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

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Here is the text we could read:

IN THE COURT OF COMMON PLEAS OF ______________ COUNTY
TẠI TÒA ÁN XÉT XỬ RỘNG QUYỀN QUẬN ____________________________

PLAINTIFF / NGUYÊN ĐƠN

CASE NO. / HỒ SƠ SỐ __________________

___________________________

VS.

DEFENDANT / BỊ ĐƠN

___________________________

PROTECTION FROM ABUSE /
BẢO VỆ CHỐNG NGƯỢC ĐÃI

PETITION FOR PROTECTION OF VICTIMS
OF

SEXUAL VIOLENCE
SEXUAL VIOLENCE AGAINST A
MINOR CHILD
INTIMIDATION

ĐƠN XIN BẢO VỆ NẠN NHÂN KHỎI

BẠO HÀNH TÌNH DỤC
BẠO HÀNH TÌNH DỤC VỚI TRẺ VỊ
THÀNH NIÊN
HĂM DỌA

Plaintiff:

1.
__________________________________
First

Last Name

Middle

Nguyên đơn:

1.
__________________________________
Tên

Tên đệm

Họ

Plaintiff’s Address: _________________

Địa chỉ của Nguyên đơn: _____________

Plaintiff’s  address  is  confidential  pursuant

Địa  chỉ  của Nguyên  đơn được  bảo mật

to 42 Pa.C.S. § 62A11.

theo 42 Pa.C.S. § 62A11.

Plaintiff’s Date of Birth: _______________

Ngày sinh của Nguyên đơn: ___________

another person.

I  am  filing  this  petition  on  behalf  of myself
or
If you checked “myself,” please answer all
questions referring to yourself as “Plaintiff.”  If
you checked “another person,” please answer
all questions referring to that person as
“Plaintiff,” and provide your name and address
below.

Tôi  nộp đơn  xin này  cho

bản thân  tôi  hoặc

một người khác.

Nếu quý vị đánh dấu chọn “bản thân tôi,” vui
lòng trả lời tất cả các câu hỏi đề cập đến quý
vị với vai trò “Nguyên đơn.” Nếu quý vị đánh
dấu chọn “một người khác,” vui lòng trả lời tất
cả các câu hỏi đề cập đến người đó với vai trò
“Nguyên đơn,” và cung cấp tên và địa chỉ của
quý vị bên dưới.

AOPC PSVI (Vietnamese)

Date created: December 26, 2016

Name: ____________________________

Tên: ____________________________

Address: __________________________

Địa chỉ: __________________________

If you checked “another person,” indicate your
relationship to the plaintiff:

Nếu  quý  vị đánh  dấu  chọn  “một  người  khác,”
cho biết quan hệ của quý vị với nguyên đơn:

__________________________________

__________________________________

2.

Defendant:

2.

Bị đơn:

________________________________
Last Name
First

Middle

__________________________________
Họ
Tên

Tên đệm

Defendant’s Address:
________________________________
________________________________

Địa chỉ của Bị đơn:
________________________________
________________________________

DEFENDANT IDENTIFIERS

THÔNG TIN NHẬN DẠNG CỦA BỊ ĐƠN

DOB

SEX

RACE

HAIR

SSN

DRIVERS
LICENSE #

EXP DATE

HEIGHT

WEIGHT

EYES

STATE

NGÀY SINH
GIỚI TÍNH
CHỦNG TỘC
TÓC
SSN

SỐ BẰNG LÁI

NGÀY HẾT
HẠN

CHIỀU CAO
CÂN NẶNG
MẮT

TIỂU BANG

Name(s) of other designated person(s)

3.
under 42 Pa.C.S. § 62A07(b)(1):

(Các) tên của (những) người được chỉ

3.
định khác theo 42 Pa.C.S. § 62A07(b)(1):

_____________________________________
_____________________________________

_____________________________________
_____________________________________

4.
Is there a relationship between Plaintiff
and Defendant? ________.   If yes, what is the
relationship?
_____________________________________
_____________________________________

Có quan hệ giữa Nguyên đơn và Bị

4.
đơn không? ________.   Nếu có, quan hệ như
thế nào?
_____________________________________
_____________________________________

AOPC PSVI (Vietnamese)

Date created: December 26, 2016

Have Plaintiff and Defendant been

5.
involved in any other legal proceedings?  If so,
state when and where the case was filed and
the court docket number, if known:
_____________________________________
_____________________________________
_____________________________________
_____________________________________

Nguyên đơn và Bị đơn có tham gia bất
5.
kỳ tiến trình pháp lý nào khác không? Nếu có,
cho biết thời gian và nơi nộp vụ kiện đó và số
ghi án của tòa, nếu đã biết:
_____________________________________
_____________________________________
_____________________________________
_____________________________________

Has Defendant been involved in any

6.
criminal proceedings?
_____________________________________
_____________________________________

