FINAL PROTECTION FROM 
ABUSE  ORDER 
 Extended Order    Amended Order 

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

PLAINTIFF 

DEFENDANT 

V. 

Defendant’s address: 

 First 

 

       

 

     Middle 

 

     Last 

 

   Plaintiff’s DOB 

Name(s) of all protected persons, including minor children and DOB: 

_________________________________________________________________________________________________________________________ 

_________________________________________________________________________________________________________________________ 

First 

 

     Middle 

     Last 

     Suffix 

DEFENDANT IDENTIFIERS 

HEIGHT 
WEIGHT 
EYES 

DOB 
SEX 
RACE 
HAIR 
SSN 
DRIVERS 
LICENSE # 
EXP DATE 

___________________________________________________________ 

___________________________________________________________ 

CAUTION: 
  Weapon Involved 
  Weapon Present on Property 
  Weapon Ordered Relinquished 
____________________________________________________________________________________________________ 

STATE

 

The Court Hereby Finds:  That it has jurisdiction over the parties and subject matter, and Defendant has been 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 as provided in 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. VIOLATION MAY 
ALSO SUBJECT YOU TO PROSECUTION AND CRIMINAL PENALTIES UNDER THE PENNSYLVANIA CRIMES CODE.  A VIOLATION OF THIS ORDER 
MAY  RESULT  IN  THE  REVOCATION  OF  THE  SAFEKEEPING  PERMIT,  WHICH  WILL  REQUIRE  THE  IMMEDIATE  RELINQUISHMENT  OF  YOUR 
FIREARMS, OTHER WEAPONS, OR AMMUNITION TO THE SHERIFF OR THE APPROPRIATE LAW ENFORCEMENT AGENCY.  PLAINTIFF’S CONSENT 
TO CONTACT BY DEFENDANT SHALL NOT INVALIDATE THIS ORDER WHICH CAN ONLY BE MODIFIED BY FURTHER ORDER OF COURT.  23 Pa C.S. 
§6108(g). 

THIS  ORDER  IS  ENFORCEABLE  IN  ALL  FIFTY  (50)  STATES,  THE  DISTRICT  OF  COLUMBIA,  TRIBAL  LANDS,  U.S.  TERRITORIES,  AND  THE 
COMMONWEALTH OF PUERTO RICO UNDER THE VIOLENCE AGAINST WOMEN ACT, 18 U.S.C.  §2265. IF YOU TRAVEL OUTSIDE OF THE STATE AND 
INTENTIONALLY VIOLATE THIS ORDER YOU MAY BE SUBJECT TO FEDERAL CRIMINAL PROCEEDINGS UNDER THAT ACT.  18 U.S.C. §§2261-2262.  IF 
YOU POSSESS A FIREARM OR ANY AMMUNITION WHILE THIS ORDER IS IN EFFECT, YOU MAY BE CHARGED WITH A FEDERAL CRIMINAL OFFENSE 
EVEN  IF  THIS  PENNSYLVANIA  ORDER  DOES  NOT  EXPRESSLY  PROHIBIT  YOU  FROM  POSSESSING  FIREARMS  OR  AMMUNITION  UNDER  18  U.S.C. 
§922(g)(8) OR STATE CRIMINAL OFFENSES AND STATE CRIMINAL PENALTIES UNDER 18 PA.C.S. §6105. 

ENGLISH/KHMER PFA Final Order 

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

    Page 1 of 10 / ទំព័រ  1 ៃន 10  

    AOPC Rev. 4-2019 

ដ

ីកករពរចុងេ្រកយ  

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

ព

ឹ ងទូេទៃនេខនធី

ុងតុលករបណ�

េនក�
_____________________  រដ�េផនសុ
េលខ 

ីលវ៉េនៀ 

េដមេចទ 

នាម 

 

 

                      នាមកណា� ល 

 

     េគាត�នាម 

  ៃថ�ែខឆា�

ំកំេណ ត 

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

ច
_______________________________________________________________________________________________________ 

ំកំេណ ត:

_______________________________________________________________________________________________________ 

ទល់នឹង

ច

ុងេចទ 

នាម 

អសយដ� នចុងេចទ:

នាមកណា� ល 

េគាត�នាម 

បច�

័យ 

ំណុ ចសមា� ល់ចុងេចទ 

ច

កម�ស់ 

ទម�ន់ 

ែភ�ក 

__________________________________________________ 

ៃថ�ែខឆា�

ំកំេណ ត 

__________________________________________________ 

ព

ូជសសន៍ 

េភទ 

សក់ 

ករ្របយ័ត�្របែយង:
  អវុធពក់ព័ន� 
  អវុធែដលមានេនេល្រទព្យសម្បតិ
 
  អវុធែដលេស�
_____________________________________________________________________________________________________ 

័ណ�េបកបរេលខ 

ឲ្យលះបង់

ៃថ�ផុតកំណត់ 

ិសុខសង�ម 

េលខសន�

សុ

រដ� 

ប

ុលករយល់េឃញ: ថាតុលករមានយុត� ធិករេលបណា� ភាគី និងកម�វត�

ត
ករជូនដំណឹ ងសម�សប និងឱកសទទួលបានករេបកសវនាករ។

ុៃនពក្យបណ�

ឹ ង េហយចុងេចទ្រត�វទទួលបាន

ុលករបង� ប់:

ត
   ឲ្យចុងេចទមិន្រត�វរ ំេលភបំពន យាយី េដរឈ�បតម គំរម ឬប៉

 ទីកែន�ងែដលអចជួបពួកេគេឡយ។ 

នប៉ងឬគំ�មកំែហងេ�បើក��

ង�ប�ំងជនខងេល េន 

   េលកែលងែតមានែចងក�

ុងកថាខណ�  5 ៃនដីកេនះ ចុងេចទមិន្រត�វទក់ទងេដមេចទ ឬជនដៃទណាមួយ ែដល្រត�វបានករពរ តមដីករេនះ តម

ទ

ូរស័ព� ឬមេធ្យោបាយដៃទេទៀត រប់ទំងតមរយៈភាគីទីបីផងែដរ។ 
   ករយល់េឃញបែន�មេទៀតៃនដីករេនះ្រត�វបានែចង ដូចខងេ្រកម។ 

ៃថ�ែខឆា�
________________________________________________________________________________________________ 

ីកមាន្របសិទិ

ីកផុតកំណត់ 

ភាព__________________ ៃថ�ែខឆា�

ដ

ដ

ករជូនដំណឹ ងចំេពះចុងេចទ 

។េម�វ��រ�រក�

ី�ត�វ�នជូនដំណឹង��រមិនេ�រព�មប��េនះ�ច�លទ�ផលៃន�រសេ�មចចិត�ែដល�ត�វ�នកំណត់េ���

ំ 23 PA.C.S. 

