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PETITION FOR PROTECTION 
FROM ABUSE 

NO. 

IN THE COURT OF COMMON PLEAS OF 
____________________ COUNTY, PENNSYLVANIA 

First 

Middle 

Last 

Plaintiff’s DOB 

  Plaintiff’s Address: 
    Plaintiff’s address is confidential       or         Plaintiff’s address is:  __________________________________________________ 
   __________________________________________________ 

First 

Middle 

Last 

Suffix 

___________________________________________________ 

CAUTION: 

 Weapon Involved
 Weapon Present on the Property
 Weapon Requested Relinquished

DEFENDANT IDENTIFIERS 
HEIGHT 
WEIGHT 
EYES 

STATE 

បណ�

ឹ ងករពរពីកររ ំេលភបំពន 

ក�

ុងតុលករបណ�
____________________ រដ�េផនសុ

ឹ ងទូេទៃនេខនធី 

ីវ៉េនៀ 

DOB 
SEX 
RACE 
HAIR 
SSN 
DRIVERS 
LICENSE # 
EXP. DATE 

េលខ. 

1. PLAINTIFF

V. 

2. DEFENDANT

Defendant’s Address: 

1.

េដមេចទ

ទល់នឹង 

2. ចុងេចទ

នាម 

នាមកណា� ល 

េគាត�នាម 

ៃថ�ែខឆា�

ំកំេណ ត 

  អសយដ� នេដមេចទ:  
    អសយដ� នេដមេចទជាករសំងត់       ឬ          អសយដ� នេដមេចទគឺ: __________________________________________________
__________________________________________________ 

នាម 

នាមកណា� ល 

េគាត�នាម 

បច�

័យ 

អសយដ� នចុងេចទ: 

ច

ំណុ ចសមា� ល់ចុងេចទ 

_______________________________________________ 

ៃថ�ែខឆា�

ំកំេណ ត 

ព

ូជសសន៍ 

េភទ 

សក់ 

េលខសន�

ិសុខសង�ម 

ប

័ណ�េបកបរេលខ 

ៃថ�ផុតកំណត់ 

កម�ស់ 

ទម�ន់ 

ែភ�ក 

រដ� 

ករ  ្របយ័ត�្របែយង 

 អវុធពក់ព័ន� 
 អវុធែដលមានេល្រទព្យសម្បតិ
 អវុធែដលេស�

ស

 

ំឲ្យលះបង់េដយស�

្រគចិត� 

ENGLISH/KHMER PFA Petition 

Pa. R.C. P. 1905(b) Rev. 11-08 

Page 1 of 7 / ទំព័រ 1 ៃន 7 

   AOPC Rev. 6-2011 

�

ុ
័
កែន�ងករងររបស់ចុងេចទគឺ:_______________________ 
  ចូរគូស្របអប់េនះ ្របសិនេបអ�កមានមូលេហតុេជឿជាក់ថា ចុងេចទជាអ�កលក់កំេភ�
ង

ែដលមានអជា� ប័ណ� ជួលេដយអ�កលក់ ឬអ�កផលិតកំេភ�

ង ែដលមានអជា� ប័ណ� ជួលឲ្យ

េធ�

ជាអ�កនិពន� អ�ក�សវ្រជាវ ឬអ�កបេច�កេទសក�

ុងឧស្សោហកម�ផលិតកំេភ�

ង ឬបរបាញ់ ឬ

ងជាលក�ខណ� ៃនករងរ។  

ត្រម�វឲ្យកន់កំេភ�
 
3.  ខ�
    ខ�

ំដក់ពក្យបណ�

ឹ ងេនះ តងនាមឲ្យ    

ំផា� ល់             ឬ                 ជនេផ្សងេទៀត។ 

្របសិនេបអ�កគូសយក "ខ�

ំផា� ល់" សូមេឆ�

យសំណួ រទំងអស់អំពីអ�កជា “េដមេចទ”។ 

្របសិនេបអ�កគូសែត "ជនេផ្សងេទៀត" មួយគត់ សូមេឆ�

យសំណួ រទំងអស់ទក់ទងនឹងជន

េនាះ ជា “េដមេចទ” េហយ្របាប់េឈ� ះ និងអសយដ� នរបស់អ�កជាអ�កបំេពញ េន

្រតង់េនះ ្របសិនេបព័ត៌មានេនះមិនែមនជាករសំងត់េនាះេទ។  
 

is:________________________________ 
  Check here if you have reason to believe that Defendant is a licensed 
firearms dealer, employed by a licensed firearms dealer or manufacturer; 
employed as a writer, researcher, or technician in the firearms or hunting 
industry, or is required to carry a firearm as a condition of employment. 
 

efendant’s place of employment 

  D

3.  I am filing this petition on behalf of    
 

   Myself          or            Another Person. 

If you checked “myself”, please answer all questions referring to 
yourself as “Plaintiff”.  If you ONLY checked “another 
person”, please answer all questions referring to that person 
as the “Plaintiff”, and provide your name and address here, 
as filer, unless confidential. 

Filer’s Name / េឈ�ះអ�កបំេពញ 

 

 

 

  

 

 

 

Suffix / បច�័យ 

First / នាម 

Middle / េឈ�ះកណា� ល 

Last /េគាត�នាម 

  Filer’s address is confidential     or       

  Filer’s address is: 

____________________________________________________ 

 
If you checked “Another Person”, indicate your relationship with 
Plaintiff: 

  អសយដ� នអ�កបំេពញជាករសំងត់ ឬ       
  អសយដ� នរបស់អ�កបំេពញគឺ: 
______________________________________________________ 
 

្របសិនេបអ�កគូសយក “ជនេផ្សងេទៀត” ចូរ្របាប់ពីទំនាក់ទំនងរបស់អ�កជាមួយនឹងេដមេចទ: 

  parent of minor Plaintiff(s) 

  ឪពុកឬមា� យរបស់េដមេចទែដលជាអនីតិជន 

  applicant for appointment as guardian ad litem of minor 

  អ�កេស�

សុ

ំករែតងតំងជាអណាព្យោបាលផ�ល់ផល្របេយាជន៍្របេសរបំផុតេលេដម

Plaintiff(s) 

  adult household member with minor Plaintiff(s) 
  court appointed guardian of incompetent Plaintiff(s) 
 
 

េចទែដលជាអនីតិជនពីតុលករ 

  សមាជិកេពញវ ័យមា� ក់ក�
  អណាព្យបាលែតងតំងេដយតុលករស្រមាប់េដមេចទែដលអសមត�ភាព 

ុង្រគ�សរជាមួយនឹងេដមេចទែដលជាអនីតិជន 

4.  Name(s) of all persons, including minor child/ren, who seek 
protection from abuse:_________________________________ 

4. ចូរសរេសរេឈ� ះជនទំងអស់ រប់ទំងកុមារជាអនីតិជន ែដលេស�
រ ំេលភបំពន: _____________________________________ 

សុ

ំករករពរពីករ

___________________________________________________ 

_____________________________________________________ 

___________________________________________________ 

_____________________________________________________ 

__________________________________________________ 

5.  Indicate the relationship between Plaintiff and Defendant: 
CHECK ALL THAT APPLY: 
  spouse or former spouse of Defendant 
  parent of a child with Defendant 
  current or former sexual or intimate partner with Defendant  
  child of Plaintiff 
  child of Defendant 
  family member related by blood (consanguinity) to 

