Free Pleading Wizard - Nevada

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Case No. ___________________ Dept. No. ___________________ IN THE JUSTICE COURT OF LAS VEGAS TOWNSHIP COUNTY OF CLARK, STATE OF NEVADA

APPLICATION FOR ORDER FOR _____________________________________ PROTECTION OF CHILDREN ) (NRS 33.400) Applicant(s)
) ) vs. ) _____________________________________ ) Adverse Party(s) ) (must be Age 18 or older). )

ORDER FOR PROTECTION OF CHILDREN

- In addition to any other remedy provided by law, the parent or guardian of a child may petition any court of competent jurisdiction on behalf of the child for a temporary or extended Order against a person who is 18 years of age or older and who the parent or guardian reasonably believes has committed or is committing a crime involving: (a) Physical or mental injury to the child of a nonaccidental nature; or (b) Sexual abuse or sexual exploitation of the child. (NRS 33.400)
T T

PLEASE TYPE OR PRINT CLEARLY.
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COMPLETE THE APPLICATION TO THE BEST OF YOUR KNOWLEDGE. I am applying for protection (check all that apply):



For my minor child For my ward For my minor child and other person(s) For my ward and for other person(s)

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Application for Order for Protection of Children (NRS 33.400) January 2007

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Applicant states the following facts under penalty of perjury: I reasonably believe that the Adverse Party has committed and/or is committing a crime against a child as defined above. The acts occurred as follows: (NOTE: BE SPECIFIC AS TO WHO COMMITTED WHAT ACTS, AGAINST WHOM, WHEN, WHERE, WHETHER COMMITTED OR THREATENED; INDICATE APPROXIMATE DATE(S) AND LOCATION(S).) THIS FORM IS A PUBLIC RECORD ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

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______________________________________________________________________________
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NOTE: PLEASE DO NOT WRITE ON THE BACKS OF ANY PAGES; CHECK BOX IF YOU ARE USING ADDITIONAL PAGES.

Check if you use a continuation page (to be incorporated by reference)

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Application for Order for Protection of Children (NRS 33.400) January 2007

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Has this matter been reported to law enforcement or child protective services?

Yes

No

If yes, approximate date(s): _____________________________________________________________________ Name of agency: _____________________________________________________________________
Case/Event number if known:

_____________________________________________________________________ (IF YOU HAVE A REPORT AVAILABLE, PLEASE ATTACH A COPY OR BRING IT TO THE COURT HEARING.) For purposes of this form, a "TPO Action" is defined to include the following Justice Court actions: (1) An Order for Protection Against Stalking and Harassment (NRS 200.591); (2) An Order for Protection of Children (NRS 33.400); (3) An Order for Protection Against Harassment in the Workplace (NRS 33.270). A "TPO Action" is also defined to include the following Family/District, Justice Court action: (a) An Order for Protection Against Domestic Violence (NRS 33.020) Please Check the Appropriate Box Below:



In the last 2 years, Applicant or any party seeking protection has not filed a TPO action against the Adverse Party anywhere in the State of Nevada, and the Adverse Party has not filed a TPO action against Applicant or any party seeking protection anywhere in the State of Nevada. In the last 2 years, the following TPO action(s) in the State of Nevada have been filed involving Applicant, Adverse Party, and/or any party seeking protection: Case # (if known) Court Place of (Justice/Family) Filing Approx. Date Filed Outcome (TPO granted, denied, rescinded, etc.)



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Application for Order for Protection of Children (NRS 33.400) January 2007

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Has the Adverse Party ever been involved in any other relevant Court actions (e.g., eviction, divorce, custody, criminal, etc.)?

