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/ARABIC  PFA Temp. Order    
Pa. R.C.P. 1905(c) Rev. 3-19 

 
  Page 1 of 6 / 6 ﻦﻣ 1 ﺔﺤﻔﺻ 

  AOPC Rev. 4-2019 

 

ﺔﻌطﺎﻘﻤﻟ ﺔﻣﺎﻌﻟا ﺔﯿﺋاﺪﺘﺑﻻا ﺔﻤﻜﺤ

ﻤﻟا ﻲﻓ

 

ﺎﯿﻧﺎﻔﻠﺴﻨﺑ
 

__________________
     

ﻢﻗر 

 

ةءﺎﺳإ ﻦﻣ ﺔﯾﺎﻤﺤﺑ ﺖﻗﺆﻣ ﺮﻣأ
   
 
 

 لّﺪﻌﻣ ﺮﻣأ
  

ﻞﺟﺆﻣ

 

 

 

ﻲﻋﺪﻤﻟا

ﺪﺿ 

 

ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا

 

لوﻷا ﻢﺳﻻا

 

ﻲﻋﺪﻤﻟا دﻼﯿﻣ ﺦﯾرﺎﺗ

 

ﺔﻠﺋﺎﻌﻟا ﻢﺳا

 

ﻂﺳوﻷا

 ﻢﺳﻻا

  

لوﻷا
 

ﻢﺳﻻا

:دﻼﯿﻤﻟا ﺦﯾرﺎﺗو ﺮﺻﺎﻘﻟا (

لﺎﻔطﻷ

ا) ﻞﻔﻄﻟا ﻢﮭﯿﻓ

 

ﻦﻤﺑ

 ،ﻦﯿﯿﻤﺤﻤﻟا صﺎﺨﺷﻷا
 

ﻊﯿﻤﺟ

 (ءﺎﻤﺳأ) ﻢﺳا

 
 
 

_________________________________________________________
_________________________________________________________
_________________________________________________________    

 

 ﺔﯿﻓﺮﺣ ﺔﻘﺣﻻ

 

ﺔﻠﺋﺎﻌﻟا ﻢﺳا

 

ﻂﺳوﻷا ﻢﺳﻻا

ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا
 

فﺎﺻوأ

 
 
لﻮﻄﻟا
نزﻮﻟا
 
ﻦﯿﻨﯿﻌﻟا

 

 

ﺔﯾﻻﻮﻟا

 

دﻼﯿﻤﻟا ﺦﯾرﺎﺗ
 
ﺲﻨﺠﻟا
 
ق ْﺮِﻌﻟا
 
ﺮﻌﺸﻟا
ﻤﺘﺟﻻا نﺎﻤﻀﻟا ﻢﻗر
ﻲﻋﺎ
 
ةدﺎﯿﻘﻟا ﺔﺼﺧر ﻢﻗر
ﺎﮭ
ﺘﻧا ﺦﯾرﺎﺗ

ﺔﯿﺣﻼﺼﻟا ء

 

 

ﻟا ناﻮﻨﻋ
___________________________________________________

:ﮫﯿﻠﻋ
 

ﻰﻋﺪﻤ

 

 

 

___________________________________________________

 
 دﻮﺟﻮﻣ ح

حﻼﺳ كﺎﻨھ
ﻼﺳ كﺎﻨھ
ﻢﯿﻠﺴﺘﺑ ﺮﻣأ رﺪﺻ

 

 

ﻦﻜﺴﻤﻟا ﻲﻓ
 

 حﻼﺴﻟا

     

 
ﮫﯿﺒﻨﺗ
 
 
 

 

:ﮫﺒﺟﻮﻤﺑ ﺔﻤﻜﺤﻤﻟا ﺮﻣﺄﺗ
  نﺄﺑ
.ﮫﯿﻓ
 

 

.ﮫﯿﻟإ عﺎﻤﺘﺳﻼﻟ
 

ﻦﯿ

ﻟا ﺪﺠﺗ
ﻟﻮﻘﻌﻤﻟا ﺔﺻﺮﻔﻟاو رﺎﻌﺷﻹﺎﺑ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﺪﯾوﺰﺗ ﻢﺘﯿﺳو ،عﻮﺿﻮﻤﻟاو فاﺮطﻷا ﻰﻠﻋ ﺔﯿﺋﺎﻀﻘﻟا ﺔﯿﺣﻼﺼﻟا ﺎﮭﻟ نﺄﺑ

 ﺔﻤﻜﺤﻤ

ﮫﺒﺟﻮﻤﺑ

: 

 نوﺪﺟ

اﻮﺘﯾ ﺪﻗ نﺎﻜﻣ يأ ﻲﻓ هﻼﻋأ

 صﺎﺨﺷﻷ

ا ﻦﻣ يأ

 ﺪﺿ

 ﺔﯾﺪﺴﺠﻟا ةﻮﻘﻟا ماﺪﺨﺘﺳا ﺔﻟوﺎﺤﻣ وأ

 ﺪﯾﺪﮭﺗ

 وأ
 

 وأ ﺐّﻘﻌﺗ

ﺔﻘﯾﺎﻀﻣ

 وأ 

ةءﺎﺳﻹﺎﺑ مﻮﻘﯾ ﻻ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا
 

 ﻲﻤﺤﻣ ﺺﺨﺷ يأ وأ ،ﻲﻋﺪﻤﻟﺎﺑ لﺎﺼﺗﻻا ﻦﻣ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻊﻨﻤُﯾ ،ﺮﻣﻷا اﺬھ ﻦﻣ

5 
ﻟﺎﺛ فﺮط يأ ﻚﻟذ

 ةﺮﻘﻔﻟا ﮫﺑ ﺢﻤﺴﺗ
 ﺪﻗ 
 ﻲﻓ ﺎﻤﺑ ،ىﺮﺧأ
 
لﺎﺼﺗا

.ﺚ 

ﺎﻤﺒﺴﺣ ﺮﺻﺎﻘﻟا (لﺎﻔطﻷا) ﻞﻔﻄﻟﺎﺑ لﺎﺼﺗﻻا اﺪﻋ ﺎﻣ

 

ﻞﺋﺎﺳو
 

 يأ

وأ ﻒﺗﺎ

ﮭﻟا ﺔﻄﺳاﻮﺑ ،ﺮﻣﻷا اﺬھ
 

  
ﺐﺟﻮﻤﺑ

  ﺮﻣﻷا لﻮﻌﻔﻣ ءﺎﮭﺘﻧا ﺦﯾرﺎﺗ      

         

________________________________

ﺮﻣﻷا لﻮﻌﻔﻣ نﺎﯾﺮﺳ ﺦﯾرﺎﺗ

 

هﺎﻧ

دأ ﺔﻨّﯿﺒﻣ ﺮﻣﻷا اﺬﮭﻟ ﺔﯿﻓﺎﺿﻹا ﺞﺋﺎﺘﻨﻟا

  

 

___________________________________________________________________________________________________________

ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻰﻟإ رﺎﻌﺷإ 

ﮫﯿﻠﻋ ﺾﺒﻘﻟا
 ﺔﻣﺎﻗﻹا نﺎﻜﻣ ﻰﻟإ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا عﻮﺟر ﻰﻠﻋ ﻲﻋﺪﻤﻟا ﺔﻘﻓاﻮﻣ نإ