Defendant 

_____________________________________________________ 
 
 5. ចូរ្របាប់ពីទំនាក់ទំនងរវងេដមេចទ និងចុងេចទ: 

ីឬ្របពន� ឬអតីតប�

ច
ូរគូស្របអប់ទំងអស់ែដលពក់ព័ន�: 
  ប�
ីឬ្របពន�របស់ចុងេចទ 
  ឪពុកឬមា� យកូនែដលេនជាមួយចុងេចទ 
  ៃដគូេស�ហបច�
  កូនរបស់េដមេចទ 
  កូនរបស់ចុងេចទ 
  សមាជិក្រគ�សរជាញាតិពីកំេណ ត (ក�

ុប្បន� ឬអតីតៃដគូេស�ហជាមួយចុងេចទ 

ុង្រគ�សរែតមួយ) ជាមួយនឹងចុងេចទ 

  family member related by marriage or affinity to Defendant 
  sibling (person who shares parenthood) of Defendant 

  សមាជិក្រគ�សរតមចំណងអពហ៍ពិពហ៍ ឬទំនាក់ទំនងជាមួយនឹងចុងេចទ 
  បងប�
ូន (អ�កែដលមានឪពុកមា� យែតមួយ) ជាមួយនឹងចុងេចទ 

   

 

 

   

  Check here if Defendant is 17 years old or younger. 
 

  ចូលគូស្របអប់េនះ ្របសិនេបចុងេចទមានអយុ 17 ឆា�

ំ ឬេក�ងជាងេនះ។ 

ENGLISH/KHMER PFA Petition 

 

 

 

 

             Page 2 of 7 / ទំព័រ 2 ៃន 7   

 

 

 

 

 

 

 

   AOPC Rev. 4-2019 

Pa. P.C. P. 1905(b) Rev. 3-19     

ុ
ុ
ុ
6. Have Plaintiff and Defendant been involved in any of the
following court actions?

6.

ខងេ្រកម?

េតអ�កេដមបណ�

ឹ ងនិងអ�កចុងេចទចូលរួមក�

ុងសកម�ភាពណាមួយរបស់តុលករដូច

 Divorce 
 Custody 
 Support 
 Protection from Abuse 

 Divorce 
 Custody 
 Support 
 Protection from Abuse 

If you checked any of the above, briefly indicate when and where 
the case was filed and the court number, if known: 
_____________________________________________________
_____________________________________________________ 

េបអ�កបានគូសយកអ�

ីែដលមានខងេលេនះប�� ក់េដយសេង�ប េនេពលនិង កែន�ងែដល 

ំណុ

ំ េរឿង្រត�វបានេគដក់េហយេលខតុលករេបស� ល់៖ 

ស
______________________________________________________
______________________________________________________ 

7. Has Defendant been involved in any criminal court action?
_____________________________________________________

7.

េតជនចុងេចទមានចុងពក់ព័ន�ក�

ុងសកម�ភាពតុលករ្រពហ�ទណ� ណា មួយែដរឬេទ?

______________________________________________________________________ 

  If you answered Yes, is Defendant currently on probation? 
____________________________________________________ 

្របសិនេបអ�កេឆ�

ុងករសកល្បង? 
____________________________________________________________________ 

យថាបាទ / ចសេនាះេតជនចុងេចទបច�

ុប្បន�កំពុងស�

ិតក�

Has Defendant been determined to be a perpetrator in a 
founded or indicated report under the Child Protective Services 
Law, 23 Pa.C.S. §§ 6301 – 6386? 

If you answered Yes, what county’s court or child protective 
services agency issued the founded or indicated report? 
___________________________________________________
___________________________________________________ 

ជនចុងេចទ្រត�វបានកំណត់ថាជាជនេល�

សេនក�

ុងរបាយករណ៍ ែដលបានបេង�

តេឡងឬ 

ែដល ្រត�វបានបង� ញេនេ្រកមច្បោប់េសវករពរកុមារ, 23 Pa.C.S. §§ 6301 – 6386? 

្របសិនេបអ�កេឆ�

យថាបាទ / ចសេទេតទីភា� ក់ងរេសវកម�ករពរកុមារ ឬ�ស�ករបស់េខត�

បានេចញរបាយករណ៍ ែដលបានបេង�

តេឡងឬបង� ញ? 

______________________________________________________________________ 

8. Plaintiff and Defendant are the parents of the following minor
child/ren:

8. េដមេចទ និងចុងេចទជាឪពុកមា� យរបស់កុមារអនីតិជន ដូចខងេ្រកម:

Name(s) / េឈ�ះ 

Age(s) / អយុ 

Who reside at (list address unless confidential) /  

កែដលរស់េន (សូមសរេសរអសយដ�ន េបមិនែមនជាករសំងត់េទេនាះ) 
�
អ

9. If Plaintiff and Defendant are parents of any minor child/ren
together, is there an existing court order regarding their custody?

9. ្របសិនេបេដមេចទ និងចុងេចទជាឪពុកមា� យកុមារអនីតិជន េតមានដីក តុលករ

 YES       NO 

ទក់ទងនឹងសិទិ

ំ្រគងែដរឬេទ?

�ឃុ
 មាន       គា� ន  

If you answered “Yes,” describe the terms of the order (e.g., 
primary, shared, legal or physical custody): 
____________________________________________________ 
____________________________________________________ 

         ្របសិនេបអ�កេឆ�

យថា "បាទ / ចស" បានពិពណ៌ នាលក�ខណ� ៃនករប�� ទិញ 

         (ឧ. ចំបង, ែចករ ំែលក, ច្បោប់ឬសិទ�
ឹម)៖ __________________________ 
ិេមលចិ��
       _________________________________________________ 

If you answered “yes”, in what county and state was the order 
issued? 
__________________________________________________ 

If you are now seeking an order of child custody as part of this 
petition, list the following information: 

្របសិនេបអ�កេឆ�

យថា "បាទ / ចស" េតេនេខនធីនិងរដ�ណាែដល្រត�វបានេចញ 

ប�� ?_________________________________________________ 

        ្របសិនេបអ�កកំពុងែស�ងរកបទប�� ទរកែដលជាែផ�កមួយៃនញត�

ិេនះចូររយ 

        ព័ត៌មានដូចតេទ៖ 

(a) Where has each child resided during the past five years?

(a) េតកុមារមា� ក់ៗរស់េនកែន�ងណា ក�

ុងអំឡុង្របាំឆា�

ំកន�ងមកេនះ?

Child’s Name / 
េឈ�ះកុមារ 

Person(s) child lived with / 
ជនែដលកុមាររស់េនជាមួយ 

Address, unless confidential /  
អសយដ�ន េបមិនែមនជាករសំងត់េទេនាះ 

When? /េពលណា? 

ENGLISH/KHMER PFA Petition 

Pa. P.C. P. 1905(b) Rev. 3-19     

   Page 3 of 7 / ទំព័រ 3 ៃន 7 

   AOPC Rev. 4-2019 

(b) List any other persons who are known to have or claim a right
to custody of each child listed above.

