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TEMPORARY PROTECTION 
FROM ABUSE ORDER 
  Amended Order    Continued Order 

IN THE COURT OF COMMON PLEAS OF 
____________________ COUNTY, PENNSYLVANIA 
NO. 

PLAINTIFF 

DEFENDANT 

First 

Middle 

Last 

Plaintiff’s DOB 

Name(s) of all protected persons, including minor child/ren and DOB:  _____________________________________ 
_____________________________________ 
    _____________________________________ 

 

V. 

First 

Middle 

Last 

Suffix 

Defendant’s Address: 
________________________________________________ 

________________________________________________ 

DEFENDANT IDENTIFIERS 
HEIGHT 
WEIGHT 
EYES 

DOB 
SEX 
RACE 
HAIR 
SSN 
DRIVERS 
LICENSE # 
EXP DATE 

STATE 

CAUTION: 

  Weapon Involved 
  Weapon Present on the Property 
  Weapon Ordered Relinquished 

The Court Hereby Finds:   
That it has jurisdiction over the parties and subject matter, and Defendant will be provided with reasonable notice and opportunity to 
be heard. 

The Court Hereby Orders: 
   Defendant shall not abuse, harass, stalk, threaten, or attempt or threaten to use physical force against any of the above persons 

in any place where they might be found. 

   Except for such contact with the minor child/ren as may be permitted under Paragraph 5 of this order, Defendant shall not 

   contact Plaintiff, or any other person protected under this order, by telephone or by any other means, including through third 
   persons. 

   Additional findings of this order are set forth below. 

Order Effective Date________________________________      Order Expiration Date _______________________________   

NOTICE TO DEFENDANT 

Defendant is hereby notified that failure to obey this order may result in arrest as set forth in 23 Pa.C.S. § 6113 and that violation of the order may 
result in a charge of indirect criminal contempt as set forth in 23 Pa.C.S. §6114.  Consent of Plaintiff to Defendant’s return to the residence shall not 
invalidate this order, which can only be changed or modified through the filing of appropriate court papers for that purpose.  23 Pa.C.S. §6108(g).  If 
Defendant is required to relinquish any firearms, other weapons, ammunition, or any firearm license, those items must be relinquished to the sheriff 
or the appropriate law enforcement agency within 24 hours of the service of this order.  As an alternative, Defendant may relinquish any firearm, 
other weapon, or ammunition listed herein to a third party provided Defendant and the third party first comply with all requirements to obtain a 
safekeeping permit.  If, due to their current location, firearms, other weapons, or ammunition cannot reasonably be retrieved within the time for 
relinquishment, Defendant shall provide an affidavit to the sheriff or the appropriate law enforcement agency listing the firearms, other weapons, or 
ammunition and their current location no later than 24 hours after the service of this order.  Defendant is further notified that violation of this order 
may subject him/her to state charges and penalties under the Pennsylvania Crimes Code under 18 Pa.C.S. § 6105 and to federal criminal charges and 
penalties under 18 U.S.C. § 922(g)(8) and the Violence Against Women Act, 18 U.S.C. §§ 2261-2262. 

ENGLISH/KHMER  PFA Temp. Order 

Pa R.C.P. 1905(c) Rev. 3-19 

Page 1 of 6 / ទំព័រ 1 ៃន 6 

    AOPC Rev. 4-2019 

ដ

ីកករពរបេណា� ះអសន� 

ព

ីកររ ំេលភបំពន 
  ដីកែដលែកែ្រប    ដីកែដលបន�អនុវត�

េលខ 

ុងតុលករបណ�

េនក�
____________________ រដ�េផនសុ

ឹ ងទូេទៃនេខនធី 

ីលវ៉េនៀ 

េដមេចទ 

ទល់នឹង    

ច

ុងេចទ 

នាម 

នាមកណា� ល 

េគាត�នាម 

ៃថ�ែខឆា�

ំកំេណ ត 

ច

ូររយនាមជនទំងអស់ែដល្រត�វករពរ រប់ទំងកុមារជាអនីតិជន និងៃថ�ែខឆា�

ក

ំេណ ត:  ________________________________________________ 
      ________________________________________________ 

  ________________________________________________ 

នាម 

នាមកណា� ល 

េគាត�នាម 

បច�

័យ 

អសយដ� នចុងេចទ: 

_______________________________________________ 
_______________________________________________ 

ំណុ ចសមា� ល់ចុងេចទ 

ច

ៃថ�ែខឆា�

ំកំេណ ត 

េភទ 

សក់ 

ព

ូជសសន៍ 

េលខសន�

ិសុខសង�ម 

ប

័ណ�េបកបរេលខ 

ៃថ�ផុតកំណត់ 

កម�ស់ 

ទម�ន់ 

ែភ�ក 

រដ� 

ករ្របយ័ត�្របែយង 

 អវុធពក់ព័ន� 
 អវុធែដលមានេនេល្រទព្យសម្បតិ
 
 អវុធែដលេស�
ស

ំឲ្យលះបង់

ុលករយល់េឃញ:

ត

ថាតុលករមានយុត� ធិករេលបណា� ភាគី និងកម�វត�

ឹ ង េហយចុងេចទ្រត�វទទួលបានករជូនដំណឹ ងសម�សប និងឱកសទទួលបានសវនាករ។ 

ុពក្យបណ�

ុលករបង� ប់:
ត
  ឲ្យចុងេចទមិន្រត�វរ ំេលភបំពន យាយី េដរឈ�បតម គំរមជនខងេល ឬប៉

 េឡយ។ 

ុនប៉ងឬគំរមកំែហងេ្របកមា�

ំង្របឆាំងេនទីកែន�ងែដលអចជួបពួកេគ  

   េលកែលងែតករទក់ទងជាមួយនឹងកុមារជាអនីតិជន ែដលអចអនុ�� តតមកថាខណ�  5 ៃនដីកេនះ ចុងេចទមិន្រត�វទក់ទងេដមេចទ ឬជនដៃទ

