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Blank Texas Order PDF Form

The Texas Order form is a legal document designed to initiate protective orders in cases of family violence or threats. This form serves as a means for individuals seeking safety to request court intervention and establish guidelines that protect them from further harm. Understanding how to properly complete and submit this form is crucial for anyone in need of immediate legal protection.

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The Texas Order form is a crucial legal document designed to provide protection for individuals facing threats or violence from another person. It serves as a means to obtain a protective order, which can prohibit the alleged aggressor from contacting or approaching the victim and their family members. This form outlines the necessary steps to request protection, including the completion of various forms such as the Application for Protective Order and the Temporary Ex Parte Protective Order. Additionally, it addresses important considerations like living arrangements, child custody, and financial support, ensuring that the safety and well-being of the applicant and any children involved are prioritized. The process is free of charge, but it requires attendance at a court hearing to finalize the protective measures. Understanding how to navigate this form can empower individuals to seek the protection they need in a timely manner, while also providing guidance on what to expect during the court proceedings.

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Protective Orders

What is a protective order?

It is a court order that protects you from someone who has been violent or threatened to be violent.

How can a protective order help me?

It can order the other person to:

Not hurt you or threaten to hurt you

Not contact you or go near you, your children, other family relatives, your home, where you work, or your children’s schools

Not have a gun or a license to carry a gun

The police can arrest the other person for violating any of these orders.

Can I get a protective order?

You can get a protective order if:

What if the other person and I live together or have children together?

The judge can make orders about who gets to use the house, apartment or car.

The judge can also make other orders, like child custody, child support, visitation, and spousal support.

Can I get protection right away?

The judge may give you a temporary order that protects you until your court hearing. This order is called a “Temporary Ex Parte Protective Order”.

In some cases, the judge orders the other person to leave the home right away. If you want this, you should ask the judge. Be ready to testify at a hearing when you file your Application.

Someone has hurt you, or threatened to hurt you, and

You have a close relationship with that person (you were or are married, dating or living together, have a child together or are close relatives), and

You are afraid that person may hurt you again.

How much does it cost?

It is free for you.

Do I have to go to court?

Yes. Even if you get a Temporary Ex Parte Protective Order, you must go to the next hearing. It should be in about 2 weeks. The judge will decide if you should have protection and for how long. If you do not go, the Temporary Ex Parte Protective Order may end.

Read Get Ready for Court in this kit. Or get it from the court clerk or from: www.texaslawhelp.org/protectiveorderkit

How do I ask for a protective order?

Fill out the forms in this kit:

-Application for Protective Order

-Temporary Ex Parte

Protective Order

- Protective Order

- Respondent Information

Where do I file the forms?

After you fill out the forms, take the forms with 2 copies to the courthouse. File them in the county where you or the other person lives. But if you have a divorce or custody case pending against the other person, file the forms in that same county or the county where you live.

How will the other person know about the protective order?

You must have the other person “served” before the court hearing. This means someone—not you—will serve the other person a copy of your application for a protective order.

The clerk can arrange for law enforcement to serve the other person the court papers for FREE (for you).

Need help?

There is an instruction sheet for each form. But, if you need more help, contact:

Family Violence Legal Line: 800-374-HOPE

Or, go to: www.texaslawhelp.org/protectiveorderkit

Although you may file these forms without having a lawyer, you are encouraged to get a lawyer to help you in this process. Your county or district attorney or legal aid office may be able to help for free. The State Bar of Texas may also be able to refer you to a lawyer if you call 800-252-9690.

Get Ready for Court

Don’t miss your hearing!

If you miss it, your Temporary Ex Parte Protective Order may end and you will have to start from the beginning.

Get ready.

Fill out a Protective Order before you go to court and bring it with you.

Bring any evidence you have, like photographs, medical records, torn clothing. Also bring witnesses who know about the violence, like a neighbor, relative or police. The judge may ask them to testify.

Bring proof of your and the other person’s income and expenses, like bills, paycheck stubs, bank accounts, tax returns.

If the Proof of Service was returned to you, file it with the clerk and bring a copy to court.

