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IN THE COURT OF COMMON PLEAS OF ______________ COUNTY 
DEVAN TRIBINAL PREMYE ENSTANS NAN KONTE ____________________ 

LAINTIFF / PLENYAN 

 
___________________________ 
 
                       VS. 
 
DEFENDANT / AKIZE 

__________________________ 

CASE NO. / NO. DOSYE  

__________________________ 

PROTECTION FROM ABUSE / 
PWOTEKSYON KONT ABI 

 
TEMPORARY ORDER FOR 
PROTECTION OF VICTIMS OF  

 
ÒDONANS TANPORÈ POU  
PWOTEKSYON VIKTIM  

  SEXUAL VIOLENCE 
  SEXUAL VIOLENCE AGAINST A 

  VYÒL 
  VYÒL KONT YON TIMOUN MINÈ 

 

MINOR CHILD 
INTIMIDATION 
 

 

  ENTIMIDASYON 

 

laintiff: 

leyan an: 

__________________________________ 
First 

Last Name 

Middle  

 

__________________________________ 
     Dezyèm Non 
Prenon 

  Siyati 

laintiff’s address: 

drès Pleyan an: 

_________________________________ 
 

_________________________________ 
 

   Plaintiff’s  address 

is  confidential 

   Adrès  pleyan  an  konfidansyèl  selon 

pursuant to 42 Pa.C.S. § 62A11. 

lwa 42 Pa.C.S. § 62A11. 

efendant: 

efandè: 

_______________________________ 

First 

 

Middle  

Last Name 

_______________________________ 
  Siyati 
     Dezyèm Non 

Prenon 

  P

  _

 

  P

    P

    D

  _

         

 

  P

    A

    D

  _

         

 
 

AOPC PSVI (Haitian Creole) 

Created: December 26, 2016 

Defendant’s Address: 
________________________________ 
________________________________ 

Adrès Defandè an: 
________________________________ 
________________________________ 

DEFENDANT IDENTIFIERS 

IDANTIFIKASYON DEFANDÈ A 

 

 
 

 

WOTÈ 

PWA KÒ 
KOULÈ 
ZYE 
 

 

 
ETA 

   

 

 

 
 

 

DAT 
NESANS 
SÈKS 
RAS 

KOULÈ 
CHEVE 
# SEK. 
SOSYAL 
# LISANS 
DAT EKSP. 

 

 
 

 

HEIGHT 

WEIGHT 
EYES 

 
 
 

STATE 

   

 

DOB 

SEX 
RACE 
HAIR 
SSN 

DRIVERS 
LICENSE # 

EXP DATE 

 

 
 

 

AND NOW, this ____________ day 

  
of ______________, 20__, upon 
consideration of the attached Petition for 
Protection of Victims of Sexual Violence or 
Intimidation, the court hereby enters the 
following Temporary Order: 
 

EPI KOUNYE A,  ____________ 

  
jou  ______________, 20__, apre nou te 
fin konsidere Petisyon Pou Pwoteksyon 
Viktim Kont Vyòl oswa Entimidasyon ki vini 
ak dokiman sa a, tribinal la enskri 
Òdonans Tanporè sa a: 
 

 Plaintiff’s request for a Temporary 

 Nou refize demann Pleyan an pou yon 

Protection Order is denied.  
 

Òdonans Pwoteksyon Tanporè.  
 

 Plaintiff’s request for a Temporary 

 Nou akòde Pleyan an demann li pou 

Protection Order is granted. 

yon Òdonans Pwoteksyon Tanporè. 

The following person is protected 

Men kimoun ki gen pwoteksyon sou 

under this order: 
__________________________________
__________________________________ 

òdonans sa: 
__________________________________
__________________________________ 

Defendant is: 

Nou entèdi Defandè a: 

 A.  Restrained from having any contact 
with the victim, including, but not limited to, 
entering the victim’s residence, place of 
employment, business, or school.  
 

 A.  Pran okenn kontak ak viktim sa. Sa 

gen ladan pa antre kote viktim nan rete, 
kote l ap travay, biznis li, oswa lekòl li.  

 B.   Prohibited from indirect contact with 

 B.   Itilize lòt moun pou pran kontak 

the victim through third parties. 

endirèk ak viktim nan. 

. 

  1

. 

  2

 

. 

  1

. 

  2

 

   

 
 

AOPC PSVI (Haitian Creole) 

Created: December 26, 2016 

 C.  Itilize lòt moun yo nome sa yo pou 
pran kontak dirèk oswa endirèk ak viktim 
nan: 
__________________________________
__________________________________ 
 

 3.   Plis pwoteksyon, tankou pase yon 
òdonans selon 42 Pa.C.S. § 62A11(b) pou 
pa pataje adrès viktim nan, nimewo telefòn 
li, ki kote li ye oswa lòt enfòmasyon 
demografik:  

_________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________ 
 

 4. 