Bị đơn đã tham gia bất kỳ thủ tục tố

6.
tụng hình sự nào chưa?
_____________________________________
_____________________________________

If you answered Yes, is Defendant currently on
probation or parole?
_____________________________________
_____________________________________

Nếu quý vị trả lời Có, hiện Bị đơn có bị quản
chế hay được ân xá không?
_____________________________________
_____________________________________

(a)

7.
incident of sexual violence are as follows:

The facts of the most recent

(a)

7.
tình dục gần nhất là như sau:

Dữ kiện của vụ việc bạo hành

Approximate Date:
__________________________________

Ngày Ước chừng:
__________________________________

Approximate Time:
__________________________________

Thời gian Ước chừng:
__________________________________

Place:
__________________________________

Địa điểm:
__________________________________

Describe in detail what happened, including
any physical or sexual abuse, threats, injury,
incidents of stalking, medical treatment
sought, and/or calls to law enforcement (attach
additional sheets of paper if necessary):

Mô tả chi tiết những gì đã xảy ra, bao gồm bất
kỳ sự hành hung hay ngược đãi về tình dục,
đe dọa, thương tích, vụ việc đi lén theo, tìm
kiếm điều trị y tế, và/hoặc gọi cho cơ quan
công lực (đính kèm thêm giấy nếu cần thiết):

_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________

_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________

AOPC PSVI (Vietnamese)

Date created: December 26, 2016

(b)

The facts of the most recent

(b)

Dữ kiện của vụ việc hăm dọa

incident of intimidation are as follows:

gần nhất là như sau:

Approximate Date:
__________________________________

Ngày Ước chừng:
__________________________________

Approximate Time:
__________________________________

Thời gian Ước chừng:
__________________________________

Place:
__________________________________

Địa điểm:
__________________________________

Describe in detail what happened, including
medical treatment sought, and/or calls to law
enforcement (attach additional sheets of paper
if necessary):
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________

If Defendant has committed prior acts

8.
of sexual violence or intimidation against
Plaintiff, describe these prior incidents, and
indicate approximately when such acts
occurred (attach additional sheets of paper if
necessary):
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________

Mô tả chi tiết những gì đã xảy ra, bao gồm tìm
kiếm điều trị y tế, và/hoặc gọi cho cơ quan
công lực (đính kèm thêm giấy nếu cần thiết):

_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________

Nếu Bị đơn đã có các hành vi bạo
8.
hành tình dục hoặc hăm dọa trước đó với
Nguyên đơn, mô tả các vụ việc trước đó, và
cho biết thời gian ước chừng hành vi đó xảy ra
(đính kèm thêm giấy nếu cần thiết):

_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________

Identify the sheriff, police department,

9.
or other law enforcement agency in the area in
which Plaintiff lives that should be provided
with a copy of the protection order:
_____________________________________
_____________________________________

Nêu tên cảnh sát quận, đồn cảnh sát,

9.
hoặc cơ quan công lực khác trong khu vực
Nguyên đơn sống mà phải được cung cấp một
bản sao của án lệnh bảo vệ:
_____________________________________
_____________________________________

AOPC PSVI (Vietnamese)

Date created: December 26, 2016

Is Plaintiff in immediate and present

10.
danger from Defendant?  If so, please
describe:
_____________________________________
_____________________________________

Bị đơn có nguy cơ gặp nguy hiểm trực
10.
tiếp và hiện tạitừ Nguyên đơn không?  Nếu có,
vui lòng mô tả:
_____________________________________
_____________________________________

FOR THE REASONS SET FORTH ABOVE, I
REQUEST THAT THE COURT ENTER A
TEMPORARY ORDER AND, AFTER A
HEARING, A FINAL ORDER THAT WOULD
INCLUDE ALL OF THE FOLLOWING RELIEF
(CHECK ALL FORMS OF RELIEF
REQUESTED):

VÌ NHỮNG LÝ DO NÊU TRÊN, TÔI YÊU CẦU
TÒA TIẾP NHẬN MỘT ÁN LỆNH TẠM THỜI,
VÀ, SAU PHIÊN ĐIỀU TRẦN, MỘT ÁN LỆNH
CHÍNH THỨC MÀ SẼ BAO GỒM TẤT CẢ
CÁC BIỆN PHÁP TRỢ GIÚP SAU ĐÂY
(ĐÁNH DẤU CHỌN TẤT CẢ CÁC HÌNH
THỨC TRỢ GIÚP ĐƯỢC YÊU CẦU):

A. Restrain Defendant from having any

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

A. Hạn chế Bị đơn có bất kỳ hình thức
liên lạc nào với nạn nhân bao gồm, nhưng
không giới hạn ở, đến nơi cư trú, nơi làm việc,
kinh doanh, hoặc trường học của nạn nhân.

B. Prohibit indirect contact through third

B. Cấm liên lạc gián tiếp qua các bên thứ

parties.

ba.

