Adult Abuse Petitions and Child Protection Petitions are obtained at the Circuit Clerk's Office, Bates County, Courthouse, Clinton, Missouri.

Information Regarding Domestic Violence and the Law (http://www.mobar.org/pamphlet/domviol.htm)

Click here for the following available forms: Adult Abuse Petition, Motion for Renewal of Full Order of Protection, Petition for Order of Child Protection, and Child Protection Motion for Renewal of Full Order of Protection.

Adult Abuse Petition:

IN THE CIRCUIT COURT OF BATES COUNTY, MISSOURI

Judge or Division:	Case Number:	(Date File Stamp)
	Court ORI Number:
Petitioner: vs.	Respondent's Home Address:
Petitioner’s DOB or SSN: Age: Sex F M Race:
Respondent:	Respondent's Work Address:
Respondent's DOB or SSN: Age: Sex F M Race: Eye Color: Hair Color: Height: Weight: (Identifying Information for use by Law Enforcement)
Adult Abuse/Stalking Petition for Order of Protection
1. I am Petitioner and at least 18 years of age under 18 but emancipated Respondent is at least 18 years of age under 18 but emancipated
I reside in , , in the County of . Respondent may be found in , , in the County of .
3. An act of abuse or stalking occurred at , , , in the County of .
4. Other address(es) where Respondent may be served: (provide as many as possible)
Respondent and I: (check one or more) are spouses. are related by blood. were spouses. were related by marriage. have child(ren) in common. are related by marriage. are or were residing together. have no relationship other than Respondent has stalked me.
Complete for Adult Abuse Petition Only. 6. Respondent and I: (check one or more) reside together. previously resided together at , , , in the County of . never resided together.
Complete for Stalking Petition Only. 7. Respondent is stalking me. Explain relationship (example: co-workers, neighbors, etc.)
Complete for Adult Abuse Petition Only. 8. The residence in which I live is: (check one or more) jointly owned, leased or rented or jointly occupied by Respondent and me. owned, leased, rented or occupied by me. jointly owned, leased or rented by me and someone other than Respondent. owned, leased or rented by someone else, and Respondent is my spouse. jointly occupied by me and another person, and Respondent has no property interest therein.
9. Respondent has knowingly and intentionally: (check at least one) coerced me followed me from place to place stalked me caused or attempted to cause me physical harm harassed me placed or attempted to place me in apprehension of immediate physical harm sexually assaulted me threatened to do any of the above unlawfully imprisoned me by the following act(s): (Include the most recent date(s) of each act described.)
I am afraid of Respondent, and there is an immediate and present danger of abuse or stalking of me because: (describe)
11. Photographs/Exhibits are filed as evidence of my injuries.
Complete for Adult Abuse Petition Only. 12. It is in the best interest of the minor children that custody be awarded as follows: Child’s Name DOB SSN Age Address (If other than Petitioner) 1. 2. 3. Who did each Child Relationship to Parties Persons to Receive Custody reside with during last six months (Explain if not Custody (check one or both) six months Respondent's Child) Temporary Full 1. 2. 3. (If necessary, attach additional sheets.)
Identify any pending court cases before, or orders entered by, this court or another court involving the following (if none, so state). a. Petitioner b. Respondent c. Children (identified in item 12)
Pursuant to Section 455.010 to Section 455.085 RSMo, it is requested that the court issue an Ex Parte Order of Protection restraining Respondent from: (check all that apply) abusing, threatening to abuse, molesting or disturbing the peace of Petitioner wherever Petitioner may be found. stalking Petitioner. entering the dwelling of the Petitioner located at (see notice below): other:
It is further requested that, upon the hearing of this cause, the court issue an Order of Protection enjoining Respondent from the above acts for such time as is necessary to protect Petitioner and that the court: (one or more may be selected) Award custody of the minor child(ren) to Petitioner Respondent. Order visitation with the minor child(ren) to Petitioner Respondent as follows: Order Petitioner Respondent to pay child support to Petitioner Respondent in the amount of $ (check one:) per week per month. Order Petitioner Respondent to pay maintenance to Petitioner Respondent in the amount of $ (check one:) per week per month. Order that Respondent make or continue to make the rent or mortgage payments in the amount of $ on the residence occupied by Petitioner. Order that Respondent pay Petitioner’s rent at a residence, other than the residence previously shared with Respondent, in the amount of $ . Order that Petitioner be given temporary possession of the following personal property: Prohibit Respondent from transferring, encumbering, or otherwise disposing of the following property mutually owned or leased with Petitioner: Order Respondent to participate in a court-approved counseling program designed to help batterers stop violent behavior. Order Respondent to pay a reasonable fee for housing and other services provided to Petitioner by a shelter for victims of domestic violence. Order Respondent to pay Petitioner’s attorneys fees. Order Respondent to pay court costs. Other (specify):
I swear/affirm under penalty of perjury that these facts are true according to my best knowledge and belief.
Notice: Section 455.030 (3) RSMo provides that a Petitioner seeking protection under the Adult Abuse Act is not required to reveal any current address or place of residence on this petition. However, it may be necessary to contact you. Complete the entry if such disclosure will not endanger you.	______________________________________________________ Petitioner’s Signature ______________________________________________________ Address (Unless Disclosure waived) ______________________________________________________ City, State And Zip ______________________________________________________ Telephone
	______________________________________________________ Attorney’s Name, Missouri Bar No., if Applicable ______________________________________________________ Address ______________________________________________________ City, State and Zip ______________________________________________________ Telephone