 Nou dwe bay cherif oswa 
depatman polis kote Pleyan an abite ak 
nenpòt lòt ajans espesifik (mete non ajans 
la) yon kopi sètifye òdonans sa a:  

________________________________  

 5.   ÒDONANS SA A RANPLASE 
NENPÒT PWOTEKSYON VIKTIM VYÒL 
OSWA ENTIMIDASYON MENM PLEYAN 
AN TE GEN POU MENM DEFANDÈ A 
AVAN.  

. 

DEFANDÈ A DWE RESPEKTE SA 
KI NAN ÒDONANS SA A TOUSWIT EPI L 
AP VALAB JISKA  __________________ 
(mete dat ekspirasyon) OSWA JISKASKE 
TRIBINAL LA CHANJE LI OSWA ANILE LI 
APRE YON AVI AK YON ODYANS.  

   

 C.  Prohibited from direct or indirect 

contact with the following designated 
persons: 
__________________________________
__________________________________ 
 

 3.   Additional relief, including, but not 

limited to, issuing an order under 42 
Pa.C.S. § 62A11(b) related to the 
non disclosure of the victim's address, 
telephone number, whereabouts or other 
demographic information: 
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________ 
 

 4. 

 A certified copy of this order shall 

be provided to the sheriff or police 
department where Plaintiff resides and any 
other agency specified (insert name of 
agency): 
_________________________________  
 

 5.   THIS ORDER SUPERSEDES ANY 

PRIOR PROTECTION OF VICTIMS OF 
SEXUAL VIOLENCE OR INTIMIDATION 
ORDER OBTAINED BY THE SAME 
PLAINTIFF AGAINST THE SAME 
DEFENDANT.  

. 

THIS ORDER APPLIES 
IMMEDIATELY TO THE DEFENDANT 
AND SHALL REMAIN IN EFFECT UNTIL 
__________________ (insert expiration 
date) OR UNTIL OTHERWISE MODIFIED 
OR TERMINATED BY THIS COURT 
AFTER NOTICE AND A HEARING.  

  6

 

  _

  _

 

    6

 
 

AOPC PSVI (Haitian Creole) 

Created: December 26, 2016 

   

 
 

NOTICE TO THE DEFENDANT 

AVÈTISMAN POU DEFANDÈ A 

Defendant is hereby notified that 

Nan dokiman sa a nou avèti 

violation of this order may result in arrest 
for indirect criminal contempt.  Under 18 
U.S.C. § 2265, an order entered by the 
court may be enforceable in all fifty (50) 
States, the District of Columbia, Tribal 
Lands, U.S. Territories and the 
Commonwealth of Puerto Rico.  If you 
travel outside of the state and intentionally 
violate this order, you may be subject to 
federal criminal proceedings under the 
Violence Against Women Act, 18 U.S.C. § 
2262.  Consent of Plaintiff shall not 
invalidate this order, which can only be 
changed or modified through the filing of 
appropriate court papers for that purpose.  
42 Pa.C.S. § 62A17.  Defendant is further 
notified that violation of this order may 
subject him/her to prosecution and criminal 
penalties under the Pennsylvania Crimes 
Code.  

Defandè a yo kapab arete li pou 
dezobeyisans kriminèl endirèk si li ta vyole 
òdonans sa a.  Selon lwa 18 U.S.C. § 
2265, yo gen dwa fè respekte yon 
òdonans ki anrejistre nan tribinal la nan 
tout senkant (50) Eta yo, Distri Columbia, 
Tè Tribal, Teritwa Ameriken, ak Pòtoriko.  
Si ou kite eta a epi ou fè eksprè ou vyole 
òdonans sa a, ou kapab gen pou ale nan 
pwosedi kriminèl nan nivo federal sou 
Violence Against Women Act (lwa pou 
vyolans kont fanm), 18 U.S.C. § 2262 .  
Menm si Pleyan an ta bay konsantman, ou 
p ap ka anile òdonans sa a. Se sèlman 
apre nou fin depoze papye tribinal pou fè 
sa n ap kapab chanje oswa modifye li.  42 
Pa.C.S. § 62A17.  Nou avèti Defandè a 
tou, yo kapab pouswiv li nan lajistis epi 
enpoze penalite kriminèl sou Kòd Krim 
Pennsylvania si li vyole òdonans sa a.  

