Here is the text we could read:
PETITION FOR EMERGENCY
RELIEF IN CONNECTION WITH
CLAIMS OF SEXUAL VIOLENCE OR
INTIMIDATION
فاصنإ
بلطل سامتلا
فنع
ىواعدب قلعتي اميف ئراط
ديدهت وأ يسنج
NAME and ADDRESS
مسلاا
ن
و
ل
ا
ع
ن
و
ا
V. / دض.
NAME and ADDRESS
مسلاا
ن
و
ل
ا
ع
ن
و
ا
LAINTIFF:
يعدملا
:
P
D
DEFENDANT:
ىعدملا
ع
ي
ل
ه
:
ocket No / عئاقولا مقر:
Case Filed / ىوعدلا ميدقت:
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ____________
Mag. Dist. No:
حلصلا ةعطاقم
مقر
DJ Name:
حلصلا يضاق مسا
ddress:
ناونعلا
Telephone:
فتاه
PLAINTIFF REQUESTS CONFIDENTIALITY OF
PERMANENT/TEMPORARY ADDRESS
تقؤملا/مئادلا ناونعلا ةيرس ىلع ظافحلا يعدملا بلطي
PETITION OF THE PLAINTIFF
يعدملا سامتلا
I, ______________________________________; hereby
(Name of Plaintiff - please print)
petition for emergency relief:
بجومب
؛
______________________________________
انأ مدقأ
هذه
ةقيثولا
–
)مسلاا ةعابط ىجرُي
:ةئراط ةناعإ بلطل سامتلا
يعدملا مسا(
On behalf of myself
On behalf of the following minor (child) (children) of whom
I am a (parent) (adult household member) (guardian).
On behalf of the following incapacitated person to whom I
am guardian.
انأ ربتعأ نيذلاو مهؤامسأ يتلآا رص
لزنملا
.مهيلع يصو انأ ربتعأ نيذلا مهؤامسأ يلاتلا نيزجاعلا
.)مهيلع يصو( )
يسفن نع ةباين
قلا/رصاقلا )لافطلأا( )لفطلا( نع ةباين
ُ
يف غلاب وضع( )مهدلاو(
صاخشلأا نع ةباين
________________________________
(Name / نسلا)
________________________________
(Name / نسلا)
The cause for seeking relief is as follows:
_____________________________________
(Address / ناونعلا)
_____________________________________
(Address / ناونعلا)
____________________
(Age / مسلاا)
____________________
(Age / مسلاا)
:ةناعلإا
سامتلا ببس يلي اميف
M
A
MDJS 306A-BL
Petition for Emergency Relief (English/Arabic)-Translated on 6/25/2021
1
FREE INTERPRETER
جم يروف مجرتم
ا
ي
ن
www.pacourts.us/language-rights
PETITION FOR EMERGENCY
RELIEF IN CONNECTION WITH
CLAIMS OF SEXUAL VIOLENCE OR
INTIMIDATION
فاصنإ
بلطل سامتلا
فنع
ىواعدب قلعتي اميف ئراط
ديدهت وأ يسنج
NAME and ADDRESS
مسلاا
ن
و
ل
ا
ع
ن
و
ا
V. / دض.
NAME and ADDRESS
مسلاا
ن
و
ل
ا
ع
ن
و
ا
ocket No / عئاقولا مقر:
Case Filed / ىوعدلا ميدقت:
LAINTIFF:
يعدملا
:
P
D
DEFENDANT:
ىعدملا
ع
ي
ل
ه
:
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ____________
Mag. Dist. No:
حلصلا ةعطاقم
مقر
DJ Name:
حلصلا يضاق مسا
ddress:
ناونعلا
Telephone:
فتاه
PLAINTIFF REQUESTS CONFIDENTIALITY OF
PERMANENT/TEMPORARY ADDRESS
تقؤملا/مئادلا ناونعلا ةيرس ىلع ظافحلا يعدملا بلطي
Emergency relief from abuse is required because there
is immediate and present danger of abuse by the
defendant to me and to the above listed minor (child)
(children) (incapacitated person).
ثودح نم
رضاحو
يروف
)لافطلأا( )لفطلا( هاجتو يهاجت هيلع ىعدملا
رطخ كانه نلأ ا بولطم
ئراطلا فاصنلإا
هلكشي
.هلاعأ نيجردملا )نيزجاعلا صاخشلأا( رص
بلط نإ
ديدهت وأ يسنج فنع
قلا/رصاقلا
(Print additional names/addresses on a separate sheet of paper and attach
hereto.)
I certify that this filing complies with the provisions of the Case
Records Public Access Policy of the Unified Judicial System of
Pennsylvania that require filing confidential information and
documents differently than non-confidential information and
documents.
