PLAINTIFF’S MOTION TO
MODIFY OR TERMINATE
ABUSE PREVENTION ORDER

DOCKET NO. (FOR COURT USE ONLY)

TRIAL COURT OF MASSACHUSETTS

PLAINTIFF’S NAME

DEFENDANT’S NAME

COURT DIVISION

________________________________________, Plaintiff in the above entitled matter, respectfully moves that this court

modify or

terminate the abuse prevention order issued pursuant to G.L. c. 209A.

In support of this request, the Plaintiff states: ______________________________________________________________

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Plaintiff: Please read and check box below.

I understand that I can request at any time a new abuse prevention order, if the Defendant harms or attempts to
harm me physically; or places me in fear of imminent serious physical harm; or, by using force, threat or duress,
makes me engage in sexual relations.

Signed under the penalties of perjury.

___________________________________________
Signature of Plaintiff

________________
Date

The motion is:

ALLOWED

DENIED

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SIGNATURE OF JUDGE
PRINT/TYPE NAME OF JUDGE

DATE OF ORDER

TIME OF ORDER

A.M.

P.M.

WITNESS - FIRST OR CHIEF JUSTICE

A true copy, attest (Asst.) Clerk-Magistrate/ (Asst.) Register of Probate

FA-13 (1/12)

COURT COPY