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Here is the text we could read:

 
 

   

 

 

 

 

 

PETITION  FOR  PROTECTION 
FROM  ABUSE 

NO. 

IN  THE  COURT  OF  COMMON  PLEAS  OF 
____________________ COUNTY,  PENNSYLVANIA 

First 

Middle 

Last 

Plaintiff’s  DOB 

  Plaintiff’s Address: 
    Plaintiff’s address is confidential       or         Plaintiff’s address is:  __________________________________________________ 
                                                                                                                         __________________________________________________ 

1.  PLAINTIFF 

 

 

V. 

2.  DEFENDANT 

 

 

 

 

 

DO B 
SEX 
RACE 
HAIR 
SSN 
DRIVER’S 
LICENSE # 
EXP.  DATE 

 

 

DEFENDANT  IDENTIFIERS  
 
 
 
 
 

HEIGHT 
WEIGHT 
EYES 

STATE 

 
 
 

 

  Defendant’s Address: 

___________________________________________________ 

AUTION: 
  Weapon  Involved 
  Weapon  Present on the  Property 
  Weapon  Requested  Relinquished 

  C

   
 

 

ﺎﯿﻧﺎﻔﻠﺴﻨﺑ ،

__________________________

ةءﺎﺳإ ﻦﻣ ﺔﯾﺎﻤﺣ

 

سﺎﻤﺘﻟا

 

 

 ﺔﻣﺎﻌﻟا ﺔﯿﺋاﺪﺘﺑﻻا  ﺔﻤﻜﺤﻤﻟا ﻲﻓ
 
 
ﻢﻗر 

ﺔﻌطﺎﻘﻤﻠﻟ
 

First 

Middle 

Last 

Suffix 

ﻲ 

ﻋﺪﻤﻟا

1. 

 

لوﻷا ﻢﺳﻻا
        
 
:ﻲﻋﺪﻤﻟا ناﻮﻨﻋ
 

 
  

 

  
 يﺮﺳ ﻲﻋﺪﻤﻟا ناﻮﻨﻋ

 
 

ﺪﺿ 

 
 
 

 

ﮫﯿﻠﻋ  ﻰﻋﺪﻤﻟا

2. 

   

   

 

ﻲﻋﺪﻤﻟا  دﻼﯿﻣ ﺦﯾرﺎﺗ

ﺔ 

ﻠﺋﺎﻌﻟا ﻢﺳا

 

ﻂﺳوﻷا ﻢﺳﻻا

 
_________________________________________________

   

 

 

 

 

 

 

 
: ﻲﻋﺪﻤ

 

 
 
ﻟا ناﻮﻨﻋ

 
 
       وأ

 

 

           _______________________________________________

 

 

 

(رﻮﺘﻛد ،ﻞﺜﻣ)  ﺔﯿﻓﺮﺣ ﺔﻘﺣﻻ

ﺔ 

ﻠﺋﺎﻌﻟا ﻢﺳا

 

ﻂﺳوﻷا ﻢﺳﻻا

 

لوﻷا ﻢﺳﻻا

    

   

 
ﮫﯿﺒﻨﺗ
 
 
 

 

 

حﻼﺳ كﺎﻨھ
ﻦﻜﺴﻤﻟا ﻲﻓ دﻮﺟﻮﻣ حﻼﺳ كﺎﻨھ
ﻼﺴﻟا ﻢﯿﻠﺴﺗ ﻢﺗ

بﻮﻠﻄﻤﻟا ح

 

:ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ناﻮﻨﻋ
 
_______________________________________________

 

 

ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا

 

فﺎﺻوأ

 

لﻮﻄﻟا
 
 
نزﻮﻟا
ﻦﯿﻨﯿﻌﻟا

 

 
 
 
 
 
 
 

 

دﻼ 

ﯿﻤﻟا ﺦﯾرﺎﺗ
ﺲﻨﺠﻟا
 
ق ْﺮ ِﻌﻟا
ﺮﻌﺸﻟا
 
ﻲﻋﺎﻤﺘﺟﻻا نﺎﻤﻀﻟا ﻢﻗر
ةدﺎﯿﻘﻟا ﺔﺼﺧر ﻢﻗر
ﺎﮭ
ﺘﻧا ﺦﯾرﺎﺗ

ﺔﯿﺣﻼﺼﻟا ء

 

 

 

 

 

ﺔﯾﻻﻮﻟا
 

ENGLISH/ARABIC  PFA Petition 
Pa. R.C. P. 1905(b) Rev. 11-08 

 

 

 

 

 

 

 

 

 
Page 1 of 7 / 7 ﻦﻣ 1 ﺔﺤﻔﺻ 

 

 

 

 

 

AOPC Rev. 6-2011 

   

   

 

 

 
 
 

 

   

 

   

 

 

 

 

 
 
 

 

 

 

 
 
 
 
 
 

efendant’s place of employment  is:_______________________ 

  Check here if  you have reason to believe that Defendant is a 
licensed firearms  dealer; is employed by a licensed firearms 
dealer or manufacturer;  is employed as a writer,  researcher or 
technician in the firearms  or hunting industry; or is required to 
carry a firearm  as a condition of employment. 
 
 
3.  I am  filing  this petition on behalf of    
     myself    and/or        another person. 
If you checked “myself”, please answer all  questions referring to 
yourself as “Plaintiff”.   If you ONLY  checked “another person”, 
please answer all questions referring to that person as the 
“Plaintiff”,  and provide your name and address here, as filer, 
unless confidential. 
 
Filer’s  Name  / 

م ﻻاسﺎﻤﺘﻟ

ﺪﻘﻣ ﻢﺳا

 

 

 

 

_______________________

 ﻰﻋﺪﻤﻟا نﺄﺑ
 ﺔﯾرﺎﻧ
 
ﺔﺤﻠﺳأ

 دﺎﻘﺘﻋﻼﻟ ﺐﺒﺳ يأ ﻚﯾﺪﻟ نﺎﻛ
 ﻊّﻨﺼﻣ وأ ﺮﺟﺎﺗ ىﺪﻟ ﻞﻤﻌﯾ
 وأ

 وأ ﺔﯾرﺎﻨﻟا ﺔﺤﻠﺳﻷا ﺔﻋﺎﻨﺻ ﻲﻓ ﻲّﻨﻓ وأ ﺚﺣﺎﺑ وأ ﺐﺗﺎﻜﻛ ﻞﻤﻌﯾ

 وأ ﮫﻠﻤﻋ

 
طوﺮﺷ ﻦﻣ طﺮﺸﻛ

 يرﺎﻧ حﻼﺳ ﻞﻤﺣ

 اذإ ﻊﺑﺮﻤﻟا ﻰﻠﻋ ﺔﻣﻼﻋ ﻊﺿﻮﺑ ﻢﻗ
 ؛ﮫﻟ ﺺﺧ

 :ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻞﻤﻋ نﺎﻜﻣ
  
ﺮﻣ ﺔﯾرﺎﻧ ﺔﺤﻠﺳأ ﺮﺟﺎﺗ ﮫﯿﻠﻋ
 ؛ﮫﻟ ﺺﺧﺮﻣ
 وأ
 وأ ؛ﺪﯿﺼﻟا لﺎﺠﻣ ﻲﻓ
.ﮫﺘﻔﯿظو
 

 
ﮫﻨﻣ بﻮﻠﻄﻣ

 

 
ﻻا اﺬھ مﺪﻗأ ﺎﻧأ .
3
  
 ﻲﺘﻟا ﺔﻠﺌﺳﻷا ﻊﯿﻤﺟ ﻦﻋ ﺔﺑﺎﺟﻹا ﻰﺟﺮﯿﻓ ،"ﻲﺴﻔﻧ"  ﻊﺑﺮﻣ ﻰﻠﻋ ﺔﻣﻼﻋ ﻊﺿﻮﺑ  ﺖﻤﻗ اذإ
 ﺔﻣﻼﻋ ﺖﻌﺿو اذإ ﺎﻣأ ."ﻲﻋﺪﻣ" ـﻛ ﻚﺴﻔﻧ ﻰﻟإ ﺮﯿﺸﺗ
 ،"ﺮﺧآ ﺺﺨﺷ" ﻊﺑﺮﻣ ﻰﻠﻋ
ﻰﺟﺮﯿﻓ
ﻼﻟ  مﺪﻘﻤﻛ ،ﺎﻨھ ﻚﻧاﻮﻨﻋو ﻚﻤﺳا
 

 ،"ﻲﻋﺪﻣ" ـﻛ ﺺﺨﺸﻟا ﻚﻟذ ﻰﻟإ  ﺮﯿﺸﺗ ﻲﺘﻟا ﺔﻠﺌﺳﻷا ﺔﻓﺎﻛ ﻦﻋ ﺔﺑﺎﺟﻹا

ﻦﻋ ﺔﺑﺎﯿﻨﻟﺎﺑ
سﺎﻤﺘﻟ
 
       
وأ/و     ﻲﺴﻔﻧ

 نﺎﻛ اذإ ﻻإ ،

 ﺮﺧآ ﺺﺨﺷ

ًﺎﯾﺮﺳ ﻚﻟذ
.

