Abuse Prevention Orders
209A Protection from Abuse Order/Restraining Order
Complaint for Protection from Abuse (page 1): This form is actually three pages. The first page has blanks for you to fill in with names and basic information. It also asks you what you would like the court to order. A second page has an Affidavit of abuse. The third page has instructions to help you fill out this form.
The Affidavit: You need to write on the affidavit why you need the 209A protection order. This is what the judge will read when he first hears your case. So be sure to fill this out carefully. You do not need to write a lot, but you need to be clear and you need to write down exactly what happened. You may want to start by telling the judge about the most recent incident, why you came to court to get a protective order. Then you might want to tell the judge about any history of abuse, why you are afraid, etc.
Do not just say, "He threatens me." Instead, write down the things he said or did: "He told me he would get his gun and shoot me." Write down the things that happened most recently. Also write down what the abuser did before.
There is a separate Confidential Information form for your address and phone number so you can keep them secret from the abusive person. See How do I file for a 209A Protective Order?
Translation of Affidavit Use this form if your affidavit is not in English. The person who translates your affidavit writes the English translation on this form. The translator also signs and prints his or her name at the bottom of the page, where it says, in English “I have provided a written translation into English, complete and accurate to the best of my ability”.
Complaint for Protection from Abuse (page 2): You only need to fill out "page 2" of the Complaint if you have a child and you want the court to include things about your child in the order. See a sample Complaint for Protection from Abuse (page 2).
209A Plaintiff Confidential Information form: On this form you write your name, home address, home telephone number, workplace name, address, and telephone number, and school. This information is confidential. Only certain authorized persons who ask for this information on a Request for Access to Confidential Information form can see it. See a sample 209A Plaintiff Confidential Information form.
209A Defendant Information form: The court will need this so that the police can find the defendant to serve him his copy of the order. Be sure to include any and all information that will help the police find him. See a sample 209A Defendant Information form.
209A Motion for Impoundment and Affidavit: This form is used for keeping your addresses and other information in the case file, hidden from the defendant or public. It also keeps information like your children's schools idden. You must write why it is important to keep this information private. See a sample Motion for Impoundment and Affidavit.
Plaintiff's Affidavit in Support of Request for a Child Support Order: This form allows you to fill out basic information about both parents' expenses and income to ask for child support. See a sample Plaintiff's Affidavit in Support of Request for a Child Support Order.
Defendant's Affidavit in Connection with Request for a Child Support Order: This form is for the defendant to fill out basic information about his or her work, income and expenses, if the plaintiff asks for child support. See a sample Defendant's Affidavit in Connection with Request for a Child Support Order.
Request for Access to Plaintiff Confidential Information Form: Only certain kinds of people like a prosecutor or a domestic violence counselor can use this form to ask to see the plaintiff's confidential information. See a sample Request for Access to Plaintiff's Confidential Information.
Sample 209A Abuse Prevention Order - page 1 and page 2: This is a sample 209A abuse prevention order form. After your hearing, if the order is granted, the court will type up your order on this form. It is signed by a judge.
Plaintiff's Motion to Modify or Terminate Abuse Prevention Order: Fill out this form to change or end an abuse prevention order.
Defendant's Motion to Modify or Terminate Abuse Prevention Order: Fill out this form if you are a defendant and you need to change or end an abuse prevention order.
Affidavit Disclosing Care and Custody Proceedings: The clerk should only give you this form if a child is involved. If you ask for protection, custody, or support for your children, you have to fill out this form. The form tells the court if there are already any court orders about your child. It also tells the court if any judge is making decisions about your child now. See a sample Affidavit Disclosing Care or Custody Proceedings.
Affidavit for Filing Out-of-State Protective Order: Use this form to get your protective order from outside Massachusetts enforced in Massachusetts. Also see Protective Orders from Another State.
Complaint for Modification - Child Support - sample This is a copy of the Probate and Family Court Complaint for Modification Form. It has been filled out for an increase in child support case.
Complaint for Contempt - Child Support - sample This is a copy of the Probate and Family Court Complaint for Contempt Form. It has been filled out for a non-payment of child support case.
Motion for Temporary Support and Proposed Order - sample This is an example of the Probate and Family Court's Motion Form. You also need to file a Proposed Order for the Judge to sign; an example is included. This particular form is filled in so that it asks for an order that the father of the children pay child support. But you can make a motion for almost anything you need.
Department of Revenue Child Support Enforcement
Failure to Pay Child Support May Result in License Suspension Notice An example of the warning notice you might get from Child Support Enforcement if you do not pay the child support you owe.
Notice to Suspend An example of the notice DOR/CSE sends to a licensing agency if you do not pay your child support. The notice tells the agency you have not paid child support and the agency must take away your license.
Final Determination of Delinquency An example of the notice Child Support Enforcement sends you after they have told the licensing agency to take away your license.
Offer in Settlement Application Use this form to ask DOR/CSE to accept less child support than you owe.
Request for Equitable Adjustment Application Use this form to ask DOR/CSE to adjust the amount of past due child support they say you owe.
Keeping your address unknown/hidden
Motion to Impound Plaintiff's Address, supporting affidavit, proposed order - sample This is an example of a Probate and Family Court Motion to Impound (remove) your address from all court papers so that your abuser cannot find out from court papers where you are living. The second page shows an example of a supporting affidavit. The supporting affidavit can be handwritten.
Confidential Information Form for Abuse Prevention Cases (209A) and Harassment Prevention Cases (258E)
Affidavit of Indigency If you cannot afford court fees and costs, ask the court to have the state pay them.