Motion for Renewal of Full Order of Protection:

IN THE CIRCUIT COURT OF BATES COUNTY, MISSOURI

Judge or Division:

Case Number:

(Date File Stamp)

Court ORI Number:

Petitioner:

vs.

Respondent’s Home Address:

Petitioner’s DOB or SSN:

Age:

Sex F M Race:

Respondent:

Respondent’s Work Address:

Respondent’s DOB or SSN

Age:

Sex FM Race:

Eye Color: Hair Color:

Height: Weight:

(Identifying Information for use by law Enforcement)

Respondent’s Relationship to Petitioner:

Spouse Ex-Spouse Related by Blood/Marriage

Child(ren) in Common Resided Together

Other

Adult Abuse/Stalking Motion for Renewal of Full Order of Protection

The Petitioner requests that the court renew the full order of protection that was issued in this case on

and terminates                                         on for the reason that:

The allegations in the petition for the order of protection still exist on this date.

The following incidents of abuse have occurred since the date the petition was filed:

Other reasons

      Pursuant to 455.040 RSMo, the Petitioner requests that the court renew the full order of protection for such time as is necessary to protect the Petitioner, at least 180 days, and not more than one year. I swear by the facts stated in the above motion are true according to my best knowledge and belief.

____________________________________________

                                Petitioner’s Signature

Subscribed and sworn before me _________ ____________________________________________

                                                                 Date                                 Notary Public

My commission expires __________________ ____________________________________________

                                Judge/Clerk

____________________________________________

        Attorney’s Name, Missouri Bar No., if Applicable

____________________________________________

                                Address

____________________________________________

____________________________________________

                                Telephone

Child Protection Petition:

IN THE CIRCUIT COURT OF BATES COUNTY, MISSOURI

Judge or Division:

Case Number:

(Date File Stamp)

Court ORI Number:

Petitioner(s):

In the interest of: (Include name, and date of birth or age of each child)

vs.

Petitioner’s Address:

Address of Child(ren) (Unless disclosure waived)

Respondent(s):

DOB or SSN:

Sex F M Race:

Eye Color: Hair Color:

Height: Weight:

DOB or SSN:

Sex F M Race:

Eye Color: Hair Color:

Height: Weight:

(Identifying Information for use by Law Enforcement)

Respondent’s Home Address:

Respondent’s Work Address

Petition for Order of Child Protection

I am the Petitioner and: (check appropriate boxes)

a parent or guardian of the victim.

a guardian ad litem for the victim.

a court appointed special advocate for the victim.

the juvenile officer.

The Respondent(s) is an adult household member, an emancipated child, or person stalking the child.

Explain Respondent’s relationship to child(ren):

Respondent 1

Respondent 2

3. The family home of the child(ren) is: (check appropriate boxes)

owned                     leased                     rented

By:           Respondent 1           Respondent 2

                 Petitioner                   Other (name)

Occupied by: (include name only if different from above)

4. Respondent(s) has intentionally: (check at least one)

caused physical injury to the child(ren).

stalked the child(ren).

sexually abused the child(ren).

inflicted emotional abuse on the child(ren).

By the Following Acts: (Include date of most recent acts described.)

An act of abuse, described in section 4 of this petition, occurred at: (address, county, city, state)

An immediate and present danger of abuse to the child(ren) exists because: (describe)

An immediate and present danger of abuse to the child(ren) does not exist.