سﺎﻤﺘﻟ

ﻢﯾﺪﻘﺗو

  ﻂﻘﻓ

 

 

 

 

First / لوﻷا ﻢﺳﻻا 

Middle / ﻂﺳوﻷا ﻢﺳﻻا 

ﺔ
Last /  ﻠﺋﺎﻌﻟا ﻢﺳا

 

  Filer’s  address is confidential      or       

  Filer’s  address is: 
____________________________________________________ 

 
If you checked “Another Person”, indicate your relationship with 
Plaintiff: 

  parent of minor  Plaintiff(s) 

  applicant for appointment as guardian ad litem  of minor 

Plaintiff(s) 

  adult household member  with minor  Plaintiff(s) 

  court appointed guardian of incompetent Plaintiff(s) 

 
4.  Name(s)  of all  persons, including minor  child/ren who seek 
protection from  abuse:_________________________________ 

____________________________________________________ 
 

 

ﻚﺘﻗﻼﻋ ﺔﻌﯿﺒط  ﺮﻛذ  ﻰﺟﺮﯿﻓ ،

هﻼﻋأ

 
"ﺮﺧآ ﺺﺨﺷ" ﻊﺑﺮﻣ ﻰﻠﻋ ﺔﻣﻼﻋ  ﺖﻌﺿو اذإ
:ﻲﻋﺪﻤﻟﺎﺑ

 

 

ﺮﺻﺎﻘ
ﻟا

  (ﻦﯿﻋﺪﻣ)
 

 

ﺮﺻﺎﻗ  (

ﻦﯿﻋﺪﻣ
) ﻲﻋﺪﻣ
 
ةﺪﻟاو/ﺪﻟاو
ﻲﻋدﻣﻠﻟ ﺔﯾﺿﻘﻟا ﻲﻓ ﻲﺻوﻛ نﯾﯾﻌﺗﻟا بﻠط

 

ﺮﺻﺎﻗ  (ﻦﯿﻋﺪﻣ) ﻲﻋﺪﻣ ﻊﻣ ﻎﻟﺎﺑ ﻲﻠﺋﺎﻋ ﻮﻀﻋ

 

ﺔﯿﻠھﻷﺎﺑ  ﻊﺘﻤﺘﯾ ﻻ

  (ﻦﯿﻋﺪﻤﻟ) ﻲﻋﺪﻤﻟ ﺔﻤﻜﺤﻤﻟا ﻞﺒﻗ ﻦﻣ ﻦّﯿﻌﻣ ﺮﻣأ ﻲﻟو

 ﻰﻌﺴﯾ
 

يﺬﻟا ﺮﺻﺎﻘﻟا  (لﺎﻔطﻷا) ﻞ

_________________________________

 
 
ﻔﻄﻟا ﻚﻟذ ﻲﻓ ﺎﻤﺑ ،صﺎﺨﺷﻷا ﻊﯿﻤﺟ  (ءﺎﻤﺳأ) ﻢﺳا .
4
ةءﺎﺳإ ﻦﻣ ﺔﯾﺎﻤﺣ ﻰﻠﻋ لﻮﺼﺤﻠﻟ

 :

___________________________________________________ 

_____________________________________________________

___________________________________________________ 

 

_____________________________________________________

___________________________________________________ 

 

_____________________________________________________
 

 

Suffix  /   ﺔﯿﻓﺮﺣ ﺔﻘﺣﻻ
 
(
رﻮﯿ
 ،ﻞﺜﻣ)

ﻧﻮﺟ

 

وأ     يﺮﺳ
 
سﺎﻤﺘﻟ
:ﻮھ 
 
سﺎﻤﺘﻟ

ﻻا  مﺪﻘﻣ ناﻮﻨﻋ
ﻻا  مﺪﻘﻣ ناﻮﻨﻋ

 
  

 
5.  Indicate the relationship between Plaintiff  and Defendant: 
CHECK  ALL  THAT APPLY: 
  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 

  family  member  related by marriage  or affinity to Defendant 
  sibling (person who shares parenthood) of Defendant 

Defendant 

 

 
  Check here if  Defendant is 17  years old or younger. 
 

 

:ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟاو ﻲﻋﺪﻤﻟا ﻦﯿﺑ ﺔﻗﻼﻌﻟا ﺔﻌﯿﺒط  ﺮﻛذا .
5
:ﺐﺳﺎﻨﻣ ﻊﺑﺮﻣ ﻞﻛ ﻰﻠﻋ ﺔﻣﻼﻋ ﻊﺿ
 
 

ﮫﯿﻠﻋ ﻰﻋﺪﻤﻠﻟ ﻖﺑﺎﺳ (ﺔـ) جوز وأ ﻲﻟﺎﺣ (ﺔـ) جوز
ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا
 
ةﺪﻟاو/ﺪﻟاو

 ﻞﻔط

 ﻊﻣ

 

 

 

 

ﮫﯿﻠﻋ ﻰﻋﺪﻤﻠﻟ ﻖﺑﺎﺳ وأ ﻲﻟﺎﺣ

 ﻲﻤﯿﻤﺣ وأ

 ﻲﺴﻨﺟ ﻚﯾﺮﺷ
 
ﻲﻋﺪﻤﻟا ﻞﻔط
ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻞﻔط

 

 

(مﺪﻟا ﺔﻄﺑار) م

ﺪﻟﺎﺑ ﮫﯿﻠﻋ

 
ﻰﻋﺪﻤﻠﻟ

  ﺐﯾﺮﻗ
 
ﺔﻠﺋﺎﻌﻟا ﻦﻣ  دﺮﻓ

 

ةﺮھﺎﺼﻤﻟا وأ جاوﺰﻟا

 

ﻢﻜﺤﺑ

 ﮫﯿﻠﻋ

  ﺐﯾﺮﻗ
 
ﺔﻠﺋﺎﻌﻟا ﻦﻣ  دﺮﻓ
ﮫﯿﻠﻋ ﻰﻋﺪﻤﻠﻟ (ﺔﯾﺪﻟاﻮﻟا كرﺎﺸﯾ  ﺺﺨﺷ) ﻖﯿﻘﺷ

 
ﻰﻋﺪﻤﻠﻟ

 

 

.نود ﺎﻣ وأ ﺔﻨﺳ

17 

 ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﺮﻤﻋ نﺎﻛ ذإ ﺎﻨھ ﺔﻣﻼﻋ ﻊﺿ

   

 
 

 

 

 

 

  D

   

 

 

 

 

 

ENGLISH/ARABIC  PFA Petition 
Pa. P.C. P. 1905(b) Rev. 11-08     

 

 

 

 

 

 

 

 

Page 2 of 7 / 7

 ﻦﻣ 2  ﺔﺤﻔﺻ     

 

 

 

 

 

 

AOPC Rev. 6-2011 

 
 
 
 
 

   

 

 

:ﺔﯿﻟﺎﺘﻟا  ﺔﯿﺋﺎﻀﻘﻟا ﺎﯾﺎﻀﻘﻟﺎﺑ

  نﺎﻄﺒﺗﺮﻣ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟاو ﻲﻋﺪﻤﻟا .
6

 
  
  
  
 
  
 
 
          ﺦﯾرﺎﺘﻟا
   __________________________________________________

قﻼط
 
 
ﺔﻧﺎﻀﺣ
 
 
 ﺔﻘﻔﻧ
ةءﺎﺳإ ﻦﻣ ﺔﯾﺎﻤﺣ
 

هﻼﻋأ ةرﻮﻛﺬﻤﻟا ﺎﯾﺎﻀﻘﻟا ﻊﻓر ﻢﺗ
      
  

ﺔﻤﻜﺤﻤﻟا ﻢﻗر

صﺎﺼﺘﺧﻻا

 ﻲﺋﺎﻀﻘﻟا

          

      
 

      

    

   

: 

 

 

 

 

 

 .ﺔﯿﺋﺎﻨﺟ

 

ﺔﻤﻜﺤﻤﺑ

 ﺔﯿﻀﻗ يﺄﺑ

ﺎﻓﺮط ﻦﻜﯾ ﻚﻟ

  /  

ﺎﻓﺮط نﺎﻛ

  

 
 ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا .
7

 

.ﺎﯿﻟﺎﺣ ﺔﯿﺋﺎﻀﻘﻟا  ﺔﺒﻗاﺮﻤﻟا

 
ﺎﯿﻟﺎﺣ ﺖﺤﺗ

ﺎﯿﻟﺎﺣ /   ﺲﯿﻟ
  

 ﻮھ

 ﮫﯿﻠﻋ 

ﻰ 

ﻋﺪﻤﻟا

 
:ﻲﻟﺎﺘﻟا  (لﺎﻔطﻷا) ﻞﻔﻄﻠﻟ ناﻮﺑأ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟاو ﻲﻋﺪﻤﻟا .
8

 

.  Plaintiff  and Defendant are involved in the following  court 
actions: 
   Divorce 
   Custody 
   Support 
   Protection from  Abuse 
 
        Date                     Jurisdiction                         Court  Number 

The above referenced actions were filed: 

        _________________________________________________ 

 
7.  The Defendant  HAS  /  HAS NOT  been involved in any 
criminal  court action. 
 

  The Defendant  IS /  IS NOT  currently on probation. 