 ﻲﻓ ﮫﯿﻠﻋ صﻮﺼﻨﻤﻟا

ا ﻰﻠﻋ
 

 ﻮﺤﻨﻟ

 ﻰﻟإ يدﺆﯾ ﺪﻗ اﺬھ ﺔﻤﻜﺤﻤﻟا
 
. 23 Pa.C.S. §6114

ﻣﺘلﺎﺜ

 ﺮﻣﻷ 
 
ﻲﻓ ﮫﯿﻠﻋ صﻮﺼﻨﻤﻟا ﻮﺤﻨﻟا ﻰﻠﻋ

ﻹا مﺪﻋ

 

ﻻ 

 ﻦﻋ

 ﺞﺘﻨﯾ ﺪﻗ ﺚﯿﺣ

 ﺮﻣﻷا اﺬھ ﺔﻔﻟﺎﺤﻣ

23 Pa.C.S. § 6113 

 نﺎﯿﺼﻌﻟا
 ﻻإ ﮫﻠﯾﺪﻌﺗ وأ هﺮﯿﯿﻐﺗ ﻦﻜﻤﯾ ﻻ يﺬﻟا ،ﺮﻣﻷا اﺬھ ﻲﻐﻠﯾ
 ﺐﺠﯾ ﮫﻧﺈﻓ ،يرﺎﻧ حﻼﺳ ةزﺎﯿﺣ ﺔﺼﺧر وأ ةﺮﯿﺧذ وأ ىﺮﺧأ ﺔﺤﻠﺳأ وأ ﺔﯾرﺎﻧ ﺔﺤﻠﺳ
 ة
 ﻦﻜﻤﯾ

ﺳ يأ ﻢﯿﻠﺴﺘ
 رّﺬﻌﺗ لﺎﺣ ﻲﻓو
 .

ﺮﯿﺧذ وأ ﺮﺧآ حﻼﺳ يأ و
 وأ ﺔﯾرﺎﻨﻟا ﺔﺤﻠﺳﻷا
ﺑﺎﺘﻛ ةدﺎﮭﺸﺑ
 
نﻮﻧﺎﻘﻟا ذﺎﻔﻧﺈﺑ ﻲﻨﻌﻤﻟا ﺐﺳﺎﻨﻤﻟا زﺎﮭﺠﻟا
ﻒﯾﺮﺸﻟا
 ﺪﯾوﺰﺗ
 
ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻰﻠﻋ
 وأ
 
ﮫﺿ ّﺮﻌ
 
ﺮﻣﻷا اﺬھ ﺔﻔﻟﺎﺨﻣ نﺄﺑ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا غﻼ
 
ﺗ
 ﺪﻗ
ﺑإ ﻢﺘ
ﯾ ﺎﻤﻛ
 .
ﺮﻣﻷﺎﺑ
 
18 
 ،ءﺎﺴﻨﻟا
 
ﺪﺿ ﻒﻨﻌﻟا ﺔﺤﻓﺎﻜﻣ ن
18 U.S.C. § 922(g)(8) 

أ يرﺎﻧ حﻼ

ﻮﻧﺎﻘﻟ ًﺎﻘﺒط

ةدﺎﻌﺘﺳا

  و

 ﺔﯿ

 

ﺑ مﻮﻘﯾ نأ

 
 لﻼﺧ
دﺪﺼﻟا اﺬھ ﻲﻓ ﻦﻣﻵا ظﺎﻔﺤﻟا ﺔﺼﺧر ﻰﻠﻋ لﻮﺼﺤﻠﻟ تﺎﺒﻠﻄﺘﻤﻟا ﺔﻓﺎﻜﺑ ًﻻوأ ﺚﻟﺎﺜﻟا فﺮﻄﻟا

ﻣﻷا اﺬﮭﺑ ﮫﻏﻼﺑإ ﻦﻣ ﺔﻋﺎﺳ

ﮫﯿﻠﻋ ﻰﻋﺪﻤﻠ
ﻟ

 .ﺮ

 

أ يأ ﻢﯿﻠﺴﺗ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻦﻣ ًﺎﺑﻮﻠﻄﻣ نﺎﻛ اذإ .
 ،ﻚﻟﺬﻟ ﻞﯾﺪﺒﻛو
24 

23 Pa.C.S. §6108(g)

 .ضﺮﻐﻟا اﺬﮭﻟ ﺔﺒﺳﺎﻨﻣ ﺔﻤﻜﺤﻣ قاروأ

نﻮﻧﺎﻘﻟا ذﺎﻔﻧﺈﺑ ﻲﻨﻌﻤﻟا ﺐﺳﺎﻨﻤﻟا زﺎﮭﺠﻟا
ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا
 و
 ﺪﯿﻘﺘ
ﺘﻟ ةدﺪﺤﻤﻟا ةﺪﻤﻟا لﻼﺧ لﻮﻘﻌﻣ ﻞﻜﺸ
ﺑ ﻲﻟﺎﺤﻟا ﺎﮭﻨﯾﺰﺨﺗ ﻊﻗﻮﻣ ﻢﻜﺤﺑ ةﺮﯿﺧﺬ
 
و
 ةﺮﯿﺧﺬﻟا وأ ىﺮﺧﻷا ﺔﺤﻠﺳﻷا وأ ﺔﯾرﺎﻨﻟا ﺔﺤﻠﺳﻷا ﺎﮭﯿﻓ

ﯾ نأ ﺔﻄﯾﺮﺷ ﺚﻟﺎﺛ فﺮط ﻰﻟإ ﺎﻨھ

ﻲﻟﺎﺤﻟا ﺎﮭﻧﺎﻜﻣ

 وأ

 

 ﺎھﺪﻨﻋ ،ﺎﮭﻤﯿﻠﺴ

ﮫﻏﻼﺑإ ﻢﺘﯾ نأ ﺪﻌﺑ ﺔﻋﺎﺳ
24 
ﺐﺟﻮﻤﺑ
 
ﺔﯿﻟارﺪﻓ
 
ﺔﯿﺋﺎﻨﺟ

 زوﺎﺠﺘ
 

ﺗ ﻻ ةﺪ
ﻣ لﻼﺧ
تﺎﺑﻮﻘﻋو ﻢﮭﺗو
 

18 Pa.C.S. § 6105 

 ﺐﺟﻮﻤﺑ

 ﺎﯿﻧﺎﻔﻠﺴﻨﺒ

 
ﻒﯾﺮﺸﻟا

 نﺄﺑ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا غﻼﺑإ ﮫﺒﺟﻮﻤﺑ ﻢﺘﯾ
 ﺮﺷﺎﺒﻤﻟا ﺮﯿﻏ ﻲﺋﺎﻨﺠﻟا
 
ﯾﺈﺑعاﺪ
 ﻰﻟإ ﺎﮭﻤﯿﻠﺴﺗ
ةرﻮﻛﺬﻣ
ﻟا وأ ىﺮﺧﻷا ﺔﺤﻠﺳﻷا
جرﺪﯾ
تﺎﺑﻮﻘﻌﻟ
U.S.C. §§2261-2262

ﻟ تﺎﯾﺎﻨﺠﻟا ن
. 

