Free Ex-Parte Petition For An HRS 586 Temporary Restraining Order - Hawaii

If Attorney filing type name, address and phone no. below

1. 2. 3. 4.

CLEAR FORM
IN THE FAMILY COURT OF THE SECOND CIRCUIT STATE OF HAWAII ) ) ) ) ) ) ) ) ) ) ) ) FC-DA NO. EX PARTE PETITION FOR AN HRS 586 TEMPORARY RESTRAINING ORDER ORDER [ ] Granting [ ] Denying Ex Parte Petition for an Temporary Restraining Order

Petitioner,

vs.

HRS

586

Respondent.

EX PARTE PETITION FOR AN HRS 586 TEMPORARY RESTRAINING ORDER
This Petition is made pursuant to Hawaii Revised Statutes Chapter 586. Petitioner in support of this Petition states that: 1. 2. Name I reside on the island of

9 Maui 9 Molokai 9 Lanai.

The following individual(s) live with me in my residence: Relationship to me Birthdate Age

-1-

2JC-jy 03/04/09

3.

I have the following relationship with the Respondent above named: A. B. C.

9 9 9

we are married. we were married. we have the following child/children in common: Child(ren)'s Name(s) Birthdate

9 E. 9 F. 9 G. 9 H. 9
D.

we are parent and child. we are related by blood as follows: we lived together in the same dwelling unit from we are now living together. we are or were in a dating relationship 1. Length of our relationship (number 2. Nature of our relationship is/was years months days) to . .

9 9 9 9 9 9 9
4.

romantic a courtship an engagement intimate or sexual a casual relationship ordinary fraternization in business/social contact Frequency of interaction times per

9 day

9 week

9 month.

My date of birth is: My Social Security Number is: XXX-XXRespondent's date of birth is: Respondent's Social Security Number is: XXX-XXThe most recent acts of domestic abuse or threats of domestic abuse against me are:

5.

-2-

9

In the past the Respondent has committed the following acts of domestic abuse or threats of domestic abuse against me and other people:

9

The Respondent has used weapons against me or threatened to use weapons in the following incidents:

9

I believe the Respondent possesses, owns, or intends to own firearms or ammunition. The reason I believe this is (include description of firearm(s) and present location):

9

I believe that the Respondent may use a firearm to threaten, injure or abuse someone because:

9

W e live together at . It is necessary that I have exclusive occupancy of our joint residence until the court hearing because:

9

Until there is a court hearing I am concerned about Respondent having contact with our minor children listed below because:

Child(ren)'s Name(s)

Birthdate

-3-

9

Until there is a court hearing I am concerned about Respondent having contact with the following people who live with me because:

Name

Birthdate

9

Until there is a court hearing I am concerned about Respondent having contact with the following family members w ho do not live with me, because:

Name

Relationship to me

Birthdate

9

I would like the Court to be aware of the following additional matters in considering my application for a protective order:

9

I am or have been involved in other legal proceedings involving the Respondent as follows: Case Name: Case number: Location of Court: Date filed: Date concluded: Type of case:

-4-

Petitioner asks the Court to immediately issue an Ex-Parte Temporary Restraining Order of Protection that orders the respondent and any other person acting on behalf of the Respondent:
1. 2. Not to threaten or physically abuse me, or any other person residing with me. Not to contact, write, telephone or otherwise electronically contact me (by recorded message, pager, etc.), and my place of employment. Not to be within one hundred (100) yards of my place of residence at:

9 9

Not to enter my place of employment at: Employer: Address: To vacate the residence at:

9 9

Not to have contact with the following minor child(ren) of the parties until a court hearing occurs:

9

Have only supervised contact with the following minor child(ren) of the parties until a court hearing occurs, as follows:

9

Arrange for supervised visits with the following minor child(ren) of the parties through a third party by telephoning at until a court hearing occurs.

9

Not to have any contact with the following people who live(s) with me: Name Birthdate

-5-

9

Not to have any contact with the following family member(s) of the petitioner who do not live with me: Name Birthdate Age

I understand that if the Court grants the relief that I have requested the court order w ill be in effect until a court hearing can be scheduled. I also understand that the terms of this order must be followed until the court hearing and that I can request changes in the order at the court hearing.

The Petitioner declares under penalty of perjury, that the statements made herein are true and correct to the best of the Petitioner's knowledge, information and belief.

Date Assisted by:

Petitioner's Signature

(Agency)

CLEAR FORM

ORDER [ ] Granting [ ] Denying Ex Parte Petition for an HRS 586 Temporary Restraining Order.

Date

Judge

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