 
8.  Plaintiff  and Defendant are the parents of the following  minor 
child/ren: 

Name(s)  / (ءﺎﻤﺳأ) ﻢﺳا 

Age(s) / (رﺎﻤﻋأ) ﺮﻤﻋ 

Who reside at (list  address unless confidential) /  

ًﺎﯾﺮﺳ نﺎﻛ اذإ ﻻإ ناﻮﻨﻌﻟا  ﺮﻛذا) ﻲﻓ  (نﻮﻨﻜﺴﯾ) ﻦﻜﺴﯾ
(

 

 يﺬﻟا

 

 
 
 
 
 

 
 
 
 
 

.  If Plaintiff  and Defendant are parents of any minor  child/ren 
together, is there an existing court order regarding their custody? 

 كﺎﻨھ ﻞﮭﻓ  ،

كاﺮﺘﺷﻻﺎﺑ

 YES        NO   

f you answered “Yes,”  in what county and state was the 
order issued?  __________________________________ 

 

  ﺮﺻﺎﻗ (ل

؟ﺎﻤﮭﺘﻧﺎﻀﺣ نﺄﺸﺑ

ﺎﻔطأ) ﻞﻔط يﻷ ﻦﯾﻮﺑأ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟاو ﻲﻋﺪﻤﻟا نﺎﻛ اذإ .
9
 ﺔﻤﻜﺤﻣ ﻢﻜﺣ
 
 
؟ﻢﻜﺤﻟا راﺪﺻإ ﻢﺗ ﺔﯾﻻو وأ  ﺔﻌطﺎﻘﻣ يﺄﺒﻓ ،"ﻢﻌﻧ" ـﺑ ﺖﺒﺟأ لﺎﺣ ﻲﻓ
__________________________________
 

       ﻻ  

  ﻢﺋﺎﻗ

 ﻢﻌﻧ

 

 

 

f you are now seeking a child custody order as part of this 
petition, list the following  information: 

 ،

سﺎﻤﺘﻟﻻا اﺬھ ﻦﻣ ءﺰﺠ

ﻛ ﻞﻔط

 

ﺔﻧﺎﻀﺤﺑ ﻢﻜﺣ

 ﻰﻠﻋ لﻮﺼﺤﻠﻟ ﻰﻌﺴﺗ ﺖﻨﻛ لﺎﺣ ﻲﻓ
تﺎﻣﻮﻠﻌﻤﻟا ﺮﻛذ  ﻰﺟﺮﯿﻓ

:ﺔﯿﻟﺎﺘﻟا

 

 

  I

  I

(a)  Where has each child resided during the past five years? 

 

؟ﺔﯿﺿﺎﻤﻟا تاﻮﻨﺳ

 ﺲﻤﺨﻟا

 
لﻼﺧ ﻞﻔط ﻞﻛ ﻦﻜﺴﯾ نﺎﻛ

 ﻦﯾأ (أ)

Child’s  Name  /  
ﻞﻔﻄﻟا ﻢﺳا 

Person(s) child lived with / 
ﮫﻌﻣ ﻞﻔﻄﻟا شﺎﻋ يﺬﻟا  (صﺎﺨﺷﻷا) ﺺﺨﺸﻟا  
 

Address, unless confidential /  

 
When? /  ﻰﺘﻣ

؟

 ًﺎﯾﺮﺳ نﺎﻛ اذإ ﻻإ ،نا

ﻮﻨﻌﻟا

  

(b)  List any other persons who are known to have or claim  a 
right to custody of each child listed above. 

 ﻞﻜﻟ ﺔﻧﺎﻀﺣ ﻖﺣ ﻢﮭﯾﺪﻟ نأ نﻮﻋﺪﯾ وأ  ﻢﮭﯾﺪﻟ نأ فوﺮﻌﻣ ﻦﯾﺮﺧآ صﺎﺨﺷأ يأ ﺮﻛذا  (ب)
.هﻼﻋأ  جرﺪﻣ ﻞﻔط

 

Name  / ﻢﺳﻻا 

Address / ناﻮﻨﻌﻟا 

Basis of claim  / ءﺎﻋدﻹا سﺎﺳأ 

 
 
 
 
 

 
 
 
 
 

 

 
 
 
 
 

 
 
 
 
 

  6

 

 
 
 
 
 

  9

 

 

 
 
 
 
 
 

 

 
 
 
 
 

       

ENGLISH/ARABIC  PFA Petition 
Pa. P.C. P. 1905(b) Rev. 11-08     

 

 

 

 

 

 

 

 

Page 3 of 7 / 7

 ﻦﻣ 3  ﺔﺤﻔﺻ     

 

 

 

 

 

 

AOPC Rev. 6-2011 

0.   The following  other minor  child/ren presently live with the 
Plaintiff: 
 

ﻲ: 

ﻋﺪﻤﻟا ﻊﻣ ًﺎﯿﻟﺎﺣ  (نﻮﺸﯿﻌﯾ) ﺶﯿﻌﯾ
 
ﻲﻟﺎﺘﻟا ﺮﺧﻵا (لﺎﻔطﻷا) ﻞﻔﻄﻟا  .

10

(
Name(s)  /  ءﺎﻤﺳﻷا) ﻢﺳﻻا

 

Age(s) / (رﺎﻤﻋﻷا)ﺮﻤﻌﻟا 

Plaintiff’s  Relationship to Child/ren  / 

(
لﺎﻔطﻷا

) ﻞﻔﻄﻟا ﻊﻣ

 ﻲ

ﻋﺪﻤﻟا ﺔﻗﻼﻋ

 

 
 
 
 

1.   The facts of the most recent incident of abuse are as follows: 

:ﻲﻟﺎﺘﻟﺎﻛ ﻲھ ًاﺪﮭﻋ

 

 ثﺪﺣﻷا ةءﺎﺳﻹا ﺔﺛدﺎﺣ ﻊﺋﺎﻗو  .

11

 

 

 تﺎ

 ﺐﻠط

ﻲﺒﻄﻟا

جﻼﻌﻟا

ﻚﺑ قﺎﺤﻠﻟا

 ثداﻮﺣ ،

  تﻻﺎﺼﺗﻻا وأ/و ،

 ___________________________________________

ﺑﺎﺻإ  ،تاﺪﯾﺪﮭﺗ ،ﺔﯿﺴﻨﺟ وأ ﺔﯾﺪﺴﺟ ة
 ،(ﺔﺴﻠ

 
___________________________
 
___________________________

 
  :ﻲﺒﯾﺮﻘﺘﻟا ﺦﯾرﺎﺘﻟا
   :ﻲﺒﯾﺮﻘﺘﻟا ﺖﻗﻮﻟا
:نﺎﻜﻤﻟا
ءﺎﺳإ يأ ﻚﻟذ ﻲﻓ ﺎﻤﺑ ،ثﺪﺣ ﺎﻣ ﻒﺻ
 َﻘﻌﺗ
 ﺧ
)  ﺐ
ﺔﯾﺪﺴﺟ
  :ﺔطﺮﺸﻟﺎﺑ ﺔﯿﻔﺗﺎﮭﻟا
 
 
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
 

 
 
 
 
 
 
 
 
 
 

 ﻞﻔﻄﻟا وأ ﻲﻋﺪﻤﻟا  ﺪﺿ ﺔﻘﺑﺎﺳ ةءﺎﺳإ لﺎﻤﻋأ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا  ﺐﻜﺗرا لﺎﺣ ﻲﻓ
 وأ  تاﺪﯾﺪﮭﺗ يأ ﻚﻟذ ﻲﻓ ﺎﻤﺑ ،ﺔﻘﺑﺎﺴﻟا لﺎﻤﻋﻷا هﺬھ ﻒﺻ  ،ﺮﺻﺎﻘﻟا (لﺎﻔطﻷا)
  ﺖﺛﺪﺣ ًﺎﺒﯾﺮﻘﺗ ﻰﺘﻣ ﺮﻛذاو  ،ﺐّﻘﻌﺗ ثداﻮﺣ وأ تﺎﺑﺎﺻإ
 

.ةءﺎﺳإ لﺎﻤﻋأ

اﺬﻜھ

 

 

12. 

pproximate  date: ___________________________ 
Approximate  time:  ___________________________ 
Place:  ___________________________________________ 
Describe what happened, including any physical or sexual 
abuse, threats, injury,  incidents of stalking, medical  treatment 
sought, and/or calls to law  enforcement: 

________________________________________________ 
_________________________________________________ 
_________________________________________________ 
_________________________________________________ 
_________________________________________________ 
_________________________________________________ 
_________________________________________________ 
_________________________________________________ 
_________________________________________________ 
_________________________________________________ 

12.  If Defendant has committed  prior acts of abuse against 
Plaintiff  or the minor  child/ren, describe these prior 
incidents, including any threats, injuries,  or incidents of 
stalking, and indicate approximately  when such acts of abuse 
occurred. 