ﻮﻧﺎﻗ ﻰﻀﺘﻘﻤﺑ
 

 

ENGLISH/ARABIC  PFA Temp. Order 
Pa R.C.P. 1905(c) Rev. 3-19 

Page 2 of 6 / 6 

 ﻦﻣ 2  ﺻﻔﺔﺤ

  

AOPC Rev. 4-2019 

ND NOW, this ____________ day of ______________, 20___, 

 

ﺮﻈﻧ

upon consideration of the attached Petition for Protection from 
Abuse, the court hereby enters the following Temporary Order: 
 

  Plaintiff’s request for a Temporary Protection Order is 

______________

 ﺪﻌﺑو ،
:ﻲﻟﺎﺘﻟا ﺖﻗﺆﻤﻟا ﺮﻣﻷا ﮫﺒﺟ
 

 
ﻮﻤﺑ ﺔﻤﻜﺤﻤﻟا رﺪﺼﺗ ،ﻖﺤﻠﻤﻟا
 

______________
ةءﺎﺳﻹا

ﺷ ﻦﻣ

ﺮﮭ

مﻮﯿﻟا اﺬھ ﻲﻓ ،نﻵاو
 ﻦﻣ ﺔﯾﺎﻤﺤﻟا سﺎﻤﺘﻟا

  

 

 

.ﺖﻗﺆﻣ ﺔﯾﺎﻤﺣ ﺮﻣأ ﻰﻠﻋ لﻮ

ﺼﺤﻠﻟ ﻲﻋﺪ

ﻤﻟا ﺐﻠط
 

   ﺾﻓر

  Plaintiff’s request for a Temporary Protection Order is 

 

.ﺖﻗﺆﻣ ﺔﯾﺎﻤﺣ ﺮﻣأ ﻰﻠﻋ لﻮﺼﺤﻠﻟ
 

ﻲﻋﺪﻤﻟ

ا ﺐﻠط

ﻠﻋﻰ 

 ﺔﻘﻓاﻮﻤﻟا

denied. 

granted. 

 

 
 
  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: 
_________________________________________________ 
 

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: 

        ________________________________________________ 
       ________________________________________________ 

 
  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. 

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

 ﺔﻟوﺎﺤﻣ وأ
 
 وأ ﻌﺗﺐﻘ
.ﮫﯿﻓ نوﺪﺟاﻮﺘﯾ نﺎﻜﻣ يأ ﻲﻓ هﻼﻋأ صﺎﺨﺷﻷا ﻦﻣ يأ
 
  

ﻀﻣ وأ ةءﺎﺳ

ﺪﯾﺪﮭﺗ وأ
 

ﺔﻘﯾﺎ

ﻹا مﺪﻋ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻰﻠﻋ

 1 .

ﺔﯾﺪﺴﺠﻟا ةﻮﻘﻟا ماﺪﺨﺘﺳا

 
   2
_____________________________________________________

ﻟا ﻦﻣ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا دﺎﻌﺑإو دﺮط ﻢﺘﯾ .

ﻤﻦﻜﺴ 

ﻊﻗاﻮﻟا

:ﻲﻓ

 

 

 

 ﻲﻤﺤﻣ ﺮﺧآ ﺺﺨﺷ يأ وأ ﻲﻋﺪ
 ﺲﯿﻟ .
 يأ
 
ﮫﯿﻠﻋ ﻰﻋ
ﺪﻤﻠﻟ
 ﻲﻤﺤﻣ ﺺﺨﺷ يأ
 
ﻦﻜﺴﻣ

ﻤﻟا ﺶﯿ
ﻌﯾ ﺚﯿﺣ
ﻦﻜﺴﻤﻠﻟ ﺔﯾﺮﺼﺣ ةزﺎﯿﺣ
 
وأ ﻲﻋﺪﻤﻟا ﻦﻜﺴﻣ ﻲﻓ

 ﺖﻗﺆﻣ وأ ﻢﺋاد ﻦﻜﺴﻣ يأ

 ﺮﺧآ
 ﻲﻋﺪﻤﻟا ﺢﻨﻤُﯾ .ﺮﻣﻷا
 
ﺪﺟاﻮﺘﻟا
ﻟﻠ

وأ 
 اﺬھ ﺐﺟﻮﻤﺑ
 زﺎﯿﺘﻣا وأ ﻖﺣ
 .ﺮﻣﻷا اﺬھ ﺐﺟﻮﻤﺑ

 وأ لﻮﺧﺪ
 

 ًﺎ 
 ﺐﺴﺣ ﮫﺑ
ﺣﻮﻤﺴﻣ نﻮﻜﯾ ﺪﻗ يﺬﻟا ﺮﺻﺎﻘﻟا (لﺎﻔطﻷا) ﻞﻔ
 وأ ﻲﻋﺪﻤﻟﺎﺑ
ﺑ
 
 ﺺﺨﺷ يﺄ
نﺎﻜﻣ يأ ﻲﻓ ،ﺮﺷﺎﺒﻣ
 ﺎﻤﺑ ،
أ ﻲﻋﺪﻤﻟا ﺔﺳرﺪﻣ ﻲﻓ
 ﮫﻠﻤﻋ و
 ﺔﯿﻟﺎﺘﻟا ﻊﻗاﻮﻤﻟا ﻦﻋ ًاﺪﯿﻌﺑ ءﺎﻘﺒﻟﺎﺑ
ًاﺪﯾﺪﺤﺗ
 

لﺎﺼﺗا يأ
 ﺮﯿﻏ
 لﺎﺼﺗا يأ ،ﺮﺼﺤﻟا
 

ﻄﻟﺎﺑ لﺎﺼﺗﻻا اﺪﻋ ﺎﻣ .
 ةﺮﻘﻔﻟا
 وأ ةﺮﺷﺎﺒﻣ ءاﻮﺳ ،ﺮﻣﻷا اﺬھ ﺐﺟﻮﻤﺑ ﻲﻤﺤﻣ
ﺲﯿﻟو لﺎﺜﻤﻟا ﻞﯿﺒﺳ ﻰﻠﻋ ،ﻚﻟذ ﻲﻓ
ﮫﺘﻔﯿظو نﺎﻜﻣ وأ
:ﺮﻣﻷا اﺬھ نﺎﯾﺮﺳ لاﻮط

 ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﺮﻣأ ﻢﺘﯾ ﺎﻤﻛ .

 ﻊﻨﻤُﯾ ،ﺮﻣﻷا اﺬھ ﻦﻣ

 ﻦﻣ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا

 ﻞﻜﺸﺑ

5 

  

 3

 

 
       ________________________________________________
       ________________________________________________

 
 

 ﺐﺴﺣ ﮫﺑ

 ًﺎ 
ﺣﻮﻤﺴﻣ نﻮﻜﯾ ﺪﻗ يﺬﻟا ﺮﺻﺎﻘﻟا (لﺎﻔطﻷا) ﻞﻔﻄﻟﺎﺑ لﺎﺼﺗﻻا اﺪﻋ ﺎﻣ
 ﺺﺨﺷ يأ وأ ،ﻲﻋﺪﻤﻟﺎﺑ لﺎﺼﺗﻻا
 ةﺮﻘﻔﻟا
 ﺮﺒﻋ ﻚﻟذ ﻲﻓ ﺎﻤﺑ ،ىﺮﺧأ ﺔﻠﯿﺳو يأ وأ ﻒﺗﺎﮭﻟا ﺔﻄﺳاﻮﺑ ،ﺮﻣﻷا اﺬھ ﺐﺟﻮﻤﺑ ﻲﻤﺤﻣ
.ﺔﺜﻟﺎﺛ فاﺮطأ

 ،ﺮﻣﻷا اﺬھ ﻦﻣ

 ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا
 

ﻊﻨﻤُﯾ

ﻣ ﻦ

5 

 

 4 .

ﺔﻧﺎﻀﺤﻟا .