Get there 30 minutes early.

Find the courtroom.

When the courtroom opens, go in and tell the clerk or officer that you are present.

Watch the other cases so you will know what to do.

When your name is called, go to the front of the courtroom.

What if I don’t speak English?

When you file your papers, tell the clerk you will need an interpreter.

If a court interpreter is not available, bring someone to interpret for you. Do not ask a child, a protected person, or a witness to interpret for you.

What if I am deaf?

When you file your papers, ask for an interpreter or other accommodation.

What if I need child support or visitation orders?

Call the Family Violence Legal Line before you go to court: 800-374-HOPE

What if I am afraid?

If you don't feel safe, call your local family crisis center or the National Domestic Violence Hotline: 800-799-SAFE

Practice what you want to say.

Make a list of the orders you want and practice saying them. Do not take more than 3 minutes to say what you want.

If you get nervous at the hearing, just read from your list. Use that list to see if the judge has made every order you asked for.

The judge may ask questions.

The other person or his or her lawyer may also ask you questions. Tell the truth. Speak slowly. Give complete answers.

If you don’t understand, say, “I don’t understand the question.”

Speak only to the judge unless it is your turn to ask questions. When people are talking to the judge, wait for them to finish. Then you can ask questions about what they said.

What happens after the hearing?

If the judge agrees you need protection, the judge will sign your Protective Order.

Take your signed order to the court clerk. Ask for copies of your order (or make extra copies) and keep one with you at all times.

Give copies of your order to your children’s day care, babysitter, or school. If the other person violates the order, call the police and show them your order.

Need help?

If you are in danger, call the police: 911 Or call Family Violence Legal Line:

800-374-HOPE

Or go to:

www.texaslawhelp.org/protectiveorderkit

Case No.: ______________________________

Your name here.

Applicant: ______________________________________

§

In the ____________________________ Court

 

You are the Applicant.

 

 

 

 

§

The clerk fills

 

v.

§

 

of

 

 

§

out this part

 

Name of person you want protection from.

 

Respondent:

____________________________________

§

__________________________ County, Texas

§

 

This is the Respondent.

 

Application for Protective Order

1Parties

 

Name:

 

County of Residence:

Applicant:

Your name here

 

County where

 

 

Respondent:

Name of person you want protection from

 

each person lives

Respondent’s address for service:

Best address to give the other person a copy of this form

Check all that apply:

 

The Applicant and Respondent are or were members of the same family or household.

The Applicant and Respondent are parents of the same child or children.

The Applicant and Respondent used to be married. The Applicant and Respondent are or were dating.

The Applicant is an adult asking for protection for the Children named below from child abuse and/or family or dating violence.

2Children: The Applicant is asking for protection for these Children under age 18:

 

Name:

Is Respondent the biological parent?

County of Residence:

a.

 

 

Yes

No

 

 

b.

Names of children

 

Yes

No

 

County where

c.

needing protection

 

Yes

No

each person lives

d.

 

 

Yes

No

 

 

Check all that apply:

Other children are listed on a sheet attached to this Application.

The Children are or were members of the Applicant’s family or household.

The Children are the subject of a court order affecting access to them or their support.

3Other Adults: The Applicant is asking for protection for these Adults, who are or were members of the

Applicant’s family or household:

 

Name:

 

 

County of Residence:

a.

Names of other adults needing protection

 

County where

b.

 

 

each person lives

 

 

4Other Court Cases: Are there other court cases, like divorce, custody, support, involving the Applicant,

Respondent, or the Children?

Yes

No

If “Yes,” say what kind of case and if the case is active or completed.

 

 

If “completed,” (check one):

A copy of the final order is attached.

 

A copy of the final order will be filed before the hearing on this Application.

5Grounds: Why is the Applicant asking for this Protective Order? ChReadck oneandor checkboth:

The Respondent committed family violence and is likely to commitonefamilyor bothviolence in the future.

The Respondent violated a prior Protective Order that expired, or will expire in 30 days or less. A copy of the

Order is (check one):

Attached, or

 

Not available now but will be filed before the hearing on this Application.

