Free 275.6 - Kentucky

type division in which this case will be heard

AOC - 275.6 Rev. 5-03 Page 1 of 1 Commonwealth of Kentucky Court of Justice www.courts.ky.gov KRS Chapter 403

Case No. Court ________________________ MOTION TO AMEND PRIOR DOMESTIC VIOLENCE ORDER County

PETITIONER First Middle Last VS. RESPONDENT First Information about Respondent: Current Residence: ____________________________________________________________________________ ____________________________________________________________________________________________ Usual Residence: Occupation: Employer Name: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________________________ Middle Last

Employer Address: ____________________________________________________________________________ ____________________________________________________________________________________________ Sex CAUTION: Comes (Date:) Race [ ] Birthdate Height [ ] Weight SSN Operator License # State

Weapon involved

Believed to be armed and dangerous and moves the Court to amend its previous order dated:

[ ] Petitioner

[ ] Respondent

in the following manner: _______________________________

_______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Date: ______________________, 2_____ __________________________________________________ Petitioner's/Respondent's Signature __________________________________________________ Attorney's Signature

CLERK Hearing Date: ________________, 2____. Hearing Time: _______ [ ] a.m. [ ] p.m. USE Hearing Location: _____________________________________________________ Copies to: ONLY ___________________________________________________________________ Court file Petitioner Court Clerk in county of Petitioner's usual residence, if different Law enforcement agency/dispatch center responsible for LINK entry Law enforcement agency(ies) designated for service ENSURE ALL INFORMATION IN BOXES IS COMPLETE AND LEGIBLE

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