 6113 

េហើយ�ររ�េ�ភបំ�នេលើប��ទិញ�បែហល��ចប��លមកពី�រគិតគូរពី�រគិតផ���េ�សេ�យៃចដន�ែដល�ត�វ�នកំណត់េ���

 23 Pa.C.S.A § 6114

។

§

ករេល�

សេលដីកេនះក៏អចបណា� លឲ្យអ�កទទួលករកត់េទស និងទណ� កម�្រពហ�ទណ�  េ្រកម្រកម្រពហ�ទណ� ៃនរដ� PENNSYLVANIA។ ករេល�

សេលដីកេនះអចបណា� លឲ្យមានករ

 

ល

ុបេចលលិខិតអនុ�� តរក្សោអវុធ ែដលឬត្រម�វឲ្យលះបង់កំេភ�

ង អវុធេផ្សងេទៀត និង្រគាប់េទឲ្យអជា� សលភា� មៗ ឬភា� ក់ងរអនុវត�ន៍ច្បោប់សមរម្យ។ករយល់្រពមពីេដមេចទឲ្យ

ច

ុងេចទទក់ទងមិន្រត�វេធ�

ឲ្យដីកេនះអស់សុពលភាពេនាះេទ ែដលអចផា� ស់ប�

ូរ ឬែកែ្របបាន ែតតមរយៈករដក់ពក្យសុ

ំសម�សបេទតុលករ េដម្បីេគាលបំណងេនាះ និងតមរយៈ

ដ

ីកបែន�មពីតុលករប៉

ុេណា� ះ។ 23 Pa.C.S. §6108(g)។ 

ដ

ីកេនះអចអនុវត�បានេន្រគប់រដ�ទំងហសិប ឌី�ស�

ីកកូឡុមប៊

ី ទឹកដីកុលសម�

័ន� ទឹកដីសហរដ�អេមរ ិក និងខុម៉

ុនែវលព័រតូរ ីកូ េ្រកមច្បោប់អំេពហិង្សោ្របឆាំង�ស�

 18 U.S.C.  §2265។ 

េបអ�កេធ�

ដំេណ រេ្រករដ� និងមានេចតនាេល�

សដីកេនះ អ�កអចទទួលរងនីតិវ ិធី្រពហ�ទណ� របស់រដ�សហព័ន� េ្រកមច្បោប់េនាះ។   18 U.S.C. §§2261-2262។ េបើអ�កកន់កប់កំេភ�

ង 

ឬ្រគាប់ េពលដីកេនះេនមាន្របសិទិ

�ភាព អ�កអច្រត�វបានេចទ្របកន់ពីបទេល�

ស ឧ្រកិដ�ជន ៃនរដ�សហព័ន� េបេទះបីជាដីកេនះមិនបានហមឃាត់ជាក់ច្បោស់ មិនឲ្យអ�កកន់កប់កំ

េភ�

ង ឬ្រគាប់ក៏េដយ េ្រកម 18 U.S.C. §922(g)(8) ឬផ�នា� េទសបទេល�

ស្រពហ�ទណ� និងផ�នា� េទស្រពហ�ទណ�  េ្រកម 18 PA.C.S. §6105។

ENGLISH/KHMER PFA Final Order 

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

    Page 2 of 10 / ទំព័រ  2 ៃន 10

    AOPC Rev. 4-2019 

�
ំ
ុ
ំ
ំ
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ំ
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ី
           FINAL PROTECTION FROM ABUSE ORDER 

កករពរចុងេ្រកយពីកររំេលភបំពន 
ី
ដ

CHECK ALL THAT APPLY: 
Plaintiff or Protected Person(s) is/are: 

 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

ូរគូស្របអប់ទំងអស់ែដលពក់ព័ន�: 

ច
េដមេចទ ឬជនែដល្រត�វករពរគឺ: 

ីឬ្របពន�របស់ចុងេចទ 

ីឬ្របពន� ឬអតីតប�

  ប�
  ឪពុកឬមា� យកូនជាមួយនឹងចុងេចទ 
  ៃដគូេស�ហបច�
  កូនេដមេចទ 
  កូនចុងេចទ 
  សមាជិក្រគ�សរជាញាតិពីកំេណ ត (ក�

ុប្បន� ឬអតីតៃដគូេស�ហជាមួយនឹងចុងេចទ 

ុង្រគ�សរែតមួយ) ជាមួយនឹងចុងេចទ 

 family member related by marriage or affinity to

  សមាជិក្រគ�សរតមចំណងអពហ៍ពិពហ៍ ឬទំនាក់ទំនងជាមួយនឹងចុងេចទ 

Defendant

Defendant

 sibling (person who shares parenthood) of Defendant

  បងប�

ូន (អ�កែដលមានឪពុកមា� យែតមួយ) ជាមួយនឹងចុងេចទ 

Defendant was served, in accordance with Pa. R.C.P. No.
1930.4 and provided notice of the time, date, and location of
the hearing scheduled in this matter.

ុងេចទបានទទួលេសចក�
ិងទីកែន�ងសវនាករ ែដលកំណត់ក�

ច
ន
1930.4។ 

ំ 
ីជូនដំណឹ ងពីេពលេវល ៃថ�ែខឆា�

ុងប�� េនះ តម Pa. R.C.P. េលខ 

AND NOW, this ____ day of __________, 20___, the court
having jurisdiction over the parties and the subject matter, it
is ORDERED, ADJUDGED, AND DECREED as follows:

េហើយឥឡូវ េនះៃថ� ____ ៃន __________, 20___, 
ត
ុលករមានយុត� ធិករេលើភាគីនិង្របធានបទ 
វ្រត�វបានប�� រ, ចត់តំងនិងកត់បន�យ ដូចខងេ្រកម៖

This order is entered by (check one) 

បទប�� េនះ្រត�វបានដក់ប��

ូ លេដយ (េ្រជសយកមួយ) 

 By Agreement
 By Agreement without an admission
 After a hearing and decision by the Court
 After Hearing at which defendant was not present, despite
proper service being made
 By Default

េដយ  
 េដយគុណវ ិបត�

   េដយករយល់្រពម 
   េដយករយល់្រពម េដយគា� នករសរភាព 
   បនា� ប់ពីសវនាករ និងករសេ្រមចេសចក�
   បនា� ប់ពីសវនាករែដលមិនមានវត�មានេនចំេពះមុខេទះបីជាមានេសវកម�្រតឹម្រត�វក៏ 

ីេដយតុលករ 

Without regard as to how this order was entered, this is a
final order of court subject to full enforcement pursuant to
the Protection from Abuse Act.