 5

 

parties: ________________________________________ 
____________________________________________________ 
____________________________________________________                                            

(county court and docket number) 

:  

 

ﻲﻟﺎﺘﻟﺎﺑ

ﻦﯿﻓﺮﻄﻟا

 ﺪﯿﻔﯾ ﻮھو

 (لﺎﻔطأ) ﻞﻔط صﻮﺼﺨﺑ
 
 كﺎﻨھ
__________________________________________________ 
________________________________________________________ 
__________________________________________________________    

ﺔﻧﺎﻀﺤﻟﺎﺑ

 ﻲﻟﺎﺣ 

ﺮﻣأ

 

(ﺔﯿﻀﻘﻟا ﻢﻗ

رو ﺔﻌطﺎﻘﻤﻟا ﺔﻤﻜﺤﻣ)

                                         

 
  THIS ORDER SHALL NOT SUPERSEDE THE CURRENT 

CUSTODY ORDER. 

  THIS ORDER SUPERSEDES ANY PRIOR ORDER 

RELATING TO CHILD CUSTODY. 

. 

ﻲﻟﺎﺤﻟا ﺔﻧﺎﻀﺤﻟا
 

ﺮﻣأ

 ﻞﻄﺒُﯾ ﻻ ﺮﻣﻷا اﺬھ

 

.ﻞﻔﻄﻟا ﺔ

ﻧﺎﻀﺣ ﺺﺨﯾ ﺎ

 ﻖﺑﺎﺳ ﻤﯿﻓ

ﺮﻣأ

 يأ ﻞﻄﺒُﯾ ﺮﻣﻷا اﺬھ

 
 
 

 

 

 

 

 

 

 

 

 

ENGLISH/ARABIC  PFA Temp. Order 
Pa R.C.P. 1905(c) Rev. 3-19 

 

 

 

 

 

 

 

Page 3 of 6 / 6 

 ﻦﻣ 3  ﺻﻔﺔﺤ

  

 

 

 

 

 

 

AOPC Rev. 4-2019 

 

      A

     

 ﻞﻔﻄﻟاو ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻦﯿﺑ تﻻﺎﺼﺗﻻا ﻊﯿﻤﺟ
 
 

نﻮﻜﺗ
______________________________

 ،ﺔﯿﺋﺎﮭﻨﻟا عﺎﻤﺘﺳﻻا ﺔﺴﻠﺟ ﻰﺘﺣ
:ﻲﻟﺎﺘﻟ
ا
 ﻮﺤﻨﻟا ﻰﻠﻋ (لﺎﻔطﻷا)

 

 
 
 
 

       _________________________________________________
       _________________________________________________
       _________________________________________________
       _________________________________________________
 
 ﻟإ
       

ﻲﻋﺪﻤﻟا ﺢﻨﻤُﯾ ،عﻮﺿﻮﻤﻟا اﺬھ ﻲﻓ ﺔﯿﺋﺎﮭﻨﻟا عﺎﻤﺘﺳﻻا ﺔﺴﻠﺟ ﺔﺠﯿﺘﻧ روﺪﺻ ﻦﯿﺣ ﻰ
ﻲﻟﺎﺘﻟا ﺮﺻﺎﻘﻟا
 
(لﺎﻔطﻷا) ﻞﻔﻄﻠﻟ ﺔﺘﻗﺆﻤﻟا ﺔﻧﺎﻀﺤﻟا ﻖﺣ

 

: 

 

______________________________________________
       ______________________________________________

 

 

 ﺪﺟاﻮﺘﯾ

 ﺚﯿﺣ ﻲﺋﺎﻀﻘﻟا صﺎﺼﺘﺧﻻا

 دﻮﻨﺑ ﻰﻀﺘﻘﻤﺑ ﻲﻋﺪﻤﻟا فاﺮﺷإ ﺖﺤﺗ

 ﺔﻘﻄﻨﻣ

 ﻲﻓ
 
و ﺔﯾﺎﻨﻋ ﻲﻓ (لﺎﻔطﻷا) ﻞﻔﻄﻟا
 

نﻮﻧﺎﻘﻟا ﻖﯿﺒﻄ
ﻊﺿو

ﺔﯿﻠﺤﻤﻟا
 

ﺔﺌﯿھ ﺗ

 
 ﻦﻤﻀﺘﺳ
 (لﺎﻔطﻷا) ﻞﻔﻄﻟا
.ﺮﻣﻷا اﺬھ

 

 

ةﺮﯿ

أواﺧﺬﻟ

 ،ىﺮﺧ

ﻷا ﺔﺤﻠﺳﻷا ،ﺔﯾرﺎﻨﻟا ﺔﺤﻠﺳﻷا دﻮﯿﻗ .

 6

 
ﻣﻷﺮ. 

 ﺬھا ا

 ﺮﺳنﺎﯾ

لاﻮط ﺔﯾرﺎﻧ ﺔﺤﻠﺳأ يأ
 

ءﺎﻨﺘﻗا

 وأ كﻼﺘﻣا ﻦﻣ عﻮﻨﻤﻣ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا

 

:ﺐﺳﺎﻨﻤﻟا ﻊﺑﺮﻤﻟا ﻰﻠﻋ ﺔﻣﻼﻋ ﻊﺿ

 ﺺ
 
ﺧ ُر

 

نﻮﻧﺎﻘﻟا ذﺎﻔﻧﺈﺑ ﻲﻨﻌﻤﻟا ﺐﺳﺎﻨﻤﻟا زﺎﮭﺠﻟا
ةزﺎﯿﺣ ﻲﻓ نﻮﻜﺗ

.ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا
 

 

ﻒﯾﺮﺸﻟا

 وأ
 
 وأ ﺎﮭﻜﻠ
ﻤﯾ ﻲﺘﻟا
________
 

 ﻢﯿﻠﺴﺗ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻰﻠ
 
ﺔﯿﻟﺎﺘﻟا
 
ﺔﯾرﺎﻨ
ﺳﻷا
______________

ﻟا ﺔﺤﻠ

 يأ
 
أ، اﻤﻟرﺪج 

نﻮﻧﺎﻘﻟا ذﺎﻔﻧﺈﺑ ﻲﻨﻌﻤﻟا ﺐﺳﺎﻨﻤﻟا زﺎﮭﺠﻟا

 وأ
 

ﻒﯾﺮﺸﻟا

 ﺖﻗﺆﻤﻟا ﺮﻣﻷا ﻖﺤﻠﻣ ﻲﻓ ةرﻮﻛﺬﻣ ةﺮﯿﺧذ وأ ىﺮﺧأ

ﮫﯿ. 

ﻠﻋ ﻰﻋﺪﻤﻟا ةزﺎﯿﺣ ﻲﻓ وأ ةﺮﻄﯿﺳ ﺖﺤﺗ ،

 

 ﻢﯿﻠﺴﺘﺑ ﮫﯿﻠﻋ

ﻰﻋﺪﻤﻟا ﺮﻣﺆُﯾ
 ﺔﺤﻠﺳأ وأ ﺔﯾرﺎﻧ ﺔﺤﻠﺳأ
ﻹﺎﺑ ﺎﻨھ

ةرﺎﺷ

  
 
 ﻋ

 
  

 

 .