  A

  _

  _

_______________________________________________ 

 

        ________________________________________________

________________________________________________ 

 

        ________________________________________________

________________________________________________ 

 

        ________________________________________________

________________________________________________ 

 

        ________________________________________________

________________________________________________ 

 

        ________________________________________________

________________________________________________ 

        ________________________________________________

 
13.   (a)  Has Defendant used or threatened to use any firearms  or 
other weapons against Plaintiff  or the minor  child/ren? If 
so, please describe the use or threatened use below and 
list on Attachment A to Petition, which is incorporated 
by reference into this petition, any firearms,  other 
weapons or ammunition  Defendant used or threatened to 
use against Plaintiff  and/or the minor  child/ren:  

 ﺔﺤﻠﺳأ وأ ﺔﯾرﺎﻧ ﺔﺤﻠﺳأ يأ لﺎﻤﻌﺘﺳﺎﺑ دﺪھ وأ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻞﻤﻌﺘﺳا ﻞھ
 
 ﻰﻋﺪﻤﻟا مﺎﻗ لﺎﺣ ﻲﻓ ؟ﺮﺻﺎﻘﻟا (لﺎﻔطﻷا) ﻞﻔﻄﻟا وأ ﻲﻋﺪﻤﻟا ﺪﺿ ىﺮﺧأ
 ﺮﻛذاو هﺎﻧدأ
 ،ﻚﻟﺬﺑ ﮫﯿﻠﻋ
 ﺔﯾرﺎﻧ ﺔ
 ،
 ﻖﺤﻠﻣ ﻲﻓ
ﻟا  ﺎﮭﻣاﺪﺨﺘﺳﺎﺑ  مﺎﻗ ةﺮﯿﺧذ وأ ىﺮﺧأ ﺔﺤﻠﺳأ وأ
  ﺎﮭﻣاﺪﺨﺘﺳﺎﺑ  دﺪھ وأ ﮫﯿﻠﻋ ﻰﻋﺪﻤ
: 
ﺮﺻﺎﻘﻟا (لﺎﻔطﻷا) ﻞﻔﻄﻟا وأ/و ﻲﻋﺪﻤﻟا ﺪﺿ

ﺎﺑ  ﺪﯾﺪﮭﺘﻟا وأ لﺎﻤﻌﺘﺳا ﻒﺻو  ﻰﺟﺮﯾ
أ سﺎﻤﺘﻟﻻا

 
حﻼﺴﻟا
ﺤﻠﺳأ يأ ،

ﻻا اﺬھ ﻲﻓ ةرﺎﺷﻹﺎﺑ

 
لﺎﻤﻌﺘﺳ
سﺎﻤﺘﻟ

  جرﺪﻤﻟا

   

(أ)

13  .

 

              _____________________________________________ 

 

_____________________________________________

               _____________________________________________ 

 

_____________________________________________

               _____________________________________________ 

 

_____________________________________________

               _____________________________________________ 

 

_____________________________________________

               _____________________________________________ 
 
 

 

_____________________________________________
 

ENGLISH/ARABIC  PFA Petition 
Pa. P.C. P. 1905(b) Rev. 11-08     

 

 

 

 

 

 

 

 

Page 4 of 7 / 7

 ﻦﻣ 4  ﺔﺤﻔﺻ     

 

 

 

 

 

 

AOPC Rev. 6-2011 

 
 
 
 

   

 
 

    1

 
 
 
 

  1

 

   

 

ا    (د)

 
15

   

 
 

 

(b)  Other than the firearms,  other weapons, or ammunition 

Defendant used or threatened to use against Petitioner or 
the minor  child/ren, does Defendant, to the best of your 
knowledge or belief  own or possess any additional 
firearm,  other weapon, ammunition  or any firearm 
license? 

 

 ﻰﻋﺪﻤﻟا ﺎﮭﻠﻤﻌﺘﺳا ﻲﺘﻟا ةﺮﯿﺧﺬﻟا وأ ىﺮﺧﻷا ﺔﺤﻠﺳﻷا وأ ﺔﯾرﺎﻨﻟا ﺔﺤﻠﺳﻷا

 
اﺪﻋ ﺎﻣ
  
 ﻚﻠﻤﯾ ﻞھ ،ﺮﺻﺎﻘﻟا (لﺎﻔطﻷا) ﻞﻔﻄﻟا وأ ﻲﻋﺪﻤﻟا ﺪﺿ ﺎﮭﻟﺎﻤﻌﺘﺳﺎﺑ  دﺪھ وأ ﮫﯿﻠﻋ
 ﺐﺴﺣ ،ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا
 
ﻖﺒﺳ ﺎﻣ ﻰﻟإ ﺔﻓﺎﺿإ
؟يرﺎﻧ حﻼﺳ ةزﺎﯿﺤﻟ

زﻮﺤﯾ وأ  ،كدﺎﻘﺘﻋا
 ﺔﺼﺧر

 وأ ةﺮﯿﺧذ وأ ىﺮﺧأ ﺔﺤﻠﺳأ وأ  يرﺎﻧ
 

تﺎﻣﻮﻠﻌﻣ ﻦﻣ ﻚﯾﺪﻟ ﺎﻣ ﻞﻀﻓأ

حﻼﺳ يأ
 

 ﺐﺴﺣ

 يأ

 وأ

 

(ب)

    □

 □ 
ﻻ 

     ﻢﻌﻧ
 

 

وأ  يرﺎﻧ حﻼﺳ يأ  ﺮﻛذا ،"ﻢﻌﻧ" هﻼﻋأ  (ب) لاﺆﺴ
 ﻖﺤﻠﻣ ﻲﻓ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ةزﺎﯿﺣ ﻲﻓ وأ ﺎﮭﻜﻠﻤﯾ ﺔﯿﻓﺎﺿإ  ةﺮﯿﺧذ وأ ﺮﺧآ حﻼﺳ
أ سﺎﻤﺘﻟﻻا

ﻻا اﺬھ ﻲﻓ ةرﺎﺷﻹﺎﺑ
 

 ﻰﻠﻋ ﺔﺑﺎﺟﻹا ﺖﻧﺎﻛ اذإ    (ج)

جرﺪﻤﻟا

سﺎﻤﺘﻟ

. 

 ،

ﻟا

 

ﺐﻠﻄ 

 ﻲﻓ ةرﻮﻛﺬﻤﻟا ةﺮﯿﺧ
 ﻖﺤﻠﻣ

 مﻮﻘﯾ نأ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﺔﻤﻜﺤﻤﻟا ﺮﻣﺄﺗ نأ
 ﻖﺤﻠﻣ

  
 
ﯾ ﻻ
ﻲﻋﺪﻤﻟ
ﺬ
ﻟا وأ ىﺮﺧﻷا ﺔﺤﻠﺳﻷا وأ ﺔﯾرﺎﻨﻟا ﺔﺤﻠﺳﻷا ﻢﯿﻠﺴﺘﺑ
 ﻲﻓ ﺪﯾﺪﺤﺘﻟا ﻰﺟﺮﯾ ،حﻼﺴﻟا ﻢﯿﻠﺴﺗ ﻲﻋﺪﻤﻟا ﺐﻠط لﺎﺣ ﻲﻓ .
أ سﺎﻤﺘﻟﻻا
ﺮﯿﺧﺬﻟاو ىﺮﺧﻷا ﺔﺤﻠﺳﻷاو ﺔﯾرﺎﻨﻟا ﺔﺤﻠﺳﻷا
 
أ سﺎﻤﺘﻟﻻا
.ﺎﮭﻤﯿﻠﺴﺘﺑ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﺮﻣﺄﺗ نأ ﺔﻤﻜﺤﻤﻟا

 ﻦﻣ ﻲﻋﺪﻤﻟا ﺐﻠﻄﯾ ﻲﺘﻟا ة

 ﺐﻠﻄﯾ

  

  /

 

 

 

.ﺔﯾﺎﻤﺤﻟا ﺮﻣأ

ﻦﻣ 

 ﺔﺨﺴﻨﺑ  ﺎﯿﻧﺎﻔﻠﺴﻨﺑ ﺔﯾﻻو ﺔطﺮﺷ  ﺪﯾوﺰﺗ ﺐﺠﯾ  .

14

. 

ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻦﻣ ىﺮﺧأ

 

ةءﺎﺳإ ثوﺪﺤﺑ ﻚﯿﺷو

 ﻲﻟﺎﺣ ﺮﻄﺧ كﺎﻨھ  .

□ Yes          □ No 
 

(c)  If the answer to (b) above is “yes,” list any additional 
firearm,  other weapon, or ammunition  owned by or in 
the possession of Defendant on Attachment A to 
Petition, which is incorporated by reference into this 
petition.  

 
(d)  Plaintiff    DOES  /  DOES  NOT  request that the 
court order Defendant to relinquish firearms,  other 
weapons or ammunition  listed on Attachment A to 
Petition. If Plaintiff  does seek relinquishment,  identify 
on Attachment A to Petition the firearms,  other weapons, 
and ammunition  Plaintiff  requests the court to order 
Defendant to relinquish. 

