ENFORCEMENT/MODIFICATION ORDER

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APPLICATION FOR LEGAL SERVICES

ENFORCEMENT / MODIFICATION ORDER

PLEASE ANSWER ALL REQUIRED QUESTIONS IN THIS APPLICATION. THE FOLLOWING INFORMATION IS FOR OUR USE ONLY. WE WILL LET YOU KNOW IF YOUR APPLICATION HAS BEEN ACCEPTED WITHIN FOUR WEEKS.

First NameMiddle NameLast Name

Browse Files

You may upload multiple documents. Limit 100mb

Browse Files

You may upload multiple documents. Limit 100mb

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please provide your contact information below where our agency can reach you.

Area CodePhone Number

Below, please provide some information about yourself. If you do not have a Social Security Number or Driver’s License, please write “N/A” in the appropriate space(s).

Street Address

Street Address Line 2

CityState

Country

Please record your citizenship or immigration information below.

Yes, Full TimeYes, Part TimeNo, not at this time

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

First NameMiddle NameLast Name

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Area CodePhone Number

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

List all of your minor children, even if they have different parents and even if they are not currently living with you:

INFORMATION ABOUT CHILDREN

please fill out as complete as possible.

Incident Information

To assist our agency in assessing the urgency of your case, please state the nature of the violence that happened to you and/or your children. Give the month, day, and year of each incident and explain what the adverse party did. Please note if there are police reports and, if so, give the case numbers. Please include ALL the incidents of violence you experienced, including those that are not very recent and those that did not involve the police. If you do not remember the dates of incidents of violence, please write “N/A” in the appropriate space(s). If the violence you experienced occurred over a long period of time or constantly during your relationship and you cannot recall a specific incident, please record the long term mistreatment and explain the frequency with which it happened.

No, the police were not contactedYes, there were no arrestsYes, other parent was arrested

Violation Information

Please state the nature of the VIOLATIONS OF YOUR CURRENT COURT ORDER by the Adverse Party towards you and/or your children. Give the month, day, and year of each incident and explain what the Adverse Party did. Please note if there are police reports and give the case numbers.

YouAdverse PartyJoint OwnershipOther

(if your current partner is NOT the Adverse Party)

(Dependents include any children under age 18, including children NOT of the marriage)

By signing and submitting this form you certify that the information provided herein (this web form) is true and correct to the best of your knowledge.

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YOUR INFORMATION

YOUR INFORMATION

ADVERSE PARTY INFORMATION

INFORMATION ABOUT CHILDREN

CASE INFORMATION

PROPERTY INFORMATION

YOUR FINANCIAL INFORMATION