(b) ចូររយនាមជនដៃទេទៀត ែដលអ�កដឹងថាមាន ឬទមទរសិទិ

ឃ

ំ្រគង

ក

ុមារមា� ក់ៗខងេល។ 

Name / េឈ�ះ 

Address / អសយដ�ន 

Basis of claim / មូលដ�នៃនករទមទរ 

10. The following other minor child/ren presently live with
Plaintiff:

10. កុមារអនីតិជនខងេ្រកមបច�

ុប្បន�កំពុងរស់េនជាមួយេដមេចទៈ

Name(s) / េឈ�ះ 

Age(s) / អយុ 

Plaintiff’s Relationship to Child/ren / 
នាក់ទំនងរបស់េដមេចទជាមួយនឹងកុមារ 
ទ
ំ

11. The facts of the most recent incident of abuse are as follows:
Approximate date: _________________________________
Approximate time: _________________________________
Place: ___________________________________________

11. អង�េហតុៃនកររ ំេលភបំពនថ�

ីបំផុតគឺដូចខងេ្រកម:

ំ:   ___________________________
ៃថ�ែខឆា�
េពលេវល: ___________________________
ីកែន�ង:__________________________________________
ទ

Describe in detail what happened, including any physical or
sexual abuse, threats, injury, incidents of stalking, medical
treatment sought, or calls to law enforcement (attach additional
sheets of paper if necessary):
________________________________________________

________________________________________________

________________________________________________

________________________________________________

________________________________________________
________________________________________________

ច

ូរេរៀបរប់េដយលំអិត េតអ�

ីបានេកតេឡង រប់ប��

ូ លទំងកររ ំេលភបំពន

រូបកយ ឬផ�

ូវេភទ ករគំរម របួស ករេដរឈ�បតម ករព្យោបាល និង/ឬ

ករទូរស័ព�េទស� ប័នអនុវត�ច្បោប់ (ភា� ប់សន�

ឹក្រកដសបែន�ម្របសិនេបចំបាច់)៖

________________________________________________

________________________________________________

________________________________________________

________________________________________________

________________________________________________
________________________________________

12. If Defendant has committed prior acts of abuse against
Plaintiff or the minor child/ren, describe these prior
incidents, including any threats, injuries, or incidents of
stalking, and indicate approximately when such acts of abuse
occurred (attach additional sheets of paper if
necessary):________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________

12.

េបចុងេចទបាន្រប្រពឹត�អំេពរ ំេលភបំពនពីមុន្របឆាំងេដមេចទ ឬកុមារអនីតិជន

ច

ូរេរៀបរប់ពីេហតុករណ៍ ទំងេនះ រប់ប��

ូ លទំងករគំរម របួស ឬករេដរឈ�ប

តម និង្របាប់ពីេពលេវលែដលអំេពរ ំេលភបំពនបានេកតេឡង(ភា� ប់សន�

ឹក

្រកដសបែន�ម្របសិនេបចំបាច់)៖

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

13. (a)  Has Defendant used or threatened to use any firearms or

13. (a)  េតចុងេចទបានេ្រប 

ឬគំរមេ្របកំេភ�

ង 

ឬអវុធេផ្សងេទៀត្របឆាំងនឹង

other weapons against Plaintiff or the minor child/ren? If 
so, please describe the use or threatened use below and list 
on Attachment A to Petition, which is incorporated by 
reference into this petition, any firearms, other weapons, or 
ammunition Defendant used or threatened to use against 

េដមេចទ  ឬកុមារជាអនីតិជនែដរឬេទ? 

េបបានេ្រប  ឬគំរមែមនេនាះ 

ស

ូមេរៀបរប់ពីករេ្រប  ឬករគំរមេ្រប  ដូចខងេ្រកម  និងសរេសរពីកំេភ�

ង 

អវុធេផ្សងេទៀត  ឬ្រគាប់  ែដលចុងេចទបានេ្រប  ឬគំរបេ្រប្របឆាំងេដមេចទ 

ENGLISH/KHMER PFA Petition 

Pa. P.C. P. 1905(b) Rev. 3-19     

   Page 4 of 7 / ទំព័រ 4 ៃន 7 

   AOPC Rev. 4-2019 

�
ុ
Plaintiff or the minor child/ren: 

      _____________________________________________ 

      _____________________________________________ 

      _____________________________________________ 

      _____________________________________________ 

      _____________________________________________ 

ឬកុមារជាអនីតិជន  ក�
ឹ ងេនះ:   

ុងពក្យបណ�

ក�

ុងឧបសម�

័ន�  ក  ៃនពក្យបណ�

ឹ ង  ែដលេយាងដក់ប��

ូ ល

      _____________________________________________ 

      _____________________________________________ 

      _____________________________________________ 

      _____________________________________________ 

      _____________________________________________ 

(b) Other than the firearms, other weapons, or ammunition
Defendant used or threatened to use against Plaintiff or
the minor child/ren, does Defendant, to the best of your
knowledge or belief, own or possess any additional
firearm, other weapon, ammunition, or any firearm
license?
□ Yes          □ No

(c)

If the answer to (b) above is “yes,” list any additional
firearm, other weapon, or ammunition owned by or in
the possession of Defendant on Attachment A to
Petition, which is incorporated by reference into this
petition.

(d) Plaintiff (check one)  

 DOES / 

 DOES NOT request

that the court order Defendant to relinquish firearms,
other weapons, or ammunition listed on Attachment A to
Petition. If Plaintiff does seek relinquishment, identify
on Attachment A to Petition the firearms, other weapons,
or ammunition Plaintiff requests the court to order
Defendant to relinquish.

(b) េ្រកពីកំេភ�

ង អវុធេផ្សងេទៀត ឬ្រគាប់ ែដលចុងេចទបានេ្រប ឬគំរមេ្រប 

្របឆាំងនឹងអ�កេដមេចទ ឬកុមារជាអនីតិជន េតតមករដឹង ឬ

ជ

ំេនឿ្របេសរបំផុតរបស់អ�ក េតចុងេចទមាន ឬកន់កប់កំេភ�

ង អវុធេផ្សង

េទៀត ្រគាប់ ឬអជា� ប័ណ�កំេភ�

ងបែន�មេទៀតឬអត់?