Sample Only – Do Not File

Page 1 of 4

Application for Protective Order

Form Approved by the Supreme Court of Texas by order in Misc. Docket No. 05-9059 (April 12, 2005)

Check all the orders you

The Applicant requests a Protective Order and asks the Court to make all Orders marked with a check want the judge to make

6Orders to Prevent Family Violence

The Applicant asks the Court to order the Respondent to (Check all that apply):

a.Not commit family violence against any person named on page 1 of this form.

b.Not communicate in a threatening or harassing manner with any person named on page 1 of this form.

c.Not communicate a threat through any person to any person named on page 1 of this form.

d.Not communicate or attempt to communicate in any manner with (Check all that apply):

Applicant Children Other Adults named on page 1 of this form.

The Respondent may communicate through: _______________________ or other person the Court appoints.

Good cause exists for prohibiting the Respondent’s direct communications.

e.Not go within 200 yards of the (Check all that apply):

Applicant

Children

Other Adults named on page 1 of this form.

f.Not go within 200 yards of the residence, workplace or school of the (Check all that apply):

Applicant

Other Adults named on page 1 of this form.

g.Not go within 200 yards of the Children’s residence, child-care facility, or school, except as specifically authorized in a possession schedule entered by the Court.

h.Not stalk, follow or engage in conduct directed specifically to anyone named on page 1 of this form that is reasonably likely to harass, annoy, alarm, abuse, torment, or embarrass them.

The Applicant also asks the Court to make these Orders (Check all that apply):

i.Suspend any license to carry a concealed handgun issued to the Respondent under state law.

j.Require the Respondent to complete a battering intervention and prevention program; or if no such program is available, counseling with a social worker, family service agency, physician, psychologist, licensed therapist, or licensed professional counselor; and pay all costs for the counseling or treatment ordered.

k.Require the Respondent to follow these provisions to prevent or reduce the likelihood of family violence.

__________________________________________________________________________________________________________________

The law requires a trial court issuing a protective order to prohibit the Respondent from possessing a firearm or ammunition, unless the Respondent is a peace officer actively engaged in employment as a sworn, full-time paid employee of a state agency or political subdivision.

7Property Orders

The Residence located at:________________________________________________________________________________________________Your home address here, unless you want it to be confidential.

(Check one): is jointly owned or leased by the Applicant and Respondent; is solely owned or leased by the Applicant; or

is solely owned or leased by the Respondent; and the Respondent is obligated to support the Applicant or a child in the Applicant’s possession.

The Applicant also asks the Court to make these orders (Check all that apply):

The Applicant to have exclusive use of the Residence identified above, and the Respondent must vacate the Residence.

The sheriff, constable, or chief of police shall provide a law enforcement officer to accompany the Applicant to the Residence, to inform the Respondent that the Court has ordered the Respondent excluded from the Residence, to provide protection while the Applicant takes possession of the Residence and the Respondent removes any necessary personal property, and, if the Respondent refuses to vacate the Residence, to remove the Respondent from the Residence and arrest the Respondent for violating the Court’s Order.

The Applicant to have exclusive use of the following property that the Applicant and Respondent jointly own

or lease:______________________________________________________________________________________________________________List the property you want to use or control, like a car or

______________________________________________________________________________________________________________________furniture, even if the other person owns it with you.

The Respondent must not damage, transfer, encumber, or otherwise dispose of any property jointly owned or leased by the parties, except in the ordinary course of business or for reasonable and necessary living expenses, including, but not limited to, removing or disabling any vehicle owned or possessed by the Applicant or jointly owned or possessed by the parties (whether so titled or not).

Sample Only – Do Not File

Page 2 of 4

Application for Protective Order

Form Approved by the Supreme Court of Texas by order in Misc. Docket No. 05-9059 (April 12, 2005)

Your home address here

8Spousal Support Order

The Applicant is married to the Respondent or otherwise legally entitled to support from the Respondent and asks

Checkthe Couheret toif orderyou wantthe Respondentspousal supportto ay support. in an amount set by the Court.