Note: Space is provided to allow for 1) the court's general
findings of abuse; 2) inclusion of the terms under which
the order was entered (e.g., that the order was entered with
the consent of the parties, or that Defendant, though
properly served, failed to appear for the hearing, or the
reasons why the plaintiff's request for a final PFA order
was denied); or 3) information that may be helpful to law
enforcement (e.g., whether a firearm or other weapon was
involved in the incident of abuse or whether Defendant is
believed to be armed and dangerous).

េដយមិនគិតពីរេបៀបែដលករប�� ទិញេនះ្រត�វបានប��

ូ លេនាះគឺជាលំដប់ចុងេ្រកយ

ៃនតុលករែដល្រត�វអនុវត�េពញេលញ�សបតមច្បោប់ករពរពីកររ ំេលភបំពន។

ក

ំណត់សមា� ល់: អវកស្រត�វបានផ�ល់ឱ្យេដម្បីអនុ�� តឱ្យ 1) កររកេឃញជាទូេទៃន 

កររ ំេលភបំពនរបស់តុលករ។ 2) ករដក់ប��

ប��

ូ ល (ឧទហរណ៍ ករប�� ទិញ្រត�វបានប��

ូ លលក�ខណ� ែដលប�� ទិញ្រត�វបាន 
ូ លជាមួយនឹងករយល់្រពមពីភាគីនានាឬ 

ថាជនជាប់េចទេទះបីជាបានបំេពញមុខងរ្រតឹម្រត�វក៏េដយក៏មិនបានបង� ញខ�

ួនស្រមា

ប

់សវនាករឬមូលេហតុែដលសំេណ របស់េដមបណ�

ឹ ងសុ

ំ លំដប់ PFA ចុងេ្រកយ្រត�វ 

បានបដិេសធ) ។ ឬ 3) ព័ត៌មានែដលអចមាន្របេយាជន៍ដល់ករអនុវត�ច្បោប់ (ឧ. អវុធ
ិេហតុៃនកររ ំេលភបំពនឬថាេតជនជាប់េចទ
ឬអវុធេផ្សងេទៀតែដលពក់ព័ន�នឹងឧប្បត�

្រត�វបានេគេជឿថាជា្របដប់អវុធនិងេ្រគាះថា� ក់ែដរឬេទ) ។

 សំេណ របស់េដមបណ�

ឹ ងស្រមាប់ករករពរចុងេ្រកយ្រត�វបានបដិេសធ។

 

ស

ំេណ របស់េដមបណ�

ឹ ងស្រមាប់ករករពរចុងេ្រកយ្រត�វបានផ�ល់។

ឬ 

 Plaintiff's request for a final protection order is denied.
OR
 Plaintiff's request for a final protection order is granted.

ENGLISH/KHMER PFA Final Order 

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

  Page 3 of 10 / ទំព័រ  3 ៃន 10

   AOPC Rev. 4-2019 

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

 1. ចុងេចទមិន្រត�វរ ំេលភបំពន យាយី េដរឈ�បតម ឬគំរម ឬប៉នប៉ង ឬគ្រមាមកំែហង

attempt or threaten to use physical force against Plaintiff
or any other protected person in any place where they
might be found.

អចជួបពួកេគេឡយ។ 

េ្របកមា�

ំងកយ ជំទស់េដមេចទ ឬជនដៃទេទៀតែដល្រត�វបានករពរ េនទីកែន�ងែដល

 2. Defendant is completely evicted and excluded from the

residence at
_______________________________________________ 

(Non-confidential address from which Defendant is excluded)

_______________________________________________ 

or any other residence where Plaintiff or any other person 
protected under this order may live. Exclusive possession of 
the residence is granted to Plaintiff. 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. 

 On

_______________________________________________ 
(Date and time) 
_______________________________________________ 

 2.ចុងេចទ្រត�វបានបេណ� ញេចញ និងហមឃាំត់ទំង�ស�ងពីលំេនដ� ន ែដលស�

ិតេន

_______________________________________________
(អសយដ�នមិនែមនជាករសំងត់ ែដលចុងេចទ្រត�វបានដកេចញ) 
 ________________________________________________ 

ឬ លំេនដ� នដៃទេទៀត ែដលេដមេចទ ឬជនដៃទេទៀតែដល្រត�វបានករពរតមដីកេនះ អច

រស់េន។ េដមេចទទទួលបានករកន់កប់ផា� ច់មុខេលលំេនដ� ន។ ចុងេចទពុ

ំមានសិទិ

� ឬ

ប

ុព�សិទិ

� ចូលេទ ឬមានវត�មានេលទីបរ ិេវណរបស់េដមេចទ ឬជនដៃទេទៀតែដល្រត�វបានករ

ពរ តមដីកេនះេឡយ។ 

 េន

_______________________________________________ 
(ៃថ�ែខឆា�ំ និងេពលេវល) 
_______________________________________________ 

Defendant may enter the residence to retrieve his/her 
clothing and other personal effects, provided that 
Defendant is in the company of a law enforcement 
officer or sheriff when such retrieval is made and 
(insert any other conditions): 
___________________________________________ 
___________________________________________ 

ច

ុងេចទអចចូលេទលំេនដ� ន េដម្បីយកសេម��កបំពក់ និង្រទព្យផា� ល់ខ�

ួនដៃទ
ីអនុវត�ច្បោប់ ឬអជា� សលអមនឹងចុងេចទ េន

េទៀត ល�

ឹកណាចុងេចទមានម�ន�

េពលេទយកសេម��កបំពក់ និង្រទព្យផា� ល់ខ�

ួនដៃទេទៀត។ 

ូ លលក�ខណ� ណាមួយេផ្សងេទៀត): 

(ប��
___________________________________________ 
___________________________________________ 

 3. Except as provided in Paragraph 5 of this order,

 3.េលកែលងែតមានែចងក�

ុងកថាខណ�  5  ចុងេចទ្រត�វបានហមឃាត់មិនឲ្យទក់ទងេដម

Defendant is prohibited from having ANY CONTACT
with Plaintiff, either directly or indirectly, or any other 
personprotected under this order 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: 
______________________________________________ 
______________________________________________ 
______________________________________________ 
______________________________________________ 

