STATE OF SOUTH CAROLINA
) ) COUNTY OF ____________________________ ) ) ________________________________________ ) Petitioner ) ) vs. ) ) ________________________________________ ) Respondent. ) ) I ask this court to issue an Order of Protection, because: 1.
IN THE FAMILY COURT _____________JUDICIAL CIRCUIT PETITION FOR ORDER OF PROTECTION (For Use in Magistrate's Court) FILE NO. Respondent's SSN: DOB: Race:
This is the county where this case should be handled, since (check one): a. The person who caused the abuse lives in this county; or, b. The person who caused the abuse does not live in this State, or can't be found, but I live in this county; or, c. The person who caused the abuse last lived with me in this county, and I still live in this county.
2. The person who caused the abuse lives at _______________________________________ in or near the town or city of __________________, which is in __________________ County, and the State of ____________________. 3. The person who was abused was (check one or both, and supply information): a. __________________________, who is the person asking for an Order of Protection; or, b. __________________________, who is a child under 18 years old who lives with me. That the abuser and the victim (check one or more): are husband and wife were formerly husband and wife are cohabiting formerly cohabiting have a child/children in common are household or family members pursuant to S.C. Code Section 20-4-20 (a)(2)
5. The abuse happened on _________________________________, at __________ o'clock, A.M./P.M, when ________________________________ did this ________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ____________________________________________________________________________________. 6. I ask this court to (check one or both and supply information): a. issue an order of protection which forbids _________________________ from abusing, threatening to abuse or molesting __________________________. b hold an emergency hearing within 24 hours. Sworn to and Subscribed before me ) this day of , ) ) ) Notary Public for South Carolina ) Signature of Petitioner or ) Person on Behalf of Petitioner under 18 years old My Commission expires )
NOTICE TO RESPONDENT: YOU HAVE THE RIGHT TO EMPLOY COUNSEL TO REPRESENT YOU. SCCA/744 (Amended 05/08)