Here is the text we could read:
PETITION FOR EMERGENCY
RELIEF FROM ABUSE
ជតនតយត ត ត
ត
ត សតត
ត
បណ្តតង
ត
តត
តតត ត ជាបន្ទត នតពតការរត
ត
ត ត ត
ត
ត
តត ង្ោភបតពាន
ត
ត
ត
សង្គ្ត ោះ
ត
ត
NAME and ADDRESS
ដ្មោះនិងអាសយដ្ឋាន
V. / ទល់នឹង
NAME and ADDRESS
ដ្មោះនិងអាសយដ្ឋាន
ជ
ជ
Case Filed / សជណ្ជជល ឿង៖
ocket No / លេខបញ្ជជបណ្ជជង៖
ជ
ជជ
ជ
ជ
ជ
ជជជជ
ជ
ជ
ជ
ជ
D
PLAINTIFF:
ដ ើមបណ្តឹង៖
DEFENDANT:
ងដោទ៖
ុ
ច
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ____________
Mag. Dist. No:
លេខសមាជ េជលៅគកមស្ជ តជ
ជជ
ជ ជ
ជជ
ជ ជ
ជ
ជជ
ជ
ជ
ជ
ជជ
ល្ជ ោះលៅគកមស្ជ តជ
ជជ
DJ Name:
ជ
ជ ជ
ជ ជជ
ជ
ddress:
អាសយដាជ ន
ជ ជ
ជ
ជ
ជ
elephone:
ជ
លេខទជ សជពជ
ជ ជជ
ជជ
ជ
M
A
T
PLAINTIFF REQUESTS CONFIDENTIALITY OF
PERMANENT/TEMPORARY ADDRESS
ដ ើមបណ្ត
ឹងដសន
អចិន្នតយ៍/បដ្ដ ោះអាសនន
ើសុ
ុំការរក្សាភាពសម្ងា ត់ននអាសយដ្ឋា ន
PETITION OF THE PLAINTIFF
I, ______________________________________;
(Name of Plaintiff - please print)
hereby petition for emergency relief from abuse
តត
បណ្តតងត
ត
ត របសតង្ តមង្ោទ
តត ត
ត
, ______________________________________; សជមដាកជបណ្ជជង
ខ
ជជជ
ជ
ជល្ជ ោះល ជមលោទ)
ជ ជ
ជ ជជ ជ
ជ ជ
ជជជជជជជជជជជជជជជជជជជជជជជជជជជជ(សជមស លស
ជជ
ជជជ
សជជ
ជ
ជជ ជជ
ជ ជ
ពជកា ជលោភបជពាន
ជ ជ
ជ
ជ
ជ
ជជជ ជជាបន្ទជ នជ
ជ
ជជនជយជ ជ ជ សលគ្ជ ោះ
ជ ជ
តត
ជជ ជ
ជ
ជ
ជ
ជ
ជ
ជ
ជ
ជ
On behalf of myself
On behalf of the following minor (child) (children) of whom
I am a (parent) (adult household member) (guardian).
On behalf of the following incapacitated person to whom I
am guardian.