- Affidavit of Indigency Instructions - for you
- Affidavit of Indigency - Summary of Instructions to court staff, so you know your rights when you file an Affidavit of Indigency with a clerk at court.
Sample Affidavit of Indigency to see how you might fill out an Affidavit of Indigency if you need to complete the Supplement.
Divorce Separation Annulment
Certification Vital Statistics Divorce or Annulment Statistical Form to be filed with all Complaints/ Petitions for Divorce and/or Annulment.
Joint Petition for Divorce under G.L. c.208, Section 1A Use when both spouses want a divorce claiming irretrievable breakdown of the marriage.
Complaint for Divorce under G.L. c.208, Section 1B Use when one spouse wants a divorce claiming irretrievable breakdown of the marriage.
Complaint for Divorce - sample This form of complaint is used for "fault" divorces where the parties do not file a joint petition.
Complaint for 1B Divorce (Irretrievable Breakdown) - Sample This form of complaint is used for for "no fault" divorces ("1B" divorces) where the parties do not file a joint petition.
Joint Petition for Divorce - sample This court form is used when both spouses participate in seeking a joint "no fault" divorce, called a "1A" divorce. They also file a notarized separation agreement and a sworn affidavit that the marriage has irretrievably broken down.
Complaint for Separate Support if you want to stay married and you need a custody order, and support or health insurance for your child, and/or support or health insurance for yourself.
Complaint for Support - Custody - Visitation where the parents are not married to each other.
Complaint for Support - sample If you are married you can use this form of complaint to seek a suitable amount of support for yourself and the children, as well as health insurance benefits.
Complaint for Separate Support - sample This form of complaint has provisions for establishing that you are living apart from your spouse for justifiable cause and for custody and support.
Complaint for Support Custody Visitation - Sample where the parents are not married to each other
Financial Statement sample This is the Probate and Family Court's Financial Statement Form. It is filled out for a mother of two children, who has custody. The father would have to fill out a form, too.
Request Financial Statement sample This is a Request for a Financial Statement Form, with an accompanying letter. You can type up your own identical form with your own Certificate of Service, and mail it to the father of the children with a Financial Statement Form. Then you will find out how much he is making. You should know that if you Request a Financial Statement in this way, under a court rule (Supplemental Rule 401), you cannot request another financial statement until after ninety days have passed, unless the court orders it. And, under this same rule, in cases involving financial issues in Probate Court, unless the court orders otherwise, both parties are required to file a financial statement with the court and with each other within 45 days of service of the summons, or, if something is scheduled in court before the 45 days passes, two days before the hearing.
Motion to Compel Financial Statement and Proposed Order - sample This is an example of a Motion you can file to ask the Court to make the other party file a financial statement if you are having difficulty getting him to do so. You must also file a Proposed Order; an example is included.
Voluntary Acknowledgement of Parentage Registry of Vital Records form
Subpoena letter sample to request employer's records
Subpoena - blank form, sample, and affidavit of service A subpoena is a written, notarized demand which makes a person come into court to testify on a case. The example is filled out to subpoena the father's wage records. You can take the blank form, fill it out with your own information, and bring it to a notary. It will be an official subpoena once it is notarized. The affidavit of service is a certification that tells the court the subpoena has been properly served.
Complaint for Modification and Answer - Visitation - sample These are samples of a Probate and Family Court Complaint for Modification form and an Answer to a Complaint for Modification.
Complaint for Contempt - Visitation - samples These are samples of a Probate and Family Court Complaint for Contempt form and an Answer to a Complaint for Contempt.
Motion for Visitation - sample forms Here are several samples of forms that are used in motions for visitation: A Motion for Specific Visitation Schedule and a Proposed Order (filled out for a case in which a parent wants the court to issue a very specific visitation with a third party to pick up and drop off). A Supplemental Order - Visitation Issues (an example of a Probate and Family Court form which can be used to propose a specific visitation order for the judge to approve. It give an idea of the options the judge has in ordering visitation. The form may look different from court to court). Agreement of Parties and Temporary Order (an example of a Probate and Family Court form that can be used for writing up an agreement on visitation and other issues. The agreement becomes a temporary order of the court. This form may look different from court to court.).
A Motion for Specific Visitation Schedule and a Proposed Order filled out for a case in which a parent wants the court to issue a very specific visitation with a third party to pick up and drop off.
A Supplemental Order - Visitation Issues- sample is an example of a Probate and Family Court form which can be used to propose a specific visitation order for the judge to approve. It gives an idea of the options the judge has in ordering visitation. The form may look different from court to court).
Agreement of Parties and Temporary Order - sample forms is an example of a Probate and Family Court forms that can be used for writing up an agreement on visitation and other issues. The agreement becomes a temporary order of the court. This form may look different from court to court.
Motion to Suspend Visitation - sample This is an example of a motion you would file if you needed to stop visitation. You must also file a Proposed Order, and a sample is included.
Proposed Order for Visitation Supervised by an Individual
DTA Welfare forms
TAFDC Denial Notice With Appeal Form (2 Pages) Sample This is an example of the kind of notice the Department of Transitional Assistance will send to you if they are going to deny your application. On the back of the notice, you will see an example of a filled out appeal request.
DTA Tracking Worksheet Use this chart to help your application for TAFDC, EAEDC, SNAP/Food Stamps, or Emergency Assistance go smoothly. Keep it in a folder with copies of all of your papers. Every time you talk to someone at DTA write down the date, who you talked to and what was said.
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Created April, 2006
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