□ មាន

□  គា� ន

(c) េបចេម�

យចំេពះសំណួ រ (b) ខងេលគឺ “មាន” ចូររយប��

ីកំេភ�

ង អវុធេផ្សង

េទៀត ឬ្រគាប់ ែដលចុងេចទមាន ឬកន់កប់ ក�

ុងឧបសម�

័ន� ក ៃនពក្យបណ�

ឹ ង

ែដលនឹងេយាងដក់ប��

ូ លក�

ុងពក្យបណ�

ឹ ង។

(d) េដមេចទ (ពិនិត្យមួយ)  បាន /  មិនបាន េស�

សុ

ំតុលករបង� ប់ចុង

េចទឲ្យលះបង់កំេភ�

ង អវុធេផ្សងេទៀត ឬ្រគាប់ែដលរយប��

ីក�

័ន� ក

ៃនពក្យបណ�

ឹ ងេទ។ េបេដមេចទពិតជាេស�

សុ

ំករលះបង់ ចូរកំណត់ក�

ឧបសម�

័ន� ក ៃនពក្យបណ�

ឹ ង ពីកំេភ�

ង អវុធេផ្សងេទៀត និង្រគាប់ ែដលេដម

េចទេស�

សុ

ំតុលករបង� ប់ឲ្យចុងេចទលះបង់។

ុងឧបសម�
ុង

14. Identify the sheriff, police department, or law enforcement
agency in the area in which Plaintiff lives that should be provided
with a copy of the protection order:
__________________________________________________

15. There is an immediate and present danger of further abuse
from Defendant.

CHECK THE FOLLOWING BOXES ONLY IF THEY APPLY 
TO YOUR CASE AND PROVIDE THE REQUESTED 
INFORMATION: 
  Plaintiff is asking the Court to evict and exclude Defendant 
from the following residence:  
 owned by (list owners, if known): ______________________ 
 rented by (list all names, if known): ____________________ 
 Defendant owes a duty of support to Plaintiff or the minor 

 child/ren: 

  Plaintiff has suffered out-of-pocket financial losses as a result 
      of the abuse described above. 
Those losses are:_______________________________________ 
_________________________________________________ 

_________________________________________________ 

14. កំណត់អត�ស�� ណម�ន�
ុង
ំបន់ែដលជនចុងេចទរស់េនែដលគួរែត្រត�វបានផ�ល់ជូននូវច្បោប់ចម�ងៃនដីកករពរ
ត

ូលីសឬភា� ក់ងរអនុវត�ច្បោប់េនក�

ីត្រម�តនាយកដ� នប៉

ម
ួយ៖
__________________________________________________ 

 

15. មានេ្រគាះថា� ក់បច�

ុប្បន� និងភា� មៗែដលជាកររ ំេលភបំពនបែន�មពីចុងេចទ។

ច

ូរគូស្របអប់ខងេ្រកម ែតក�

ុងករណី ពក់ព័ន�នឹងេរឿងក�

ីរបស់អ�ក េហយផ�ល់ព័ត៌មាន តម

ករេស�

ំ: 
សុ

 ភាគីេដមេចទកំពុងេស�

        លំេនដ� នដូចខងេ្រកម:

សុ

ំឱ្យតុលករបេណ� ញនិងដកេចញជនជាប់េចទេចញពី 

ិ (មា� ស់ប��

 មា� ស់កម�សិទ�
ី, េបដឹង)៖  ______________________
 
  ជួលេដយ (សរសរេឈ� ះទំងអស់ េបដឹង)៖_____________________
 អ�កចុងេចទជំពក់កតព�កិច�គាំ្រទដល់េដមេចទឬអនីតិជនកូន /េក�ង ។ 
 អ�កេដមេចទបានទទួលរងករខតបង់ែផ�កហិរ��វត�

ុេចញពីេហេប៉ៃនកររ ំេលភ

        ែដលបានពិពណ៌ នាខងេល។ 

 ករខតបង់ទំងេនះគឺមានដូចតេទ៖______________________________ 
_________________________________________________
_________________________________________________ 

FOR THE REASONS SET FORTH ABOVE, I REQUEST THAT THE 
COURT ENTER A TEMPORARY ORDER, AND AFTER A 
HEARING, A FINAL ORDER THAT WOULD DO THE 
FOLLOWING (CHECK ALL FORMS OF RELIEF REQUESTED): 

េដយសរមូលេហតុែដលេរៀបរប់ខងេល ខ�

ំេស�

សុ

ំតុលករេចញដីកបេណា� ះអសន� និង

បនា� ប់ពីសវនាករ េចញដីកចុងេ្រកយ ែដលនឹងសេ្រមចេលចំណុ ច ដូចខងេ្រកម (ចូរ

គ

ូស្របអប់ៃនដំេណាះ�សយទំងអស់ែដលបានេស�

សុ

ំ): 

ENGLISH/KHMER PFA Petition 

Pa. P.C. P. 1905(b) Rev. 3-19     

   Page 5 of 7 / ទំព័រ 5 ៃន 7 

   AOPC Rev. 4-2019 

ុ
ករលួចេដរតមឬករគំរមកំែហងឬករគំរមកំែហងេដម្បីេ្របកមា�

ំងរង 

កយ្របឆាំងនឹងអ�កេដមេចទឬកុមារជាអនីតិជន េនកែន�ងែដលអចជួបេដមេចទ និង/ឬ

ុមារជាអនីតិជន។ 

ក
 
  B. បេណ� ញ/ហមឃាត់ចុងេចទពីលំេនដ� នរបស់េដមេចទ និងហមឃាត់ចុង

េចទកុ

ំឲ្យព្យោយាមចូលេទក�

ុងលំេនដ� នអចិៃ�ន�យ៍ ឬបេណា� ះអសន�របស់េដមេចទ។  

 
  C.  ត្រម�វឲ្យចុងេចទផ�ល់លំេនដ� នសមរម្យេផ្សងេទៀតដល់េដមេចទ ឬកុមារជា
អនីតិជន។  
 
  D.  សេ្រមចឲ្យេដមេចទមានសិទិ

ំ្រគងរូបវន� និងតមច្បោប់ជាបេណា� ះអសន�េល

�ឃុ

ក

ុមារជាអនីតិជន និងដក់កំហិតដូចខងេ្រកមេលករទក់ទងរវងចុងេចទ និងកុមារ។  

  A.  ហមឃាត់ចុងេចទកុ

ំឲ្យរ ំេលភបំពន ករយាយី, 

 

  A.  Restrain Defendant from abusing, harassing, stalking, 
threatening, or attempting or threatening to use physical force 
against Plaintiff or the minor child/ren in any place where 
Plaintiff or the children may be found. 

 
  B.  Evict/exclude Defendant from Plaintiff’s residence and 
prohibit Defendant from attempting to enter any temporary or 
permanent residence of Plaintiff. 
 
  C.  Require Defendant to provide Plaintiff or the minor 
child/ren with other suitable housing. 

 

 
  D.  Award Plaintiff temporary custody of the minor child/ren 
and place the following restrictions on contact between Defendant 
and the child/ren: 

____________________________________________________ 

_____________________________________________________ 

____________________________________________________
____________________________________________________
____________________________________________________ 
 
  E. Prohibit Defendant from having any contact with Plaintiff 
or the minor child/ren, in person, by telephone, or in writing, 
personally or through third persons, including but not limited to 
any contact at Plaintiff’s school, business, or place of 
employment, except as the court may find necessary with respect 
to partial custody with the minor child/ren. 
 
   F.  Prohibit Defendant from having any contact with 
Plaintiff’s relatives and Plaintiff’s child/ren listed in this Petition, 
except as the court may find necessary with respect to partial 
custody with the minor child/ren.  The following persons are 
Plaintiff’s relatives or family and household members that 
Plaintiff believes require protection from stalking and harassment 
by Defendant. 

