as subsequently authorized by a custody or visitation order issued by a court of competentjurisdie?tion. The Defendant is removed and excluded from the residence of the Plaintiff, regardless of omrership of the residence. (8) The possession and use ofthe automobile, is awarded to and other essential personal effects, (Description, year. make] [Please spec ify} are awarded to The appropriate law enforcement officer shall accompany the Plaintiff to qthe residence of the parties and/or other speci?ed locations, to- wit: as necessary to protect the Plainti or any child(ren} from abuse. (9) The Defendant is prohibited from: transferring; concealing; encumbering; or otherwise disposing of specified property mutually owned or leased by the parties, as follows Original-Court Record Copy-Law Enforcement Copy-Plaintiff Copy-Defendant Judge's Initials: State ofAlabama Uni?ed Judicial System Form 04 Page 3 of3 EX PARTE PROTECTION ORDER Rev. 11?2016 (Protection from Abuse Act) Case No. I 0 30-5-2, et seq., Ala. Code 1975 b: In The Circuit Court of 595"" 0? County, Alabama El Amended Order (10) The Defendant is ordered to obey the following grant of relief deemed necessary to provide for the safety and welfare of the: Plaintiff; and/or any child(ren); and/bra any designated person, as follows: El (1 I) Other (please specify) This matter is set for a final hearing on (date) at (time) to be held at (place). The Defendant is advised that he or she has the right to counsel at this final hearing at his or her expense, but not counsel appointed by the court. Date Judge RETURN ON SERVICE Return receipt of certi?ed mail received in this of?ce on (Date) I certify that I personally delivered a copy of the Ex Parte Protection Order to in County, Alabama on (Dale) Date Server?s Signature Of?ce Address ofServer Type of Process Server Of?ce Telephone Number of Server Original-Court Record Copy?Law Enforcement Copy -Plaintiff Copy-Defendant