Protective Order Information Form: Petitioner

Wait times vary in length and depend upon, among other things, whether anyone who is line ahead of you and/or has an appointment falls within the guidelines for an Ex-Parte protective order. The average time necessary to complete the Ex-Parte protective orders is 1 and 1/2 to 3 hours but may be longer. If you are unable to or choose not to wait, you may complete this form and an advocate will contact you at the phone number and/or email address provided on this form as soon as possible.

Before applying, if the person you want to file against does not live in Hall County, has not committed a crime against you or is not related to you or has not lived with you, please see an advocate to see further options.
Protective Order Information Form: Petitioner

This is information about you. Must be 18 and older to apply for an order. If you are not requesting a Family Violence, Stalking or Dating Violence Order, please see advocate before filling out form.
This is a request for a:

Family Violence OrderStalking OrderDating Violence Order
Today's date

MonthDayYear
Date
Name

First NameMiddle NameLast NameSuffix
Date of birth

MonthDayYear
Date
Gender
Race and Ethnicity
County of Residence
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you asking for your address to remain confidential from the other person?
Phone Number
Please enter a valid phone number.
Email
example@example.com
Is it safe to leave a message on your phone?
Is it safe to email the email above?
Please provide the Name, Relationship and number for an emergency contact.
Have you contacted us before?
If yes, When?
Have you spoken to or already retained an attorney representing you for the TPO hearing?
Do you have another pending civil matter relating to this case? Examples: Divorce, paternity/legitimation or DFCS. If yes, please provide case number and what county the case is in.

Protective Orders Information Sheet: Defendant Information

This is the person you would like to file a protection order against
Defendant Name

First NameMiddle NameLast NameSuffix
Defendant Date of Birth

MonthDayYear
Date
Defendant Phone number (We will not be calling them) This information is for the sheriff’s office in the event they cannot serve him)
Defendant email (purposes of sending paperwork) We as advocates will never be contacting them
Defendant County of Residence
Defendant Address- If you do not have an address, please see advocate. We cannot proceed without an address.

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Defendant work address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is it ok to serve them at the work address if we cannot at the home address?
Best day and time to serve order
Hair Color
Eye Color
Height
Weight
Sex
Race
Military Experience?
Defendant Salary
Do you have proof of this salary?
Have you reported the behavior causing you to believe that you need a protective order against him/her/them to law enforcement?
If yes, When did you report it?
Was he/she/them arrested for this?
Please list charges here
Has a TPO been placed on this person in the past? If yes, please state year.
Do they possess any firearms?
If yes, What types of firearms do they possess?
If this is a request for a Family Violence Order or you have ever lived with this person, do you want the Sheriff’s office to confiscate weapons?
Will we need to request an interpreter for this person for when we go to court?

YesNo

Protective Order Information Sheet: Relationship Information
Relationship to This Person (Check all that Apply)

Spouse/ Former SpouseParent/ ChildStepparent/stepchildParents of the same child or childrenLive in/ Have lived in the same housholdFoster parent/ Foster child
If married, How long?
If divorced, Year of divorce?
Are you presently living with this person?
If yes, How long?
If separated, How long?
Please list the name, date of birth, sex, and race of your minor children. If children are not biologically related to the person you are filing against, please let us know below.
Have they been legitimated? Meaning is there a court order stating he is the legal father of the child/children?
If none of the above categories apply to your situation, how do you know this person?

Protective Orders Information: Incident Information
When was the last incident?

MonthDayYear
Date
Please Provide a detailed description of the most recent acts of violence/stalking that have been committed against you.
What other types of abuse have you endured from this person in the past that have caused you to feel your life is in danger?

Protective Orders Information Form: Ex-Parte Information
If your vehicle will be affected if this order goes into place, please provide information below. If not, leave blank.
Please provide address for your workplace if you would like it to be added to the protective order. If person you are filing against does not know this address, please DO NOT ADD.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please provide the name and address of any daycares/ schools you want added to the protective order
Is there any other address you want added to the protection order?
Are there any utilities, joint bank accounts, or policies under the defendant’s name that might affect you if the order is granted? If yes, please list those below
Please list items defendant needs to pick-up with the help of law enforcement from you residence in the event they are evicted upon service of this order
Do you need anything back from the defendant? If yes, please list below
Please list the name, date of birth, sex, and race of everyone you would like under the protected parties listed on the order. (Parties must either be minor children or reside in the home with you)
If you have minor children with the defendant, do you have a child visitation preference?
What is your average monthly or yearly income? If unemployed, please write "unemployed"
Is there anything that the defendant can say that would make Plaintiff look bad (whether it is true or not) in court?

I understand that for a TPO to remain in effect, I will need to attend court for a hearing within 30 days, and to speak with legal advocates to prepare for court hearing. If I do not respond to a call or email from the legal advocates, or if I miss a court hearing without giving the legal advocates advance notice, I would like for the legal advocates to take the following actions:

A. Take no further action; if I do not respond and/or do not show up for court, I understand the TPO may be dismissed.B. Call or email my emergency contact person named on my intake sheet, to inquire about my well-being.C. Request a welfare check by law enforcement, which will cause an officer to come to my residence.
If I have selected (A) above, and my well-being is not confirmed by my emergency contact after two (2) attempts by the legal advocates either by phone or email, then I understand and expect that the legal advocates will request a welfare check by law enforcement, which will cause an officer to come to my residence. If I do not want an officer to perform a welfare check, I will contact the legal advocates or request that my emergency contact do so instead.

Clear
Self Review when Applying for a Protective Order

Please review the following questions. If you are unsure on whether you have provided the advocates with this information, please ask for help.
I have listed an address where the defendant can be found to receive a copy of the petition and order

Clear
I have described the defendant

Clear
I have given the defendant’s date of birth or social security number (At least one of these must be provided to have the protective order placed on the national protective order registry. We cannot file without this information as well.

Clear
I have indicated my relationship with the defendant

Clear
I have clearly and accurately told the advocates about the abuse.

Clear
I have described the abuse to myself and my children, any injuries received, police involvement, drug and alcohol abuse, pets injured, things broken, things destroyed, and any expenses incurred because of the abuse.

Clear
I have told about past abuse both physical and emotional from the defendant

Clear
I have given an address where papers can be sent to me and whether it needs to remain confidential

Clear
I have told the court about any pending court matter including but not limited to divorce, paternity/ legitimation, DFCS

Clear
I have told the court of any weapons the respondent has and whether I desire the court to confiscate weapons

Clear
I have listed everything I would like the court to address.

Clear
REMEMBER NO ONE DESERVES TO BE ABUSED

Hall County Domestic Violence Shelter: Gateway Domestic Violence Center

Crisis line: 770-536-5860

To locate your local shelter: 1-800-33-HEAVEN

National Domestic Violence Hotline: 1-800-799-SAFE

For Legal Assistance: Georgia Legal Service Program

1-800-498-9469 or 404-206-5175

**This form has been adapted from the Georgia Commission on Family Violence**
Please provide evidence/ exhibits related to the incident above you will be presenting in court. These might include but is not limited to, police reports, emails, texts, pictures of abuse etc. If you do not have any at this time, you may email those to protectiveorders@gatewaydvcenter.org one week before your hearing date. Please disregard this section if you are not planning on presenting any evidence/exhibits.

Cancelof
Should be Empty:

Protective Order Information Form: Petitioner

Protective Orders Information Sheet: Defendant Information

Protective Order Information Sheet: Relationship Information

Protective Orders Information: Incident Information

Protective Orders Information Form: Ex-Parte Information

Self Review when Applying for a Protective Order