ណាមួយ ែដល្រត�វបានករពរ តមដីកេនះ តមទូរស័ព� ឬមេធ្យោបាយដៃទេទៀត រប់ទំងតមរយៈភាគីទីបីផងែដរ។ 

   ករយល់េឃញបែន�មៃនដីកេនះ្រត�វបានែចង ដូចខងេ្រកម។ 

ីកផុតកំណត់ ________________________________________ 
ភាព________________________________      ៃថ�ែខឆា�
ដ
ៃថ�ែខឆា�
___________________________________________________________________________________________________________________________________

ីកមាន្របសិទិ

ដ

ករជូនដំណឹ ងចំេពះចុងេចទ

ស

ូមជូនដំណឹ ងចុងេចទថា ករខកខនមិនេគារពតម ដីកអចបណា� លឲ្យមានករចប់ខ�

ួន ដូចមានែចងក�

េនះអចនាំឱ្យមានករទទួលខុស្រត�វបទ្រពហ�ទណ� ្របមាថតុលករេដយ្របេយាលដូចបានែចងេឡងេនក�

ដល់ ៦ ែខ។ 23 Pa.C.S. §6114។ ករយល់្រពមពីេដមេចទឲ្យចុងេចទវ ិល្រតឡប់មកលំេនដ� នមិន្រត�វេធ�

ុង 23 Pa.C.S. §6114 េហយកររ ំេលភបំពនេលប�� ទិញ 
ុងែដលអចពិន័យជា្របាក់រហូតដល់ $1,000 និង/ឬេទសពន�នាគាររហូត
ូរ ឬែកែ្រប តម

ឲ្យដីកេនះអស់សុពលភាពេនាះេទ ែដលអចផា� ស់ប�

រយៈករដក់ពក្យសុ

ំសម�សបេទតុលករ េដម្បីេគាលបំណងេនាះ។ 23 Pa.C.S. §6108(g)។ េបចុងេចទ្រត�វបានត្រម�វឲ្យលះបង់កំេភ�

ង អវុធេផ្សងេទៀត ឬ្រគាប់ ឬអជា�

ប

័ណ�កំេភ�

ង កំេភ�

ង អវុធេផ្សងេទៀត ឬ្រគាប់ទំងេនាះ្រត�វលះបង់ឲ្យអជា� សលឬទីភា� ក់ងរ្របតិបត�

ិករច្បោប់្រតឹម្រត�វក�

ុងរយៈេពល 24 េមា៉ ង បនា� ប់ពីបានទទួលដីកេនះ។ ក�

ុង

ជេ្រមសេផ្សង អ�កអចលះបង់កំេភ�

ង អវុធេផ្សងេទៀត ្រគាប់ ឬអជា� ប័ណ�កំេភ�

ងេទឲ្យភាគីទីបីបាន ល�

ឹកណាចុងេចទ និងភាគីទីបីបំេពញបានតមលក�ខណ� ទំងអស់ េដម្បីទទួល

បានលិខិតអនុ�� តរក្សោអវុធ ជាមុនសិន។ េបសិនជាេដយសរទីតំងបច�

ង អវុធេផ្សងេទៀត ឬ្រគាប់មិនអចយកមកលះបង់បាន េនក�

ុប្បន� កំេភ�

ុងរយៈេពលសម�សប អ�ក្រត�វ្របគល់

ល

ិខិត្របកសឲ្យអជា� សលែដលរយប��

ីកំេភ�

ង អវុធេផ្សងេទៀត ឬ្រគាប់ និងទីតំងបច�

ុប្បន�របស់វ ក�

ុងរយៈេពលមិនេលសពី 24 េឡយ បនា� ប់ពីទទួលបានដីកេនះ។ សូមជូន

ដ

ំណឹ ងចុងេចទបែន�មេទៀតថា កររ ំេលភបំពនដីករេនះអចបណា� លឲ្យចុងេចទទទួលរងករេចទ្របកន់ និងទណ� កម� តម្រកម្រពហ�ទណ� របស់រដ�េផនសុ

ីវ៉េនៀេនេ្រកម្រកម 18 

Pa.C.S. § 6105 និងករេចទ្របកន់ឧ្រកិដ�ជន និងទណ� កម�េ្រកមច្បោប់  18 U.S.C. § 922(g)(8) និង ស�

ីពីអំេពហិង្សោេល�ស�

ី 18 U.S.C. §§2261-2262 ៃនរដ�

សហព័ន�។ 

ENGLISH/KHMER  PFA Temp. Order 

Pa R.C.P. 1905(c) Rev. 3-19 

Page 2 of 6 / ទំព័រ 2 ៃន 6 

    AOPC Rev. 4-2019 

ំ
�

ុ
ំ
�
ំ
AND NOW, this ____________ day of ______________, 20___, 
upon consideration of the attached Petition for Protection from 
Abuse, the court hereby enters the following Temporary Order: 

េហយឥឡូវេនះ េនៃថ�ទី  ______________ បនា� ប់ពីបានពិចរណាេលពក្យ
បណ�

ឹ ង ករពរពីកររ ំេលភបំពន ែដលភា� ប់មកជាមួយ តុលករសេ្រមចេចញ

ីកបេណា� ះអសន� ដូចខងេ្រកម: 

ដ

  Plaintiff’s request for a Temporary Protection Order is 

  សំេណ របស់េដមេចទសុ

ំដីក ករពរបេណា� ះអសន�្រត�វបាន

  Plaintiff’s request for a Temporary Protection Order is 

  សំេណ របស់េដមេចទសុ

ំដីកករពរបេណា� ះអសន�្រត�វបានសេ្រមច

denied. 

granted. 