9Orders Related to Removal, Possession and Support of Children

The Respondent is a parent of the following of the Applicant’s children:

Check here and fill out this section if you want the

judge to make orders about who the children can stay

with,And, therestrictionsApplicantonaskstravel,for theseandOrderschild supportin the best. interest of the people named on page 1 of this form.

Check all that apply:

The Respondent must not remove the children from the Applicant’s possession or from their child-care facility or school, except as specifically authorized in a possession schedule entered by the Court. The Respondent must not remove the children from the jurisdiction of the Court.

Establish or modify a schedule for the Respondent’s possession of the Children, subject to any terms and conditions necessary for the safety of the Applicant or the Children.

Require the Respondent to pay child support in an amount set by the Court.

10Temporary Ex Parte Protective Order

Based on the information in the attached Affidavit, there is a clear and present danger of family violence that will cause the Applicant, Children or Other Adults named on page 1 of this form immediate and irreparable injury, loss and damage, for which there is no adequate remedy at law. Applicant asks the Court to issue a Temporary Ex Parte Protective Order immediately without bond, notice or hearing.

11Ex Parte Order: Vacate Residence Immediately

The Applicant now lives with the Respondent at:or has resided at this

Residence within the 30 days prior to filing this Application. The Respondent committed family violence against Checka memberhereofif theyouhouseholdwant thewithinjudgetheo 30 days prior to the filing of this Application, as described in the attached orderAffidavitthe other. Therepersonis a clearto andmovepresentou . danger that the Respondent is likely to commit family violence against a member of the household. The Applicant is available for a hearing but asks the Court to issue a Temporary Ex

Parte Protective Order immediately without bond, notice or hearing:

Granting the Applicant exclusive use and possession of the Residence and ordering the Respondent to vacate the Residence immediately, and remain at least 200 yards away from the Residence pending further Order of the Court; and

Directing the sheriff, constable, or chief of police to provide a law enforcement officer to accompany the Applicant to the Residence, to inform the Respondent that the Court has ordered the Respondent to vacate the Residence, and to provide protection while the Applicant either takes possession of the Residence or removes necessary personal property.

12 Keep Information Confidential

The Applicant asks the Court to keep addresses and telephone numbers for residences, workplaces, schools, and Check here if you want to keep

childcare facilities confidential. your contact information private.

13Fees And Costs

The Applicant asks the Court to order the Respondent to pay fees for service of process, all other fees and costs of Court, and reasonable attorneys’ fees, if applicable.

I have read the entire Application and it is true and correct to the best of my knowledge.

Sign Here

________________________________________

Applicant, Pro se

Address where Applicant may be contacted: __________________________________________________________

List your address/phone or another address/phone

Phone # where Applicant may be contacted: ____________________________ Fax #: _________________________

if you want yours kept confidential.

(List another address/phone if you want yours kept confidential)

Form Approved by the

Sample Only – Do Not File

Application for Protective Order

Page 3 of 4

Supreme Court of Texas by order in Misc. Docket No. 05-9059 (April 12, 2005)

Affidavit

 

Write the name of

 

 

your county here

 

County of ____________________________________________

 

State of Texas

 

 

My name is

___________________________________________Your name here

. I am ______ years old and otherwise competent

to make this Affidavit. The information and events described in this Affidavit are true and correct.

1Describe the most recent time the Respondent hurt you or threatened to hurt you:

 

______________________________________________________________________________________________________________________

 

______________________________________________________________________________________________________________________

 

 

Answer every question on this form.

 

______________________________________________________________________________________________________________________

 

______________________________________________________________________________________________________________________

2

 

If it happened in the last 30 days, the judge

What date did this happen? _____ / ____ / _____

3

 

 

can order the Respondent to move out.

Was a weapon involved?

Yes

No

If yes, what kind? ____________________________________________

4

Were any children there?

Yes

No

If yes, who? __________________________________________________

5

Did you call the police?

Yes

No

If yes, what happened? _____________________________________

6

Did you get medical care?

Yes

No

If yes, describe your injuries: _______________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

7Has the Respondent ever threatened or hurt you BEFORE? Describe below, including date(s).