េចទ េទះេដយផា� ល់ ឬ្របេយាលក�

ី ឬជនដៃទណាមួយែដល្រត�វបានករពរតមដីកេនះ

េនទីតំងណាក៏េដយ ែដលរប់ប��

ូ លគា� នក្រមិតនូវ សលេរៀន អជីវកម� ឬទីកែន�ងករ

ងររបស់េដមេចទ។ ចុងេចទ្រត�វបានបង� ប់ឲ្យេនឆា� យពីទីកែន�ងដូចខងេ្រកម ក�
ំឡុងរយៈេពលៃនដីកេនះ:
អ
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

ុង

 4. Except as provided in Paragraph 5 of this order,

 4. េលកែលងែតមានែចងក�

Defendant shall not contact Plaintiff, either directly or
indirectly, or any other person protected under this order, 
by telephone or by any other means, including through 
third persons. 

ុងកថាខណ្  5  ៃនដីករេនះស�

ីពីសិទិ

�ឃុ

ំ្រគងបេណា� ះអសន�ក�

ុង

ដ

ីកេនះ ចុងេចទមិន្រត�វទក់ទងេដមេចទ េដយផា� ល់ឬេដយ្របេយាល, ឬជនដៃទ

ណាមួយ ែដល្រត�វបានករពរតមដីករេនះ តមទូរស័ព� ឬមេធ្យោបាយដៃទេទៀត រប់

ទ

ំងតមរយៈភាគីទីបីផងែដរ។ 

 5. Temporary custody of the minor children, (names of the
children subject to the provision of this paragraph)

 5. សិទិ

�ឃុ

ំ្រគងកុមារអនីតិជនជាបេណា� ះអសន�

េឈ�ះរបស់កុមារែដលស�ិតេនេ្រកមករផ�ល់ៃនកថាខណ�េនះ) 
(

_____________________________________________ 
_____________________________________________ 
_____________________________________________ 

      shall be as follows: 

Check all that apply: 

 

_____________________________________________ 
(State to whom primary physical custody is awarded; state terms of 
partial custody or visitation, if any) 

_____________________________________________ 
_____________________________________________ 
_____________________________________________ 

      មានដូចខងេ្រកម: 

ូរគូស្របអប់ទំងអស់ែដលពក់ព័ន�: 

ច

 

 _____________________________________________ 

ENGLISH/KHMER PFA Final Order 

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

  Page 4 of 10 / ទំព័រ  4 ៃន 10

   AOPC Rev. 3-2019 

_____________________________________________ 
_____________________________________________ 
_____________________________________________ 

 There is a current custody order as to the

children of the parties:

__________________________________________________ 

__________________________________________________ 
(County Court and docket number) 

   (ប�� ក់ថាេតអ�កណាទទួលបានសិទិ�ឃុំ្រគងរូបវន� ប�� ក់ពីលក�ខណ�ៃនសិទិ�ឃុំ្រគងមិនេពញេលញ 
ឬករេទេលង ្របសិនេបមាន) 
_____________________________________________ 
_____________________________________________ 
_____________________________________________ 

 មានដីកស�

ីពីសិទ�

ិឃុ

ំ្រគងទក់ទងនឹងកូនរបស់បណា� ភាគី: 

__________________________________________________ 

__________________________________________________ 

(តុលករេខនធី និងេលខសំណុំេរឿង) 

 A custody petition is pending.

 A hearing is scheduled for

 ញត�

ិដក់ឃុ

ំឃាំងមួយកំពុងរង់ចំ 

 សវនាករ្រត�វបានេ្រគាងស្រមាប់៖

_____________________________________________ 

(Date, time and location)

         ___________________________________________ 

 (ៃថ�ែខឆា�ំ េពលេវល និងទីកែន�ង) 

 THIS ORDER SHALL NOT SUPERSEDE THE 
CURRENT CUSTODY ORDER 

 ដីកេនះមិន្រត�វលុបេចលដីកសិទិ

ឃ

ំ្រគងបច�

ុប្បន�េឡយ។

 THIS ORDER SUPERSEDES ANY PRIOR 
ORDER RELATING TO CHILD CUSTODY 

The custody provisions of Paragraph 5 of this order 
are temporary. Either party may initiate custody 
proceedings pursuant to the custody statute at 23 
Pa.C.S. §§ 5321— 5340. Any valid custody order 
entered after the final Protection From Abuse order 
supersedes the custody provisions of this order. 

 ដីកេនះលុបេចលដីកពីមុនទក់ទងនឹងសិទិ

�ឃុ

ំ្រគង។ 

បទប្ប��ត�

ិឃាត់ឃាំងៃនកថាខ័ណ� ទី 5 ៃនបទប�� េនះគឺជាបេណា� ះ

អសន�។ ភាគីណាមួយអចផ�

មនីតិវ ិធីឃុ

ំឃាំងេដយអនុេលមតម

ួចេផ�

លក�ន�

ិកៈែថទំ 23 Pa.C.S. §§ 5321— 5340។ ដីកឃុ

ំឃាំងែដលមាន

ស

ុពលភាពណាមួយែដលបានប��

ូ លបនា� ប់ពីករករពរពីកររ ំេលភ

ប

ំពនចុងេ្រកយជំនួសឱ្យបទប្ប��ត�

ិែថរក្សោៃនករប�� ទិញេនះ។ 

 6. FIREARMS, OTHER WEAPONS, OR AMMUNITION

 6. ករកំហិតេលកំេភ�

ង អវុធេផ្សងេទៀត ឬ ្រគាប់ 

RESTRICTIONS

Check all that apply: 

   ចូរគូស្របអប់ទំងអស់ែដលពក់ព័ន�: 

 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�

ុងអំឡុងរយៈេពល

ៃនដីកេនះេឡយ។

 Defendant shall relinquish to the sheriff or the appropriate law
enforcement agency the following firearm licenses owned or
possessed by Defendant:
___________________________________________________

 ចុងេចទ្រត�វលះបង់អវុធ ែដលចុងេចទជាមា� ស់ ឬកន់កប់ ដូចខងេ្រកមេទឲ្យ

អជា� សល ឬភា� ក់ងរអនុវត�ច្បោប់សមរម្យ៖
_____________________________________________

___________________________________________________ 

_____________________________________________ 

___________________________________________________ 

_____________________________________________ 

 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 Final
Order, which is incorporated herein by reference.

