Commonwealth of Massachusetts 

 BOSTON MUNICIPAL COURT       DISTRICT COURT      JUVENILE COURT        PROBATE & FAMILY COURT   SUPERIOR COURT  

IVISION_______________________________  

 

         DOCKET NO.________________ 

 

 
 

 

 
 

 

 
 

______________________ 

Plaintiff  
 
v. 

 
 

______________________ 

Defendant 

 
 

PETITION FILED PURSUANT TO G. L. c. 209A, § 11 

 
 RELATIVE TO DOMESTICATED ANIMAL(S)

  

 

  

 __________________, a party in the above captioned matter petition this court for an order pursuant to G.L. 
c. 209A, § 11 and state that: 

          in the above-captioned matter there has been requested or issued a temporary or permanent vacate, 
stay away, restraining or no contact order or a judgment under G. L. c. 208, §§ 18, 34B or 34C, G. L. c. 209, § 
32, G. L. c. 209A, §§ 3, 4 or 5, G. L. c. 209C, §§ 15 or 20, or G. L. c. 258E, §§ 3 to 7 inclusive, or a temporary 
restraining order or preliminary or permanent injunction relative to a domestic relations, child custody, domestic 
abuse or abuse prevention proceeding. 

 petition this court issue an order relative to the following domesticated animals: (list the name and description 
of each domesticated animal and who owns, possesses, leases, keeps, or holds the domesticated animal, i.e., 
petitioner, respondent, or minor child): 

PECIFICALLY, I ASK THE COURT TO ORDER: 

that the respondent __________________(name)  refrain from abusing, threatening, taking, interfering 

with, transferring, encumbering, concealing, harming or otherwise disposing of the following animal(s):      
_______________________________________________________________________________________ 

          that I _________________ (name) be given possession, care, and control of the following animal(s): 
________________________________________________________________________________________ 

In support of this request, the petitioner states:  

igned under the penalties of perjury: 

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DATE                                                        
 

 
 

Interim Form – October 2012 

_______________________________________________ 
PETITIONER’S SIGNATURE  

   

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ptional: 

The petitioner must obtain a date for a hearing on this petition, fill in the information below 
and mail a copy to the respondent at least ten days before the hearing date OR request in the 
clerk’s office that the court schedule a hearing and notify both parties by mail. 

HECK ONE:    The petitioner has obtained a date for hearing and is mailing notice to the 

respondent. 

 

      The court has scheduled a hearing and has notified both parties by mail. 

OTICE OF HEARING:  This motion will be heard at the ____________________Court,  

located at ________________________ on __________________ at___________________ 
     

          (month/day/year) 

       (time of hearing) 

        (city/town) 

 

 

he motion is  

  ALLOWED 

 DENIED_______________________________________ 

IGNATURE/NAME OF JUDGE___________________________ 
PRINT/TYPE NAME OF JUDGE_________________________________

Date________________ 

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Interim Form – October 2012