 
14.   The Pennsylvania State Police  are to be provided a copy of 
the Protection Order. 
 
15.   There is an immediate  and present danger of further abuse 
from  Defendant. 

 

 

 

HECK  THE  FOLLOWING  BOXES  ONLY  IF THEY  APPLY 

 

تﺎﻣﻮﻠﻌﻤﻟا

 

ّﺪﻗو
م

 

ﻚﺘﯿﻀﻗ ﻰﻠﻋ

 ﻖﺒﻄﻨﺗ
 

تﻧﺎﻛ اذإ طﻘﻓ

 ﺔﯿﻟﺎﺘﻟا  تﺎﻌﺑﺮﻤﻟا

 ﻰﻠﻋ تﺎﻣﻼﻋ ﻊﺿ
 
ﺔﺑﻮﻠﻄﻤﻟا

:ﺔﯿﻟﺎﺘﻟا

 

____________________________________________________ 

 

_____________________________________________________

TO YOUR  CASE  AND PROVIDE  THE  REQUESTED 
INFORMATION: 
 
  Plaintiff  is asking the Court to evict and exclude  Defendant 
from  the residence which is  
 OWNED  /  RENTED              in the name of  
____________________________________________________ 

ocated at: ___________________________________________ 

 

____________________________________________________ 
 
  Defendant owes a duty of support to Plaintiff  and/or the minor 
      child/ren. 
 
  Plaintiff  has suffered out-of-pocket financial  losses as a result 
      of the abuse described above. 
 

These losses are as follows:___________________________ 
_________________________________________________ 

 ﻦﻋ هدﺎﻌﺑإو ﻦﻜﺴﻤﻟا ءﻼﺧﺈﺑ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﺮﻣﺄﺗ
 

 
  
 ﻦﻣ ﺐﻠﻄﯾ ﻲﻋﺪﻤﻟا
 
ﻦﻜﺴﻤﻟا
 
 
 
ﻢﺳﺎﺑ
 
  كﻮﻠﻤﻣ
____________________________________________________
 
 :ﻲﻓ ﻊﻗاﻮﻟا

______________________________________________

ﻮھ يﺬﻟا
  / 

نأ ﺔﻤﻜﺤﻤﻟا

 
  

             

 ﺮ َﺟﺄﺘﺴﻣ

  

 

 

_____________________________________________________
 

 

.ﺮﺻﺎﻘﻟا  (لﺎﻔطﻷا) ﻞﻔﻄﻟا وأ/و ﻲﻋﺪﻤﻟا

 
ﻰﻟإ  ﺔﻘﻔﻧ ﻊﻓﺪﺑ

  ﻦﯾﺪﻣ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا

 

 .هﻼﻋأ

ﺔ 

ﻓﻮﺻﻮﻤﻟا ةءﺎﺳﻹا ﻞﻌﻔﺑ
 

ىﺮﺧأ  ﺮﺋﺎﺴﺧو ﺔﯿﻟﺎﻣ

  ﺮﺋﺎﺴﺧ ﻲﻋﺪﻤﻟا  ﺪﺒﻜﺗ

 
 

 ____________________________________
 :ﻲﻠﯾ ﺎﻤﻛ ﻲھ ﺮﺋﺎﺴﺨﻟا هﺬھ
 ____________________________________________________

_________________________________________________ 

 

 ____________________________________________________

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

 

 ﺪﻌﺑو ،ًﺎﺘﻗﺆﻣ
 ًاﺮﻣأ
 

 ﺔﺴﻠﺟ
 

فﺎﺼﻧﻹا

 لﺎﻜﺷأ ﻞﻛ ﻰﻠﻋ  ﺔﻣﻼﻋ  ﻊﺿ)
 
ﻲﻠﯾ ﺎﻣ
 

 
  ﺔﻤﻜﺤﻤﻟا رﺪﺼﺗ نأ ﺐﻠطأ ،هﻼﻋأ  ﺔﺤﺿﻮﻤﻟا بﺎﺒﺳﻸﻟ
ًﺎﯿﺋﺎﮭﻧ
ﻖﯿﻘﺤﺘﻟ
 
  ،عﺎﻤﺘﺳﻻا
:(ﺔﺑﻮﻠﻄﻤﻟا

 ًاﺮﻣأ
 
 

ENGLISH/ARABIC  PFA Petition 
Pa. P.C. P. 1905(b) Rev. 11-08     

 

 

 

 

 

 

 

 

Page 5 of 7 / 7

 ﻦﻣ 5  ﺔﺤﻔﺻ     

 

 

 

 

 

 

AOPC Rev. 6-2011 

 

 

 

   

  l

   

  C

____________________________________________________ 

 

_____________________________________________________

  A.  Restrain the Defendant from  abusing, threatening, 

harassing and/or stalking Plaintiff  and/or the minor  child/ren in 
any place where Plaintiff  and/or the children may be found. 
 
  B.  Evict/exclude  the Defendant from  Plaintiff’s  residence and 
prohibit Defendant from  attempting to enter any temporary  or 
permanent residence of Plaintiff. 
 
  C.  Require Defendant to provide Plaintiff  and/or the minor 
child/ren with other suitable housing. 
 
  D.  Award Plaintiff  temporary physical and legal custody of 
the minor  child/ren and place the following  restrictions on contact 
between Defendant and the child/ren. 

____________________________________________________
____________________________________________________
____________________________________________________ 
 
  E.   Prohibit Defendant from  having any contact with Plaintiff 
and/or the minor  child/ren, either in person, by telephone, or in 
writing,  personally or through third persons, including but not 
limited  to any contact at Plaintiff’s  school, business or place of 
employment,  except as the court may  find necessary with respect 
to partial custody and/or visitation with the minor  child/ren. 
 
 
  F.  Prohibit Defendant from  having any contact with 
Plaintiff’s  relatives and Plaintiff’s  child/ren listed in this Petition, 
except as the court may find necessary with respect to partial 
custody and/or visitation with minor  child/ren.   The following 
persons are Plaintiff’s  relatives or family  and household members 
that Plaintiff  believes require  protection from  stalking and 
harassment by Defendant. 
 

 وأ/و ﻲﻋﺪﻤﻟا  ﺐّﻘﻌﺗ وأ/و  ﺔﻘﯾﺎﻀﻣ وأ/و  ﺪﯾﺪﮭﺗ وأ/و ةءﺎﺳإ ﻦﻣ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻊﻨﻣ  .أ

  
ﺪﺟاﻮﺘﯾ ﺪﻗ نﺎﻜﻣ يأ ﻲﻓ ﺮﺻﺎﻘﻟا (لﺎﻔطﻷا) ﻞﻔﻄﻟا

 وأ/و ﻲﻋﺪﻤﻟا ﮫﯿﻓ
 

. 

لﺎﻔطﻷا

 ﺔﻟوﺎ

ﺤﻣ ﻦﻣ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻊﻨﻣو ﻲﻋﺪﻤﻟا ﻦﻜﺴﻣ ﻦﻣ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا  دﺎﻌﺑإ/دﺮط

  
.ﻲﻋﺪﻤﻠﻟ  ﻢﺋاد وأ ﺖﻗﺆﻣ ﻦﻜﺴﻣ يأ لﻮﺧد

 .ب

 

 
ﺮﺧآ

  ﻦﻜﺴﻤﺑ ﺮﺻﺎﻘﻟا (لﺎﻔطﻷا) ﻞﻔﻄﻟا وأ/و ﻲﻋﺪﻤﻟا  ﺪﯾوﺰﺘﺑ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﺮﻣأ  .ج

 ﻊﺿوو ﺮﺻﺎﻘﻟا (لﺎﻔطأ) ﻞﻔﻄﻠﻟ ﺔﺘﻗﺆﻣ  ﺔﯿﺋﺎﻀﻗو ﺔﯾﺪﺴﺟ ﺔﻧﺎﻀﺣ ﻲﻋﺪﻤﻟا ﺢﻨﻣ

 

.(لﺎﻔطﻷا) ﻞﻔﻄﻟاو ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا

 ﻦﯿﺑ لﺎﺼﺗﻻا

ﻰﻠﻋ 

 
.ﺐﺳﺎﻨﻣ

 

 د. 
 ﺔﯿﻟﺎﺘﻟا دﻮﯿﻘﻟا
 

 

_____________________________________________________
_____________________________________________________
_____________________________________________________
 
 ءاﻮﺳ ،ﺮﺻﺎﻘﻟا  (لﺎﻔطﻷا) ﻞﻔﻄﻟا وأ/و ﻲﻋﺪﻤﻟﺎ
 ،ﻚﻟذ ﻲﻓ ﺎﻤﺑ ،ﺔﺜﻟﺎﺛ فاﺮطأ لﻼﺧ ﻦﻣ وأ ًﺎﯿﺼﺨﺷ ،ﺔﺑﺎﺘﻛ وأ ًﺎﯿﻔﺗﺎھ وأ
ﻲﻋﺪﻤﻟا ﺔﺳرﺪﻣ ﻲﻓ

ﺑ
 لﺎﺼﺗا يأ ﻦﻣ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻊﻨﻣ .ـھ

 
 ﻚﻟذ نﺎﻛ
 لﺎﺼﺗا يأ ،ﺮﺼﺤﻟا ﺲﯿﻟو لﺎﺜﻤﻟا ﻞﯿﺒﺳ ﻰﻠﻋ
هاﺮﺗ
 ﺪﻗ ﺎﻣ  ءﺎﻨﺜﺘﺳﺎﺑ ،
ﮫﺘﻔﯿظو
. 
ﺮﺻﺎﻘﻟا لﺎﻔطﻷا ةرﺎﯾز
ﻦﯾ
 