 

______________________________________________________________________________________________________________________

 

______________________________________________________________________________________________________________________

 

______________________________________________________________________________________________________________________

8

Were weapons ever involved?

Yes

No

If yes, what kind? ____________________________

9

Were any children there?

Yes

No

If yes, who? ___________________________________

10

Have the police ever been called?

Yes

No

 

11

Did you ever have to get medical care?

Yes

No

If yes, describe your injuries: _______________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

Do NOT sign until the notary tells you to.

____________________________________________________________

Applicant signs here

On ____ / ____ / _____, the Applicant ___________________________________ personally appeared before

me, the undersigned notary. After being sworn, the Applicant stated that she/he is qualified to make this oath, Notary fills out this part.

that she/he has read the foregoing Application and Affidavit, that she/he has personal knowledge of the facts asserted, and the facts asserted are true to the best of her/his knowledge and belief.

Subscribed and sworn to before me on ____ / ____ / _____.

_______________________________________________________________________

Notary Public in and for the State of Texas

My Commission expires: _____________________________________________

Sample Only – Do Not File

Page 4 of 4

Application for Protective Order

Form Approved by the Supreme Court of Texas by order in Misc. Docket No. 05-9059 (April 12, 2005)

 

Case No.: ______________________________

Applicant: ______________________________________

§

In the ____________________________ Court

 

§

 

v.

§

of

§

 

 

Respondent: ____________________________________

§

__________________________ County, Texas

§

 

 

 

 

Application for Protective Order

1 Parties

 

 

 

 

Name:

 

 

County of Residence:

Applicant:

 

 

 

 

Respondent:

 

 

 

 

Respondent’s address for service:

Check all that apply:

The Applicant and Respondent are or were members of the same family or household. The Applicant and Respondent are parents of the same child or children.

The Applicant and Respondent used to be married. The Applicant and Respondent are or were dating.

The Applicant is an adult asking for protection for the Children named below from child abuse and/or family or dating violence.

2Children: The Applicant is asking for protection for these Children under age 18:

 

Name:

Is Respondent the biological parent?

County of Residence:

a.

 

 

Yes

No

 

 

b.

 

 

Yes

No

 

 

c.

 

 

Yes

No

 

 

d.

 

 

Yes

No

 

 

Check all that apply:

Other children are listed on a sheet attached to this Application.

The Children are or were members of the Applicant’s family or household.

The Children are the subject of a court order affecting access to them or their support.

3Other Adults: The Applicant is asking for protection for these Adults, who are or were members of the

Applicant’s family or household:

 

Name:

 

County of Residence:

a.

 

 

 

b.

 

 

 

4Other Court Cases: Are there other court cases, like divorce, custody, support, involving the Applicant,

Respondent, or the Children?

Yes

No

If “Yes,” say what kind of case and if the case is active or completed.

 

 

If “completed,” (check one):

A copy of the final order is attached.

 

A copy of the final order will be filed before the hearing on this Application.

5Grounds: Why is the Applicant asking for this Protective Order? Check one or both:

The Respondent committed family violence and is likely to commit family violence in the future.

The Respondent violated a prior Protective Order that expired, or will expire in 30 days or less. A copy of the

Order is (check one):

Attached, or

 

 

Not available now but will be filed before the hearing on this Application.

Application for Protective Order

 

Page 1 of 4

Form Approved by the Supreme Court of Texas by order in Misc. Docket No. 05-9059 (April 12, 2005)

The Applicant requests a Protective Order and asks the Court to make all Orders marked with a check

6Orders to Prevent Family Violence

The Applicant asks the Court to order the Respondent to (Check all that apply):

a.Not commit family violence against any person named on page 1 of this form.

b.Not communicate in a threatening or harassing manner with any person named on page 1 of this form.

c.Not communicate a threat through any person to any person named on page 1 of this form.

d.Not communicate or attempt to communicate in any manner with (Check all that apply):

Applicant Children Other Adults named on page 1 of this form.

The Respondent may communicate through: _______________________ or other person the Court appoints.