Defendant may relinquish any firearms, other weapons, or 
ammunition to the sheriff or the appropriate law enforcement 
agency. As an alternative, Defendant may either 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 or relinquish firearms, other weapons, or 
ammunition to a licensed firearms dealer for consignment sale, 

 ចុងេចទ្រត�វបានប�� ឲ្យលះបង់េទឲ្យអជា� សល ឬភា� ក់ងរអនុវត�ច្បោប់
សមរម្យ កំេភ�
ុងេ្រកយេនះ ែដលបានេយាង រប់ប��
ច

ង អវុធេផ្សងេទៀត ឬ្រគាប់ ែដលរយប��

ុងឧបសម�

ីក�

័ន� ក ៃនដីក

ូ លក�

ុងដីកេនះ។

ច

ុងេចទអចលះបង់កំេភ�
� ក់ងរអនុវត�ច្បោប់សមរម្យ ក�
ភា

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

ុងជេ្រមសេផ្សងមួយ ចុងេចទអចលះបង់កំេភ�

ង 

អវុធេផ្សងេទៀត ឬ្រគាប់េទឲ្យភាគីទីបីបាន ល�

ឹកណាចុងេចទ និងភាគីទីបី

ប

ំេពញបានតមលក�ខណ� ទំងអស់ េដម្បីទទួលបានលិខិតអនុ�� តរក្សោអវុធ ជា

ម

ុនសិន ឬលះបង់កំេភ�

ង អវុធេផ្សងេទៀត និង្រគាប់េទឲ្យឈ�

ួញលក់កំេភ�

ងែដល

ENGLISH/KHMER PFA Final Order 

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

  Page 5 of 10 / ទំព័រ  5 ៃន 10

   AOPC Rev. 4-2019 

�
ុ
lawful transfer, or safekeeping pursuant to 23 Pa. C.S. § 6108.2(e). 
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. Failure to timely relinquish any firearm, 
other weapon, ammunition, or any firearm license ordered to be 
relinquished shall result in a violation of this order and may result in 
criminal conviction under the Uniform Firearms Act, 18 Pa. C.S. § 
6105. 

មានអជា� ប័ណ� េដម្បីលក់បន� េផ�រេដយ�សបច្បោប់ ឬរក្សោទុក អនុេលមតម 23 
Pa. C.S. §6108.2(e) ។ ចុងេចទ្រត�វលះបង់កំេភ�

ង អវុធេផ្សងេទៀត និង្រគាប់ 
ុងរយៈេពលមិនេលសពី 24 

ឬអជា� ប័ណ�កំេភ�

ង តមករបង� ប់ក�

ុងដីកេនះ ក�

េមា៉ ងេឡយ បនា� ប់ពីទទួលបានដីកេនះ។ ករខកខនមិនលះបង់កំេភ�

ង អវុធ

េផ្សងេទៀត ្រគាប់ ឬអជា� ប័ណ�កំេភ�

ង ែដលបានបង� ប់ឲ្យលះបង់ ជាករេល�

ស

ដ
ីករេនះ េហយអចបណា� លឲ្យមានករផ�នា� េទស្រពហ�ទណ� េ្រកមច្បោប់ 
Uniform Firearms Act, 18 Pa.C.S. §6105។ 

 7. Any firearm delivered to the sheriff or the appropriate
law enforcement agency or transferred to a licensed
firearm dealer or a qualified third party, who satisfies the 
procedural and substantive requirements to obtain a 
safekeeping permit issued under 23 Pa C.S. §6108.3 
pursuant to this order or the temporary order, shall not be 
returned to Defendant until further order of court or as 
otherwise provided by law. 

 7. កំេភ�

ង ែដល្របគល់ឲ្យអជា� សល ឬភា� ក់ងរអនុវត�ច្បោប់សមរម្យេផ�រឲ្យ ឈ�

ួញកំ

េភ�

ងែដលមានអជា� ប័ណ� ឬភាគីទីបីែដលមានលក�ណៈសម្បតិ

� ែដលបំេពញបាននូវ

លក�ខណ� នីតិវ ិធី និងអង�េសចក�

ី េដម្បីទទួលបានលិខិតអនុ�� តរក្សោអវុធ េ្រកម

23 Pa C.S.  §6108.3 អនុេលមតមដីកេនះ ឬដីកបេណា� ះ
អសន� មិន្រត�វ្របគល់ឲ្យចុងេចទវ ិញេឡយ រហូតទល់ែតមានដីករបែន�មពីតុលករ

ឬតមកំណត់េដយច្បោប់។ 

 8. The Pennsylvania State Police, the municipal police, or
the sheriff shall accompany Plaintiff to his or her
residence to retrieve personal belongings. 

 9. The following additional relief is granted as authorized

by §6108 of the Act:
_____________________________________________ 
_____________________________________________ 
_____________________________________________ 

 8. នគរបាលរដ� Pennsylvania នគរបាល្រក�ងឬម�ន�

ីត្រម�ត្រត�វេទជាមួយភាគីេដម

េចទេដម្បីេទយក្រទព្យសម្បត�

ិផា� ល់ខ�

ួន។

 9. ដំេណាះ�សយបែន�មេទៀត ដូចខងេ្រកម ្រត�វបានសេ្រមចឲ្យ តមអំណាចៃន §6108
ៃនច្បោប់៖

  ________________________________________________ 
________________________________________________ 
________________________________________________ 

 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 ដូចកំណត់និយម
ុង 18 Pa.C.S. §2709.1 ឬយាយី ដូចកំណត់និយមន័យក�
ុង 18
ន
័យក�
Pa.C.S. §2709 េលសមាជិក្រគ�សរដូចខងេ្រកមរបស់េដមេចទ។: 

Name / េឈ�ះ 

Address / អសយដ�ន 

Relationship to Plaintiff / 
នាក់ទំនងជាមួយនឹងេដមេចទ 
ទ
ំ

 Other relief:

_________________________________________ 
_________________________________________ 

 ដំេណាះ�សយដៃទេទៀត:
____________________________________________
____________________________________________

 10. Defendant is directed to pay temporary support for:

 10. ចុងេចទ្រត�វបានប�� ឲ្យបង់្របាក់ឧបត�ម�បេណា� ះអសន�ឲ្យ:

_____________________________________________
_____________________________________________ 

(Names of the persons for whom support is to be paid) 

as follows: 
_____________________________________________ 
_____________________________________________ 
_____________________________________________ 
(Amount, frequency and other terms and conditions of the Support Order) 