ជ
ជ
ជ
តាងន្ទមឲ្យខជ ជនឯងផ្ទជេជ
ជ
ជ ជ
តាងន្ទមឲ្យអនជតជជន
ជជ ជ
ដ េមាន
(កជមា )ជ ខាងលគកាមជ
ជ ជ ជ
ជ ជ
ជ
ជជ
ជ
(ឪពជកឬមាជ យ)ជ(សមាជជកគគជសា លពញវ ជយ)ជ(អាណាពាបាេ
)។
ជ
ជ ជ ជ
ជជជជ
ជ ជ
ជជ ជ ជ
តាងន្ទមឲ្យបជគជេបាតជបងជសមតជភាព
ជ
ជ
អាណាពាបាេ។
ជ
ជជជ ជ
ជ ជជជ
ជ
ជជជ
ជ ជ
ជ ជ
ជ
ជ ជ ជ
ជជ ជ
ជ ជ
ជ ជ
ជជជជ
ជ
ជ
ជ
ជ
ជ
ជ
ជ ខាងលគកាមជ ដ េមានខជជជជា
ជ
ជ
ជ
ជ
ជ
ជ ខជជជគជជាជ
ជ
ជ ជ
ជ)
________________________________
(Name / ល្ជ ោះ
________________________________
(Name / ល្ជ ោះ
ជ)
ជ ជ
ជ
ជ
ជ
_____________________________________
(Address / អាសយដាជ ន
_____________________________________
(Address / អាសយដាជ ន
ជ ជ )
ជ ជ )
ជ
ជ
ជ
ជ
ជ
____________________
(Age / អាយជ
)
____________________
)
(Age / អាយជ
ជ
ជ
The cause for seeking relief is as follows:
ជ
លេតជបងជឲ្យមានកា ដសជង ក
ជជ
ជ ជ ជជ
ជជជ ជ
ជ
ជជ ជជនជយជ ជ ជ សលគ្ជ ោះ
ជ
ជជជ ជមាន ជចខាងលគកាម៖
ជ ជ
ជជជ
ជ
ជ
ជ
ជ
ជ
ជ
ជ
ជ
MDJS 307A-BL
Petition for Emergency Relief (English/Khmer)-Translated on 6/25/2021
1
FREE INTERPRETER
នកបកប្របផ្ទា ល់មាត់ឥតគិតថ្លៃ
www.pacourts.us/language-rights
អ្
PETITION FOR EMERGENCY
RELIEF FROM ABUSE
ត ត ត
ត
បណ្តតងសតតជតនតយ
តត តត
ត
ត
ត
សង្គ្ត ោះជាបន្ទត នតពតការរតង្ោភបតពាន
ត ត
ត
ត ត ត
តតត ត ត
ត
ត
ត
ត
NAME and ADDRESS
ដ្មោះនិងអាសយដ្ឋាន
V. / ទល់នឹង
NAME and ADDRESS
ដ្មោះនិងអាសយដ្ឋាន
ជ
ជ
Case Filed / សជណ្ជជល ឿង៖
ocket No / លេខបញ្ជជបណ្ជជង៖
ជ
ជជ
ជ
ជ
ជ
ជជជជ
ជ
ជ
ជ
ជ
D
PLAINTIFF:
ដ ើមបណ្តឹង៖
DEFENDANT:
ងដោទ៖
ុ
ច
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ____________
Mag. Dist. No:
លេខសមាជ េជលៅគកមស្ជ តជ
ជជ
ជ ជ
ជជ
ជ ជ
ជ
ជជ
ជ
ជ
ជ
ជជ
ល្ជ ោះលៅគកមស្ជ តជ
ជជ
DJ Name:
ជ
ជ ជ
ជ ជជ
ជ
ddress:
អាសយដាជ ន
ជ ជ
ជ
ជ
ជ
elephone:
ជ
លេខទជ សជពជ
ជ ជជ
ជជ
ជ
PLAINTIFF REQUESTS CONFIDENTIALITY OF
PERMANENT/TEMPORARY ADDRESS
ដ ើមបណ្ត
ឹងដសន
អចិន្នតយ៍/បដ្ដ ោះអាសនន
ើសុ
ុំការរក្សាភាពសម្ងា ត់ននអាសយដ្ឋា ន
Emergency relief from abuse is required because there is
immediate and present danger of abuse by the defendant
to me and to the above listed minor (child) (children)
(incapacitated person).
(Print additional names/addresses on a separate sheet of paper and attach
hereto.)
Has Defendant been determined to be a perpetrator in a
founded or indicated report under the Child Protective
Services Law, 23 Pa.C.S. §§ 6301 - 6386? Yes No
If you answered Yes, what county's court or child protective
services agency issued the founded or indicated report?
____________________________________________
I certify that this filing complies with the provisions of the Case
Records Public Access Policy of the Unified Judicial System of
Pennsylvania that require filing confidential information and
documents differently than non-confidential information and
documents.