 ﺔﻤﻜﺤﻤﻟا

 نﺎﻜﻣ وأ ﮫﻠﻤﻋ وأ
 وأ/و ﺔﯿﺋﺰﺠﻟا

ﺔﻧﺎﻀﺤﻟﺎﺑ ﻖﻠﻌﺘﯾ  ﺎﻤﯿﻓ ﺎﯾروﺮﺿ

ﮫﺼﺨﺸﺑ

 ﻖﺣ

 

 

 

 

 
 
 رﻮﻛﺬﻤﻟا ﻲﻋﺪﻤﻟا (لﺎﻔطأ) ﻞﻔطو ﻲﻋﺪﻤﻟا  برﺎﻗﺄﺑ لﺎﺼﺗا
ﺔﻧﺎﻀﺤﻟﺎﺑ ﻖﻠﻌﺘﯾ  ﺎﻤﯿﻓ ًﺎﻣزﻻ
ﻲﻓ  (ﻦﯾرﻮﻛﺬﻤﻟا)
 
 
 وأ ﻲ
 ﻖﺣ 
 وأ/و ﺔﯿﺋﺰﺠﻟا
ﻋﺪﻤﻟا  برﺎﻗأ
 ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا  ﺐّﻘﻌﺗ ﻦﻣ ﺔﯾﺎﻤﺣ ﻰﻟإ ﺔﺟﺎﺤﺑ  ﻢﮭﻧﺄﺑ ﻲﻋﺪﻤﻟا  ﺪﻘﺘﻌﯾ ﻲﺘﻟا ﮫﺘﻠﺋﺎﻋ
داﺮﻓأ
و ﮫﺘﻠﺋﺎﻋ
 
.ﻢﮭﺘﻘﯾﺎﻀﻣ
و 
 ﻢﮭﻟ

 ﺔﻤﻜﺤﻤﻟا هاﺮﺗ ﺎﻣ اﺪﻋ ﺎﻣ ،
ﻦﯾ

ﺮﺻﺎﻘﻟا لﺎﻔطﻷا  ةرﺎﯾز

 ﻦﻣ ﻲﻋﺪﻤﻟا ﻊﻨﻣ .و

ﯿﻟﺎﺘﻟا صﺎﺨﺷﻷا  .

اﺬھ ﻻاسﺎﻤﺘﻟ

 ﻢھ 

 يأ

ﻦﯿ

 

Name  / ﻢﺳﻻا 

Address / ناﻮﻨﻌﻟا 

Relationship to Plaintiff  / 
 ﻲﻋﺪﻤﻟﺎﺑ ﺔﻗﻼﻌﻟا 

 
 
 
 

 
 
 
 

  G.   Order  Defendant to temporarily  relinquish some or all of 
the firearms,  other weapons, and/or ammunition  listed on 
Attachment A to Petition and any firearm  license to the sheriff of 
this county and/or prohibit Defendant from  transferring, acquiring 
or possessing some or all firearms  for the duration of the order. 
 
  H.  Order  Defendant to pay temporary support for Plaintiff 
and/or the minor  child/ren, including medical  support and 
payment of the rent or mortgage on the residence. 

و/

 وأ

 
ﺔﺤﻠﺳﻷا
 
 يرﺎﻧ حﻼﺳ ةزﺎﯿﺤﻟ ﺔﺼﺧر يأو
 وأ  ﺾﻌﺑ
  
 
وأ  ءﺎﻨﺘﻗا

 ﺔﯾرﺎﻨﻟا ﺔﺤﻠﺳﻷا ﻊﯿﻤﺟ وأ ﺾﻌﺒﻟ ﺖﻗﺆﻤﻟا  ﻢﯿﻠﺴﺘﻟﺎﺑ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﺮﻣأ  .ز

 أ سﺎﻤﺘﻟﻻا

 
ﻖﺤﻠﻣ ﻲﻓ ةرﻮﻛﺬﻤﻟا ةﺮﯿﺧﺬﻟا وأ/و ىﺮﺧﻷا
 ﻒﯾﺮﺷ
 هﺬھ
 ﻰﻟإ
ا ﺔﺤﻠﺳﻷا ﻊﯿﻤﺟ

 وأ ﻞﻘﻧ ﻦﻣ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻊﻨﻣ وأ/و ﺔﻌطﺎﻘﻤﻟ
ا
 
 
 ﺔﯾرﺎﻨﻟ

 ةﺪﻣ لاﻮط

.ﺔﻤﻜﺤﻤﻟا

ةزﺎﯿﺣ

ﺮﻣأ

 

 

 ﺎﻤﺑ ،ﺮﺻﺎﻘﻟا  (لﺎﻔطﻷا) ﻞ
 

ﻦﻜﺴﻤﻟﺎﺑ صﺎﺨﻟا

. 

ﻔﻄﻟا وأ/و ﻲﻋﺪﻤﻠﻟ
يرﺎﻘﻌﻟا ﻦھﺮﻟا

 

ﺔﺘﻗﺆﻣ  ﺔﻘﻔﻧ  ﻊﻓﺪﺑ

 ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا

 ﺮﻣأ  .ح

 وأ ﻦﻜﺴﻤﻟا رﺎﺠﯾإ ﻊﻓدو ﺔﯿﺒﻄﻟا

 

ﺔﻘﻔﻨﻟا

 
 
 ،ﻚﻟذ ﻲﻓ

  I.  Direct  Defendant to pay Plaintiff  for the reasonable 
financial  losses suffered as the result of the abuse, to be 
determined at the hearing. 
 
  J.  Order Defendant to pay the costs of this action, including 
filing  and service fees. 
 
ENGLISH/ARABIC  PFA Petition 
Pa. P.C. P. 1905(b) Rev. 11-08     

 

 

 

 

 

 

 

 

 
  ﺔﺠﯿﺘﻨﻛ ﺎھﺪﺒﻜﺗ ﻲﺘﻟا ﺔﻟﻮﻘﻌﻤﻟا ﺔﯿﻟﺎﻤﻟا ﻲﻋﺪﻤﻟا  ﺮﺋﺎﺴﺧ ﺾﯾﻮﻌﺘ
ﺑ
 ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا
.عﺎﻤﺘﺳﻻا ﺔﺴﻠﺟ ﻲﻓ  ﺎھﺪﯾﺪﺤﺗ ﻢﺘﯾ نأ ﻰﻠﻋ ،ةءﺎﺳﻺﻟ

 .طﺮﻣأ

 

 

 مﻮﺳر ﻚﻟذ ﻲﻓ ﺎﻤﺑ ،ﺔﯿﺋﺎﻀﻘﻟا

 

تاءاﺮﺟﻹا هﺬھ ﻒﯿﻟﺎﻜﺗ  ﻊﻓﺪ
ﺑ
 ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﺮﻣأ

. 

ﺔﻤﻜﺤﻤﻟا قاروأ ﻢﯿﻠﺴﺗو

 
 
  .ي
 ﺔﯿﻀﻘﻟا ﻊﻓر

Page 6 of 7 / 7

 ﻦﻣ 6  ﺔﺤﻔﺻ     

 

 

 

 

 

 

AOPC Rev. 6-2011 

 

 

 

 

 

   

 
 
 
 

   

   

 
 
 

   

     

  K.  Order  Defendant to pay Plaintiff’s  reasonable attorney’s 

fees. 
 
  L.   Order the following  additional relief,  not listed above: 
 
___________________________________________________ 

 

.ﺔﻟﻮﻘﻌﻤﻟا ﻲﻋﺪﻤﻟا ﻲﻣﺎﺤﻣ  بﺎﻌﺗأ

 

ﻊﻓﺪﺑ

 ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﺮﻣأ .

 ك

 

:هﻼﻋأ ةرﻮﻛﺬﻤﻟا ﺮﯿﻏ ،ﺔﯿﻟﺎﺘﻟا ﺔﯿﻓﺎﺿﻹا

 

فﺎﺼﻧﻹا لﺎﻜﺷﺄﺑ ﺮﻣﻷا

 .ل

 

___________________________________________________ 

___________________________________________________ 

___________________________________________________ 

___________________________________________________ 

___________________________________________________ 

 
  M.  Grant such other relief  as Plaintiff  requests and/or the 
court deems appropriate. 
 
  N.  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 Hearing.   Plaintiff  will  inform  the 
designated authority of any addresses, other than the Defendant’s 
residence, where the Defendant can be served. 
 
 

 

VERIFICATION 
 

ًﺎﺒﺳﺎﻨﻣ ﺔﻤﻜﺤﻤﻟا هاﺮﺗ ﺎﻤﺒﺴﺣ وأ/و
.