 وأ 

دﺪﺼﻟا ا

 ﻰﻠﻋ لﻮﺼﺤﻠﻟ تﺎﺒﻠﻄ

نﻮﻧﺎﻘﻟا ذﺎﻔﻧﺈﺑ ﻲﻨﻌﻤﻟا ﺐﺳﺎﻨﻤﻟا زﺎﮭﺠﻟا

 ﻰﻋﺪﻤﻟا ﻦﻜﻤﯾ ،ﻚﻟﺬﻟ ﻞﯾﺪﺒﻛو
 ﺔﻄﯾﺮﺷ ﺚﻟﺎﺛ فﺮط ﻰﻟإ
 

ةﺮﯿﺧذ وأ ﺮﺧآ حﻼﺳ يأ وأ يرﺎﻧ حﻼﺳ
ﺘﻤﻟا ﺔﻓﺎﻜﺑ ًﻻوأ ﺚﻟﺎﺜﻟا فﺮﻄﻟاو

 ﻰﻟإ ةﺮﯿﺧذ وأ ىﺮﺧأ ﺔﺤﻠﺳأ وأ ﺔﯾرﺎﻧ ﺔﺤﻠﺳأ يأ ﻢﯿﻠﺴﺗ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻠﻟ ﻦﻜﻤﯾ
ﻒﯾﺮﺸﻟا
 يأ ﻢﯿﻠﺴﺗ ﮫﯿﻠﻋ
ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا
 
ﺪﯿﻘﺘﯾ نأ
ﺬھ ﻲﻓ ﻦﻣﻵا ظﺎﻔﺤﻟا ﺔﺼﺧر
 ﺔﺼﺧر يأ و ةﺮﯿﺧذ وأ ﺮﺧآ حﻼﺳ يأ و يرﺎﻧ
ﻟ
 زوﺎﺠﺘﺗ ﻻ ةﺪﻣ لﻼﺧ ﺮﻣﻷا
ةدﺎﻌﺘﺳا
 ﻲﻟﺎﺤﻟا
 ﺪﯾوﺰﺗ
 ةﺮﯿﺧﺬﻟا وأ ىﺮﺧﻷا ﺔﺤﻠﺳﻷا وأ ﺔﯾرﺎﻨﻟا ﺔﺤﻠﺳﻷا ﺎﮭﯿﻓ
وﺎﺠﺘﺗ ﻻ
حﻼﺳ يأ وأ يرﺎﻧ
دﺪﺤﻤﻟا
 ،ﺪﺣﻮﻤﻟا ﺔﯾرﺎﻨﻟا ﺔﺤﻠﺳﻷا

 ﻢﯿﻠﺴﺗ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻰﻠﻋ ﺐﺠﯾ .
 حﻼﺳ يأ
 اﺬھ ﺐﺟﻮﻤﺑ
 
يرﺎﻧ حﻼﺳ ةزﺎﯿﺤ
 رّﺬﻌﺗ لﺎﺣ ﻲﻓو .
ﺮﻣﻷا
ﻷا ﺔﺤﻠﺳﻷا وأ ﺔﯾرﺎﻨﻟا ﺔﺤﻠﺳﻷا
 
 ﺎﮭﻨﯾﺰﺨﺗ ﻊﻗﻮﻣ ﻢﻜﺤﺑ ةﺮﯿﺧﺬﻟا وأ ىﺮﺧ
 ﺎھﺪﻨﻋ ،ﺎﮭﻤﯿﻠﺴﺘﻟ ةدﺪﺤﻤﻟا ةﺪﻤﻟا لﻼﺧ لﻮﻘﻌﻣ ﻞﻜﺸﺑ
 
ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻰﻠﻋ
 جرﺪ
ﯾ ﺔﯿﺑﺎﺘﻛ ةدﺎﮭﺸﺑ
 
ﻒﯾﺮﺸﻟا
 ةﺪﻣ لﻼﺧ
 
 حﻼﺳ يأ ﻢﯿﻠﺴﺘﺑ
 ﺖﻗﻮﻟا ﻲﻓ
 
 نﻮﻧﺎﻗ ﻰﻀﺘﻘﻤﺑ ﺔﯿﺋﺎﻨﺟ ﺔﻧادإ ﮫﻨﻋ ﻢﺠﻨﯾ ﺪﻗو

ﺔﻋﺎﺳ
ﮫﻏﻼﺑإ ﻢﺘﯾ نأ ﺪﻌﺑ
 
ﻟ
 ﺔﺼﺧر يأ وأ ةﺮﯿﺧذ وأ ﺮﺧآ
 
 
ﺮﻣﻷا
 اﺬھ ﺔﻔﻟﺎﺨﻣ ﻰﻟإ يدﺆﯾ
 
. 
18 Pa.C.S. §6105

نﻮﻧﺎﻘﻟا ذﺎﻔﻧﺈﺑ ﻲﻨﻌﻤﻟا ﺐﺳﺎﻨﻤﻟا زﺎﮭﺠﻟا

 اﺬﮭﺑ ﮫﻏﻼﺑإ ﺪﻌﺑ ﺔﻋﺎﺳ

يرﺎﻧ حﻼﺳ ةزﺎﯿﺤ

 مﺎﯿﻘﻟا مﺪﻋ نإ .

ﻲﻟﺎﺤﻟا ﺎﮭﻧﺎﻜﻣو

ﺮﻣﻷﺎﺑ
 

 ز24 

24 

 وأ
 

 
  Until the final hearing, all contact between Defendant and the 
child/ren shall be limited to the following: ______________ 
       _________________________________________________ 
       _________________________________________________ 
       _________________________________________________ 
       _________________________________________________ 
 
  Pending the outcome of the final hearing in this matter, 
Plaintiff is awarded temporary custody of the following 
minor child/ren: 
______________________________________________ 
       ______________________________________________ 

 
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. 
 
  6.  FIREARMS, OTHER WEAPONS, OR 
AMMUNITION RESTRICTIONS 

 
Check all that apply: 
 
  Defendant is prohibited from possessing or  
       acquiring any firearms for the duration of this order. 
  Defendant shall relinquish to the sheriff or the appropriate 
law enforcement agency the following firearm licenses 
owned or possessed by Defendant. ___________________ 

 
  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 

 
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. 

 

 

 

 

       

       ______________________________________________ 

       ______________________________________________

ENGLISH/ARABIC  PFA Temp. Order 
Pa R.C.P. 1905(c) Rev. 3-19 

 

 

 

 

 

 

 

Page 4 of 6 / 6 

 ﻦﻣ 4  ﺻﻔﺔﺤ

  

 

 

 

 

 

 

AOPC Rev. 4-2019 

َ
  7.  The following additional relief is granted: 

: 

ﻲﻟﺎﺘﻟا ﻲﻓ

ﺎﺿﻹا فﺎﺼﻧﻹا

 ﺢﻨﻤُﺗ

 7. 

  

  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: 

، 

18 Pa.C.S. §2709.1
 ﺔﻠﺋﺎﻌﻟا
 

داﺮﻓأ

، 

ﺮﻌﻣ ﻮھ ﺎﻤﻛ ،ﺐّﻘﻌﺗ ﻦﻣ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻊﻨﻤُﯾ
 ةدﺎﻤﻟا ﻲﻓ ف
 
 
18 Pa.C.S. §2709
 ةدﺎﻤﻟا ﻲﻓ ف ّﺮﻌﻣ ﻮھ ﺎﻤﻛ ،ﺔﻘﯾﺎﻀﻣ وأ
 
:ﻦﯿﯿﻟﺎﺘﻟا لﺰﻨﻤﻟاو

  

Name / ﻢﺳﻻا 

Address (optional) / (يرﺎﯿﺧ) ناﻮﻨﻌﻟا 

Relationship to Plaintiff / 
ﻲﻋﺪﻤﻟﺎﺑ ﺔﻗﻼﻌﻟا 

  Other relief: ___________________________________ 
      _____________________________________________ 
      _____________________________________________ 
      _____________________________________________ 
     ______________________________________________ 

:ىﺮﺧﻷا

 ____________________________

 
      ______________________________________________
      ______________________________________________
      ______________________________________________
      _____________________________________________ 

 فﺎﺼﻧﻹا لﺎﻜﺷأ

  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. 