The best interest of the child(ren) require(s), and it is appropriate, to award custody as follows:

Child’s Name Relationship to Parties Person to Receive Custody

By (check one or both) temporary order of custody

full order of custody

8. Indicate any court cases pending or orders entered by this court or another court regarding the above children and or the parties. (If none, so state.)

9. Pursuant to Sections 455.510 to 455.520, RSMo, Petitioner requests that the Court issue an ex parte order of protection: (check boxes that apply)

restraining Respondent       1       2 from abusing, threatening to abuse, stalking, molesting or disturbing

the peace of the child(ren).

restraining Respondent       1      2 from having any contact with the child(ren), except as specifically

authorized by the Court.

10. I request an ex parte order of protection excluding Respondent 1 2 from the premises of the family home of the child(ren), and attest that:

a substantial risk to the child(ren) exists unless the Respondent(s) is excluded.
A remaining adult family or household member is able to care adequately for the child(ren) in the absence of the excluded party.
A commitment has been obtained from the local Division of Family Services to provide appropriate social services to the family or household members during the period of time which an order of protection is in effect.

Check this box if excluding Respondent(s) from the premises of the family home of the child(ren) is not being requested.

I further request that the court, after hearing, issue a full order of protection and order the following:

(check boxes that apply).

Respondent 1 2 not to abuse, stalk, molest or disturb the peace of the child(ren).

Respondent 1 2 not to have any contact with the child(ren), except as specifically authorized by the

court.

Respondent 1 2 not to enter the premises of the family home of the child(ren), except as specifically

authorized by the court.

Grant a temporary order of custody of minor child(ren) named in the petition to petitioner

other party

Respondent 1 2 to pay child support because the Respondent is able and support is needed in the

amount of $            per child, per week           per month

Respondent 1 2 to pay maintenance because Respondent is able and Petitioner is in need of

maintenance in the amount of $             per week          per month

Respondent 1 2
to make an assignment of periodic earnings or other income.

Respondent 1 2 be permitted visitation as directed by the court.

Respondent 12 be required to attend counseling designed to help child abusers stop violent

behavior.

Respondent 1 2 be required to attend substance abuse counseling.

Respondent 12
to pay treatment costs as directed by the court.

Respondent 1 2 to pay rent or mortgage on the residence occupied by the child(ren) in the amount

of $                     per                   .

Respondent 1 2 to pay for victim shelter services as directed by the court.

Respondent 1 2 to pay Petitioner’s attorney fees as directed by the court.

I swear the facts stated in the above petition are true according to my best knowledge and belief.

_________________________________________________

Petitioner’s signature

Subscribed and sworn before me ______________________

                                                                               Date

My commission expires _____________________________

_________________________________________________

Notary Public/Judge/Clerk

_________________________________________________

Attorney’s Name, Missouri Bar No., if Applicable

_________________________________________________

Address

_________________________________________________

_________________________________________________

Telephone

MOTION FOR RENEWAL CHILD PROTECTION:

IN THE CIRCUIT COURT OF BATES COUNTY, MISSOURI

Judge or Division:

Case Number:

(Date File Stamp)

Court ORI Number:

Petitioner(s):

In the interest of : (Include name, and date of birth or age of each child)

vs.

Petitioner’s Address:

Address of child(ren) (Unless disclosure waived)

Respondent(s)

DOB or SSN:
Sex: F M	Race:
Eye Color:	Hair Color:
Height:	Weight:

Respondent’s Home Address:

DOB or SSN:
Sex: F M	Race:
Eye Color:	Hair Color:
Height:	Weight:
(Identifying Information for use by Law Enforcement)

Respondent’s Work Address:

Child Protection Motion for Renewal of Full Order of Protection

The Petitioner requests that the court renew the Full Order of Protection which was issued in this case on and terminates on for the reason that:

The allegations in the Petition for the Order of Protection still exist on this date.

The following incidents of abuse have occurred since the date the petition was filed:

Other reasons:

Pursuant to 455.516 RSMo, the petitioner requests that the court renew the full Order of Protection for such time as is necessary to protect the children, not to exceed 180 days.

I swear the facts stated in the above motion are true according to my best knowledge and belief.

______________________________________________

Petitioner’s Signature

Subscribed and sworn before me __________________ ______________________________________________

Notary Public/Judge/Clerk

My commission expires _________________________ ______________________________________________

Attorney’s Name Missouri Bar No., if Applicable

______________________________________________

Address

______________________________________________

______________________________________________

Telephone

[Bates County Information]