_____________________________________________________
_____________________________________________________
_____________________________________________________ 
 
  E.  ហមឃាត់ចុងេចទមិនឲ្យទក់ទងេដមេចទ ឬកុមារជាអនីតិជនេដយផា� ល់ក�
ី 

តមទូរស័ព�ក�

ី ឬជាលយលក�ណ៍ អក្សរក�

ូ លេដយ
� នក្រមិតនូវករទក់ទងេនសលេរៀនរបស់េដមេចទ អជីវកម� ឬកែន�ងករងរ េលក

ួន ឬតមរយៈភាគីទីបី រប់ប��

ី ផា� ល់ខ�

គា

ែលងែតតុលករអចយល់េឃញជាករចំបាច់ទក់ទងនឹងសិទិ
ុមារជាអនីតិជន។  
ក

�ឃុ

ំ្រគងមិនេពញេលញ 

  F.  ហមឃាត់ចុងេចទមិនឲ្យទក់ទងសច់ញាតិេដមេចទ និងកូនរបស់េដមេចទ 

ដ

ូចរយនាមក�

ុងពក្យបណ�

ឹ ងេនះ េលកែលងែតតុលករអចយល់េឃញជាករចំបាច់

ទក់ទងនឹងសិទិ

�ឃុ

ំ្រគងមិនេពញេលញ កុមារជាអនីតិជន។ ជនខងេ្រកមជាសច់ញាតិ

របស់េដមេចទ ឬ្រគ�សរ និងសមាជិក្រគ�សរែដលេដមេចទេជឿជាក់ថា្រត�វករករករពរ
ីករេដរឈ�បតម និងករយាយីេដយចុងេចទ។ 
ព

Name /េឈ� ះ 

Address / អសយដ� ន 

Relationship to Plaintiff / 
ំនាក់ទំនងជាមួយនឹងេដមេចទ 
ទ

 
 
 
 

 
 
 
 
 
  G. Order Defendant to temporarily reliquish the firearms, 
other weapons, or ammunition listed on Attachment A to Petition, 
under Defendant’s control, or in Defendant’s possession, or any 
firearm license to the sheriff or the appropriate law enforcement 
agency. 

 
  H. Prohibit Defendant from acquiring or possessing firearms 
for the duration of the order.  
 
 
  I. Order Defendant to pay temporary support for Plaintiff or 
the minor child/ren, including medical support and payment of 
the rent or mortgage on the residence. 

 
  J.  Direct Defendant to pay Plaintiff for the reasonable 
financial losses suffered as the result of the abuse, to be 
determined at the hearing. 

 
 
 
 

 G. ជនជាប់េចទប�� ទិញេដម្បីផ�ល់អវុធជាបេណា� ះអសន�ដល់អវុធឬអវុធេផ្សង
ុង

ិេ្រកមករ្រគប់្រគងរបស់ជនចុងេចទឬក�

េទៀត ែដលមានចុះក�

ុងឯកសរភា� ប់ A េទ ញត�
ករកន់កប់របស់ជនជាប់េចទឬអជា� ប័ណ�អវុធណាមួយចំេពះម�ន�
អនុវត�ច្បោប់សមរម្យ។ 
 
 
 H. ហមឃាត់ជនជាប់េចទពីករទទួលឬមានអវុធក�
 

ីត្រម�តឬទីភា� ក់ងរ

ុងរយៈេពលៃនលំដប់។

 

 
 I. ជនេល�

សប�� ទិញេដម្បីបង់ៃថ�្រទ្រទង់បេណា� ះអសន�ចំេពះអ�កេដមេចទឬកូន 

េក�ង អនីតិជនរួម ទំងជំនួយែផ�កេវជ�ស�ស� និងករបង់ៃថ�ជួលឬ្របាក់កម�

ីេនេល 

ំេនដ� ន។

ល
 
 
  J. ប�� ឲ្យចុងេចទបង់ករខតបង់ហិរ��វត�

 

េដយសរកររ ំេលភបំពន ែដលនឹង្រត�វកំណត់ក�

ុសម�សបដល់េដមេចទ ែដលទទួលរង
ុងេពលសវនាករ។  

ENGLISH/KHMER PFA Petition 

 

 

 

 

             Page 6 of 7 / ទំព័រ 6 ៃន 7   

 

 

 

 

 

 

 

   AOPC Rev. 4-2019 

Pa. P.C. P. 1905(b) Rev. 3-19     

  K.  Order Defendant to pay the costs of this action, including 
filing and service fees. 

បណ�

ឹ ង និងៃថ�េសវ។  

  K.  បង� ប់ឲ្យចុងេចទបង់ៃថ�ចំណាយបណ�

ឹ ងេនះ រប់ទំង្របាក់កៃ្រមដក់ពក្យ

  L.  Order Defendant to pay Plaintiff’s reasonable attorney’s 
fees. 

  L.  បង� ប់ឲ្យចុងេចទបង់ឲ្យេដមេចទៃថ�េសវេមធាវ ីែដលសម�សប។ 

  M.  Order the following additional relief, not listed above: 

  M. បង� ប់ឲ្យមានដំេណាះ�សយបែន�មខងេ្រកម ពុ

ំមានេនខងេល: 

___________________________________________________ 

___________________________________________________ 

___________________________________________________ 

___________________________________________________ 

___________________________________________________ 

___________________________________________________ 

  N.  Grant such other relief as Plaintiff requests or the court 
deems appropriate. 

  N. សេ្រមចដំេណាះ�សយដៃទេទៀត ែដលេដមេចទេស�
�សប។  

សុ

ំ ឬ តុលករយល់ថាសម

  O.  Order the police, sheriff, or other law enforcement agency 
to serve Defendant with a copy of this petition, any order issued, 
and the order for hearing.  Plaintiff will inform the designated 
authority of any addresses, other than Defendant’s residence, 
where Defendant can be served. 

  O.  បង� ប់ឲ្យប៉

ូលីស អជា� សល ឬភា� ក់ងរអនុវត�ច្បោប់ដៃទេទៀត ឲ្យប��

ូ នច្បោប់

ចម�ងៃនពក្យបណ�

ឹ ងេនះ ដីកែដលបានេចញ និងដីកសវនាករ េទឲ្យចុងេចទ។ េដម

េចទនឹងជូនដំណឹ ងអជា� ធរែដលបានកំណត់ ពីអសយដ� ន េ្រកពីលំេនដ� នរបស់ចុង

េចទ ែដលអចប��

ូ នពក្យបណ�

ឹ ង ដីក និងដីកសវនាករេទចុងេចទបាន។  

  P. Direct the Pennsylvania State Police, the municipal police, 
or the sheriff to accompany Plaintiff to his or her residence to 
retrieve personal belongings or accompany Plaintiff while the 
petition or order is served on Defendant, if Plaintiff has reason to 
believe his or her safety is at risk. 

  P. ប��

ូ នប៉

ូលីសរដ� Pennsylvania ប៉

ូលីស្រក�ង 

ឬម�ន�

ីត្រម�តឱ្យេទជាមួយភាគីេដមេចទ េដម្បីេទយក្រទព្យសម្បត�

ិផា� ល់ខ�

ឬេទជាមួយភាគីេដមេចទ េនេពលែដលញត�

ិឬប�� ្រត�វបានបេ្រមករេនេលចុងេចទ 

្របសិនេបភាគីេដមេចទ្រត�វេជឿជាក់ថាសុវត�

ិភាពរបស់ខ�

ួនគឺេន ហនិភ័យ។

ួន 

 

VERIFICATION 

ករប�� ក់ 

 
I  verify  that  I  am  the  petitioner  as  designated  in  the 
present  action  and  that  the  facts  and  statements  contained  in 
the  above  Petition  are  true  and  correct  to  the  best  of  my 
knowledge. 