 ﻲﻋﺪﻤﻟا ﺔﻘﻓاﺮﻣ
 ﻢﯾ

 
ﻒﯾﺮﺸﻟا
ﺪﻘﺗ ءﺎﻨﺛأ ﻲﻋﺪﻤﻟا

 وأ ﺔﯾﺪﻠﺒﻟا ﺔطﺮﺸﻟا وأ ﺎﯿﻧﺎﻔﻠﺴﻨﺑ ﺔﯾﻻو ﺔطﺮﺷ
ﺔﻘ 

 ﻰﻠﻋ ﺐﺠﯾ
ﻓاﺮﻤﻟ وأ ﺔﯿﺼﺨﺸﻟا ﻢﮭﺗﺎﻘﻠﻌﺘﻣ ةدﺎﻌﺘﺳﻻ ﮫﺘﻣﺎﻗإ ﻞﺤﻣ ﻰﻟإ
سﺎﻤﺘﻟﻻا

 ﺪﺿ ﺮﻣﻷا وأ
 

ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا

. 

 8. 

  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) 
______________________________________________ 
_______________________________________________ 

ﻒﯾﺮﺸﻟا
 ﻢﯿﻘﯾ ﺚﯿﺣ ﺔطﺮﺸﻟا ﻢﺴﻗ وأ
 
: 
ﻲﻠﯾ

 ﻰﻟإ ﺮﻣﻷا اﺬھ
 ﻦﻣ 
 ﺎﻤﯿﻓ ةدﺪﺤﻤﻟا ىﺮﺧﻷا
 

ةﺪﻤﺘﻌﻣ
 ﻢﯿﻠﺴﺗ ﻢﺘﯾ
 
ﺔﺨﺴﻧ
تﺎﺌﯿﮭﻟا
 ﻦﻣ يأو ﻲﻋﺪﻤﻟا

 9. 

_________________________________________________ 
_________________________________________________ 

  10.  THIS ORDER SUPERSEDES ANY PRIOR 

 ﺪﺿ ﮫﺗاذ ﻲ

ﻋﺪﻤﻟا ﮫﯿﻠﻋ ﻞﺼﺣ

 ﻖﺑﺎﺳ

 ةءﺎﺳإ ﻦﻣ ﺔﯾﺎﻤﺣ ﺮﻣأ يأ ﺮﻣﻷا اﺬھ ﻞ ِﻄﺒُﯾ .

 10
ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا

 

.ﮫﺗاذ

 

  

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

  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. 

 وأ ﮫﻠﯾﺪﻌﺗ ﻢﺘﯾ
 

ﻰﻘﺒﯾو ﮫﯿﻠﻋ ﻰ

 لﻮﻌﻔﻤﻟا يرﺎﺳ
 
ﺘﺣ وأ
ﻚﻟذ اﺪﻋ
ﻰ 
 
 
.عﺎﻤﺘﺳا ﺔﺴﻠﺟو رﺎﻌﺷإ ﺪﻌﺑ ﺔﻤﻜﺤﻤﻟا

ﻋﺪﻤﻟا ﻰﻠﻋ ًارﻮﻓ ﺮﻣﻷا اﺬھ يﺮﺴﯾ
___________________________
هؤ 

 ﻞﺒﻗ ﻦﻣ

 11 .
ﻰﺘﺣ
ﺎﻐﻟإ

 هﺬھ

 

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 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/ARABIC  PFA Temp. Order 
Pa R.C.P. 1905(c) Rev. 3-19 

Page 5 of 6 / 6 

 ﻦﻣ 5  ﺻﻔﺔﺤ

  

AOPC Rev. 4-2019 

ّ
ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻰﻟإ رﺎﻌﺷإ 

 
ﻔ
ﺔ
ﻦﻋ ﺞﺘﻨﯾ ﺪﻗ ﺚﯿﺣ
ﺤﻣ
ﺎ
ﻟ
 
 
23 Pa.C.S. § 6113 
صﻮﺼﻨﻤﻟا ﻮﺤﻨﻟا ﻰﻠﻋ
 
ﻋ
ﯿ
ﻠ
ﮫ
 
ﻓ
ﻲ
 
يدﺆﯾ ﺪﻗ اﺬھ ﺔﻤﻜ
ﻋﮫﯿﻠ 
ا
 
ﻟ
ﻘ
ﺒ
ﺾ
 
إ
 
ﻟ
ﻰ
ﻹ
ﻰﻋﺪﻤﻟا غﻼﺑإ ﮫﺒﺟﻮﻤﺑ ﻢﺘﯾ
مﺪﻋﻣﺘلﺎﺜ ﺮﻣﻷ ﻤﻟاﺤ
 
ا
 
ﻋ
ﯿ
ﻠ
ﮫ
ﺑ
 
ﺄ
ن
 
ﺬھ ﻲﻐﻠﯾ
ا
 
 
ﻻ
 
ﺔﻣﺎﻗﻹا نﺎﻜﻣ ﻰﻟإ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا عﻮﺟر ﻰﻠﻋ ﻲﻋﺪﻤﻟا ﺔﻘﻓاﻮﻣ نإ
 
. 23 Pa.C.S. §6114
 
ﻲ
صﻮﺼﻨﻤﻟا ﻮﺤﻨﻟا ﻰﻠﻋ
 
ﻋ
ﻠ
ﯿ
ﮫ
 
ﻓ
ﺮﺷﺎﺒﻤﻟا ﺮﯿﻏ ﻲﺋﺎﻨﺠﻟا نﺎﯿﺼﻌﻟا
 
ﺮﻣﻷا اﺬھ
 
. 
 
