_________________________ 

 

 

 

 

_________________________ 
 
vs. 

ORDER GRANTING PETITION FOR EMERGENCY 
RELIEF IN CONNECTION WITH CLAIMS OF 
SEXUAL VIOLENCE OR INTIMIDATION 
ÒDONANS POU BAY PETISYON POU 
PWOTEKSYON IJAN KI ASOSYE AK VYÒL AK 
ENTIMIDASYON 

 

  

 

   

Docket No / No. Dosye: 
Case Filed / Dat Depoze: 
DOB / Dat Nesans:  
SSN / No. Sekirite Sosyal:  

COMMONWEALTH OF PENNSYLVANIA 
COUNTY OF _____________ 

 

 

 

 
 

 

Mag. Dist. No:  
No Dist. Maj 

DJ Name: 

Non Jij la 

 
Adrès 

ddress:  
 

elephone:   
Telefòn 

 

 
 

 

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ORDER 

ÒDONANS 

AKÒDE PETISYON POU PWOTEKSYON IJAN KI ASOSYE AK 
VYÒL AK ENTIMIDASYON 

GRANTING PETITION FOR EMERGENCY RELIEF IN 
CONNECTION WITH CLAIMS OF SEXUAL VIOLENCE OR 
INTIMIDATION 
 
I have found upon good cause that it is necessary to protect 
the following individual(s) listed in the plaintiff’s petition. 

wen jije ak rezon valab li nesesè pou pwoteje moun sa a, 

oswa moun sa yo, ki nan petisyon pleyan an. 

laintiff: _______________________________________ 

leyan: _______________________________________ 

inor Children: _________________________________ 

imoun Minè: _________________________________ 

ncapacitated Person: ____________________________ 

oun Andikape: ____________________________ 

aving found good cause at an ex parte hearing held 

on_________, I order the following actions be taken on the 
petition: 

aske mwen te jwenn rezon valab nan yon odyans ki te fèt 
_____________ san defandè a, mwen òdone pou fè bagay 
sa yo nan petisyon an: 

 
Ordered the defendant to refrain from contacting the 

individual(s) named above. 
 The defendant is ordered to refrain from contacting the 
individual(s) named above.  This restrains the defendant 
from entering the residence, place of employment, business 
or school of this individual(s). 
 Other Relief Deemed Appropriate: 

 
Òdone defandè a pou li sispann pran kontak ak moun 

non li, oswa yo, anba a. 
 Òdone defandè a pou li sispann pran kontak ak moun 
non li, oswa yo, anba a.  Sa entèdi defandè a antre nan kay, 
travay, biznis, oswa lekòl moun nan, oswa moun yo. 
 Lòt Pwoteksyon Nou Jije Apwopriye: 

_______________________________________________ 

_____________________________________________ 

_______________________________________________ 

_____________________________________________ 

DJS 306D-BL (Haitian Creole) 
 

1 

Date Created:  December 26, 2016 

 

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efendant is hereby notified that violation of the order may 
result in arrest for indirect criminal contempt. These orders 
expire at the end of the next business day the Court of 
Common Pleas deems itself available.  These orders will be 
immediately certified to the Court of Common Pleas, which 
has the effect of commencing proceedings against you 
under the above mentioned Act. 
 

an dokiman sa a nou avèti Defandè a yo kapab arete li pou 

dezobeyisans kriminèl endirèk si li ta vyole òdonans la. 
Òdonans sa yo ap ekspire nan fen pwochen jou travay 
Tribinal Defans Komen an jije li disponib.  Tribinal Defans 
Komen an ap sètifye òdonans sa yo touswit, epi sa ap fè yo 
kapab kòmanse demach kont ou selon Lwa nou te mansyon 
anwo a. 
 

NOTICE TO DEFENDANT 

AVÈTISMAN POU DEFANDÈ A 

 
 

 
 

 
 

_________________________   __________________________________________ 
Date / Dat 

Magisterial District Judge / Jij Distri Majisteral 

 

 

 

 

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Date Created:  December 26, 2016 

DJS 306D-BL (Haitian Creole) 
 

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