Free Petition for Permanent Protection from Domestic Violence - Maryland

CIRCUIT COURT

DISTRICT COURT OF MARYLAND FOR

City/County

Located at

Court Address

Case No. vs.

Petitioner

Respondent

Street Address, Apt No. Home: Work: Telephone Number(s)

Street Address, Apt No. Home: Work: Telephone Number(s)

City, State, Zip Code

City, State, Zip Code

PETITION FOR PERMANENT PROTECTION FROM DOMESTIC VIOLENCE (Family Law 4-506(h))
(NOTE: Fill in the following, checking the appropriate boxes. Petitioners need not give an address if doing so risks further abuse or reveals the confidential address of a shelter. If this is the case, check here . If you need additional paper, ask the clerk.) 1. I want relief for myself minor child vulnerable adult, from abuse by . 2. I was a victim of the abuse and a person eligible for relief under this statute in Case No. , and granted a Final Protection Order in said case. 3. The person(s) I want protected are persons who were protected under the Final Protection Order in Case No.
Names(s)

(include yourself if you are a victim):
Birthdate Relationship to Respondent

4. Case No.

, the Respondent in this petition, was the respondent in . and
Crime for which Sentence was served

5. The respondent was convicted in Criminal Case No. served a term of imprisonment of at least five years for

.

6. The acts of abuse for which the Respondent was incarcerated led to the issuance of the Final Protection Order in Case No. .

I solemnly affirm under penalties of perjury that the contents of the foregoing are true to the best of my knowledge, information and belief.
Date Petitioner

I have filled in the Addendum (Description of Respondent), CC-DC/DV 1A.
CC-DC/DV 18 (4/2009)

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