23 Pa.C.S. §6108(g)
ﺪﻌﺗ وأ هﺮﯿﯿﻐﺗ ﻦﻜﻤﯾ ﻻ يﺬﻟ
ﯾ
ﻠ ﻻإ ﮫ
ﺪ
ضﺮﻐﻟا اﺬﮭﻟ ﺔﺒﺳﺎﻨﻣ ﺔﻤﻜﺤﻣ قاروأ
.
 
 
ع
ﺑ
ﺈ
ﯾ
ا
ا
 
ﺮﻣﻷا
،
ﻰﻋﺪﻤﻟا ﻦﻣ ًﺎﺑﻮﻠﻄﻣ نﺎﻛ اذإ
ذ
 
  وأ
ﻒ
 
ﺔﺼﺧر وأ ةﺮﯿﺧذ وأ ىﺮﺧأ ﺔﺤﻠﺳأ وأ ﺔﯾرﺎﻧ ﺔﺤﻠﺳ
ي
ﯿ
ﻠ
ﺗ
ﻌﻤﻟا ﺐﺳﺎﻨﻤﻟا زﺎﮭﺠﻟا
ﻨ
ﻲ
 
ﺈ
ﺑ
ﻧ
ﻔ
ﺎ
ﺮﺸﻟا
ﯾ
ﮭﻤﯿﻠﺴﺗ ﺐﺠﯾ ﮫﻧﺈﻓ ،يرﺎﻧ حﻼﺳ ةزﺎ
 
ﺎ
إ
ﻟ
ﻰ
 
ﺣ
ﯿ
 
ﻋ
ﯿ
ﻠ
ﮫ
 
ﺴ
ﻢ
 
أ
 
أ
ﺔﻄﯾﺮﺷ ﺚﻟﺎﺛ فﺮط ﻰﻟإ ﺎﻨھ
 
ة
رﻮﻛﺬﻣ ة
ﺮ
ﺧذ وأ ﺮﺧآ حﻼﺳ يأ وأ يرﺎﻧ حﻼﺳ يأ ﻢﯿﻠﺴﺘ
ﯿ
ﻏﻼﺑإ ﻦﻣ ﺔﻋﺎﺳ
 
لﻼﺧ24 
اﻘنﻮﻧﺎ 
ﻟ
 
مﻮﻘﯾ نأ
 
 
ﺑ
ﮫ
ﻰﻋﺪﻤﻠ
 
ﻋ
ﯿ
ﻠ
ﻟ
ﻦﻜﻤﯾ
 
 
ﻛو
 
ﺒ
ﺪ
ﯾ
ﻞ
ﻟ
 
ﺬ
ﻟ
ﻚ
،
ﺮﻣﻷا اﺬﮭﺑ
.
 
ﮫ
ّ
دﺪﺼﻟا اﺬھ ﻲﻓ ﻦﻣﻵا ظﺎﻔﺤﻟا ﺔﺼﺧر ﻰﻠﻋ لﻮﺼﺤﻠﻟ تﺎﺒﻠﻄﺘﻤﻟا ﺔﻓﺎﻜﺑ ًﻻوأ ﺚﻟﺎﺜﻟا ف
ىﺮﺧﻷا ﺔﺤﻠﺳﻷا وأ ﺔﯾرﺎﻨﻟ
أ
 
و
 
ا
ﺔﺤﻠﺳﻷا
 
 
ا
 
ﺳ
ﺘ
ﻌ
ﺎ
د
ة
ﺬﻌﺗ لﺎﺣ
ر
.ﻲﻓو 
 
وﺮﻄﻟا
 
ﮫ
ﻰﻋﺪﻤﻟا
 
ﻋ
ﻠ
ﯿ
ﺘ
ﻘ
ﯿ
ﺪ
 
أ
ن
 
ﯾ
ﺔ
 
ا
ﻟ
 
 
 
دﺪﺤﻤﻟا ةﺪﻤﻟا لﻼﺧ لﻮﻘﻌﻣ ﻞﻜﺸﺑ ﻲﻟﺎﺤﻟا ﺎﮭﻨﯾﺰﺨﺗ ﻊﻗﻮﻣ ﻢﻜﺤﺑ ةﺮﯿﺧﺬﻟا
ة
 
ﯿ
ﮭﺸﺑ
 
ﺎ
د
ة
 
ﻛ
ﺎ
ﺘ
ﺑ
نﻮﻧﺎﻘﻟا ذﺎﻔﻧﺈﺑ ﻲﻨﻌﻤﻟا ﺐﺳ
ﮭﺠﻟا
ﺎ
ز
ﻤ
ﺎ
ﻨ
  وأ
ﺮﺸﻟا
ﯾ
ﻒ
وﺰﺗ
ﯾ
ﺪ
 
ﮫ
ﻰﻋﺪﻤﻟا ﻰﻠﻋ
ﻋ
ﯿ
ﻠ
ﮭﻤﯿﻠﺴ
ﺎ
،
 
ﻋ
ﻨ
ﺪ
ھ
 
ﺎ
ﻟ
ﺘ
ﺬھ ﺔﻔﻟﺎﺨﻣ نﺄﺑ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا غﻼﺑإ ﻢﺘﯾ ﺎﻤﻛ
ا
 
 
 
ﻟ
 
و
ﺧﺬﻟا وأ ىﺮﺧ
ﯿ
ﺮ
ة
ﺔﺤﻠﺳﻷا وأ ﺔﯾرﺎﻨﻟا ﺔﺤﻠﺳﻷا ﺎﮭﯿﻓ
 
ا
.
 ﺮﻣﻷﺎﺑ
ﮫﻏﻼﺑإ ﻢﺘﯾ نأ ﺪﻌﺑ ﺔﻋﺎﺳ
24 
زوﺎﺠﺘﺗ ﻻ ةﺪﻣ لﻼﺧ
ﺤﻲﻟﺎ 
ﻜﻣ
ﺎ
ﮭ
ﻧ
 
ﺎ
ا
جرﺪﯾ 
ﻷ
ً
ن
ﻮ
 
ط
و
ﺒ
ﺎ
ﻘ
 
ﻟ
ﻘ
ﺎ
ﻧ
 ﺐﺟﻮﻤﺑ
ﻋو ﻢﮭﺗو
ﻘ
ﻮ
ﺎ
ﺑ
ت
 
18 Pa.C.S. § 6105 
 
 
18 U.S.C. § 922(g)(8) 
ﺎ
ﺮﻣﻷا  ﺪﻗﺗﮫﺿّﺮﻌ تﺎﺑﻮﻘﻌﻟ
 
ﺐﺟﻮﻤﺑ
 
ﻧ
ﯿ
ﺎ
 
ﺒ
ﻨ
ﺴ
ﻠ
ﻔ
ن
 
ا
ﻟ
ﺠ
ﺎ
ﻨ
ﯾ
ﺎ
ت
ﻟ
 
ﻰﻀﺘﻘﻤﺑ
 
ﺎ
ﻗ
ﻧ
ﻮ
. 
18 U.S.C. §§2261-2262
ﺪﺿ ﻒﻨﻌﻟا ﺔ
 
ﻟ
ا
ﻨ
ﺴ
ﺎ
ء
،
 
ﻜﻣﺤ
ﺎ
ﻓ

 ﺔﯿﺋﺎﻨﺟ ﺔﯿﻟارﺪﻓ

 
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. 
 

نﻮﻧﺎﻘﻟا ﻖﯿﺒﻄﺗ ﻲﻟوﺆﺴﻣو ﺔطﺮﺸﻟاو ﻒﯾﺮﺸﻟا ﻰﻟإ رﺎﻌﺷإ 

. 
 
 

أ 
و

 
 ﻲﻋﺪﻤ
ا
ﻟ
 ﺔﻣﺎﻗإ ﺔﻘﻄﻨﻣ ﻰﻠﻋ ﻲﺋﺎﻀﻘﻟا صﺎﺼﺘﺧﻻا ﻚﻠﻤﯾ يﺬﻟا
 
  وأﻒﯾﺮﺸﻟا
ﺔطﺮﺸﻟا ﻢﺴﻗ ﺔﻄﺳاﻮﺑ ﺮﻣﻷا اﺬھ ﻖﯿﺒﻄﺗ ﻢﺘﯾ
ﺣ
ﯿ
ﺚ
 
 وأ 
 ﻲﺋﺎﻀﻘﻟا
ﺮﻣﻷا اﺬ
 ﺔﻔﻟﺎﺨﻣ ﮫﯿ
ھ
ﻓ
 ثﺪﺤﺗ ﻊﻗﻮﻣ يأ
 
ﻓ ﻢﺘﯿ
،
ﻘ
ت
ﺮ ﻦﻣ 1  ﻰﻟإ6  ﻦﻣ
ﻔ
ﯿ
ﮫ
ا
.
ﻋ
ﻠ
ﮫ
ﻰﻋﺪﻤﻟا ﺪﺟاﻮﺘﯾ
ﯾ
أ 
ﺘ
ﻢ
ا
 
ﻟ
ﻘ
ﺒ
ﺾ
 
ﻋ
ﻠ
ﻰ
 
 
ن
ﻦﻜﻤﯾ .ﺮﺷﺎﺒﻤﻟا ﺮﯿﻏ ﻲﺋﺎﻨﺠﻟا نﺎﯿﺼﻌﻟا ﺔﻤﮭﺘﺑ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا
 