 
I understand that any false statements are made subject to the 
penalties of 18 Pa.C.S. §4904, relating to unsworn falsification to 
authorities. 

 

ខ�

ំប�� ក់ថា ខ�

ំជាេដមបណ�

ឹ ង ក�

ុងបណ�

ឹ ងបច�

ុប្បន� និងអង�េហតុ និងេសចក�

ីែថ�ង ែដល

មានក�

ុងពក្យបណ�

ឹ ងខងេល គឺជាករពិត និង្រតឹម្រត�វ តមករដឹង ្របេសរបំផុតរបស់ខ�

ំ។  

        ខ�

ំយល់ដឹងថា េសចក�

ីែថ�ងមិនពិតអចនឹងទទួលរងទណ� កម�េ្រកម 

 18 Pa.C.S. §4904 ទក់ទិននឹងករផ�ល់ព័ត៌មានមិនពិត្របាប់អជា� ធរ។  

_____________  ___________________________ 

___________
Date /ៃថ�ែខឆា�ំ 

__________________________________________ 
      Signature / ហត�េលខ 

ENGLISH/KHMER PFA Petition 

Pa. P.C. P. 1905(b) Rev. 3-19     

   Page 7 of 7 / ទំព័រ 7 ៃន 7 

   AOPC Rev. 4-2019 

ុ
ុ
ុ
ុ

Khmer Petition for Protection From Abuse

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About This Form:

Sourced from www.pacourts.us (2023-03)
Page(s): 7
Fields(s): 326
Average fields per page: 46
Reading Level: Grade 8
LIST Grouping(s): GO-00-00-00-00.

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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.