ត
ត
ត
ត
ត តត
ត ត ពតករណ្តរតង្ោភបតពាន
តត
ត
ត
ជតនតយត ត ត សង្គ្ត ោះជាបន្ទត នត
តតត ត ត
ត
ត តង្ោយសារ
តត ភ្លត មៗ
បច្តតបបនត
ត
ត មានង្គរោះថ្នត កត
ពតង្គពាោះ
ត ត
ត
ត
ត ត
តតត
ត
ត ច្តង្ពាោះខតតតត
ត
ត ច្តងង្ោទ
គបគពតត្តតង្ោយ
តត
រតង្ោភបតពានដ ល
ត តត ត
អតង្ពត
ត
ត ត
តត
ត តត
ត
ត
តត
តត
ត
ត
ត
ត តត
ត តត
ត
ត
នតងត ត អនតត្តជន
តតដ ល
ត
ត
ត ត
ត ងតសមត្តភ្លព)ត
ត
ត
ត ត បាត្តប
តតតត
ត)ត(បតគតល
ត ត (កតមារ
ត ត ត
ត
ត តត
ត
បានរាយខាងង្លត។
ត ត
ត
ត
តោតបាច្តត
ត
ត
ត គតជាកតច្តការ
ត ត ត
ត
ត
ជ
ជ ជ
ជ/អាសយដាជន
ជល្ជ ោះ
ជជ
(សជមស លស
ជ
ជជ ជ
ជ
ជ ជ បដនជម
ជ
ជ
ជជជ
លេជយភាជ បជមកជាមជយ។)
ជ ជ
ជ
ជ
ជ
ជ ជ
ជ
ជជ
តតើចុងតោទរតូវបានកំណត់ថាជាោរ ីតទ តៅកន
ជ
ជ
ជជ
សនជជកគកដាស
ជ
ជជ ជ លៅលេជ
ជជ
ជ
ជ មជយលដាយដែកជ
ជ ជ
ជជ
ជជ
ជជ
ជ
ជ
ជ
ីពីតស្វាការពារតកេង, 23 Pa.C.S. §§ 6301 - 6386?
ុងរបាយការណ៍រកត ើញឬ
បញ្ជា ក់ តរកាមចាប់ស្ដ
បាទ/ោស្ តទ
តបើអ្នកបានត្ៃ
ើយ បាទ/ោស្ តតើតុលាការរបស្់តោនធីណា ឬទីភ្នន ក់ងារ
តស្វាការពារកុមារណា បានតចញនូវរបាយការណ៍រកត ើញឬបញ្ជា ក់ត ោះ?
____________________________________________
ុំសូ មបញ្ជា ក្ស់ថា ការដ្ឋក្ស់ឯក្សសារដនោះអនុដោមតាមបទបញ្ញ តត
ខ
ដោលការណ្៍ទទួលជាសាធារណ្ៈនូ វក្សុំណ្ត់ត្រតាដរឿងក្សដ
ី របស់ត្របព័នធ
តុោការរ ួមននរ ា Pennsylvania ដ លតត្រមូវឲ្យដ្ឋក្ស់ព័ត៌ម្ងននិង
ឯក្សសារសម្ងា ត់ដ្ឋច់ដដ្ឋយដែក្សពីព័ត៌ម្ងននិងឯក្សសារមិនសម្ងា ត់។
ិនន
__________________________________________
(Signature of the Plaintiff)
(េតជលេខា
ជ
ជ ជជ
ជ
ជជ ជ
បសជល ជមលោទ
ជជ
ជ )
ជជ
ជ
MDJS 307A-BL
Petition for Emergency Relief (English/Khmer)-Translated on 6/25/2021
2
FREE INTERPRETER
នកបកប្របផ្ទា ល់មាត់ឥតគិតថ្លៃ
www.pacourts.us/language-rights
អ្
M
A
T
្
ញ
(Untitled)
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): 2
- Fields(s): 52
- Average fields per page: 26
- 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.