បដិេសធ។ 

ឲ្យ តមសំេណ ។ 

  1.  Defendant shall not abuse, harass, stalk, threaten, or 

attempt or threaten to use physical force against any of 
the above persons in any place where they might be 
found 

  2.  Defendant is evicted and excluded from the residence at: 

 1. ចុងេចទមិន្រត�វរ ំេលភបំពន យាយី េដរឈ�បតម គំរម, ឬប៉

ុនប៉ង 

 ឬគំរមកំែហងេ្របកមា�

ំង្របឆាំងជនខង េនទីកែន�ងែដលអចជួបពួកេគ 

 េឡយ។ 

  2.  ចុងេចទ្រត�វបានបេណ� ញេចញ និងហមឃាត់ពីលំេនដ� ន ស�

ិតេន: 

___________________________________________________ 

___________________________________________________ 

or any other permanent or temporary residence where 
Plaintiff or any other person protected under this order may 
live.  Plaintiff is granted exclusive possession of the 
residence.  Defendant shall have no right or privilege to enter 
or be present on the premises of Plaintiff or any other person 
protected under this order. 

  3.  Except for such contact with the minor child/ren as may be 
permitted under Paragraph 5 of this order, Defendant is 
prohibited from having ANY CONTACT with Plaintiff, or 
any other person protected under this order, either directly or 
indirectly, at any location, including but not limited to any 
contact at Plaintiff’s school, business, or place of 
employment.  Defendant is specifically ordered to stay away 
from the following locations for the duration of this order: 

       ________________________________________________ 
       ________________________________________________ 

ឬ លំេនដ� នបេណា� ះអសន� ឬអចិៃ�ន�យ៍ដៃទេទៀត ែដលេដមេចទ ឬ

ជនេផ្សងេទៀតែដល្រត�វបានករពរតមដីកេនះ អចរស់េន។ េដមេចទ

ទទួលបានករកន់កប់ផា� ច់មុខេលលំេនដ� ន។ ចុងេចទពុ

ំមានសិទិ

 ឬ

� ចូលេទ ឬមានវត�មានេលទីបរ ិេវណរបស់េដមេចទ ឬជនេផ្សង

ុព�សិទិ

ប
េទៀតែដល្រត�វបានករពរ តមដីកេនះេឡយ។ 

  3.  េលកែលងែតករទក់ទងជាមួយនឹងកុមារជាអនីតិជន ែដលអចអនុ

�

� តតមកថាខណ�  5 ៃនដីកេនះ ចុងេចទ្រត�វបានហមឃាត់មិនឲ្យទក់

ទងេដមេចទ ឬជនដៃទណាមួយ ែដល្រត�វបានករពរតមដីករេនះ េទះ

េដយផា� ល់ ឬ្របេយាលក�

ូ លគា� ន
ក្រមិតនូវសលេរៀន អជីវកម� ឬទីកែន�ងករងររបស់េដមេចទ។ ចុង

ី េនទីតំងណាក៏េដយ ែដលរប់ប��

េចទ្រត�វបានបង� ប់ឲ្យេនឆា� យពីទីតំងដូចខងេ្រកម ក�
េពលៃនដីកេនះ៖   
________________________________________________ 
       ________________________________________________ 

ុងអំឡុងរយៈ

   4.  Except for such contact with the minor child/ren as may 

be permitted under Paragraph 5 of this order, Defendant shall 
not contact plaintiff, or any other person protected under this 
order, by telephone or by any other means, including through 
third persons. 

  4.  េលកែលងែតករទក់ទងជាមួយនឹងកុមារជាអនីតិជន ែដលអច 

អនុ�� តតមកថាខណ�  5 ៃនដីកេនះ ចុងេចទមិន្រត�វទក់ទងេដមេចទ ឬ

ជនដៃទណាមួយ ែដល្រត�វបានករពរតមដីកេនះ តមទូរស័ព� ឬ
មេធ្យោបាយដៃទេទៀត រប់ទំងតមរយៈភាគីទីបីផងែដរ។ 

  5.  CUSTODY 

  5.  សិទិ

្រគង 

ឃ

  There is a current custody order as to the child/ren of the 

parties: __________________________________________ 
       _________________________________________________ 
       _________________________________________________ 
(county court and docket number)

  បច�

�ឃុ

ុប្បន�មានដីកសិទិ

ំ្រគង ទក់ទិននឹងកូនរបស់បណា� ភាគី:
____________________________________________________ 
 _____________________________________________________________ 
  _______________________________________________________ 
    (តុលករេខនធី និងេលខសំណុំេរឿង) 

  THIS ORDER SHALL NOT SUPERSEDE THE CURRENT 

  ដីកេនះមិន្រត�វលុបេចលដីកសិទិ

�ឃុ

ំ្រគងបច�

ុប្បន�េឡយ។

CUSTODY ORDER. 

  THIS ORDER SUPERSEDES ANY PRIOR ORDER 

RELATING TO CHILD CUSTODY. 

  ដីកេនះលុបេចលដីកពីមុន ទក់ទិននឹងសិទិ

�ឃុ

ំ្រគងកូន។  

ENGLISH/KHMER  PFA Temp. Order 

Pa R.C.P. 1905(c) Rev. 3-19 

Page 3 of 6 / ទំព័រ 3 ៃន 6 

    AOPC Rev. 4-2019 

�
�
ុ
ំ
  Until the final hearing, all contact between Defendant and the 
child/ren shall be limited to the following: ______________ 
       _________________________________________________ 
       _________________________________________________ 
       _________________________________________________ 
       _________________________________________________ 

  រហូតដល់េពលសវនាករចុងេ្រកយ ករទក់ទងទំងអស់រវងចុងេចទ 

ិងកុមារជាអនីតិជន្រត�វក្រមិត្រតឹមចំណុ ចដូចខងេ្រកម: __________ 
ន
       _________________________________________________ 
       _________________________________________________ 
    _________________________________________________ 
  _________________________________________________ 

  Pending the outcome of the final hearing in this matter, 
Plaintiff is awarded temporary custody of the following 
minor child/ren: 
______________________________________________ 
       ______________________________________________ 
       ______________________________________________ 

  េដយរង់ចំលទ�ផលៃនសវនាករចុងេ្រកយក�

ុងេរឿងក�

ីេនះ េដមេចទ្រត�វ

ំ្រគងកុមារជាអនីតិជន ដូចខងេ្រកម: 

បានសេ្រមចឲ្យឃុ
______________________________________________ 
       ______________________________________________ 
       ______________________________________________ 

The local law enforcement agency in the jurisdiction where the 
child/ren are located shall ensure that the child/ren are placed in 
the care and control of the Plaintiff in accordance with the terms 
of this order. 