_____________________________________________
_____________________________________________ 

(េឈ�ះអ�កែដលទទួលបាន្របាក់ឧបត�ម�) 

ូចខងេ្រកម: 
ដ
_____________________________________________ 
_____________________________________________ 
_____________________________________________ 
(ចំនួន ភាពញឹកញាប់ និង្របករ និងលក�ខណ�ដៃទេទៀតៃនដីក្របាក់ឧបត�ម�) 

This order for support shall remain in effect until a final support order is 
entered by this court.  However, this order shall lapse automatically if 
Plaintiff does not file a complaint for support with the Domestic 
Relations Section of the court within two weeks of the date of this 

ក្របាក់ឧបត�ម�េនះ្រត�វមាន្របសិទិ�ភាព រហូតទល់ែតតុលករេនះ សេ្រមចដីកចុង
ី
ដ

េ្រកយ។ ប៉ុែន�ដីករេនះ្រត�វផុតកំណត់េដយស�័យ្របវតិ� េបេដមេចទមិនដក់ពក្យបណ�ឹងសុំ

្របាក់ឧបត�ម� េនករិយាល័យទំនាក់ទំនង្រគ�សរៃនតុលករ ក�ុងរយៈេពលពីរសបា�ហ៍ គិត

ENGLISH/KHMER PFA Final Order 

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

  Page 6 of 10 / ទំព័រ  6 ៃន 10

   AOPC Rev. 4-2019 

order.  The amount of this temporary order does not necessarily reflect 
Defendant's correct support obligation, which shall be determined in 
accordance with the guidelines at the support hearing.  Any adjustments 
in the final amount of support shall be credited, retroactive to this date, 
to the appropriate party. 

ចប់ពីកលបរិេច�ទៃនដីកេនះ។ ចំនួន្របាក់ៃនដីកបេណា� ះអសន�េនះមិនឆ�ុះប�� ំងពីកតព�

បង់្របាក់ឧបត�ម�្រតឹម្រត�វរបស់ចុងេចទេឡយ ែដលនឹង្រត�វកំណត់អនុេលមតមេគាល
�
ច
ិ
ក

ករែណនាំ ក�ុងសវនាករស�ីពី្របាក់ឧបត�ម�។ ករែកែ្របចំនួន្របាក់ឧបត�ម�ចុងេ្រកយនឹង្រត�វ

ណត់ជូនដល់ភាគីសម�សប េដយមាន្របតិសកម�មកដល់ៃថ�េនះ ។  
ំ
ក

 11.   (a) The costs of this action are imposed on

 11.   (a) ៃថ�ចំណាយបណ�

ឹ ងេនះ្រត�វកំណត់ឲ្យចុងេចទបង់។

Defendant. 

 (b) Upon a showing of good cause or finding that the
Defendant is unable to pay, the costs of this action are
waived.

 (c) Because this order followed a contested
proceeding, or a hearing at which the Defendant was not
present, despite being served with a copy of the Petition
for Protection from Abuse and notice of the date, time
and place of the hearing, Defendant is ordered to pay an
additional $100 surcharge to the court, which shall be
distributed in the manner set forth in 23 Pa. C.S.
§6106(d).

 (b) េនេពលបង� ញពីមូលេហតុ្រតឹម្រត�វ ឬកររកេឃញថា ចុងេចទមិន

អចមានលទ�ភាពបង់បាន ៃថ�ចំណាយបណ�

ឹ ងេនះ្រត�វលះបង់េចល។

 (c) េ្រពះដីកេនះបានឆ�ងកត់នីតិវ ិធីែដលមានករេដញេដលឬសវនា

ករ ែដលចុងេចទមិនអចមានវត�មាន េបេទះបីជាបានទទួលច្បោប់ចម�ងៃន

ឹ ង  និងេសចក�

ពក្យបណ�
ីជូនដំណឹ ងពីកលបរ ិេច�ទ េពលេវល និងទីកែន�ង
សវនាករក៏េដយ។ ចុងេចទ្រត�វបានបង� ប់ឲ្យបង់្របាក់បែន�ម $100 េទ

ុលករ ែដល្រត�វែបងែចក តមវ ិធីដូចមានែចងក�
ត
§6106(d) 

ុង 23 Pa. C.S.

 12. Defendant shall pay $ ____________ to Plaintiff by

___________________ as compensation for Plaintiff’s 

12.  ចុងេចទ្រត�វបង់ $ ____________ េទឲ្យេដមេចទ េន្រតឹម

___________________ ជា្របាក់សំណងេលករខតបង់េចញពី 

   (Date) 

   (កលបរិេច�ទ) 

out-of-pocket losses, which are as follows: 

_____________________________________________ 
_____________________________________________ 
_____________________________________________ 
_____________________________________________ 
_____________________________________________ 

 An installment Schedule is ordered as follows:
_____________________________________________ 
_____________________________________________ 
_____________________________________________ 

OR 

 Plaintiff is granted leave to present a petition, with
appropriate notice to Defendant, to _________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
  (Insert name of Judge or court to which the petition should be presented) 

requesting recovery of out-of-pocket losses. The  
petition shall include an exhibit itemizing all claimed  
out-of-pocket losses, copies of all bills and estimates of  
repair and an order scheduling a hearing. No fee shall  
be required by the prothonotary’s office for the filing of 
this petition. 

េហេប៉របស់េដមេចទ ែដលមានដូចខងេ្រកម: 

_____________________________________________ 
_____________________________________________ 
_____________________________________________ 
_____________________________________________ 
_____________________________________________ 

 កលវ ិភាគបង់ជាដំណាក់កល្រត�វបានបង� ប់ដូចខងេ្រកម:
_____________________________________________
_____________________________________________
_____________________________________________

ឬ 

 េដយមានករជូនដំណឹ ងសម�សបេទឲ្យចុងេចទ េដមេចទ្រត�វបានអនុ�� ត

ំដល់ _______________________________
ឲ្យបង� ញពក្យសុ
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
  (ចូរសរេសរេឈ� ះរបស់េច្រកមតុលករ ែដលេដមេចទ្រត�វបង� ញពក្យសុំ) 