Good cause exists for prohibiting the Respondent’s direct communications.

e.Not go within 200 yards of the (Check all that apply):

Applicant

Children

Other Adults named on page 1 of this form.

f.Not go within 200 yards of the residence, workplace or school of the (Check all that apply):

Applicant

Other Adults named on page 1 of this form.

g.Not go within 200 yards of the Children’s residence, child-care facility, or school, except as specifically authorized in a possession schedule entered by the Court.

h.Not stalk, follow or engage in conduct directed specifically to anyone named on page 1 of this form that is reasonably likely to harass, annoy, alarm, abuse, torment, or embarrass them.

The Applicant also asks the Court to make these Orders (Check all that apply):

i.Suspend any license to carry a concealed handgun issued to the Respondent under state law.

j.Require the Respondent to complete a battering intervention and prevention program; or if no such program is available, counseling with a social worker, family service agency, physician, psychologist, licensed therapist, or licensed professional counselor; and pay all costs for the counseling or treatment ordered.

k.Require the Respondent to follow these provisions to prevent or reduce the likelihood of family violence.

__________________________________________________________________________________________________________________

The law requires a trial court issuing a protective order to prohibit the Respondent from possessing a firearm or ammunition, unless the Respondent is a peace officer actively engaged in employment as a sworn, full-time paid employee of a state agency or political subdivision.

7Property Orders

The Residence located at:________________________________________________________________________________________________

(Check one): is jointly owned or leased by the Applicant and Respondent; is solely owned or leased by the Applicant; or

is solely owned or leased by the Respondent; and the Respondent is obligated to support the Applicant or a child in the Applicant’s possession.

The Applicant also asks the Court to make these orders (Check all that apply):

The Applicant to have exclusive use of the Residence identified above, and the Respondent must vacate the Residence.

The sheriff, constable, or chief of police shall provide a law enforcement officer to accompany the Applicant to the Residence, to inform the Respondent that the Court has ordered the Respondent excluded from the Residence, to provide protection while the Applicant takes possession of the Residence and the Respondent removes any necessary personal property, and, if the Respondent refuses to vacate the Residence, to remove the Respondent from the Residence and arrest the Respondent for violating the Court’s Order.

The Applicant to have exclusive use of the following property that the Applicant and Respondent jointly own

or lease:______________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

The Respondent must not damage, transfer, encumber, or otherwise dispose of any property jointly owned or leased by the parties, except in the ordinary course of business or for reasonable and necessary living expenses, including, but not limited to, removing or disabling any vehicle owned or possessed by the Applicant or jointly owned or possessed by the parties (whether so titled or not).

Application for Protective Order

Page 2 of 4

Form Approved by the Supreme Court of Texas by order in Misc. Docket No. 05-9059 (April 12, 2005)

8Spousal Support Order

The Applicant is married to the Respondent or otherwise legally entitled to support from the Respondent and asks the Court to order the Respondent to pay support in an amount set by the Court.

9Orders Related to Removal, Possession and Support of Children

The Respondent is a parent of the following of the Applicant’s children:

And, the Applicant asks for these Orders in the best interest of the people named on page 1 of this form. Check all that apply:

The Respondent must not remove the children from the Applicant’s possession or from their child-care facility or school, except as specifically authorized in a possession schedule entered by the Court. The Respondent must not remove the children from the jurisdiction of the Court.

Establish or modify a schedule for the Respondent’s possession of the Children, subject to any terms and conditions necessary for the safety of the Applicant or the Children.

Require the Respondent to pay child support in an amount set by the Court.

10Temporary Ex Parte Protective Order

Based on the information in the attached Affidavit, there is a clear and present danger of family violence that will cause the Applicant, Children or Other Adults named on page 1 of this form immediate and irreparable injury, loss and damage, for which there is no adequate remedy at law. Applicant asks the Court to issue a Temporary Ex Parte Protective Order immediately without bond, notice or hearing.