ិតក�

ក
ុមារស�
ៃនដីកេនះ។ 

ភា

� ក់ងរអនុវត�ច្បោប់ក�

ុង�ស�ក េនក�

ុងយុត� ធិករ ែដលកុមារស�

ិតេន ្រត�វធានាថា 

ុងករែថរក្សោ និង្រគប់្រគងរបស់េដមេចទ អនុេលមតមលក�ខណ�

  6.  FIREARMS, OTHER WEAPONS, OR 
AMMUNITION RESTRICTIONS 

  6.  ករកំហិតេលកំេភ�

ង អវុធេផ្សងេទៀត ឬ ្រគាប់ 

Check all that apply: 

ូរគូស្របអប់ទំងអស់ ែដលពក់ព័ន�: 

ច

  Defendant is prohibited from possessing or acquiring any 

firearms for the duration of this order. 

 ចុងេចទ្រត�វបានហមឃាត់មិនឲ្យកន់កប់ ឬទិញយកកំេភ�

ង ក�

ុងអំឡុង

រយៈេពលៃនដីកេនះេឡយ។ 

  Defendant shall relinquish to the sheriff or the appropriate law 
enforcement agency the following firearm licenses owned or 
possessed by the Defendant. 
_________________________________________________ 

 ចុងេចទ្រត�វលះបង់អវុធ ឬទីភា� ក់ងរអនុវត�ច្បោប់សមរម្យ
 ដូចខងេ្រកមែដលចុងេចទជាមា� ស់ ឬកន់កប់ េទឲ្យអជា� សល។ 
 

____________________________________________________________ 

  Defendant is directed to relinquish to the sheriff or the 

appropriate law enforcement agency any firearm, other 
weapon, or ammunition listed in Attachment A to Temporary 
Order, which is incorporated herein by reference, under 
Defendant’s control or in Defendant’s possession. 

 ចុងេចទ្រត�វបានប�� ឲ្យលះបង់កំេភ�

ង ឬទីភា� ក់ងរអនុវត�ច្បោប់សមរម្យ 

អវុធេផ្សងេទៀត ឬ្រគាប់ែដលរយប��

ីក�

ុងឧបសម�

័ន� ក ៃនដីកបេណា� ះ

អសន�េនះ ែដលបានេយាងដក់ប��

ូ លក�

ុងដីកេនះ េ្រកមករ្រត�ត្រត 

របស់ចុងេចទ ឬក�

ុងករកន់កប់របស់ជនជាប់េចទ។ 

Defendant may relinquish any firearms, other weapons, or 
ammunition to the sheriff or the appropriate law enforcement 
agency.  As an alternative, Defendant may relinquish firearms, 
other weapons, or ammunition to a third party provided 
Defendant and the third party first comply with all the 
requirements to obtain a safekeeping permit.  Defendant must 
relinquish any firearm, other weapon, ammunition, or firearm 
license ordered to be relinquished no later than 24 hours after 
service of this order.  If, due to their current location, firearms, 
other weapons, or ammunition cannot reasonably be retrieved 
within the time for relinquishment, Defendant shall provide to the 
sheriff or the appropriate law enforcement agency an affidavit 
listing the firearms, other weapons, or ammunition and their 
current location no later than 24 hours after the service of this 
order.  Failure to timely relinquish any firearm, other weapon, 
ammunition, or any firearm license shall result in a violation of 
this order and may result in criminal conviction under the 
Uniform Firearms Act, 18 Pa.C.S. §6105. 

ច

ុងេចទអចលះបង់កំេភ�

ង អវុធេផ្សងេទៀត ឬ្រគាប់េទឲ្យអជា� សល 

ឬទីភា� ក់ងរអនុវត�ច្បោប់សមរម្យ។ ក�

ុងជេ្រមសេផ្សងមួយ ចុងេចទអចលះបង់

ក

ំេភ�

ង អវុធេផ្សងេទៀត ឬ្រគាប់េទឲ្យភាគីទីបីបាន ល�

ឹកណាចុងេចទ 

ន

ិងភាគីទីបីបំេពញបានតមលក�ខណ� ទំងអស់ េដម្បីទទួលបានលិខិតអនុ�� ត

រក្សោអវុធ ជាមុនសិន។ ចុងេចទ្រត�វលះបង់កំេភ�

ង អវុធេផ្សងេទៀត និង្រគាប់ 

ក

ំេភ�

ុងដីកេនះ ក�

ឬអជា� ប័ណ�កំេភ�

ង តមករបង� ប់ក�

េមា៉ ងេឡយ បនា� ប់ពីទទួលបានដីកេនះ។ េបសិនជាេដយសរទីតំងបច�

ុងរយៈេពលមិនេលសពី 24 
ុប្បន� 
ុងរយៈេពល
សម�សប ចុងេចទ្រត�វ្របគល់លិខិត្របកសឲ្យអជា� សល ឬទីភា� ក់ងរអនុវត� 
ច្បោប់សមរម្យ ែដលរយប��

ង អវុធេផ្សងេទៀត ឬ្រគាប់មិនអចយកមកលះបង់បាន េនក�

ុប្បន�
ុងរយៈេពលមិនេលសពី 24 េមា៉ ងេឡយ បនា� ប់ពីទទួលបានដីកេនះ។ 

ង អវុធេផ្សងេទៀត ឬ្រគាប់ និងទីតំងបច�

របស់វ ក�

ីកំេភ�

ករខកខនមិនលះបង់កំេភ�

ង អវុធេផ្សងេទៀត ្រគាប់ ឬអជា� ប័ណ�កំេភ�

ងជា

សេលដីករេនះ េហយអចបណា� លឲ្យមានករផ�នា� េទស្រពហ�ទណ�

ករេល�
េ្រកមច្បោប់ Uniform Firearms Act, 18 Pa.C.S. §6105។ 

ENGLISH/KHMER  PFA Temp. Order 

Pa R.C.P. 1905(c) Rev. 3-19 

Page 4 of 6 / ទំព័រ 4 ៃន 6 

    AOPC Rev. 4-2019 

  7.  The following additional relief is granted: 

  7.  ដំេណាះ�សយបែន�មខងេ្រកម ្រត�វបានសេ្រមចឲ្យ: 

  Defendant is prohibited from stalking, as defined in 

       18 Pa.C.S. §2709.1, or harassing, as defined in  
       18 Pa.C.S. §2709, the following family and household 

members of Plaintiff. 

