
State of Alabama Case Number
Unified Judicial System
Form C-2 (Page 1 of 5)
PETITION FOR PROTECTION FROM ABUSE
Rev. 12/10
IN THE CIRCUIT COURT OF_______________________________COUNTY, ALABAMA
(Name of County)
___________________________________________________V. ______________________________________________________________
Plaintiff (person to be protected) Defendant (person to be restrained)
____________________________________________________ ______________________________________________________
Plaintiff's Date of Birth Defendant's Address (Business or Home)
Ala. Code 1975, Section 30-5-5(e)(1) provides “ [t] he ______________________________________________________
following information shall not be contained on any court City State Zip Code
document made available to the public and the defendant by
the circuit clerk’s office: The plaintiff’s home address and, if ______________________________________________________
applicable, business address; a plaintiff’s home telephone Defendant's Date of Birth
number and, if applicable, business telephone number; the
home or business
address or telephone number of any member
of the plaintiff’s family or household; or an address that would
_____________________________________________________
reveal the confidential location of a shelter for victims of Defendant's Social Security Number
domestic violence as defined in Section 30-6-1.”
YOU MUST PROVIDE COMPLETE AND TRUTHFUL INFORMATION. IF YOU DO NOT, THE COURT MAY DISMISS THIS CASE,
AND YOU MAY BE SUBJECT TO BEING CHARGED WITH PERJURY FOR KNOWINGLY PROVIDING FALSE INFORMATION.
I. ELIGIBLE PLAINTIFFS: CHECK ALL THAT APPLY
(Note: The word, “Plaintiff,” is used throughout to describe you and/or the person(s) for whom you are applying):
I am 18 years of age or older seeking protection f
rom domestic violence for myself;
I am a parent; a legal guardian; a legal custodian; or the State Department of Human Resources seeking this petition for protection
from domestic violence on behalf of the Plaintiff who is: a minor, or any person prevented by physical or mental incapacity from
seeking a protection order.
I am under 18 years of age and am married; or emancipated, and seeking protection from domestic violence for myself.
.
CHECK AND FI
LL OUT ONLY ONE
SECTION (
1,2,3,4 OR 5):
1. The Defendant is the Plaintiff’s spouse; or former spouse; common-law marriage
Date of Marriage: ________________________________: Date of Divorce (if applicable):
_____________________________.
2. The Defendant is related to the Plaintiff by marriage.
3. The Defendant and the Plaintiff have a dating relationship* (A relationship means a recent frequent, intimate association, primarily
characterized by the expectation of affectionate or sexual involvement within the last six months. A dating relationship does not
include a casual or business relationship).
4. The Defendant is a current or former household member* (A household member is a person maintaining or having maintained a living
arrangement with the Defendant where he/she is in or was engaged in, a romantic or sexual relationship).
5. The Defendant and the Plaintiff are unmarried parents of a child.
*If you select 3 or 4 you must briefly explain the relationship:
_____________________________________
_________________
I state that the following is true and correct:
The Plaintiff is a resident of ____________________
__________in_______________________. The Plaintiff’s age is: __________ years old.
(Name of County) (Name of State)
Is the Plaintiff involved in any other civil, domestic relations, child support, or juvenile case (for example, divorce, paternity or custody) with
the Defendant? YES NO
If YES, please state the County and State in which the case was brought: _______________________________ County,
____________________________(State).
Are there any criminal charges against the Defendant because of abuse to the Plaintiff? YES NO
If YES, the charges were brought in __________________________________County,
_________________________(State).
(Note: If there are more civil or other cases with the Defendant or more criminal charges against the Defendant, please attach
additional 8” x11” sheets of paper, if necessary, stating the case number(s), County(ies), and States(s) in which these cases are
being handled).
Original-Court Record Copy-Law Enforcement Copy-Plaintiff Copy-Defendant