 

 

ﺮﺧآ فﺎﺼﻧإ ﻦﻣ ﻲﻋﺪﻤﻟا ﮫﺒﻠﻄﯾ  ﺪﻗ ﺎﻣ

  .م

 

 ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا
ﻢﯿﻠﺴﺘﺑ
 
 غﻼﺑﺈﺑ ﻲﻋﺪﻤﻟا مﻮﻘﯿﺳ  .عﺎﻤﺘﺳﻻا ﺔﺴﻠﺟ

ﻖﯿﺒﻄﺗ
 
نﻮﻧﺎﻗ
 
 
ﺮﻣأ

 ىﺮﺧأ

 

 ﻢﯿﻠﺴﺗ ﻦﻜﻤﯾ ﺚﯿﺣ

 ،ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا ﻦﻜﺴﻣ ناﻮﻨﻋ ﺮﯿﻏ

 يأ وأ

 
 
ﺔﺌﯿھ
 وأ ﺔطﺮﺸﻟا ﺮﻣأ .ن
 
ﻒﯾﺮﺸﻟا
ﻦﻣ 
 ﺔﺨﺴﻧ
و  ردﺎﺻ ﺮﻣأ يأو
 
سﺎﻤﺘﻟ
ﻻا اﺬھ
ﻦﯾوﺎﻨﻋ
 يﺄﺑ ﺔﺼﺘﺨﻤﻟا
 
ﺔﻄﻠﺴﻟا
.ﺔﻤﻜﺤﻤﻟا قاروأ ﮫﯿﻠﻋ ﻰﻋﺪﻤﻟا

، 
 

 
I  verify  that  I  am  the  Plaintiff  as  designated  in  the  present 
action  and  that  the  facts  and statements contained in the above 
petition are true and correct to the best of my  knowledge. 

ﺋﺎﻗﻊ 
 ﻦﻣ  يﺪﻟ  ﺎﻣ  ﻞﻀﻓأ

ﻮﻟا ﻞﻛ  نأو  ﺔﯿﻟﺎﺤﻟا  ﺔﯿﻀﻘﻟا  ﻲﻓ  ﻦﯿﺒﻣ  ﻮھ  ﺎﻤﻛ
 
  ﺐﺴﺣ  ﺔﺤﯿﺤﺻو
  هﻼﻋأ

ﺔﯿﻘﯿﻘﺣ

 

سﺎﻤﺘﻟ
 
سﺎﻤﺘﻟ

ﻻا  مﺪﻘﻣ  ﻲﻨﻧﺄﺑ
 
 ﺎﻧأ
ﺪﻛؤأ
ﻻا  ﻲﻓ  ﺔﻨﻤﻀﺘﻤﻟا
 
. 

         
تادﺎﻓﻹا
و
.تﺎﻣﻮﻠﻌﻣ

 

I  understand  that  any  false  statements  are  made  subject  to  the 
penalties  of  18  Pa.C.S.A.  §4904,  relating  to unsworn falsification 
to authorities. 
 

 

ةدﺎﻤﻟا  ﺐﺴﺣ  ﺔﯿﻧﻮﻧﺎﻗ  تﺎﺑﻮﻘﻌﻟ  ﻲﻨﺿﺮﻌﺗ  ﺔﻔﺋاز  تادﺎﻓإ  يأ  نﺄﺑ  ﻢﮭﻓأ  ﻲﻨﻧ
 
أ
 
 ﻰﻟإ

ﺎﮭﯾﻠﻋ  موﺳﻘﻣ  رﯾﻏ  ﺔﺑذﺎﻛ  تادﺎﻓإ  مﯾدﻘﺗﺑ

  ﺔﻘﻠﻌﺘﻤﻟا

    ،

  ﺎﻤﻛ

18  Pa.C.S.A.  §4904
 
تﺎﻄﻠﺴﻟا

. 

ﺪﯿﻛﺄﺗ 
 

______________________________________  
 

Date /ﺦﯾرﺎﺘﻟا 

 

 

 

 

 

 

 

 
 

 
 

 
 

 
 

 
 

 
 

__________________________________________ 
 

Signature / ﻊﯿﻗﻮﺘﻟا 

 

 

ENGLISH/ARABIC  PFA Petition 
Pa. P.C. P. 1905(b) Rev. 11-08     

 

 

 

 

 

 

 

 

Page 7 of 7 / 7

 ﻦﻣ 7  ﺔﺤﻔﺻ     

 

 

 

 

 

 

AOPC Rev. 6-2011 

     

   

 

                             

          _

Arabic PFA Petition

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): 7
Fields(s): 327
Average fields per page: 46
Reading Level: Grade 13
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.