Yes

If yes, please explain: ________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Applicant must be at least 18 years of age. If not 18 years of age, consult with the Clerk. 1. a) Applicant's Name ____________________________________________ (Last) (First) (Middle)
b) Protected Minor's Name

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Age _______

Age

____________________________________________ (Last) (First) (Middle)

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c) Protected Minor's relationship to Applicant: _______________________________ Protected Minor's relationship to Adverse Party: ___________________________ d) Applicant's relationship to Adverse Party: _________________________________ e) Provide names below of those for whom you are additionally seeking protection, including family and household members that need this protection. Indicate the relationships of all persons listed to the minor and to the Adverse Party (i.e., spouse, intimate partner, friend, roommate, neighbor, relative, acquaintance, co-worker, stranger): NAME OF OTHERS SEEKING PROTECTION AGE RELATIONSHIP TO PROTECTED MINOR RELATIONSHIP TO ADVERSE PARTY

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Application for Order for Protection of Children (NRS 33.400) January 2007

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Explain why protection is needed for the individuals listed above: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ (NOTE: YOUR APPLICATION WILL NOT BE DENIED BASED UPON A PARTICULAR RELATIONSHIP. HOWEVER, DEPENDING UPON YOUR RELATIONSHIP, YOU MAY ALSO BE ELIGIBLE TO APPLY FOR AN ORDER OF PROTECTION AGAINST DOMESTIC VIOLENCE PURSUANT TO NRS CHAPTER 33.) 2. Have the minor and the Adverse Party ever lived together?

Yes Yes

No No

If so, for how long? _______________________________________________________ 3. Is anyone listed on Page 4 living with the Adverse Party now? If so, who? ___________________________________ 4. Are there other children involved?

Yes No.

If so, how are they involved?

________________________________________________________________________ ________________________________________________________________________ 5. Residence(s) where protection is needed:

CONFIDENTIAL (If confidential, check and move to the next question) or, If not confidential, list address, city, state and zip code:
________________________________________________________________________ ________________________________________________________________________ 6. Place(s) of employment where protection is needed:

CONFIDENTIAL (If confidential, check and move to the next question) or, If not confidential, list name, address, city, state and zip code:
________________________________________________________________________ ________________________________________________________________________

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Application for Order for Protection of Children (NRS 33.400) January 2007

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7.

School(s) where protection is needed:

CONFIDENTIAL, (If confidential, check and move to the next question): or, If not confidential, list name, address, city, state and zip code:
________________________________________________________________________ ________________________________________________________________________ 8. Other specific locations frequented where protection is needed (i.e., sports, extracurricular activities, church, employment, after-school activities, etc.):

CONFIDENTIAL (If confidential, check and move to the next question) or, If not confidential, list name, address, city, state and zip code:
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 9. If there are persons other than those listed on page 4 that the Adverse Party should be directed not to contact, please name the individuals and explain why these precautions are needed: ___________________________________________________________ 10. If there are any other safety concerns that the Court should know (i.e., firearms, etc.), please briefly explain: _____________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ RELIEF REQUESTED
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THEREFORE, I REQUEST that a Temporary Order be issued requiring the Adverse Party to refrain from contacting, intimidating, threatening or otherwise interfering with the minor and/or other persons identified in this application, either directly or through an agent.

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Application for Order for Protection of Children (NRS 33.400) January 2007

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I FURTHER REQUEST that the Court require the Adverse Party to stay away from the places listed above.

I FURTHER REQUEST the following other conditions: ________________________ ___________________________________________________________________________

I ACKNOWLEDGE that if I wish to apply for an Extended Order of Protection, I must wait until 3 weeks after the date the Temporary Order is served before a Motion to Extend can be filed with the Court.

I ACKNOWLEDGE that an Extended Order may only be granted after notice of the petition for the Order and of the Hearing thereon is served upon the Adverse Party pursuant to the Rules of Civil Procedure, and a hearing is held on the petition.

DECLARATION (NRS 53.045) I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAW OF THE STATE OF NEVADA THAT: (1) I AM THE APPLICANT HEREIN, (2) I HAVE READ THE STATEMENTS CONTAINED HEREIN OR HAVE HAD THEM READ TO ME, (3) I BELIEVE THESE STATEMENTS TO BE TRUE, AND (4) THE REQUESTED ORDER IS NEEDED. Dated:___________________________ __________________________________ APPLICANT'S SIGNATURE __________________________________ PRINT NAME

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Application for Order for Protection of Children (NRS 33.400) January 2007