   

   

   

NOTICE TO SHERIFF, POLICE AND 
LAW ENFORCEMENT OFFICIALS 

AVÈTISMAN POU CHERIF, LAPOLIS AK 
LÒT AJAN NAN LAPOLIS 

 
The police department and sheriff 

 
 
who have jurisdiction over Plaintiff’s 
residence, the location where a violation of 
this order occurs, or where Defendant may 
be located, shall enforce this order.  The 
court shall have jurisdiction over any 
indirect criminal contempt proceeding, 
either in the county where the violation 
occurred or where this protective order 
was entered.  An arrest for violation of 
paragraphs 2 and 3 of this order may be 
without warrant, based solely on probable 
cause, whether or not the violation is 
committed in the presence of the police or 
any sheriff.  42 Pa.C.S. § 62A12.  

 
Depatman lapolis ak cherif ki gen 

 
 
jiridiksyon sou rezidans Pleyan an, kote yo 
te vyole òdonans sa a, oswa kote Defandè 
a kapab ye, dwe fè respekte òdonans sa 
a.  Tribinal la ap gen jiridiksyon sou nenpòt 
pwosedi pou dezobeyisans endirèk 
kriminèl, swa nan konte kote vyolasyon an 
te fèt oswa kote yo te enskri òdonans pou 
pwoteksyon sa a.  Yo kapab arete 
Defandè a pou vyolasyon paragraf 2 ak 3 
òdonans sa a san manda, epi li kapab 
baze sèlman sou kòz pwobab, kit li te 
komèt vyolasyon an devan lapolis oswa 
nenpòt cherif ou pa.  42 Pa.C.S. § 62A12.  
 

AOPC PSVI (Haitian Creole) 

Created: December 26, 2016 

è yo arete yon Defandè paske li vyole 
òdonans la, y ap mennen Defandè a bay 
otorite ki apwopriye a pou bay Defandè a 
akizasyon ofisyèl la.  Apresa polis, cherif, 
oswa Pleyan an ap ranpli yon fòm "Plent 
Pou Dezobeyisans Kriminèl Endirèk" epi 
siyen li.  Nou pa bezwen Pleyan an la 
oswa siyen pou depoze plent la.  

Si yo bay ase prèv li te vyole 
òdonans sa a: (1) Y ap mennen Defandè a 
nan tribinal pou bay li akizasyon ofisyèl li; 
(2) fikse kosyon li, si sa apwopriye; epi (3) 
y ap bay Pleyan an ak Defandè a dat 
odyans la.  
 

  L

       

When Defendant is placed under 

arrest for violation of the order, Defendant 
shall be taken to the appropriate authority 
or authorities before whom Defendant is to 
be arraigned.  A ‘‘Complaint for Indirect 
Criminal Contempt’’ shall then be 
completed and signed by the police officer, 
sheriff or Plaintiff.  Plaintiff’s presence and 
signature are not required to file the 
complaint.  
 

If sufficient grounds for violation of 
this order are alleged: (1) Defendant shall 
be arraigned; (2) bond set, if appropriate; 
and (3) both parties shall be given notice 
of the date of the hearing. 

Y THE COURT / POU TRIBINAL LA:  

_____________________________________ 

Judge / Jij 

Date / Dat 
 

 

_____________________________________ 

   

  B

 

  _

  _

AOPC PSVI (Haitian Creole) 

Created: December 26, 2016

Haitian Creole Notice of Hearing and Order, Petition, Temporary Order, Affidavit of Service and the Final Order

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): 5
Fields(s): 97
Average fields per page: 19
Reading Level: Grade 9
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.

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count was COUNTY_3 (0.37 conf)
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defendan_akiz_e was DEFENDANT AKIZE_3 (0.42 conf)
cas_e_n_dosy was CASE NO NO DOSYE_3 (0.48 conf)
plaintiff was Plaintiff (1.00 conf)
pleyan was Pleyan an (0.32 conf)
plaintiffs_address was Plaintiffs address (0.42 conf)
adr_pleyan was Adrès Pleyan an_2 (0.35 conf)
defendant was Defendant (1.00 conf)
defand was Defandè (0.35 conf)
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day was day (0.34 conf)
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donans_sa__1 was òdonans sa 1 (0.49 conf)
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persons__1 was persons 1 (0.45 conf)
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agency was agency (0.54 conf)
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shal_l_remai_n_effec was AND SHALL REMAIN IN EFFECT UNTIL (0.39 conf)
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judge_jij was Judge Jij_2 (0.47 conf)
date_dat was Date Dat_3 (0.42 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Haitian Creole Notice of Hearing and Order, Petition, Temporary Order, Affidavit of Service and the Final Order

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Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02