  ចុងេចទ្រត�វបានហមឃាត់មិនឲ្យេដរឈ�បតម ដូចកំណត់និយមន័យ
ុង 18
ុង 18 Pa.C.S. §2709.1 ឬយាយី ដូចកំណត់និយមន័យក�
ក�
Pa.C.S. §2709 សមាជិក្រគ�សររបស់េដមេចទ ដូចខងេ្រកម ។ 

Name / េឈ�ះ 

Address (optional) / អសយដ�ន (ជាជេ្រមស) 

Relationship to Plaintiff / 

នាក់ទំនងជាមួយនឹងេដមេចទ 
ំ
ទ

  Other relief: _________________________________ 
    _____________________________________________ 
    _____________________________________________ 
    _____________________________________________ 
   _____________________________________________ 

 ដំេណាះ�សយដៃទេទៀត: ____________________________ 
      _____________________________________________ 
       _____________________________________________ 
      _____________________________________________ 
      _____________________________________________ 

  8.  The Pennsylvania State Police, the municipal police, or 

the sheriff shall accompany Plaintiff to his or her residence to 
retrieve personal belongings or accompany Plaintiff while the 
petition or order is served on Defendant. 

 8. ប៉

ូលីសរដ� Pennsylvania បូ

៉លីសរក�ងឬម�ន�

តរម�តរត�េវទ ជាមួយភាគី 

េដមេចទេដម្បីេទយក្រទព្យសម្បត�

ិផា� ល់ខ�

ួនឬអមដំេណ រជាមួយភាគីេដម

េចទេនេពលែដលញត�

ិឬប�� ្រត�វបានបេ្រមេនេលចុងេចទ។

  9. A certified copy of this order shall be provided to the 

sheriff or police department where plaintiff resides and any 
other agency specified hereafter: (insert name of agency) 
_______________________________________________
_______________________________________________ 

 9.  ច្បោប់ចម�ងមានប�� ក់ៃនដីកេនះ្រត�វ្របគល់ឲ្យអជា� សល ឬប៉

ូលីស 

 

ែដលេដមេចទស� ក់េន និងទីភា� ក់ងរដៃទេទៀត ែដលកំណត់ដូចតេទ: 
_________________________________________________ 
_________________________________________________ 

  10. THIS ORDER SUPERSEDES ANY PRIOR 

  10.  ដីកេនះលុបេចលដីកករពរពីកររ ំេលភបំពនពីមុន ែដលេដម

PROTECTION FROM ABUSE ORDER OBTAINED BY 
THE SAME PLAINTIFF AGAINST THE SAME 
DEFENDANT. 

េចទដែដលទទួលបាន្របឆាំងនឹងចុងេចទដែដល។ 

  11.  THIS ORDER APPLIES IMMEDIATELY TO 

DEFENDANT AND SHALL REMAIN IN EFFECT UNTIL 
___________________________ OR UNTIL OTHERWISE 
MODIFIED OR TERMINATED BY THIS COURT AFTER 
NOTICE AND HEARING. 

  11.  ដីកេនះអនុវត�ភា� មេលចុងេចទ េហយ្រត�វបន�មានសុពលភាពរហូត
ដល់ ___________________________ ឬរហូតទល់ែតមានករែកែ្រប ឬ

ល

ុបេចល េដយតុលករេនះ បនា� ប់ពីករជូនដំណឹ ង និងសវនាករ។ 

NOTICE TO DEFENDANT 

Defendant is hereby notified that failure to obey this order may result in arrest as set forth in 23 Pa.C.S. § 6113 and that violation of 
the order may result in a charge of indirect criminal contempt as set forth in 23 Pa.C.S. §6114.  Consent of Plaintiff to Defendant’s 
return to the residence shall not invalidate this order, which can only be changed or modified through the filing of appropriate court 
papers for that purpose.  23 Pa.C.S. § 6108(g).  

If Defendant is required to relinquish any firearms, other weapons, ammunition, or any firearm license, those items must be 
relinquished to the sheriff or the appropriate law enforcement agency within 24 hours of the service of this order.  As an alternative, 
Defendant may relinquish any firearm, other weapon, or ammunition listed herein to a third party provided Defendant and the third 
party first comply with all requirements to obtain a safekeeping permit.  If, due to their current location, firearms, other weapons, or 
ammunition cannot reasonably be retrieved within the time for relinquishment, Defendant shall provide an affidavit to the sheriff or 
the appropriate law enforcement agency listing the firearms, other weapons, or ammunition and their current location no later than 24 
hours after the service of this order.  Defendant is further notified that violation of this order may subject him/her to state charges and 
penalties under the Pennsylvania Crimes Code under 18 Pa.C.S. § 6105 and to federal criminal charges and penalties under 18 U.S.C. 
§ 922(g)(8) and the Violence Against Women Act, 18 U.S.C. §§ 2261-2262.