េស

ស

ំករបង់សងករខតបង់្របាក់ពីេហេប៉។ ពក្យសុ

ំ្រត�វដក់ប��

ល   

ឧបសម័

�ន�ែដលកំណត់ពីករខតបង់្របាប់ពីេហេប៉ទំងអស់ ច្បោប់ចម�ង       

វ ិក�យប្រត និងករបា៉ ន់្របមាណេលករជួសជុល និងដីកែដលកំណត់េពលសវនា 

ករ។ ពុ

ំត្រម�វឲ្យបង់កៃ្រមេទករិយាល័យនាយក្រកឡាប��

ី េឡយ េដម្បីដក់ 

ពក្យសុ

ំេនះេទ។ 

ENGLISH/KHMER PFA Final Order 

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

  Page 7 of 10 / ទំព័រ  7 ៃន 10

   AOPC Rev. 4-2019 

�
ុ
ូ
 13. THIS ORDER SUPERSEDES ANY PRIOR

 13. ដីកេនះលុបេចលដីកករពរពីកររ ំេលភបំពន  ែដលេដមេចទ

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

ដែដលទទួលបាន ្របឆាំងនឹងចុងេចទដែដល។ 

 14. All provisions of this order shall expire

 (Check one): 

 in _________________, on _________________

   (Days, months, or years)

(Date) 

 14. រល់ប��តិ

ៃនដីកេនះ្រត�វផុតកំណត់

 (ចូរគូស្របអប់មួយ): 

OR 

 in three years on
__________________________________________.

(Expiration Date)

 ក�

ុងរយៈេពល_____________, េន _________________

  (ចំនួនៃថ� ឬែខ ឬឆា�ំ)

 (កលបរិេច�ទ) 

ឬ 

 ក�
__________________________________________.

ុងរយៈេពលបីឆា�

ំេន

(កលបរិេច�ទផុតកំណត់ៃថ�) 

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.  VIOLATION  MAY  ALSO  SUBJECT  YOU  TO  PROSECUTION  AND 
CRIMINAL PENALTIES UNDER THE PENNSYLVANIA CRIMES CODE.  A VIOLATION OF THIS ORDER MAY RESULT IN 
THE  REVOCATION  OF  THE  SAFEKEEPING  PERMIT,  WHICH  WILL  REQUIRE  THE  IMMEDIATE  RELINQUISHMENT  OF 
YOUR  FIREARMS,  OTHER  WEAPONS,  AND  AMMUNITION  TO  THE  SHERIFF  OR  THE  APPROPRIATE  LAW 
ENFORCEMENT  AGENCY.    PLAINTIFF’S  CONSENT  TO  CONTACT  BY  DEFENDANT  SHALL  NOT  INVALIDATE  THIS 
ORDER, WHICH CAN ONLY BE MODIFIED BY FURTHER ORDER OF COURT.  23 Pa C.S. §6108(g). 

THIS  ORDER  IS  ENFORCEABLE  IN  ALL  FIFTY  (50)  STATES,  THE  DISTRICT  OF  COLUMBIA,  TRIBAL  LANDS,  U.S. 
TERRITORIES, AND THE COMMONWEALTH OF PUERTO RICO UNDER THE VIOLENCE AGAINST WOMEN ACT, 18 U.S.C.  
§2265. IF YOU TRAVEL OUTSIDE OF THE STATE AND INTENTIONALLY VIOLATE THIS ORDER, YOU MAY BE SUBJECT
TO FEDERAL CRIMINAL PROCEEDINGS UNDER THAT ACT.  18 U.S.C. §§2261-2262.  IF YOU POSSESS A FIREARM OR ANY
AMMUNITION WHILE THIS ORDER IS IN EFFECT, YOU MAY BE CHARGED WITH A FEDERAL CRIMINAL OFFENSE EVEN
IF  THIS  PENNSYLVANIA  ORDER  DOES  NOT  EXPRESSLY  PROHIBIT  YOU  FROM  POSSESSING  FIREARMS  OR
AMMUNITION UNDER 18 U.S.C. §922(g)(8) OR STATE CRIMINAL OFFENSES AND STATE CRIMINAL PENALTIES UNDER
18 PA.C.S. §6105.

េសចក�ីជូនដំណឹងចំេពះចុងេចទ 

។េមធាវ ីករពរក�

ី្រត�វបានជូនដំណឹ ងថាករមិនេគារពតមប�� េនះអចជាលទ�ផលៃនករសេ្រមចចិត�ែដល្រត�វបានកំណត់េនឆា�

ំ 23 PA.C.S. § 6113 

េហយកររ ំេលភបំពនេលប�� ទិញ្របែហលជាអចបណា� លមកពីករគិតគូរពីករគិតផ�នា� េទសេដយៃចដន្យែដល្រត�វបានកំណត់េនឆា�

ំ 23 Pa.C.S.A § 6114

ករេល�

សេលដីកេនះក៏អចបណា� លឲ្យអ�កទទួលករកត់េទស និងទណ� កម�្រពហ�ទណ�  េ្រកម្រកម្រពហ�ទណ� ៃនរដ� PENNSYLVANIA។ ករេល�

សេលដីកេនះអំចបណា� លឲ្យ

មានករលុបេចលលិខិតអនុ�� តរក្សោអវុធ ែដលឬត្រម�វឲ្យលះបង់កំេភ�

ង អវុធេផ្សងេទៀត និង្រគាប់េទឲ្យអជា� សលភា� មៗ ឬភា� ក់ងរអនុវត�ន៍ច្បោប់សមរម្យ។ករយល់្រពមពីេដម

េចទឲ្យចុងេចទទក់ទងមិន្រត�វេធ�

ឲ្យដីកេនះអស់សុពលភាពេនាះេទ ែដលអចផា� ស់ប�

ូរ ឬែកែ្របបាន ែតតមរយៈករដក់ពក្យសុ

ំសម�សបេទតុលករ េដម្បីេគាលបំណងេនាះ និង

តមរយៈដីកបែន�មពីតុលករប៉

ុេណា� ះ។ 23 Pa.C.S. §6108(g)។

ដ

ីកេនះអចអនុវត�បានេន្រគប់រដ�ទំងហសិប ឌី�ស�

§2265។ េបអ�កេធ�

ដំេណ រេ្រករដ� និងមានេចតនាេល�

ី ទឹកដីកុលសម�

ីកកូឡុមប៊
សដីកេនះ អ�កអចទទួលរងនីតិវ ិធី្រពហ�ទណ� របស់រដ�សហព័ន� េ្រកមច្បោប់េនាះ។   18 U.S.C. §§2261-2262។ េបើអ�កកន់

ុនែវលព័រតូរ ីកូ េ្រកមច្បោប់អំេពហិង្សោ្របឆាំង�ស�

័ន� ទឹកដីសហរដ�អេមរ ិក និងខុម៉

ី 18 U.S.C.

