GUIDE FOR DRAFTING APPLICATION FOR PROTECTIVE ORDER
(Revised 10-14-11)
The Application must be signed under oath by each adult Applicant when seeking
ex parte relief. §82.009. THIS IS IN ADDITION TO ANY REQUIRED AFFIDAVIT that
is attached to the application pursuant to §83.006 .
The Affidavit should provide detailed facts and circumstances (dates and specific
instances) concerning the alleged family violence and the need for the immediate protective
order.
BE SURE TO FILE a completed address form to obtain a Temporary Ex Parte
Protective Order. Address form and TCIC form can be found on this website.
DO NOT rely on this or any guide without considering the applicable statutes, instructions
found elsewhere on this website, and the facts unique to your own case.
Cause No. _________________
[NAME OF APPLICANT]
Vs.
[NAME OF RESPONDENT]
§
IN THE DISTRICT COURT OF
§
HARRIS COUNTY, T E X A S
§
280TH JUDICIAL DISTRICT
APPLICATION FOR PROTECTIVE ORDER
Paragraph 1: State the name and county of residence of each Applicant.
Examples:
This Application for Protective Order is filed by Applicant,
____(name)________, who is a resident of _______________ County, Texas.
This Application for Protective Order is filed by Applicant,
____(name)________, on behalf of (herself/himself) and (his/her) minor children,
____(name)________, ____(name)________, and ____(name)________. Each
of the foregoing named persons is a resident of _______________ County, Texas.
This Application For Protective Order is filed by Applicant,
____(name)________, on behalf of (herself/himself) and (her/his) adult
daughter/son, ____(name)________. Applicant ____(name)________ is a
resident of _______________ County, Texas; and (her/his) adult daughter/son,
____(name)________ is a resident of _______________ County, Texas.
Each of the foregoing named persons is an “Applicant” as the term is
used below.
Paragraph 2: State the name and county of residence of the Respondent.
Name only one Respondent in each Application.
Respondent is ____(name)________, who is a resident of _______________
County, Texas.
Paragraph 3: Service.
[State whichever of the following options is a viable location for
service. You may state more than one of the options below.]
Process may be served on Respondent at Respondent’s residence at
_____(address) ________.
or
Process may be served on Respondent at Respondent’s place of
employment at _____(address) ________.
or
Process may be served on Respondent at _____(address) ________
which is [what connection to Respondent].
Paragraph 4: Relationships.
State the relationship to the Respondent of each Applicant (each person on
whose behalf the application is filed).
State the relationship to the filing Applicant of each person on whose behalf
the application is filed.
Examples:
Paragraphs 4 and 5 may be combined where appropriate.
Applicant is the spouse of Respondent. Applicant and Respondent are
now living in separate locations.
Applicant, ____(name)________, is the biological mother of minor child,
____(name)________. The Respondent is the husband of Applicant,
____(name)________, and the biological father of minor child,
____(name)________.
Applicant, ____(name)________, is the biological mother of Respondent.
Applicant, ____(name)________, is the husband of Applicant,
____(name)________, and the step-father of Respondent.
Applicant, ____(name)________, had a dating relationship with
Respondent. Applicant is the biological mother of minor child,
____(name)________. Respondent is the biological father of minor child,
____(name)________.
Paragraph 5: Living Arrangements.
State the current living arrangements of Applicant(s) and Respondent; and if
Applicant and Respondent are neither married to each other nor divorced
from each other, state the past living arrangements. If a child’s current
living arrangement is contrary to an existing court order for access and
possession, explain why and whether it is agreed by both parties.
Examples:
Applicant, ____(name)________and the minor child, ____(child’s
name)________, formerly lived in the same residence with Respondent, but now
reside in a separate location.
Applicant, ____(name)________ formerly lived in the same household
with respondent, but currently resides in a separate location. The minor child,
____(name)________, currently resides in Respondent’s household.
Applicant, ____(name)________ formerly lived in the same household
with respondent, but now resides in a separate CONFIDENTIAL location in
____________________ County, Texas.
Paragraph 6: Application Filed After Dissolution of Marriage.
If Applicant is a former spouse of Respondent, the application must include:
(a) A copy of the decree dissolving the marriage (and a statement in the
application that the copy is attached);
OR
(b) A statement that the decree is unavailable to the Applicant and a copy of the
decree will be filed with the court before the hearing on the application.
Paragraph 7: Application Filed For Child Subject to Continuing Jurisdiction.
In an application filed for or against a minor child, state whether or not the
child is subject to the continuing exclusive jurisdiction of a court under Title
5. If a child is subject to exclusive continuing jurisdiction of any court, the
application must include:
(a) A copy of each court order affecting the conservatorship, support, and
possession of or access to the child (and a statement in the application that the
copy is attached);
OR
(b) A statement that the orders affecting the child are unavailable to the applicant
and that a copy of the orders will be filed with the court before the hearing on
the application.
Paragraph 8: Grounds.