ENGLISH/KHMER  PFA Temp. Order 

Pa R.C.P. 1905(c) Rev. 3-19 

Page 5 of 6 / ទំព័រ 5 ៃន 6 

    AOPC Rev. 4-2019 

ី
េសចក�ីជូនដំណឹងចំេពះចុងេចទ 
 

ូមជូនដំណឹ ងចុងេចទថា ករខកខនមិនេគារពតមដីកអចបណា� លឲ្យមានករចប់ខ�

ស

ួន ដូចមានែចងក�

េនះអចនាំឱ្យមានករទទួលខុស្រត�វបទ្រពហ�ទណ� ្របមាថតុលករេដយ្របេយាលដូចបានែចងេឡងេនក�

ល

ំេនដ� នមិន្រត�វេធ�

ឲ្យដីកេនះអស់សុពលភាពេនាះេទ ែដលអចផា� ស់ប�

ូរ ឬែកែ្រប តមរយៈករដក់ពក្យសុ

ុង 23 Pa.C.S. §6114 េហយកររ ំេលភបំពនេលប�� ទិញ 
ុង 23 Pa.C.S. §6114។ ករយល់្រពមពីេដមេចទឲ្យចុងេចទវ ិល្រតឡប់មក

ំសម�សបេទតុលករ េដម្បីេគាលបំណងេនាះ។ 23 Pa.C.S. §6108(g)។ 

េបចុងេចទ្រត�វបានត្រម�វឲ្យលះបង់កំេភ�

ង អវុធេផ្សងេទៀត ឬ្រគាប់ ឬអជា� ប័ណ�កំេភ�

ង កំេភ�

ង អវុធេផ្សងេទៀត ឬ្រគាប់ទំងេនាះ្រត�វលះបង់ឲ្យអជា�

សលឬទីភា� ក់ងរ្របតិបត�

ិករច្បោប់្រតឹម្រត�វក�

ុងរយៈេពល 24 េមា៉ ង បនា� ប់ពីបានទទួលដីកេនះ។ ក�

ុងជេ្រមសេផ្សង អ�កអចលះបង់កំេភ�

ង អវុធេផ្សងេទៀត ្រគាប់ ឬអជា� ប័ណ�

ក

ំេភ�

ងេទឲ្យភាគីទីបីបាន ល�

ឹកណាចុងេចទ និងភាគីទីបីបំេពញបានតមលក�ខណ� ទំងអស់ េដម្បីទទួលបានលិខិតអនុ�� តរក្សោអវុធ ជាមុនសិន។ េបសិនជាេដយសរទីតំង

បច�

ុប្បន� កំេភ�

ង អវុធេផ្សងេទៀត ឬ្រគាប់មិនអចយកមកលះបង់បាន េនក�

ុងរយៈេពលសម�សប អ�ក្រត�វ្របគល់លិខិត្របកសឲ្យអជា� សលែដលរយប��

ីកំេភ�

ង អវុធេផ្សងេទៀត ឬ

្រគាប់ និងទីតំងបច�

ុប្បន�របស់វ ក�

ុងរយៈេពលមិនេលសពី 24 េឡយ បនា� ប់ពីទទួលបានដីកេនះ។ សូមជូនដំណឹ ងចុងេចទបែន�មេទៀតថា កររ ំេលភបំពនដីករេនះអចបណា� លឲ្យ

ុងេចទទទួលរងករេចទ្របកន់ និងទណ� កម� តម្រកម្រពហ�ទណ� របស់រដ�េផនសុ

ីវ៉េនៀេនេ្រកម្រកម 18 Pa.C.S. § 6105 និងករេចទ្របកន់ឧ្រកិដ�ជន និងទណ� កម�េ្រកមច្បោប់  18 

ច
U.S.C. § 922(g)(8) និង ស�
 

ីពីអំេពហិង្សោេល�ស�

ី 18 U.S.C. §§2261-2262 ៃនរដ�សហព័ន�។ 

 
NOTICE TO SHERIFF, POLICE AND LAW ENFORCEMENT OFFICIALS 

his order shall be enforced by the police department or sheriff who has jurisdiction over Plaintiff’s residence OR any location where 
a  violation  of  this  order  occurs  OR  where  Defendant  may  be  located.    If  Defendant  violates  Paragraphs  1  through  6  of  this  order, 
Defendant  shall be arrested on the charge of indirect criminal contempt.  An arrest  for violation of this order may be  made  without 
warrant, based solely on probable cause, whether or not the violation is committed in the presence of a police officer or sheriff. 

ubsequent to an arrest, the law enforcement officer or sheriff shall seize all firearms, other weapons, or ammunition in Defendant’s 
possession which were used or threatened to be used during the violation of the protection order or during prior incidents of abuse and 
any other firearms in Defendant’s possession. Any firearm, other weapon, ammunition, or any firearm license must be delivered to the 
sheriff or the appropriate law enforcement agency, which sheriff or agency shall maintain possession of the firearms, other weapons, 
or ammunition until further order of this court, unless the weapon(s) are evidence of a crime, in which case, they shall remain with the 
law enforcement agency whose officer or sheriff made the arrest. 

េសចក�ីជូនដំណឹងចំេពះអជា�សល ប៉ូលីស និងម�ន�ីអនុវត�ច្បោប់ 

េនះ្រត�វអនុវត�េដយប៉ូលីស ឬអជា�សល ែដលមានែដនសមត�កិច�េលលំេនដ�នរបស់េដមេចទ ឬទីតំងណាែដលមានករេល�សេលដីកេនះ ឬទីកែន�ង
ែដលចុងេចទអចស�ិតេន។ េបចុងេចទេល�សកថាខណ� 1 ដល់ 6 ៃនដីកេនះ ចុងេចទ្រត�វបានចប់ខ�ួនពីបទ្រពហ�ទណ�្របមាថតុលករេដយ្របេយាល។ ករ
ចប់ខ�ួនក�ុងករណីេល�សអចេធ�េឡង េដយពុំចំបាច់មានដីកចប់ខ�ួនេទ ែផ�កេលមូលេហតុគួរេជឿ េបេទះបីជាករេល�សេនាះបាន្រប្រពឹត� េពលប៉ូលីស ឬអជា�
សលមានវត�មាន ឬអវត�មាន ក៏េដយ។  

នា

�ប់ពីករចប់ខ�ួន ម�ន�ីអនុវត�ច្បោប់ ឬអជា�សល្រត�វរឹបអូសយកកំេភ�ង អវុធេផ្សងេទៀត ឬ្រគាប់ ែដលចុងេចទកន់កប់ ែដលបានេ្រប ឬគំរមេ្រប ក�ុងអំឡុង