11Ex Parte Order: Vacate Residence Immediately

The Applicant now lives with the Respondent at: _________________________________ or has resided at this

Residence within the 30 days prior to filing this Application. The Respondent committed family violence against a member of the household within the 30 days prior to the filing of this Application, as described in the attached Affidavit. There is a clear and present danger that the Respondent is likely to commit family violence against a member of the household. The Applicant is available for a hearing but asks the Court to issue a Temporary Ex Parte Protective Order immediately without bond, notice or hearing:

Granting the Applicant exclusive use and possession of the Residence and ordering the Respondent to vacate the Residence immediately, and remain at least 200 yards away from the Residence pending further Order of the Court; and

Directing the sheriff, constable, or chief of police to provide a law enforcement officer to accompany the Applicant to the Residence, to inform the Respondent that the Court has ordered the Respondent to vacate the Residence, and to provide protection while the Applicant either takes possession of the Residence or removes necessary personal property.

12Keep Information Confidential

The Applicant asks the Court to keep addresses and telephone numbers for residences, workplaces, schools, and childcare facilities confidential.

13Fees And Costs

The Applicant asks the Court to order the Respondent to pay fees for service of process, all other fees and costs of Court, and reasonable attorneys’ fees, if applicable.

I have read the entire Application and it is true and correct to the best of my knowledge.

________________________________________

Applicant, Pro se

Address where Applicant may be contacted: __________________________________________________________

Phone # where Applicant may be contacted: ____________________________ Fax #: _________________________

(List another address/phone if you want yours kept confidential)

Application for Protective Order

Page 3 of 4

Form Approved by the Supreme Court of Texas by order in Misc. Docket No. 05-9059 (April 12, 2005)

AFFIDAVIT

County of ____________________________________________

State of Texas

My name is ___________________________________________. I am ______ years old and otherwise competent

to make this Affidavit. The information and events described in this Affidavit are true and correct.

1Describe the most recent time the Respondent hurt you or threatened to hurt you:

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

2What date did this happen? _____ / ____ / _____

3

Was a weapon involved?

Yes

No

If yes, what kind? ____________________________________________

4

Were any children there?

Yes

No

If yes, who? __________________________________________________

5

Did you call the police?

Yes

No

If yes, what happened? _____________________________________

6

Did you get medical care?

Yes

No

If yes, describe your injuries: _______________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

7Has the Respondent ever threatened or hurt you BEFORE? Describe below, including date(s).

 

______________________________________________________________________________________________________________________

 

______________________________________________________________________________________________________________________

 

______________________________________________________________________________________________________________________

8

Were weapons ever involved?

Yes

No

If yes, what kind? ____________________________

9

Were any children there?

Yes

No

If yes, who? ___________________________________

10

Have the police ever been called?

Yes

No

 

11

Did you ever have to get medical care?

Yes

No

If yes, describe your injuries: _______________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

____________________________________________________________

Applicant signs here

On ____ / ____ / _____, the Applicant ___________________________________ personally appeared before

me, the undersigned notary. After being sworn, the Applicant stated that she/he is qualified to make this oath, that she/he has read the foregoing Application and Affidavit, that she/he has personal knowledge of the facts asserted, and the facts asserted are true to the best of her/his knowledge and belief.

Subscribed and sworn to before me on ____ / ____ / _____.

_______________________________________________________________________

Notary Public in and for the State of Texas

My Commission expires: _____________________________________________

Application for Protective Order

Page 4 of 4

Form Approved by the Supreme Court of Texas by order in Misc. Docket No. 05-9059 (April 12, 2005)

 

Document Specs

Fact Name Details
Definition of Protective Order A protective order is a court order designed to protect individuals from someone who has been violent or threatened violence against them.
Eligibility Criteria To obtain a protective order, the applicant must demonstrate a close relationship with the respondent and show that they have been harmed or threatened.
Temporary Orders Judges may issue a Temporary Ex Parte Protective Order to provide immediate protection until a full hearing can be conducted, usually within two weeks.
Cost of Filing There are no fees associated with filing for a protective order in Texas, making it accessible for individuals in need of protection.
Legal Framework The Texas Family Code governs protective orders, specifically under Title 4, Chapter 81, which outlines the procedures and requirements for obtaining such orders.
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