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

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

INFORMATION AND INSTRUCTIONS

FOR

APPLICANTS FOR ORDERS OF PROTECTION

Please read the following, and complete the attached questionnaire, before proceeding.

WHEN YOU CAN FILE A PETITION FOR AN ORDER OF PROTECTION

Age:  You and the person you are filing against must both be:

    A.    18 years old or older; or

    B.    "Emancipated" (married, in the armed services, on your own etc.)

Relationship:  Unless there has been a "stalking" (see below) you and the person you are filing against must be present spouses, former spouses, related by blood or marriage, persons who are presently residing together or have resided together in the past, or persons who have a child together.

"Stalking":  You may be entitled to an order of protection even if you and the person you are filing against are not related as described above, if there has been a stalking as defined in the law.  "Stalking" is when a person purposely and repeatedly harasses or follows with the intent of harassing another person.  "Harasses" means to engage in a "course of conduct" (a pattern of conduct composed of a series of acts over a period of time) directed at a specific person, serving no legitimate purpose, that would cause a reasonable person to suffer substantial emotional distress.

Abuse includes attempts, threats and actual acts of assault, battery, coercion, harassment, sexual assault and unlawful imprisonment.

Coercion means compelling a person by force or threat of force to engage in conduct from which that person has a right to abstain or to abstain from conduct in which the person has a right to engage.

 

HOW TO FILE A PETITION FOR AN ORDER OF PROTECTION

    Petition:  In addition to the attached questionnaire, in order to fill for an order of protection you must fill out a petition, stating in detail what the other party has done, why you believe you are entitled to legal relief, and what relief you desire.  You must specifically describe the dates involved and the acts of the other person.

    Costs:  There is not advanced filing fee required to file for an order of protection.  However, at the time of the hearing court costs may be assessed against either party, regardless of the outcome of the case.

    Service:  The person you are filing against must be located and served with a copy of the Petition.  You must be able to tell the Court where that person can be found by the Sheriff's Department to be served, whether at a residence or at work.  Until the other person can be served a hearing cannot be held in your case.

    Hearing: Your petition for an order of protection will be scheduled for a hearing by the Judge at a future date.  The Respondent must be served and notified of the hearing date before the hearing can proceed.  If you do not appear for the hearing your case will be dismissed, and any Ex Parte order will terminate.

    Ex Parte Orders:  Immediately upon filing of your Petition the Court may issued an Ex Parte order of protection, if there is an immediate and present danger of abuse.  The Ex Parte order is only a temporary order until the time of the hearing.

    Dismissal: You may voluntarily dismiss your petition before the hearing, or you may appear on the hearing date and ask that your petition be dismissed.  The Judge will dismiss your petition if you do not appear for the hearing.

    WHAT YOU CAN AND CAN'T ASK FOR IN AN ORDER OF PROTECTION

    The Petition contains places for you to tell the Court what you are asking for in your case.  Orders of protection are only temporary (for up to one year) but may in some cases be renewed.  You may not use a petition for an order of protection solely to obtain custody of children.  The Court cannot change custody when a previous custody order is in effect, or a dissolution of marriage action is pending.  While the Court can award temporary possession of property, the Court cannot determine the ownership of property in an adult abuse case.  Adult abuse petitions may not be used as a substitute for criminal charges, dissolution of marriage actions, custody actions or other types of cases.

 

The following form must be filled out and returned to the Circuit Clerk's Office before you will be given on Adult Abuse Petition to complete.

IN THE CIRCUIT COURT OF HENRY COUNTY, MISSOURI

Adult Abuse/Stalking Pre-Filing Questionnaire

NAME:                                                                                    CASE NO.                                           

INSTRUCTIONS:  Answer all questions before beginning the petition.

1.    Is there, or has there previously been, another court action between you and the Respondent or which concerns any children which are involved in this proceeding?                     YES                NO

If so, check the type of action:

         Dissolution                         Adult Abuse

         Child Protection                 Juvenile    

         Paternity                             Other:                                                                                                   

Is this other action still pending?                                                               YES                NO   

Where is/was this action?                                                                      

2.    Have you filed for a protective order before?                                    YES                NO

        If so did you follow through with it?                                                  YES                NO

        If not, please explain:                                                                                                                          

                                                                                                                                                                   

3.    Where did the abuse/stalking occur?                                                                                                    

        In what county do you live?                                                                                                               

        In what county does the respondent live?                                                                                           

(NOTE:  Unless (1) the abuse/stalking occurred in Henry County; (2) either you or the Respondent live in Henry County; or (3) the Respondent may be fond in Henry County, you cannot obtain an Order of Protection in this County>)

4.    Do you have a good address for the Respondent?                                YES                NO

5.    Have you filed a police report?                                                             YES                NO

        If not, please explain:                                                                                                                       

                                                                                                                                                               

                                                                                                                                                               

        If the Respondent violates the Order of Protection, will you be willing to prosecute? YES NO

        If not, please explain:                                                                                                                       

                                                                                                                                                               

                                                                                                                                                                                  

6.    Are there children involved?                                                                    YES                NO

        If yes, do you currently have physical custody of them?                           YES               NO

        If no, please indicate where the children are at this time:                                                                     

                                                                                                                                                                

                                                                                                                                                                

7.    Do you understand that for the Court to consider your request for a Full Order of Protection you must come to Court?                                                                                            YES                NO

8.    Do you understand that you may be assessed court costs and that these costs may total $75.00 or more?

                                                                                                                    YES                NO

 

                                                                                                                                                                   

                                                                                                Petitioner's Signature

 

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  HENRY 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

  1. I reside in                   ,                            , in the County of                         .

    2. 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)

     

  1. Respondent and I: (check one or more)
    2.

    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.)
  1. 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.)
  1. 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)

  1. 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:

  1. 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  HENRY 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 HENRY 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):

1.

DOB or SSN:

Sex F M                       Race:

Eye Color:                             Hair Color:

Height:                                 Weight:

2.

DOB or SSN:

Sex F  M                      Race:

Eye Color:                             Hair Color:

Height:                                 Weight:

 

(Identifying Information for use by Law Enforcement)

Respondent’s Home Address:

1.

 

2.

Respondent’s Work Address

1.

 

 

2.

Petition for Order of Child Protection

 

  1. I am the Petitioner and: (check appropriate boxes)

    2. 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.

  2. 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.)

 

 

 

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

    2.  

     

     

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

    3.  

     

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

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

    4.   
    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:

    1. a substantial risk to the child(ren) exists unless the Respondent(s) is excluded.
    2. A remaining adult family or household member is able to care adequately for the child(ren) in the absence of the excluded party.
    3. 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.

  1. 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 HENRY 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)

1.

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

Respondent’s Home Address:

1.

 

2.

2.

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

Respondent’s Work Address:

1.

 

2.

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

 

[Henry County Information]