ﻰ
ا
ﻟ
ﻘ
ﺒ
ﺾ
ﻋ
ﻠ
 
ﺮﻣﻷا اﺬھ
ا
ﻰﻋﺪﻤﻟا
 
ﻋ
ﻠ
 
ﻟ
ﺧ 
 
ﺎ
ﻒ
ﻟ
 
ﯿ
إ
 
ذ
ا
ﻰﻋﺪﻤﻟا
ﺮﺸﻟا
 
ﯾ
ﻒ
ﻲطﺮﺷ رﻮﻀﺣ ﻲﻓ ﻢﺘﺗ ﻢﻟ وأ ﺔﻔﻟﺎﺨﻤﻟا ﺖﻤﺗ
أ
 
و
،ءاﻮﺳ 
 
ﻞﻤﺘﺤﻣ ﺐﺒﺳ
دﻮﺟو 
ﻗ
ﻀ
ﺎ
ﺋ
ﻲ
،
 
ﻋ
ﻠ
ﻰ
 
أ
ﺳ
ﺎ
س
 
 
ﺮ
نود ﺮﻣﻷا اﺬھ ﺔﻔﻟﺎﺨﻣ
 
أ
ﻣ
ﺑ 
ﺴ
ﺒ
ﺐ
 
ﻋ
ﯿ
ﻠ
ﮫ
 
 
 نﻮﻜﺗ 
ﻲ
ﺘ
ﺧﺬﻟا
 
ﯿ
ﺮ
ة
ا
 
ﻟ
و
 
أ
ىﺮﺧﻷا ﺔﺤﻠﺳﻷاو ﺔﯾرﺎﻨﻟا ﺔﺤﻠﺳﻷا ﻊﯿﻤﺟ
 
ﺮﺸﻟا
 
ﯾ
ﻒ
نﻮﻧﺎﻘﻟا ﻖﯿﺒﻄﺗ لوﺆﺴﻣ ردﺎﺼﯾ ،
أ
 
و
ﻰﻋﺪﻤﻟا
 
 
ﻋ
ﯿ
ﻠ
ﮫ
ا
 
ﻟ
ﻘ
ﺒ
ﺾ
 
ﻋ
ﻠ
ﻰ
ﺪﻌﺑ
 
ﺔﺤﻠﺳأ وأ ﺔﯾرﺎﻧ ﺔﺤﻠﺳأ يأ ﻢﯿﻠﺴﺗ ﺐﺠﯾ .ﮫﯿ
ﻠ
ﻋ
ﻰﻋﺪﻤﻟا ةزﻮﺣ ﻲﻓ ىﺮﺧأ ﺔﯾرﺎﻧ ﺔﺤﻠﺳأ يأو ﺔﻘﺑﺎﺳ
 
لﻼﺧ وأ ﺔﯾ
ﺎ
 
 
ة
ﻮﺣ
ا
د
ث
إ
 
ﺳ
ﺎ
ء
ﻤﺤﻟا ﺮﻣأ ﺔﻔﻟ
ﺎ
ﺨﻣ لﻼﺧ ﺎﮭﻟﺎﻤﻌﺘﺳﺎﺑ ﺪﯾ
ﺪ
ﮭ
ﻤﻌﺘﺳا
ﻟ
ﺎ
ﮭ
 
ﺎ
أ
و
ا
 
ﻟ
ﺘ
ﺮﺧﻷا ﺔﺤﻠﺳﻷ
 
نﻮﻧﺎﻘﻟا ذﺎﻔﻧﺈﺑ ﻲﻨﻌﻤﻟا ﺐﺳﺎﻨﻤﻟا زﺎﮭﺠﻟا
أ 
و
ﻒ
ﺮﺸﻟا
يرﺎﻧ حﻼﺳ
 
ﻟ
ﻰ
 
ﺔﺼﺧر يأ وأ ةﺮﯿﺧذ وأ ىﺮﺧأ
 
ىأو 
ا
ﺔﺤﻠﺳﻷﺎﺑ
ا
 
ﻟ
ﻨ
ﺎ
ر
ﯾ
ﺔ
 
و
اﺮﻒﯾ 
ﻟ
ﺸ
ﻜﻣ ﻆﻔﺘﺤﯾ نأ ﻰﻠﻋ ،
ﺘ
ﺐ
 
 
ﯾ
 
إ
ﺣ
ﯿ
ز
ﺎ
ة
 
 َﻼﯿﻟد
ن
إ
ذ
 
ﺔﻤﻜﺤﻤﻟا هﺬھ ﻦﻣ
 
ﺮﺧآ ًﺮﻣأ رﺪﺼﯾ ﻰﺘﺣ ةﺮﯿﺧﺬﻟا
نﻮﻧﺎﻘﻟا ﻖﯿﺒﻄﺗ ﺔﻟﺎﻛو ةزﻮﺣ ﻲﻓ ﺔﺤﻠﺳﻷا ﻰﻘﺒﺗ ﺔﻟﺎﺤﻟا اﺬھ ﻲﻓو ،ﺔﻤﯾﺮﺟ
ا
 
ﻟ
ﺘ
ﻲ
 
ﯾ
ﺘ
ﻊ
ﺒ
ﻟ
 
ﮭ
ﺎ
 
ا
 
ر
ﺗ
ﻜ
ﺎ
ب
 
ﻌﺪ 
ﯾ
 
ﻛ حﻼﺴﻟا
ﺎ
،
إ
 
ﻻ
 
ا
ﻋ
ﻠ
ﻰ
   
ﻲطﺮﺸﻟا
.
ﻰﻋﺪﻤﻟا
 
ﻋ
ﻠ
ﯿ
ﮫ
 
ﻰ
ﺎ
ﻟ
ﺑ
ﻘ
ﺒ
ﺾ
 
ﻋ
ﻠ
يﺬﻟا
 
ﻗ
ﺎ
م
 
 
أﻒﯾﺮﺸﻟا
و
 
 
 

ﻰﻋﺪﻤﻟا ةزﻮﺣ ﻲﻓ
 
ﻋ
ﯿ
ﻠ
ﮫ
 
و
ﻟ
ا
ﺘ
ﻲ
ﺗ
 
ﻢ
 

: 
BY THE COURT /  ﻤﻜﺤﻤﻟا ﺔﻄﺳاﻮﺑ

ﺔ

_____________________________________________ 
 
 

Judge / ﻲﺿﺎﻘﻟا 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date / ﺦﯾرﺎﺘﻟا 

 
 

 

 
 

 
 

 

 
 

 
 

 

 
 

 
 

 

 
 

 
 

 

 
 

 
 

 

 
 

 
 

 

 
 

 
 

 

 
 

 
 

 

 
 

 
 

 

 
 

 
 

 

 
 

 
 

 

 
 

 
 

 

 
 

 
 

 

 
 

 
 

 

     

 

   

 

 

 

  T

  S

ENGLISH/ARABIC  PFA Temp. Order 
Pa R.C.P. 1905(c) Rev. 3-19 

 

 

 

 

 

 

 

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AOPC Rev. 4-2019