េពលេល�សេលដីករក្សោករពរេនះ ឬក�ុងអំឡុងេពលេហតុករណ៍រំេលភបំពនពីមុន ្រពមទំងកំេភ�ងដៃទេទៀត ែដលចុងេចទកន់កប់។ កំេភ�ង អវុធេផ្សង
េទៀត ្រគាប់ ឬអជា�ប័ណ�កំេភ�ង ្រត�វ្របគល់ឲ្យ ត្រម�តឬទីភា�ក់ងរអនុវត�ច្បោប់សមរម្យ, ែដលេចញដីកេនះ ត្រម�តឬទីភា�ក់ងរេនាះ្រត�វរក្សោកន់កប់កំេភ�ង 
អវុធេផ្សងេទៀត ឬ្រគាប់ រហូតទល់ែតមានដីកបែន�មពីតុលករេនះ ្របសិនេបអវុធេនាះមិនែមនជាភស�ុតងៃនបទេល�សេនាះេទ ែដលក�ុងករណីេនះ អវុធ្រត�វ

តេនជាមួយនឹងទីភា�ក់ងរអនុវត�ច្បោប់ែដលេធ�ករចប់ខ�ួនចុងេចទ។  
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BY THE COURT / េដយតុលករ: 

_____________________________________________ 
Judge / េច្រកម 
 
 

 

 

 

 

 

 

 

_____________________________________________ 
 
 

Date / ៃថ�ែខឆា�ំ 

 

 

 

 

 

 

 

ENGLISH/KHMER  PFA Temp. Order 

Pa R.C.P. 1905(c) Rev. 3-19 

Page 6 of 6 / ទំព័រ 6 ៃន 6 

 

 

 

 

 

 

 

           AOPC Rev. 4-2019 

  T

  S

     

 

    

    

 

  

 