Respondent has engaged in conduct that constitutes family violence as
defined in Section 71.004 of the Texas Family Code. Respondent committed acts
that were intended by Respondent to result in physical harm, bodily injury,
assault, or sexual assault against Applicant(s) OR that reasonably placed
Applicant(s) in fear of imminent physical harm, bodily injury, assault, or sexual
assault. Applicant’s affidavit in support of this application is attached as Exhibit
1 and incorporated herein by reference for all purposes.
[If your application is based on Section 71.004(2), then state the
statutory grounds Applicant expects to prove.]
[If Applicant seeks to prohibit Respondent from all communication
with Applicant(s), then state: “Good cause exists for prohibiting
Respondent from communicating with Applicant(s),
____(name)________, ____(name)________, and ____(name)________,
except through Respondent’s attorney, or if Respondent has no attorney,
then through Applicant’s attorney.”]
Paragraph 9: Request for Protective Order.
Applicant requests the Court, after notice and hearing, to issue a protective order:
[Pick from among the following provisions. Do not include any
request that is not appropriate for your circumstance.]
(1)
Prohibiting Respondent from committing family violence against any Applicant.
“Family violence” is defined by section 71.004 of the Texas Family Code;
(2)
Prohibiting Respondent from doing any act that is intended to result in physical
harm, bodily injury, assault, or sexual assault against any Applicant;
(3)
Prohibiting Respondent from doing any act that is a threat that reasonably places
any Applicant in fear of imminent physical harm, bodily injury, assault, or sexual
assault;
(4)
Prohibiting Respondent from communicating directly with any Applicant in a
threatening or harassing manner;
(5)
Prohibiting Respondent from communicating a threat through any person to any
Applicant;
(6)
Prohibiting Respondent from communicating in any manner with any Applicant,
except through Respondent’s attorney, or if respondent has no attorney, then
Respondent may communicate through Applicant’s attorney;
[if there is another person through whom communication should be
made, you may put that name here if it is explained in the application
or in the affidavit why this person would be a reasonable go-between
contact. DO NOT say “or person appointed by the court.” If any
such person is to be appointed, this is the spot to request that a certain
person be appointed. Describe who this person is and the person’s
connection to the parties. This prohibition may not be practical if the
parties have children together and will need to communicate
regarding the children. A more specific order may be crafted to
restrict communication, but not cut it off altogether.]
(7)
Prohibiting Respondent from going within 400 feet of Applicant’s residence
located at [address];
[Make a separate section for each protected address. Do not include
the same address in more than one section]
[The distance may be shorter based on the discretion of Applicant’s
attorney, or may be longer based on circumstances shown to the
Court]
[If evidence is submitted that the residence is an apartment, and the
Respondent does not live or work in the same apartment complex, the
order may say that Respondent may not go within 400 feet of the
apartment complex and parking lot at [address].
[You must include addresses of all protected locations unless you state
in both the application and the order that such addresses are
confidential. If the residence address is confidential, the order must
state the county in which the person resides.]
(8)
Prohibiting Respondent from going within 400 feet of Applicant’s place of
employment located at [address];
(9)
Prohibiting Respondent from going within 400 feet of [name and address of
facility], which is the child care facility or school that ____(child’s
name)________ normally attends;
(10)
Prohibiting Respondent from following any Applicant;
(11)
Prohibiting Respondent from engaging in conduct directed specifically toward
any Applicant that is reasonably likely to harass, annoy, alarm, abuse, torment, or
embarrass the person;
(12)
Prohibiting Respondent from possessing a firearm, unless the Respondent is a
peace officer, as described by section 1.07, Penal Code, actively engaged in
employment as a sworn, full-time paid employee of a state agency or political
subdivision;
(13)
Prohibiting Respondent from removing the minor child, ____(child’s
name)________, from the jurisdiction of the court;
(14)
Prohibiting Respondent from removing the minor child, ____(child’s
name)________, from the possession of ____(Applicant’s name)________;
(15)
Prohibiting Respondent from interfering with the Applicant’s use of the
Residence at ____[address]______________, including, but not limited to,
disconnecting utilities or telephone service or causing such services to be
disconnected.
(16)
Prohibiting Respondent from transferring, encumbering, or otherwise disposing of
property, other than in the ordinary course of business, that is mutually owned or
leased by the parties.
(17)
Suspending the license to carry a concealed handgun issued to Respondent under
Section 411.177 of the government Code.
(18)
Requiring Respondent to complete a battering intervention and prevention
program accredited under Article 42.141 of the Texas Code of Criminal
Procedure.
Paragraph 10: Request for Temporary Ex Parte Protective Order.