defendants_address was Defendants Address (0.50 conf)
b was DO B (0.34 conf)
height was HEIGHT (0.36 conf)
sex was SEX (0.38 conf)
weight was WEIGHT (0.36 conf)
race was RACE (0.41 conf)
eyes was EYES (0.34 conf)
caution was CAUTION (0.41 conf)
weapon_present_property was Weapon Present on the Property (0.35 conf)
weapon_requested_relinquished was Weapon Requested Relinquished (0.34 conf)
hair was HAIR (0.34 conf)
ssn was SSN (0.34 conf)
driver_li_c_ense was DRIVERS LIC ENSE (0.38 conf)
ex_p_date was EXP DATE (0.32 conf)
users1_address_state was STATE (1.00 conf)
fill__1 was fill_6 (0.36 conf)
fill__2 was fill_7 (0.36 conf)
toggle__1 was toggle_7 (0.38 conf)
toggle__2 was toggle_6 (0.38 conf)
undefined__1 was undefined (0.38 conf)
row__1 was Row1 (0.35 conf)
fill__3 was fill_24 (0.36 conf)
row__2 was Row2 (0.35 conf)
fill__4 was fill_25 (0.36 conf)
fill__5 was fill_9 (0.36 conf)
row__3 was Row3 (0.35 conf)
fill__6 was fill_26 (0.36 conf)
fill__7 was fill_27 (0.36 conf)
toggle__3 was toggle_8 (0.38 conf)
toggle__4 was toggle_9 (0.38 conf)
toggle__5 was toggle_10 (0.38 conf)
county was County (0.39 conf)
no was No (0.45 conf)
middle_name was Middle Name (0.40 conf)
last_name was Last Name (0.42 conf)
users1_birthdate was DOB (1.00 conf)
check_box__1 was Check Box6 (0.37 conf)
check_box__2 was Check Box7 (0.37 conf)
first_name was First Name (0.42 conf)
text__1 was Text13 (0.35 conf)
text__2 was Text14 (0.35 conf)
text__3 was Text15 (0.35 conf)
text__4 was Text16 (0.35 conf)
text__5 was Text17 (0.35 conf)
text__6 was Text18 (0.35 conf)
text__7 was Text19 (0.35 conf)
text__8 was Text20 (0.35 conf)
text__9 was Text21 (0.35 conf)
text__10 was Text23 (0.35 conf)
text__11 was Text1 (0.35 conf)
text__12 was Text2 (0.35 conf)
text__13 was Text3 (0.35 conf)
text__14 was Text4 (0.35 conf)
defendants_place_employment was Defendants place of employment is (0.34 conf)
firearms_dealer_employed was licensed firearms dealer is employed by a licensed firearms (0.41 conf)
toggle__6 was toggle_2 (0.38 conf)
fill__8 was fill_13 (0.36 conf)
andor was andor (0.36 conf)
please_answer_questions was If you checked myself please answer all questions referring to (0.33 conf)
toggle__7 was toggle_6_2 (0.33 conf)
toggle__8 was toggle_5 (0.38 conf)
filers_address_confidential was Filers address is confidential (0.42 conf)
undefined__2 was undefined_2 (0.39 conf)
toggle__9 was toggle_9_2 (0.33 conf)
toggle__10 was toggle_10_2 (0.33 conf)
filers_address was Filers address is (0.45 conf)
fill__9 was fill_4 (0.36 conf)
parent_minor_plaintiffs was parent of minor Plaintiffs (0.52 conf)
appointment_ad_minor was applicant for appointment as guardian ad litem of minor (0.39 conf)
household_member_minor was adult household member with minor Plaintiffs (0.51 conf)
court_incompetent_plaintiffs was court appointed guardian of incompetent Plaintiffs (0.46 conf)
toggle__11 was toggle_15 (0.38 conf)
toggle__12 was toggle_16 (0.38 conf)
toggle__13 was toggle_17 (0.38 conf)
toggle__14 was toggle_18 (0.38 conf)
persons_minor_children was 4 Names of all persons including minor children who seek (0.39 conf)
fill__10 was fill_6_2 (0.40 conf)
protection_abuse__1 was protection from abuse 1 (0.30 conf)
protection_abuse__2 was protection from abuse 2 (0.30 conf)
protection_abuse__3 was protection from abuse 3 (0.30 conf)
fill__11 was fill_8 (0.36 conf)
fill__12 was fill_10 (0.36 conf)
fill__13 was fill_12 (0.36 conf)
chec_k_al_l_tha_apply was CHECK ALL THAT APPLY (0.53 conf)
parent_child_defendant was parent of a child with Defendant (0.38 conf)
current_sexual_partner was current or former sexual or intimate partner with Defendant (0.53 conf)
child_plaintiff was child of Plaintiff (0.46 conf)
child_defendant was child of Defendant (0.50 conf)
family_related_blood was family member related by blood consanguinity to (0.28 conf)
member_related_defendant was family member related by marriage or affinity to Defendant (0.45 conf)
sibling_person_defendant was sibling person who shares parenthood of Defendant (0.38 conf)
check_years_old_younger was Check here if Defendant is 17 years old or younger (0.37 conf)
toggle__15 was toggle_27 (0.38 conf)
toggle__16 was toggle_28 (0.38 conf)
toggle__17 was toggle_29 (0.38 conf)
toggle__18 was toggle_30 (0.38 conf)
toggle__19 was toggle_31 (0.38 conf)
toggle__20 was toggle_32 (0.38 conf)
toggle__21 was toggle_33 (0.38 conf)
toggle__22 was toggle_34 (0.38 conf)
toggle__23 was toggle_36 (0.38 conf)
text__15 was Text24 (0.35 conf)
text__16 was Text25 (0.35 conf)
text__17 was Text26 (0.35 conf)
text__18 was Text27 (0.35 conf)
toggle__24 was toggle_5_2 (0.33 conf)
toggle__25 was toggle_6_3 (0.33 conf)
toggle__26 was toggle_7_2 (0.33 conf)
toggle__27 was toggle_8_2 (0.33 conf)
divorce was Divorce (0.41 conf)
custody was Custody (0.47 conf)
support was Support (0.43 conf)
protection_abuse__4 was Protection from Abuse (0.29 conf)
signature_date was Date (1.00 conf)
fill__14 was fill_1 (0.36 conf)
defendant__1 was 7 The Defendant (0.42 conf)
has was HAS (0.36 conf)
defendant__2 was The Defendant (0.40 conf)
is was IS (0.32 conf)
toggle__28 was toggle_15_2 (0.33 conf)
toggle__29 was toggle_14 (0.38 conf)
fill__15 was fill_5 (0.36 conf)
fill__16 was fill_6_3 (0.40 conf)
fill__17 was fill_7_2 (0.40 conf)
fill__18 was fill_8_2 (0.40 conf)
fill__19 was fill_9_2 (0.40 conf)
fill__20 was fill_10_2 (0.40 conf)
fill__21 was fill_11 (0.36 conf)
fill__22 was fill_12_2 (0.40 conf)
fill__23 was fill_13_2 (0.40 conf)
fill__24 was fill_14_2 (0.40 conf)
fill__25 was fill_15_2 (0.40 conf)
fill__26 was fill_16_2 (0.40 conf)
fill__27 was fill_17 (0.36 conf)
fill__28 was fill_18 (0.36 conf)
fill__29 was fill_19 (0.36 conf)
together_regarding_custody was together is there an existing court order regarding their custody (0.38 conf)
yes__1 was YES (0.45 conf)
toggle__30 was toggle_19 (0.38 conf)
toggle__31 was toggle_18_2 (0.33 conf)
answered_yes_county_state was If you answered Yes in what county and state was the (0.43 conf)
fill__30 was fill_4_2 (0.40 conf)
fill__31 was fill_20 (0.36 conf)
fill__32 was fill_21 (0.36 conf)
fill__33 was fill_22 (0.36 conf)
fill__34 was fill_23 (0.36 conf)
fill__35 was fill_24_2 (0.40 conf)
fill__36 was fill_25_2 (0.40 conf)
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fill__52 was fill_41 (0.37 conf)
fill__53 was fill_42 (0.37 conf)
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fill__55 was fill_44 (0.37 conf)
fill__56 was fill_45 (0.36 conf)
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fill__61 was fill_50 (0.36 conf)
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fill__74 was fill_57 (0.37 conf)
fill__75 was fill_58 (0.37 conf)
fill__76 was fill_59 (0.37 conf)
fill__77 was fill_60 (0.37 conf)
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approximate_time was Approximate time (0.34 conf)
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sought_calls_law_enforcement__3 was sought andor calls to law enforcement 3 (0.43 conf)
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sought_calls_law_enforcement__5 was sought andor calls to law enforcement 5 (0.43 conf)
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occurred__1 was occurred 1 (0.36 conf)
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occurred__4 was occurred 4 (0.36 conf)
occurred__5 was occurred 5 (0.36 conf)
occurred__6 was occurred 6 (0.36 conf)
unknown__1 was 1 (0.38 conf)
unknown__2 was 2 (0.38 conf)
unknown__3 was 3 (0.38 conf)
unknown__4 was 4 (0.38 conf)
unknown__5 was 5 (0.38 conf)
unknown__6 was 6 (0.38 conf)
use_plaintiff_minor_children__1 was use against Plaintiff andor the minor children 1 (0.45 conf)
use_plaintiff_minor_children__2 was use against Plaintiff andor the minor children 2 (0.45 conf)
use_plaintiff_minor_children__3 was use against Plaintiff andor the minor children 3 (0.45 conf)
use_plaintiff_minor_children__4 was use against Plaintiff andor the minor children 4 (0.45 conf)
use_plaintiff_minor_children__5 was use against Plaintiff andor the minor children 5 (0.45 conf)
1_2 was 1_2 (0.38 conf)
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3_2 was 3_2 (0.38 conf)
4_2 was 4_2 (0.38 conf)
5_2 was 5_2 (0.38 conf)
license was license (0.47 conf)
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toggle__34 was toggle_3 (0.38 conf)
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residence was from the residence which is (0.32 conf)
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fill__92 was fill_4_4 (0.40 conf)
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located__2 was located at 2 (0.41 conf)
fill__93 was fill_6_5 (0.40 conf)
fill__94 was fill_8_4 (0.40 conf)
owes_duty_plaintiff_minor was Defendant owes a duty of support to Plaintiff andor the minor (0.44 conf)
plaintiff_financial_losses was Plaintiff has suffered outofpocket financial losses as a result (0.38 conf)
toggle__39 was toggle_15_3 (0.33 conf)
toggle__40 was toggle_17_2 (0.33 conf)
fill__95 was fill_10_4 (0.40 conf)
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losses_follows__2 was These losses are as follows 2 (0.36 conf)
fill__96 was fill_12_4 (0.40 conf)
fill__97 was fill_14_4 (0.40 conf)
check_box__4 was Check Box29 (0.37 conf)
harassing_stalking_plaintiff was harassing andor stalking Plaintiff andor the minor children in (0.40 conf)
toggle__41 was toggle_2_2 (0.33 conf)
defendant_attempting_enter was prohibit Defendant from attempting to enter any temporary or (0.43 conf)
toggle__42 was toggle_4_2 (0.33 conf)
children_suitable_housing was children with other suitable housing (0.41 conf)
toggle__43 was toggle_6_4 (0.33 conf)
place_restrictions_contact was the minor children and place the following restrictions on contact (0.40 conf)
toggle__44 was toggle_8_3 (0.33 conf)
minor_either_person was andor the minor children either in person by telephone or in (0.40 conf)
toggle__45 was toggle_10_3 (0.33 conf)
defendant_children__1 was between Defendant and the children 1 (0.44 conf)
defendant_children__2 was between Defendant and the children 2 (0.44 conf)
1_3 was 1_3 (0.38 conf)
2_3 was 2_3 (0.38 conf)
plaintiffs_relatives_petition was Plaintiffs relatives and Plaintiffs children listed in this Petition (0.45 conf)
toggle__46 was toggle_12_2 (0.33 conf)
fill__98 was fill_5_2 (0.40 conf)
fill__99 was fill_6_6 (0.40 conf)
fill__100 was fill_7_3 (0.40 conf)
fill__101 was fill_8_5 (0.40 conf)
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fill__104 was fill_11_2 (0.40 conf)
fill__105 was fill_12_5 (0.40 conf)
firearms_weapons_ammunition was the firearms other weapons andor ammunition listed on (0.34 conf)
toggle__47 was toggle_14_2 (0.33 conf)
minor_including_support was andor the minor children including medical support and (0.40 conf)
toggle__48 was toggle_16_2 (0.33 conf)
financial_losses_abuse was financial losses suffered as the result of the abuse to be (0.33 conf)
toggle__49 was toggle_18_3 (0.33 conf)
filing_service_fees was filing and service fees (0.44 conf)
toggle__50 was toggle_20 (0.38 conf)
text__19 was Text30 (0.35 conf)
text__20 was Text31 (0.35 conf)
text__21 was Text32 (0.35 conf)
text__22 was Text33 (0.35 conf)
text__23 was Text34 (0.35 conf)
text__24 was Text35 (0.35 conf)
text__25 was Text36 (0.35 conf)
text__26 was Text37 (0.35 conf)
fees was fees (0.39 conf)
toggle__51 was toggle_2_3 (0.33 conf)
order_following_additional_relief__1 was L Order the following additional relief not listed above 1 (0.40 conf)
order_following_additional_relief__2 was L Order the following additional relief not listed above 2 (0.40 conf)
order_following_additional_relief__3 was L Order the following additional relief not listed above 3 (0.40 conf)
undefined__5 was undefined_5 (0.39 conf)
fill__106 was fill_2_4 (0.40 conf)
fill__107 was fill_4_5 (0.40 conf)
fill__108 was fill_6_7 (0.40 conf)
court_deems_appropriate was court deems appropriate (0.50 conf)
toggle__52 was toggle_5_3 (0.33 conf)
toggle__53 was toggle_7_4 (0.33 conf)
serve_defendant_petition_order was to serve the Defendant with a copy of this petition any order (0.43 conf)
fill__109 was fill_9_4 (0.40 conf)
fill__110 was fill_10_6 (0.40 conf)
check_box__5 was Check Box38 (0.37 conf)

We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

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

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