  ដីក

  ប

Khmer Temporary Protection from Abuse Order

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Sourced from www.pacourts.us (2023-03)
Page(s): 6
Fields(s): 168
Average fields per page: 28
Reading Level: Grade 18
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)
amended_order was Amended Order (0.41 conf)
continued_order was Continued Order (0.30 conf)
last was Last (0.34 conf)
unknown__1 was 1 (0.38 conf)
unknown__2 was 2 (0.38 conf)
defendants_address__1 was Defendants Address 1 (0.31 conf)
defendants_address__2 was Defendants Address 2 (0.31 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)
hair was HAIR (0.34 conf)
ssn was SSN (0.34 conf)
weapon_involved was Weapon Involved (0.37 conf)
weapon_present_property was Weapon Present on the Property (0.35 conf)
weapon_ordered_relinquished was Weapon Ordered Relinquished (0.40 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)
defendant_shall_threaten_attempt was Defendant shall not abuse harass stalk threaten or attempt or threaten to use physical force against any of the above persons (0.44 conf)
permitted_defendant_shall was Except for such contact with the minor children as may be permitted under Paragraph 5 of this order Defendant shall not (0.42 conf)
additional_findings_order_set was Additional findings of this order are set forth below (0.36 conf)
order_effective_date was Order Effective Date (0.38 conf)
order_expiration_date was Order Expiration Date (0.40 conf)
text__1 was Text1 (0.35 conf)
text__2 was Text2 (0.35 conf)
text__3 was Text3 (0.35 conf)
fill__1 was fill_1 (0.36 conf)
toggle__1 was toggle_1 (0.38 conf)
toggle__2 was toggle_2 (0.38 conf)
fill__2 was fill_2 (0.36 conf)
fill__3 was fill_3 (0.36 conf)
undefined__1 was undefined (0.38 conf)
fill__4 was fill_5 (0.36 conf)
fill__5 was fill_22 (0.36 conf)
fill__6 was fill_10 (0.36 conf)
fill__7 was fill_11 (0.36 conf)
fill__8 was fill_12 (0.36 conf)
fill__9 was fill_13 (0.36 conf)
fill__10 was fill_14 (0.36 conf)
fill__11 was fill_15 (0.36 conf)
toggle__3 was toggle_3 (0.38 conf)
toggle__4 was toggle_4 (0.38 conf)
toggle__5 was toggle_5 (0.38 conf)
fill__12 was fill_16 (0.36 conf)
fill__13 was fill_17 (0.36 conf)
fill__14 was fill_18 (0.36 conf)
fill__15 was fill_19 (0.36 conf)
fill__16 was fill_20 (0.36 conf)
toggle__6 was toggle_7 (0.38 conf)
fill__17 was fill_8 (0.36 conf)
fill__18 was fill_7 (0.36 conf)
text__4 was Text4 (0.35 conf)
text__5 was Text5 (0.35 conf)
text__6 was Text6 (0.35 conf)
unknown__3 was 20 (0.38 conf)
fill__19 was fill_2_2 (0.40 conf)
request_temporary_order__1 was Plaintiffs request for a Temporary Protection Order is (0.36 conf)
request_temporary_order__2 was Plaintiffs request for a Temporary Protection Order is_2 (0.35 conf)
toggle__7 was toggle_3_2 (0.33 conf)
toggle__8 was toggle_4_2 (0.33 conf)
defendant_shall_harass was 1 Defendant shall not abuse harass stalk threaten or (0.53 conf)
defendant_excluded_residence was 2 Defendant is evicted and excluded from the residence at (0.42 conf)
toggle__9 was toggle_6_2 (0.33 conf)
toggle__10 was toggle_8 (0.38 conf)
undefined__2 was undefined_2 (0.39 conf)
undefined__3 was undefined_3 (0.39 conf)
except_contact_minor_may__1 was 3 Except for such contact with the minor children as may be (0.37 conf)
except_contact_minor_may__2 was 4 Except for such contact with the minor children as may (0.37 conf)
custody was 5 CUSTODY (0.46 conf)
current_custody_order was There is a current custody order as to the children of the (0.43 conf)
thi_r_shal_l_e_th was THIS ORDER SHALL NOT SUPERSEDE THE CURRENT (0.50 conf)
thi_orde_r_supersede_prio was THIS ORDER SUPERSEDES ANY PRIOR ORDER (0.44 conf)
toggle__11 was toggle_10 (0.38 conf)
toggle__12 was toggle_12 (0.38 conf)
toggle__13 was toggle_14 (0.38 conf)
toggle__14 was toggle_16 (0.38 conf)
toggle__15 was toggle_18 (0.38 conf)
toggle__16 was toggle_20 (0.38 conf)
1_2 was 1_2 (0.38 conf)
2_2 was 2_2 (0.38 conf)
fill__20 was fill_6_2 (0.40 conf)
fill__21 was fill_8_2 (0.40 conf)
undefined__4 was undefined_4 (0.39 conf)
parties__1 was parties 1 (0.43 conf)
parties__2 was parties 2 (0.43 conf)
1_3 was 1_3 (0.38 conf)
2_3 was 2_3 (0.38 conf)
unknown__4 was 4 (0.38 conf)
text__7 was Text7 (0.35 conf)
text__8 was Text8 (0.35 conf)
hearing_contact_defendant was Until the final hearing all contact between Defendant and the (0.39 conf)
outcome_final_hearing was Pending the outcome of the final hearing in this matter (0.39 conf)
toggle__17 was toggle_2_2 (0.33 conf)
toggle__18 was toggle_4_3 (0.33 conf)
undefined__5 was undefined_5 (0.39 conf)
shall_limited_following__1 was children shall be limited to the following 1 (0.38 conf)
shall_limited_following__2 was children shall be limited to the following 2 (0.38 conf)
shall_limited_following__3 was children shall be limited to the following 3 (0.38 conf)
shall_limited_following__4 was children shall be limited to the following 4 (0.38 conf)
fill__22 was fill_2_3 (0.40 conf)
fill__23 was fill_4 (0.36 conf)
fill__24 was fill_6_3 (0.40 conf)
fill__25 was fill_8_3 (0.40 conf)
fill__26 was fill_10_2 (0.40 conf)
minor_children__1 was minor children 1 (0.45 conf)
minor_children__2 was minor children 2 (0.45 conf)
minor_children__3 was minor children 3 (0.45 conf)
fill__27 was fill_11_2 (0.40 conf)
fill__28 was fill_13_2 (0.40 conf)
fill__29 was fill_15_2 (0.40 conf)
firearm_othe_r_weapon was 6 FIREARMS OTHER WEAPONS OR (0.34 conf)
toggle__19 was toggle_6_3 (0.33 conf)
defendant_acquiring was Defendant is prohibited from possessing or acquiring any (0.48 conf)
defendant_shall_appropriate was Defendant shall relinquish to the sheriff or the appropriate law (0.43 conf)
defendant_relinquish_sheriff was Defendant is directed to relinquish to the sheriff or the (0.34 conf)
toggle__20 was toggle_8_2 (0.33 conf)
toggle__21 was toggle_10_2 (0.33 conf)
possessed_defendant was possessed by the Defendant (0.45 conf)
fill__30 was fill_17_2 (0.40 conf)
toggle__22 was toggle_12_2 (0.33 conf)
following_additional_granted was 7 The following additional relief is granted (0.38 conf)
toggle__23 was toggle_2_3 (0.33 conf)
defendant_prohibited_stalking was Defendant is prohibited from stalking as defined in (0.38 conf)
toggle__24 was toggle_4_4 (0.33 conf)
fill__31 was fill_16_2 (0.40 conf)
fill__32 was fill_17_3 (0.40 conf)
fill__33 was fill_18_2 (0.40 conf)
fill__34 was fill_19_2 (0.40 conf)
fill__35 was fill_20_2 (0.40 conf)
fill__36 was fill_21_2 (0.40 conf)
fill__37 was fill_22_2 (0.40 conf)
fill__38 was fill_23 (0.36 conf)
fill__39 was fill_24 (0.36 conf)
fill__40 was fill_25 (0.36 conf)
fill__41 was fill_26 (0.36 conf)
fill__42 was fill_27 (0.36 conf)
undefined__6 was undefined_6 (0.39 conf)
relief was Other relief (0.41 conf)
toggle__25 was toggle_6_4 (0.33 conf)
undefined__7 was undefined_7 (0.39 conf)
1_4 was 1_4 (0.38 conf)
2_4 was 2_4 (0.38 conf)
3_2 was 3_2 (0.38 conf)
4_2 was 4_2 (0.38 conf)
fill__43 was fill_4_2 (0.40 conf)
fill__44 was fill_6_4 (0.40 conf)
fill__45 was fill_8_4 (0.40 conf)
fill__46 was fill_10_3 (0.40 conf)
pennsylvania_state_municipal was 8 The Pennsylvania State Police the municipal police or (0.52 conf)
certified_order_shall_provided was 9 A certified copy of this order shall be provided to the (0.34 conf)
thi_orde_r_supersede_prior was 10 THIS ORDER SUPERSEDES ANY PRIOR (0.35 conf)
thi_orde_r_applie_immediatel was 11 THIS ORDER APPLIES IMMEDIATELY TO (0.41 conf)
toggle__26 was toggle_9 (0.38 conf)
toggle__27 was toggle_10_3 (0.33 conf)
toggle__28 was toggle_12_3 (0.33 conf)
toggle__29 was toggle_14_2 (0.33 conf)
agency_specified_hereafter was other agency specified hereafter (0.41 conf)
fill__47 was fill_11_3 (0.40 conf)
fill__48 was fill_13_3 (0.40 conf)
defendan_shal_l_remai_n_effec was DEFENDANT AND SHALL REMAIN IN EFFECT UNTIL (0.36 conf)
fill__49 was fill_14_2 (0.40 conf)
text__9 was Text9 (0.35 conf)
fill__50 was fill_1_2 (0.40 conf)
fill__51 was fill_2_4 (0.40 conf)

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

Suggested Screen 0:

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fill__51

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