There is a clear and present danger of family violence. Therefore, Applicant
requests that, without notice to the Respondent and without a hearing, the Court immediately
issue a Temporary Ex Parte Protective Order:
(1)
Prohibiting Respondent from committing family violence against any
Applicant. “Family Violence” is defined by section 71.004 of the Texas
Code;
Family
(2)
Prohibiting Respondent from doing any act that is intended to result in physical
harm, bodily injury, assault, or sexual assault against any Applicant;
(3)
Prohibiting Respondent from doing any act that is a threat that reasonably places
any Applicant in fear of imminent physical harm, bodily injury, assault, or sexual
assault;
(4)
Prohibiting Respondent from communicating directly with any Applicant in a
threatening or harassing manner;
(5)
Prohibiting Respondent from communicating a threat through any person to any
Applicant;
(6)
Prohibiting Respondent from communicating in any manner with any Applicant,
except through Respondent’s attorney, or if respondent has no attorney, then
through Applicant’s attorney;
(7)
Prohibiting Respondent from going within 400 feet of Applicant’s residence
located at [address];
(8)
Prohibiting Respondent from going within 400 feet of Applicant’s place of
employment located at [address];
(9)
Prohibiting Respondent from going within 400 feet of [name and address of
facility], which is the child care facility or school that ____(child’s
name)________ normally attends;
(10)
Prohibiting Respondent from following any Applicant;
(11)
Prohibiting Respondent from engaging in conduct directed specifically toward
any Applicant that is reasonably likely to harass, annoy, alarm, abuse, torment, or
embarrass the person;
(12)
Prohibiting Respondent from possessing a firearm, unless the Respondent is a
peace officer, as described by section 1.07, Penal Code, actively engaged in
employment as a sworn, full-time paid employee of a state agency or political
subdivision;
(13)
Prohibiting Respondent from removing the minor child, ____(child’s
name)________, from the jurisdiction of the court;
(14)
Prohibiting Respondent from removing the minor child, ____(child’s
name)________, from the possession of ____(Applicant’s name)________;
(15)
Prohibiting Respondent from interfering with the Applicant’s use of the
Residence at ____[address]______________, including, but not limited to,
disconnecting utilities or telephone service or causing such services to be
disconnected.
(16)
Prohibiting Respondent from transferring, encumbering, or otherwise disposing of
property, other than in the ordinary course of business, that is mutually owned or
leased by the parties.
Paragraph 10-A: Kick-out Request.
ONLY, if you need a kick-out order, insert the request here. A “Guide For
Request For Kick-out Order” is found separately on this website.
Paragraph 11: Attorney fees. (If application is filed by an attorney.)
Applicant requests that reasonable attorney’s fees be assessed against Respondent
and ordered paid to Applicant’s attorney.
Paragraph 12: Fees and costs.
Applicant requests that Respondent be required to pay the $16 protective order
fee, the standard fees charged by the clerk of the court in a general civil proceeding for the cost
of serving the order, the costs of court, and all other fees, charges, or expenses incurred in
connection with the protective order.
Paragraph 13: Bond.
Applicant requests the court, in the court’s discretion, to dispense with the
necessity of a bond for the temporary ex parte order.
Paragraph 14: Prayer.
Applicant prays that this court immediately, without notice or hearing, issue a
Temporary Ex Parte Protective Order prohibiting Respondent from committing certain acts, as
requested above, and dispensing with the necessity of a bond.
[If you have requested a kick-out order, then include the following in the first
paragraph of the prayer: “Applicant also requests that this order include an
order requiring Respondent to vacate the residence and an order for a law
enforcement officer to accompany Applicant to the residence, all as requested
above.”]
Applicant further prays that, after notice and hearing, a final protective order be
issued as requested above, and that this protective order be effective for two years. Applicant
also prays that this final order award reasonable attorney fees to Applicant’s counsel to be paid
by Respondent.
[If you have requested a kick-out order, then include the following in the
second paragraph of the prayer: “If Respondent has not yet vacated the
residence at the time of the final protective order hearing, then Applicant requests
that the final protective order include an order requiring Respondent to vacate the
residence and an order for a law enforcement officer to accompany Applicant to
the residence, all as requested above.”]
(Attorney or Pro Se Signature Block)
________________________________
Name
________________________________
Attorney’s Texas Bar Number
________________________________
Address
________________________________
Phone
________________________________
Fax
________________________________
Email
VERIFICATION
My name is _______typed name__________________________. I am an Applicant in
the foregoing Application For Protective Order. I have read this entire Application. [OR, (if
Applicant does not speak English) _____name_____________ has read this Application to me
in ___(name of language)______.] The facts and circumstances contained in this Application
are true to the best of my knowledge and belief.
________________________________
Applicant’s signature
On this day, _____(printed name of Applicant)____, known to me to be the person whose
signature appears on the foregoing verification, personally appeared. Affiant’s identity was
proved to me by [Description of document, such a Texas Driver License.] After being by me
duly sworn, he/she stated that he/she has read the foregoing Application For Protective Order;
and that the facts and circumstances contained in this application are true to the best of his/her
knowledge and belief. (If Applicant cannot read English, then Applicant has not read the
Application. Explain how Applicant knows what the Application says and who translated
or read to Applicant.)
SWORN TO AND SUBSCRIBED BEFORE ME on this _______________ day of
__________________________________ 20 _______.
______________________________
Notary Public
NOTARY SEAL