).ةقيثولا هذهب اهقفرأو ةلصفنم قرو ةحفص ىلع ةيفاضلإا نيوانعلا/ءامسلأا عبطا(
Pennsylvania
يف دحوملا يئاضقلا ماظنلا ةسايس ماكحلأ لثتمي ميدقتلا اذه نأب دهشا
تادنتسملاو تامولعملا ميدقت ضرفت يتلاو اياضقلا تلاجسل ماعلا لوصولاب قلعتي اميف
:ةيرس ريغلا كلت نع فلتخت ةقيرطب ةيرسلا
__________________________________________
(Signature of the Plaintiff / يعدملا عيقوت)
M
A
MDJS 306A-BL
Petition for Emergency Relief (English/Arabic)-Translated on 6/25/2021
2
FREE INTERPRETER
جم يروف مجرتم
ا
ي
ن
www.pacourts.us/language-rights
(Untitled)
This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Pennsylvania state courts.
To learn more about the project, check out our about page.
Downloads: You can download both the original form (last checked 2023-03)
and the machine-processed form with normalized data fields.
About This Form:
- Sourced from www.pacourts.us (2023-03)
- Page(s): 2
- Fields(s): 46
- Average fields per page: 23
- Reading Level: Grade 10
- LIST Grouping(s):
GO-00-00-00-00.
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Go beyond the above insights and learn more about this or any pdf form at
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Identified Data Fields:
We have done our best to automaticly identify and name form fields according to our naming conventions.
When possible, we've used names tied to our question library. See e.g., user1_name.
If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.
Here are the fields we could identify.
county
was County (0.54 conf)md_j_number
was MDJ Number (0.45 conf)md_j_name
was MDJ Name (0.40 conf)md_j_add
was MDJ_Add1 (0.43 conf)md_j_phone
was MDJ Phone (0.39 conf)plaintiff_name
was Plaintiff Name (0.50 conf)plaintiff_address__1
was Plaintiff Address 1 (0.48 conf)plaintiff_address__2
was Plaintiff Address 2 (0.48 conf)defendant_name
was DefendantName (0.41 conf)defendant_address__1
was DefendantAddress_1 (0.42 conf)defendant_address__2
was DefendantAddress_2 (0.42 conf)docket
was Docket_No (0.36 conf)date_filed
was Date_Filed (0.44 conf)check_box__1
was CheckBox1 (0.52 conf)users1_name
was Name (1.00 conf)name
was Name_T (0.41 conf)check_box__2
was CheckBox2 (0.37 conf)check_box__3
was CheckBox3 (0.37 conf)check_box__4
was CheckBox4 (0.37 conf)bottom_name__1
was Bottom Name (0.40 conf)users1_address_line_one
was Address (1.00 conf)age__1
was Age (0.36 conf)bottom_name__2
was Bottom Name2 (0.31 conf)address
was Address2 (0.35 conf)age__2
was Age2 (0.35 conf)cause__1
was Cause (0.45 conf)cause__2
was CauseT (0.35 conf)check_box__5
was CheckBox1_T (0.52 conf)check_box__6
was CheckBox2T (0.41 conf)check_box__7
was CheckBox3T (0.41 conf)check_box__8
was CheckBox4T (0.41 conf)county_b
was CountyB (0.37 conf)md_j_number_b
was MDJ NumberB (0.39 conf)md_j_name_b
was MDJ NameB (0.35 conf)md_j_add_b
was MDJ_Add1B (0.37 conf)md_j_phone_b
was MDJ PhoneB (0.39 conf)plaintiff_name_b
was Plaintiff NameB (0.49 conf)plaintiff_address_b__1
was Plaintiff Address 1B (0.46 conf)plaintiff_address_b__2
was Plaintiff Address 2B (0.46 conf)defendant_name_b
was DefendantNameB (0.34 conf)defendant_address_b__1
was DefendantAddress_1B (0.37 conf)defendant_address_b__2
was DefendantAddress_2B (0.37 conf)docket_b
was Docket_NoB (0.37 conf)date_filed_b
was Date_FiledB (0.46 conf)check_box_b
was CheckBox1B (0.49 conf)check_box_tb
was CheckBox1_TB (0.36 conf)
We've done our best to group similar variables togther to avoid overwhelming the user.
Suggested Screen 0:
Suggested Screen 1:
plaintiff_name
defendant_name
name
Suggested Screen 2:
Suggested Screen 3:
Suggested Screen 4:
Suggested Screen 5:
check_box__1
check_box__2
check_box__3
check_box__4
check_box__5
check_box__6
check_box__7
check_box__8
check_box_b
check_box_tb
Suggested Screen 6:
md_j_number
md_j_name
md_j_add
md_j_phone
county_b
md_j_number_b
md_j_name_b
md_j_add_b
md_j_phone_b
Suggested Screen 7:
plaintiff_address__1
plaintiff_address__2
defendant_address__1
defendant_address__2
users1_name
bottom_name__1
users1_address_line_one
age__1
bottom_name__2
age__2
cause__1
cause__2
plaintiff_name_b
plaintiff_address_b__1
plaintiff_address_b__2
defendant_name_b
defendant_address_b__1
defendant_address_b__2
docket_b
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