កប់កំេភ�

ង ឬ្រគាប់ េពលដីកេនះេនមាន្របសិទិ

�ភាព អ�កអច្រត�វបានេចទ្របកន់ពីបទេល�

ស ឧ្រកិដ�ជន ៃនរដ�សហព័ន� េបេទះបីជាដីកេនះមិនបានហមឃាត់ជាក់ច្បោស់ មិនឲ្យអ�ក

កន់កប់កំេភ�

ង ឬ្រគាប់ក៏េដយ េ្រកម 18 U.S.C. §922(g)(8) ឬផ�នា� េទសបទេល�

ស្រពហ�ទណ� និងផ�នា� េទស្រពហ�ទណ�  េ្រកម 18 PA.C.S. §6105។

។ 

 

 

ENGLISH/KHMER PFA Final Order 

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

  Page 8 of 10 / ទំព័រ  8 ៃន 10

   AOPC Rev. 4-2019 

�
NOTICE TO SHERIFF, POLICE, AND LAW ENFORCEMENT OFFICIALS 

The police and sheriff who have jurisdiction over Plaintiff's residence OR any 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 1 through 7 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. 23 Pa. C.S. § 6113. 

Subsequent to an arrest, and without the necessity of a warrant, the police officer or sheriff shall seize all firearms, other 
weapons, and ammunition in Defendant's possession that 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.  

The______________________________________________________________________________________ 

shall maintain possession of firearms, other weapons, or ammunition until further order of the court. 

(Insert the appropriate name or title) 

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, Defendant shall be arraigned, bond set, if appropriate, and both 

parties given notice of the date of the hearing. 

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

ស
ី
ល
៉
ូ
ប

 ឬអជា�សល ែដលមានែដនសមត�កិច�េលលំេនដ�នរបស់េដមេចទ ឬទីកែន�ងណាក៏េដយ ែដលមានករេល�សេលដីកេនះ ឬទីកែន�ងែដល

ងេចទអចស�ិតេន  ្រត�វអនុវត�ដីកេនះ។  តុលករ្រត�វមានយុត�ធិករេលនីតិវិធីបណ�ឹង្រពហ�ទណ�េលបទេល�សមិនេគារពតមដីក  ក�ុងេខនធីែដលេកតមាន
ុ
ច
ករេល�សេលដីក ឬេនទីកែន�ងសេ្រមចេចញដីកេនះ។  អចមានករចប់ខ�ួនចុងេចទ ក�ុងករណីេល�សេលដីកេនះ េដយពុំចំបាច់មានដីកចប់ខ�ួនេឡយ។ េប
ងេចទរំេលភបំពនកថាខណ� 1 ដល់ 7 ែផ�កេលមូលេហតុគួរេជឿ េបេទះបីជាកររំេលភបំពនេនាះមិនបាន្រប្រពឹត� េពលប៉ូលីស ឬអជា�សលមានវត�មាន ឬ
ច
ុ
អវត�មាន ក៏េដយ។ 23 Pa. C.S. §6113។ 

បនា�ប់ពីករចប់ខ�ួន េហយេដយពុំចំបាច់មានដីកេឡយ ម�ន�ីអនុវត�ច្បោប់ ឬអជា�សល្រត�វរឹបអូសយកកំេភ�ង អវុធេផ្សងេទៀត និង្រគាប់ ែដលចុង
េចទកន់កប់ ែដលបានេ្រប ឬគំរមេ្រប ក�ុងអំឡុងេពលរំេលភបំពនដីករក្សោករពរេនះ ឬក�ុងអំឡុងេពលេកតេហតុករណ៍រំេលភបំពនពីមុន ្រពមទំងកំេភ�ង
ដៃទេទៀត ែដលចុងេចទកន់កប់។  

______________________________________________________________________________________ 

រសរេសរេឈ�ះ ឬមុខតំែណងែដលសម�សប) 
(
ូ
ច

្រត�វរក្សោកំេភ�ង អវុធេផ្សងេទៀត ឬ្រគាប់ រហូតទល់ែតមានដីកបែន�មពីតុលករ។ 

េនេពលចុងេចទ្រត�វបានចប់ខ�ួន េដយសរេល�សេលដីកេនះ។ ចុងេចទ្រត�វនាំេទអជា�ធរសម�សប  ែដល្រត�វេចទ្របកន់ចុងេចទេនចំេពះមុខ។ “ពក្យ

បណ�ឹងពីករមិនេគារពតមេដយ្របេយាល” ្រត�វបំេពញ និងចុះហត�េលខេដយម�ន�ីប៉ូលីសអជា�សល ឬេដមេចទ។ វត�មាន និងហត�េលខរបស់េដមេចទ 

នចំបាច់ េដម្បីដក់ពក្យបណ�ឹងេនះេទ។  
ិ
ម

ណ
ំ
ដ

ឹងភាគីទំងពីរពីកលបរិេច�ទសវនាករ។   

េបមានមូលដ�ន្រគប់្រគាន់េដម្បីេចទ្របកន់ពីបទេល�សនឹងដីកេនះ ចុងេចទ្រត�វេចទ្របកន់ កំណត់្របាក់ធានា ្របសិនេបវសម�សប េហយ្រត�វជូន

___________________________________________________           __________________________ 

 Judge / េច្រកម   

 Date / កលបរិេច�ទ 
 
 

BY THE COURT / េដយតុលករ 

This order was entered pursuant to the consent of Plaintiff and Defendant: 
បទប�� េនះ្រត�វបានសេ្រមចតមករយល់្រពមរបស់េដមេចទ និងចុងេចទ: 

__________________________________________ 
Plaintiff’s signature (ហត�េលខេដមេចទ) 

       

   _______________________________________________ 
    Defendant's signature (ហត�េលខចុងេចទ ) 

ENGLISH/KHMER PFA Final Order 

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

  Page 9 of 10 / ទំព័រ  9 ៃន 10

   AOPC Rev. 4-2019 

__________________________________________               ______________________________________________ 

Attorney for Plaintiff’s signature 
 (ហត�េលខេមធាវីេដមេចទ) 

 

Attorney for Defendant’s signature 
(ហត�េលខេមធាវីចុងេចទ) 

ENGLISH/KHMER PFA Final Order     

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

  Page 10 of 10 / ទំព័រ  10 ៃន 10

   AOPC Rev. 4-2019