Domestic Relations Case Filing Information Form

Superior Court County MUSCoGEE Date Filed

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Plahtiff(s)

Defendant(s)

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Na4*htv/
Middle

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Maiden

L Suffir Pretu

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Plaintiff/Petitioner's Attorney
First Middle

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Bar #

Check Case Type (one or more)

FAMILY1TOLENCE
Divorce (iaciudes armrimeat)

CoDtested? Child Ctrstody Issue? Chiid Support Issue?

SepaEte MaiBtenance

Yes ENo E Yes tr No D Yes E No

D

Additional Information - Ex Parte Relief

Did the fuitial pleadirg iaclude
1. From alleged faruily request for relief.)

violarce? EYes DNo

tr Adoption
Patemify (ilcludes legitimatioa) loterstate Supporl EEforcerDent Action

Yes trNo 3. Was ex parte reiief graoted? E Yes E No

2. Was ex part! rclief rcquested? D

tr
D

J lA.

Dooestication of Foreign Custody Decree

Family Violence Act Petition

OT}{FR
Have the parties agreed to bindiag Have rha panies reached
a

MODTFICATION
Modificatioa - Clstody, Visitatioq or Parentirg Tiroe
Does the Eodifcatioo ioclude a pareot selection by a cbild who is at least i4 yea$

artit-aiior? tr Yes

No

custodial agreemeni?

tr Yes tr No

Ifyes, check ooe:

old? trYes trNo

tr tr tr tr
D D

Modificatioq - Child Suppolt and A.lirrloDy Modification - Child Support Modificatioa

-

AlirDony

tr tr tr E

JoiDt Crrsiody

Joilt Irgal Custody

Joiot Pbysicat Custody
Sole Cusody to:

CONTEMi'T
Crntempt - Custody, Visitatioq or Parenting Time Coltempt - Child Suppod ald Ali.Drony
CoEteBpt - Child Support Codtempt - Alimony
Contempt

Fbanciai Affldarit

submitted? DYes trN.o

submitted? tr

Clhild SEpport Fonls

Yes

D No

tr tr

D Otler Domestic

Other Domestic Relatiors Speci6,

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IHE

SL]PERIOR COi.,RIFOR THE COT]NTY

STATEOFGEORGIA

OF MUSCOGEE

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Civil Action FiIe

PETITION FOR STAIKING TE]\,[POR.4RY PROTECTTVE

OR-DER

The Petitioaer, purst.aDt to O.C.G.A $ 16-5-94 hereby 6les this Petition for a Temporary- Protective Grder alri in support shows the Court ttre foi.lowing:

i.

The Petitioner is a resia.nt of 1p years of_age or is brtb is 6l'{lL2-sexlzno

-.be age

of f

2.

tJ Co[ e"^J',5 .:, -:@.AI;;;i-", The Respondent i" ar..id"nt-of

al

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o L.rb Countl,, Georgia ard is over al emaagipai.ed min61. Pedrionei's dz-re of

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UUI l^l(A( K/nCh.lA lt l\A(06( (Couaf,

be sewed

Georgia

OR

Colu,^h,,s,6rt

2t

a rasideat of 'rhe State of 6 S. . Uaaer O.C-G.A- $ $ i9-13-2(b) ald 1G5-9a{6) jurisdiction ard veuue are proper \,rift tlis Cour-t becar:se ths 5felHng occured il the Sbte of Georga in _ couaty ald the Petitioner lives n Cormiy. Reqiooded is srbject to &e jur:stiiction of this court aad may be
Respoadent is
served al

3,

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aad simila:'events may occur n itre fu:ue. Tbese acts had purposes, happened ar places otber tlal ttre residence of were withor.t the con-sent bf the Petitioner, ald placed Petiiioner in reas6nahl6 fsar lsr he/his own safef aad/ or the safely ofher/his imm ediare family.

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ThBREFOR-E,

eiidoner reqr:.es-o

(a) Tbal tre court set a hearirg withfu (30) days of the sising of -ihe chder aad to direct Respondent to appear before ttr," court and to show ,iy r...oos why the demaods of the Petiiicner should oot be grar@

ib) T'bzt -&e Respoadeat

be serv-ed a copy

Grder as requ=ed by law;

ofthis pefitioa aad Temporaqr protective

(c) That this Cor:it issrre al Ex parte and Twelve Montl protective Order:

V/o&er

Respondent to slcp J:arassing and

intimirl2ling petitioner

not trave a:ry direct or iadirect contact with ttre petitioner aad her,&is imm ediate family; R.qpo"d"", ;;;";ed fiom approachias wiihin ...'.---_---- yards of -S'oder Petirioner ald Peiitioner's resiCence; _--r' order Respondeat refr.ia from the cond.ci toward petitioler the as stated in this

-gmediale order Respondent

faraily;

and her,ftis

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__:1'_ ofier

--Petiaoa

law eu'orceme:t.o euiorce rhe order, order Respoade::t to receive appropnate psyclialric ot psychological ser"ices; awaid ihe Peiiiioner cosis -od ur.o-.y f*.s for iraving io bring thrs
ac-rior-

R;spectfi:JJy srbmiired"

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Petitioner's Address

Q^Vntss C$* Ac.r.e

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RESPONDANT'S IDENTIFYI{G FACT SIEET

as .*pl"o much as possible; one of t'aose iau-d be provided to hav-e ttre Order placed dre Narioaal crime ]-nfoimaiion Cen'rer regish-r RespDDdeaf s da:e orbir& o, ,o"irr

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nrmber.)

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01 0worlcs from

Repondart's soci:.l secr:ri4, nn-oter is XSffftfl0($0Of1d,rc of birl g le i ) sex nt, coior of bair_E l- Cqp'n coror or eyes , weior.r - heigit '-'*' Respondenl's race is A>;an ethlic ba.kg.ooo,i -.Respondent has distinguishiag marks lt ftorr- ,"rrq ,1.) _Respondent &ives a aad has a ,._licensetagn:.:mber (shte) d4iver's Iicense R."tpoo,i"ot' r hoi"EdrEi-

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