n_th_e_cour_f_commo_plea was IN THE COURT OF COMMON PLEAS OF (0.65 conf)
address_confidential was Plaintiffs address is confidential (0.44 conf)
plaintiffs_address was Plaintiffs address is (0.42 conf)
last__1 was Last 1 (0.34 conf)
last__2 was Last 2 (0.34 conf)
defendants_address was Defendants Address (0.32 conf)
users1_birthdate was DOB (1.00 conf)
height was HEIGHT (0.36 conf)
sex was SEX (0.38 conf)
weight was WEIGHT (0.36 conf)
race was RACE (0.41 conf)
eyes was EYES (0.34 conf)
weapon_involved was Weapon Involved (0.37 conf)
weapon_present_property was Weapon Present on the Property (0.35 conf)
weapon_requested_relinquished was Weapon Requested Relinquished (0.34 conf)
hair was HAIR (0.34 conf)
ssn was SSN (0.34 conf)
driver_license was DRIVERS LICENSE (0.46 conf)
ex_p_date was EXP DATE (0.32 conf)
users1_address_state was STATE (1.00 conf)
fill__1 was fill_6 (0.36 conf)
toggle__1 was toggle_6 (0.38 conf)
toggle__2 was toggle_7 (0.38 conf)
unknown__1 was 1 (0.38 conf)
unknown__2 was 2 (0.38 conf)
undefined__1 was undefined (0.38 conf)
fill__2 was fill_21 (0.36 conf)
fill__3 was fill_22 (0.36 conf)
fill__4 was fill_23 (0.36 conf)
fill__5 was fill_24 (0.36 conf)
fill__6 was fill_25 (0.36 conf)
fill__7 was fill_26 (0.36 conf)
toggle__3 was toggle_8 (0.38 conf)
toggle__4 was toggle_9 (0.38 conf)
toggle__5 was toggle_10 (0.38 conf)
fill__8 was fill_27 (0.36 conf)
fill__9 was fill_28 (0.36 conf)
fill__10 was fill_29 (0.36 conf)
fill__11 was fill_30 (0.36 conf)
fill__12 was fill_31 (0.36 conf)
text__1 was Text1 (0.35 conf)
text__2 was Text2 (0.35 conf)
text__3 was Text3 (0.35 conf)
text__4 was Text4 (0.35 conf)
text__5 was Text5 (0.35 conf)
text__6 was Text6 (0.35 conf)
text__7 was Text7 (0.35 conf)
text__8 was Text8 (0.35 conf)
text__9 was Text9 (0.35 conf)
text__10 was Text10 (0.35 conf)
text__11 was Text11 (0.35 conf)
text__12 was Text12 (0.35 conf)
text__13 was Text13 (0.35 conf)
text__14 was Text14 (0.35 conf)
text__15 was Text15 (0.35 conf)
text__16 was Text16 (0.35 conf)
text__17 was Text17 (0.35 conf)
text__18 was Text18 (0.35 conf)
defendants_place_employment was Defendants place of employment (0.33 conf)
undefined__2 was undefined_2 (0.39 conf)
toggle__6 was toggle_2 (0.38 conf)
check_reason_believe was Check here if you have reason to believe that Defendant is a licensed (0.47 conf)
toggle__7 was toggle_3 (0.38 conf)
toggle__8 was toggle_4 (0.38 conf)
filers_address_confidential was Filers address is confidential (0.42 conf)
filers_address was Filers address is (0.45 conf)
toggle__9 was toggle_7_2 (0.33 conf)
toggle__10 was toggle_8_2 (0.33 conf)
undefined__3 was undefined_3 (0.39 conf)
undefined__4 was undefined_4 (0.39 conf)
parent_minor_plaintiffs was parent of minor Plaintiffs (0.52 conf)
appointment_ad_minor was applicant for appointment as guardian ad litem of minor (0.39 conf)
household_member_minor was adult household member with minor Plaintiffs (0.51 conf)
court_incompetent_plaintiffs was court appointed guardian of incompetent Plaintiffs (0.46 conf)
toggle__11 was toggle_13 (0.38 conf)
toggle__12 was toggle_14 (0.38 conf)
toggle__13 was toggle_15 (0.38 conf)
toggle__14 was toggle_16 (0.38 conf)
persons_minor_children was 4 Names of all persons including minor children who seek (0.39 conf)
fill__13 was fill_5 (0.36 conf)
protection_abuse__1 was protection from abuse 1 (0.30 conf)
protection_abuse__2 was protection from abuse 2 (0.30 conf)
protection_abuse__3 was protection from abuse 3 (0.30 conf)
fill__14 was fill_8 (0.36 conf)
fill__15 was fill_10 (0.36 conf)
fill__16 was fill_11 (0.36 conf)
spouse_former_defendant was spouse or former spouse of Defendant (0.47 conf)
parent_child_defendant was parent of a child with Defendant (0.38 conf)
current_sexual_partner was current or former sexual or intimate partner with Defendant (0.53 conf)
child_plaintiff was child of Plaintiff (0.46 conf)
child_defendant was child of Defendant (0.50 conf)
family_related_blood was family member related by blood consanguinity to (0.28 conf)
member_related_defendant was family member related by marriage or affinity to Defendant (0.45 conf)
sibling_person_defendant was sibling person who shares parenthood of Defendant (0.38 conf)
check_years_old_younger was Check here if Defendant is 17 years old or younger (0.37 conf)
toggle__15 was toggle_25 (0.38 conf)
toggle__16 was toggle_26 (0.38 conf)
toggle__17 was toggle_27 (0.38 conf)
toggle__18 was toggle_28 (0.38 conf)
toggle__19 was toggle_29 (0.38 conf)
toggle__20 was toggle_30 (0.38 conf)
toggle__21 was toggle_31 (0.38 conf)
toggle__22 was toggle_32 (0.38 conf)
toggle__23 was toggle_34 (0.38 conf)
text__19 was Text19 (0.35 conf)
text__20 was Text20 (0.35 conf)
text__21 was Text21 (0.35 conf)
text__22 was Text22 (0.35 conf)
text__23 was Text23 (0.35 conf)
text__24 was Text24 (0.35 conf)
divorce__1 was Divorce (0.41 conf)
custody__1 was Custody (0.47 conf)
support__1 was Support (0.43 conf)
protection_abuse__4 was Protection from Abuse (0.29 conf)
divorce__2 was Divorce_2 (0.43 conf)
custody__2 was Custody_2 (0.46 conf)
support__2 was Support_2 (0.42 conf)
protection_abuse__5 was Protection from Abuse_2 (0.30 conf)
case_filed_court_number_known__1 was the case was filed and the court number if known 1 (0.39 conf)
case_filed_court_number_known__2 was the case was filed and the court number if known 2 (0.39 conf)
fill__17 was fill_2 (0.36 conf)
fill__18 was fill_4 (0.36 conf)
defendant_criminal_court was 7 Has Defendant been involved in any criminal court action (0.42 conf)
fill__19 was fill_6_2 (0.40 conf)
yes_defendant_probation was If you answered Yes is Defendant currently on probation (0.43 conf)
fill__20 was fill_8_2 (0.40 conf)
services_agency_report__1 was services agency issued the founded or indicated report 1 (0.30 conf)
services_agency_report__2 was services agency issued the founded or indicated report 2 (0.30 conf)
undefined__5 was undefined_5 (0.39 conf)
fill__21 was fill_17 (0.36 conf)
fill__22 was fill_18 (0.36 conf)
fill__23 was fill_19 (0.36 conf)
fill__24 was fill_20 (0.36 conf)
fill__25 was fill_21_2 (0.40 conf)
fill__26 was fill_22_2 (0.40 conf)
fill__27 was fill_23_2 (0.40 conf)
fill__28 was fill_24_2 (0.40 conf)
fill__29 was fill_25_2 (0.40 conf)
fill__30 was fill_26_2 (0.40 conf)
fill__31 was fill_27_2 (0.40 conf)
fill__32 was fill_28_2 (0.40 conf)
fill__33 was fill_29_2 (0.40 conf)
fill__34 was fill_30_2 (0.40 conf)
fill__35 was fill_31_2 (0.40 conf)
yes was YES (0.45 conf)
no was NO (0.45 conf)
toggle__24 was toggle_11 (0.38 conf)
toggle__25 was toggle_12 (0.38 conf)
primary_shared_legal__1 was primary shared legal or physical custody 1 (0.49 conf)
primary_shared_legal__2 was primary shared legal or physical custody 2 (0.49 conf)
fill__36 was fill_12 (0.36 conf)
fill__37 was fill_14 (0.36 conf)
fill__38 was fill_16 (0.36 conf)
fill__39 was fill_32 (0.36 conf)
fill__40 was fill_33 (0.36 conf)
fill__41 was fill_34 (0.36 conf)
fill__42 was fill_35 (0.36 conf)
fill__43 was fill_36 (0.36 conf)
fill__44 was fill_37 (0.37 conf)
fill__45 was fill_38 (0.37 conf)
fill__46 was fill_39 (0.37 conf)
text__25 was Text25 (0.35 conf)
fill__47 was fill_29_3 (0.40 conf)
fill__48 was fill_30_3 (0.40 conf)
fill__49 was fill_31_3 (0.40 conf)
fill__50 was fill_32_2 (0.40 conf)
fill__51 was fill_33_2 (0.40 conf)
fill__52 was fill_34_2 (0.40 conf)
fill__53 was fill_35_2 (0.40 conf)
fill__54 was fill_36_2 (0.40 conf)
fill__55 was fill_37_2 (0.32 conf)
fill__56 was fill_38_2 (0.32 conf)
fill__57 was fill_39_2 (0.32 conf)
fill__58 was fill_40 (0.36 conf)
fill__59 was fill_41 (0.37 conf)
fill__60 was fill_42 (0.37 conf)
fill__61 was fill_43 (0.37 conf)
fill__62 was fill_44 (0.37 conf)
fill__63 was fill_45 (0.36 conf)
fill__64 was fill_46 (0.37 conf)