county
was County (0.54 conf)md_j_number
was MDJ Number (0.45 conf)md_j_name
was MDJ Name (0.40 conf)md_j_add
was MDJ_Add1 (0.43 conf)md_j_phone
was MDJ Phone (0.39 conf)plaintiff_name
was Plaintiff Name (0.50 conf)plaintiff_address__1
was Plaintiff Address 1 (0.48 conf)plaintiff_address__2
was Plaintiff Address 2 (0.48 conf)defendant_name
was DefendantName (0.41 conf)defendant_address__1
was DefendantAddress_1 (0.42 conf)defendant_address__2
was DefendantAddress_2 (0.42 conf)docket
was Docket_No (0.36 conf)date_filed
was Date_Filed (0.44 conf)check_box__1
was CheckBox1 (0.52 conf)check_box__2
was CheckBox1_T (0.52 conf)users1_name
was Name (1.00 conf)name
was Name_T (0.41 conf)check_box__3
was CheckBox2 (0.37 conf)check_box__4
was CheckBox2T (0.41 conf)check_box__5
was CheckBox3 (0.37 conf)check_box__6
was CheckBox3T (0.41 conf)check_box__7
was CheckBox4 (0.37 conf)check_box__8
was CheckBox4T (0.41 conf)bottom_name__1
was Bottom Name (0.40 conf)users1_address_line_one
was Address (1.00 conf)age__1
was Age (0.36 conf)bottom_name__2
was Bottom Name2 (0.31 conf)address
was Address2 (0.35 conf)age__2
was Age2 (0.35 conf)cause__1
was Cause (0.45 conf)cause__2
was CauseT (0.35 conf)county_b
was CountyB (0.37 conf)md_j_number_b
was MDJ NumberB (0.39 conf)md_j_name_b
was MDJ NameB (0.35 conf)md_j_add_b
was MDJ_Add1B (0.37 conf)md_j_phone_b
was MDJ PhoneB (0.39 conf)plaintiff_name_b
was Plaintiff NameB (0.49 conf)plaintiff_address_b__1
was Plaintiff Address 1B (0.46 conf)plaintiff_address_b__2
was Plaintiff Address 2B (0.46 conf)defendant_name_b
was DefendantNameB (0.34 conf)defendant_address_b__1
was DefendantAddress_1B (0.37 conf)defendant_address_b__2
was DefendantAddress_2B (0.37 conf)docket_b
was Docket_NoB (0.37 conf)date_filed_b
was Date_FiledB (0.46 conf)check_box_b
was CheckBox1B (0.49 conf)check_box_tb
was CheckBox1_TB (0.36 conf)yes__1
was Yes (0.45 conf)no
was No (0.45 conf)yes__2
was YesT (0.35 conf)no_t
was NoT (0.35 conf)name_b
was NameB (0.32 conf)name_tb
was Name_TB (0.27 conf)
We've done our best to group similar variables togther to avoid overwhelming the user.
Suggested Screen 0:
Suggested Screen 1:
Suggested Screen 2:
check_box__1
check_box__2
check_box__3
check_box__4
check_box__5
check_box__6
check_box__7
check_box__8
check_box_b
check_box_tb
Suggested Screen 3:
Suggested Screen 4:
md_j_number
md_j_name
md_j_add
md_j_phone
county_b
md_j_number_b
md_j_name_b
md_j_add_b
md_j_phone_b
Suggested Screen 5:
plaintiff_name
plaintiff_address__1
plaintiff_address__2
defendant_address__1
defendant_address__2
date_filed
users1_address_line_one
plaintiff_address_b__1
plaintiff_address_b__2
defendant_address_b__1
defendant_address_b__2
date_filed_b
Suggested Screen 6:
defendant_name
users1_name
name
plaintiff_name_b
defendant_name_b
docket_b
name_b
Suggested Screen 7:
bottom_name__1
age__1
bottom_name__2
age__2
cause__1
cause__2
yes__1
no
yes__2
no_t
Suggested Screen 8:
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