C. Prohibit direct or indirect contact with

C. Cấm liên lạc trực tiếp hoặc gián tiếp

other designated persons.

với những người được chỉ định khác.

D. Order Defendant to pay the fees of this

D. Ra lệnh cho Bị đơn trả lệ phí cho biện

action.

pháp này.

E. Order the following additional relief, not

E. Ra lệnh biện pháp trợ giúp bổ sung

listed above:

sau đây, chưa được nêu ở trên:

_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________

_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________

AOPC PSVI (Vietnamese)

Date created: December 26, 2016

F. Grant such other relief as the court
deems appropriate, including, but not limited
to, issuing an order under 42 Pa.C.S. §
62A11(b) related to the nondisclosure of the
victim's address, telephone number,
whereabouts or other demographic
information.

G. Order the police, sheriff or other law
enforcement agency to serve the Defendant
with a copy of this petition, any order issued,
and the order for the hearing.  Plaintiff will
inform the designated authority of any
addresses, other than Defendant’s residence,
where Defendant can be served.

F. Chấp thuận biện pháp trợ giúp khác
mà tòa thấy thích hợp, bao gồm, nhưng không
giới hạn ở, ban hành án lệnh theo 42 Pa.C.S.
§ 62A11(b) liên quan đến việc không tiết lộ địa
chỉ, số điện thoại, nơi ở hoặc thông tin nhân
khẩu khác của nạn nhân.

G. Ra lệnh cho cảnh sát, cảnh sát quận
hoặc cơ quan công lực khác tống đạt cho Bị
đơn bản sao của đơn xin này, bất kỳ án lệnh
được ban hành nào, và án lệnh về phiên điều
trần.  Nguyên đơn sẽ thông báo cho cơ quan
thẩm quyền được chỉ định về bất kỳ địa chỉ,
nơi cư trú khác của Bị đơn, nơi Bị đơn có thể
được tống đạt.

VERIFICATION

XÁC NHẬN

I verify that the statements made in this

Tôi xác nhận rằng lời khai trong đơn

petition are true and correct to the best of my
knowledge. I understand that false statements
herein are made subject to the penalties of 18
Pa.C.S. § 4904, relating to unsworn
falsification to authorities.

xin này là đúng sự thật và chính xác trong
phạm vi hiểu biết của tôi. Tôi hiểu rằng lời khai
không đúng sự thật ở đây phải chịu các hình
phạt của 18 Pa.C.S. § 4904, liên quan đến
việc làm sai lệch lời khai không tuyên thệ với
nhà chức trách.

_____________________________________________________________________
Signature / Chữ ký

_____________________________________________________________________
Date / Ngày

AOPC PSVI (Vietnamese)

Date created: December 26, 2016

Vietnamese 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): 6
Fields(s): 171
Average fields per page: 28
Reading Level: Grade 6
LIST Grouping(s): GO-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

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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check_box__4 was Check Box1 (0.52 conf)
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first was First (0.34 conf)
middle was Middle (0.31 conf)
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height was HEIGHT (0.36 conf)
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sex was SEX (0.38 conf)
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fill__14 was fill_29 (0.36 conf)
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fill__17 was fill_34 (0.36 conf)
hair was HAIR (0.34 conf)
c was TÓC (0.34 conf)
ssn was SSN (0.34 conf)
ss_n was SSN_2 (0.37 conf)
driver_license was DRIVERS LICENSE (0.46 conf)
fill__18 was fill_40 (0.36 conf)
ex_p_date was EXP DATE (0.32 conf)
users1_address_state was STATE (1.00 conf)
fill__19 was fill_43 (0.37 conf)
fill__20 was fill_44 (0.37 conf)
pa_c_b__1 was under 42 PaCS 62A07b1 1 (0.35 conf)
pa_c_b__2 was under 42 PaCS 62A07b1 2 (0.35 conf)
fill__21 was fill_14_2 (0.40 conf)
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fill__26 was fill_2_4 (0.40 conf)
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fill__29 was fill_8 (0.36 conf)
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fill__30 was fill_10_2 (0.40 conf)
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fill__32 was fill_14_3 (0.40 conf)
fill__33 was fill_16_2 (0.40 conf)
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fill__34 was fill_18_2 (0.40 conf)
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5_2 was 5_2 (0.38 conf)
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place__2 was Place_2 (0.39 conf)
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necessary__5 was if necessary 5 (0.40 conf)
necessary__6 was if necessary 6 (0.40 conf)
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fill__43 was fill_14_4 (0.40 conf)
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check_box__23 was Check Box24 (0.37 conf)
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check_box__26 was Check Box27 (0.37 conf)
fill__63 was fill_1 (0.36 conf)
date_ng was Date Ngày_2 (0.35 conf)

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

Vietnamese Notice of Hearing and Order Petition Temporary Order Affidavit of Service and the Final Order

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