fill__65 was fill_47 (0.37 conf)
fill__66 was fill_48 (0.37 conf)
fill__67 was fill_49 (0.37 conf)
fill__68 was fill_50 (0.36 conf)
fill__69 was fill_51 (0.37 conf)
fill__70 was fill_52 (0.37 conf)
fill__71 was fill_53 (0.37 conf)
fill__72 was fill_54 (0.37 conf)
fill__73 was fill_55 (0.37 conf)
facts_recent_incident_follows__1 was 11 The facts of the most recent incident of abuse are as follows 1 (0.40 conf)
facts_recent_incident_follows__2 was 11 The facts of the most recent incident of abuse are as follows 2 (0.40 conf)
fill__74 was fill_2_2 (0.40 conf)
fill__75 was fill_4_2 (0.40 conf)
approximate_time was Approximate time (0.34 conf)
fill__76 was fill_6_3 (0.40 conf)
sheets_paper_necessary__1 was sheets of paper if necessary 1 (0.31 conf)
sheets_paper_necessary__2 was sheets of paper if necessary 2 (0.31 conf)
sheets_paper_necessary__3 was sheets of paper if necessary 3 (0.31 conf)
sheets_paper_necessary__4 was sheets of paper if necessary 4 (0.31 conf)
sheets_paper_necessary__5 was sheets of paper if necessary 5 (0.31 conf)
fill__77 was fill_8_3 (0.40 conf)
fill__78 was fill_10_2 (0.40 conf)
fill__79 was fill_12_2 (0.40 conf)
fill__80 was fill_14_2 (0.40 conf)
fill__81 was fill_16_2 (0.40 conf)
undefined__6 was undefined_6 (0.39 conf)
undefined__7 was undefined_7 (0.39 conf)
additional_sheets_paper was occurred attach additional sheets of paper if (0.42 conf)
necessary__1 was necessary 1 (0.42 conf)
necessary__2 was necessary 2 (0.42 conf)
necessary__3 was necessary 3 (0.42 conf)
necessary__4 was necessary 4 (0.42 conf)
fill__82 was fill_19_2 (0.40 conf)
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fill__84 was fill_23_3 (0.40 conf)
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fill__86 was fill_28_3 (0.40 conf)
text__26 was Text26 (0.35 conf)
text__27 was Text27 (0.35 conf)
text__28 was Text28 (0.35 conf)
text__29 was Text29 (0.35 conf)
text__30 was Text30 (0.35 conf)
text__31 was Text31 (0.35 conf)
text__32 was Text32 (0.35 conf)
text__33 was Text33 (0.35 conf)
text__34 was Text34 (0.35 conf)
text__35 was Text35 (0.35 conf)
text__36 was Text36 (0.35 conf)
text__37 was Text37 (0.35 conf)
plaintiff_minor_children__1 was Plaintiff or the minor children 1 (0.45 conf)
plaintiff_minor_children__2 was Plaintiff or the minor children 2 (0.45 conf)
plaintiff_minor_children__3 was Plaintiff or the minor children 3 (0.45 conf)
plaintiff_minor_children__4 was Plaintiff or the minor children 4 (0.45 conf)
plaintiff_minor_children__5 was Plaintiff or the minor children 5 (0.45 conf)
fill__87 was fill_2_3 (0.40 conf)
1_2 was 1_2 (0.38 conf)
2_2 was 2_2 (0.38 conf)
unknown__3 was 3 (0.38 conf)
unknown__4 was 4 (0.38 conf)
undefined__8 was undefined_8 (0.39 conf)
toggle__26 was toggle_4_2 (0.33 conf)
toggle__27 was toggle_5 (0.38 conf)
toggle__28 was toggle_6_2 (0.33 conf)
copy_protection_order was with a copy of the protection order (0.40 conf)
fill__88 was fill_12_3 (0.40 conf)
plaintiff_exclude_defendant was Plaintiff is asking the Court to evict and exclude Defendant (0.42 conf)
owned_list_owners_known was owned by list owners if known (0.36 conf)
rented_list_names_known was rented by list all names if known (0.43 conf)
owes_duty_plaintiff was Defendant owes a duty of support to Plaintiff or the minor (0.43 conf)
plaintiff_financial_losses was Plaintiff has suffered outofpocket financial losses as a result (0.38 conf)
toggle__29 was toggle_12_2 (0.33 conf)
toggle__30 was toggle_13_2 (0.33 conf)
toggle__31 was toggle_14_2 (0.33 conf)
toggle__32 was toggle_15_2 (0.33 conf)
toggle__33 was toggle_16_2 (0.33 conf)
undefined__9 was undefined_9 (0.39 conf)
undefined__10 was undefined_10 (0.39 conf)
fill__89 was fill_14_3 (0.40 conf)
undefined__11 was undefined_11 (0.39 conf)
fill__90 was fill_17_2 (0.40 conf)
losses__1 was Those losses are 1 (0.39 conf)
losses__2 was Those losses are 2 (0.39 conf)
fill__91 was fill_19_3 (0.40 conf)
fill__92 was fill_21_4 (0.40 conf)
text__38 was Text38 (0.35 conf)
text__39 was Text39 (0.35 conf)
abusing_harassing_stalking was A Restrain Defendant from abusing harassing stalking (0.48 conf)
toggle__34 was toggle_2_2 (0.33 conf)
b_evictexclude_defendant_plaintiffs_residence was B Evictexclude Defendant from Plaintiffs residence and (0.42 conf)
toggle__35 was toggle_4_3 (0.33 conf)
provide_plaintiff_minor was C Require Defendant to provide Plaintiff or the minor (0.38 conf)
toggle__36 was toggle_6_3 (0.33 conf)
plaintiff_custody_minor was D Award Plaintiff temporary custody of the minor children (0.42 conf)
toggle__37 was toggle_8_3 (0.33 conf)
children__1 was and the children 1 (0.44 conf)
children__2 was and the children 2 (0.44 conf)
1_3 was 1_3 (0.38 conf)
2_3 was 2_3 (0.38 conf)
1_4 was 1_4 (0.38 conf)
2_4 was 2_4 (0.38 conf)
1_5 was 1_5 (0.38 conf)
2_5 was 2_5 (0.38 conf)
defendant_contact_plaintiff was E Prohibit Defendant from having any contact with Plaintiff (0.49 conf)
toggle__38 was toggle_10_2 (0.33 conf)
f_prohibit_defendant_contact was F Prohibit Defendant from having any contact with (0.31 conf)
toggle__39 was toggle_12_3 (0.33 conf)
fill__93 was fill_9 (0.36 conf)
fill__94 was fill_10_3 (0.40 conf)
fill__95 was fill_11_2 (0.40 conf)
fill__96 was fill_12_4 (0.40 conf)
fill__97 was fill_13 (0.36 conf)
fill__98 was fill_14_4 (0.40 conf)
fill__99 was fill_15 (0.36 conf)
fill__100 was fill_16_3 (0.40 conf)
fill__101 was fill_17_3 (0.40 conf)
fill__102 was fill_18_2 (0.40 conf)
fill__103 was fill_19_4 (0.40 conf)
fill__104 was fill_20_2 (0.40 conf)
order_defendant_firearms was G Order Defendant to temporarily reliquish the firearms (0.38 conf)
toggle__40 was toggle_14_3 (0.33 conf)
h_prohibit_defendant_acquiring_possessing_firearms was H Prohibit Defendant from acquiring or possessing firearms (0.34 conf)
toggle__41 was toggle_16_3 (0.33 conf)
toggle__42 was toggle_18 (0.38 conf)
pay_support_plaintiff was I Order Defendant to pay temporary support for Plaintiff or (0.45 conf)
direct_defendant_pay was J Direct Defendant to pay Plaintiff for the reasonable (0.47 conf)
toggle__43 was toggle_20 (0.38 conf)
order_pay_costs_including was K Order Defendant to pay the costs of this action including (0.43 conf)
toggle__44 was toggle_1 (0.38 conf)
pay_plaintiffs_attorneys was L Order Defendant to pay Plaintiffs reasonable attorneys (0.48 conf)
toggle__45 was toggle_2_3 (0.33 conf)
toggle__46 was toggle_3_2 (0.33 conf)
order_following_additional was M Order the following additional relief not listed above (0.39 conf)
1_6 was 1_6 (0.38 conf)
2_6 was 2_6 (0.38 conf)
3_2 was 3_2 (0.38 conf)
1_7 was 1_7 (0.38 conf)
2_7 was 2_7 (0.38 conf)
3_3 was 3_3 (0.38 conf)
grant_relief_plaintiff_court was N Grant such other relief as Plaintiff requests or the court (0.44 conf)
toggle__47 was toggle_4_4 (0.33 conf)
law_enforcement_agency was O Order the police sheriff or other law enforcement agency (0.48 conf)
toggle__48 was toggle_5_2 (0.33 conf)
direct_state_municipal was P Direct the Pennsylvania State Police the municipal police (0.42 conf)
fill__105 was fill_9_2 (0.40 conf)
fill__106 was fill_8_4 (0.40 conf)
text__40 was Text40 (0.35 conf)

We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

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order_defendant_firearms
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pay_support_plaintiff
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order_following_additional
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grant_relief_plaintiff_court
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law_enforcement_agency
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direct_state_municipal
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fill__106
text__40

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