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Forms Checklist - Asking for a 209A restraining order

Produced by Massachusetts Law Reform Institute
Reviewed June 2020

Asking for a 209A restraining order

mass access forms icon Fill out a 209A application on your phone or computer. Answer questions and get all the forms you need that you can email to yourself, an advocate, save as part of your safety plan, send to the court.

Or get the paper forms

209A Restraining Order Application (5 forms)

  1. Complaint for Protection from Abuse (G.L. c. 209A) Page 1
  2. Complaint for Protection from Abuse (G.L. c. 209A) Page 2 (required if you have minor children)
  3. Affidavit
  4. Plaintiff Confidential Information Form
  5. Defendant Information Form
  • Page 1 is the Instructions to the Plaintiff. You are the "plaintiff." This form tells you how to fill out the other form.
  • Page 2 is the Complaint. It has checkboxes and spaces for you to fill in with names and basic information about you, your relationship to the defendant, and what you are asking the court to order.
  • Page 3 is the 2nd page of the Complaint. Use this form if you have children under age 18. You use this form to ask for orders about custody, contact with your children, visitation, or child support.
  • Page 4 is the Affidavit. When you sign the Affidavit, you swear that what you said in the affidavit and the Complaint is true to the best of your knowledge. See Writing your 209A Affidavit
  1. Tell the judge what happened and why you need a 209A order.
  2. Write down exactly what happened. Do the best you can. Write down the things the abusive person said or did like, "They told me they would get their gun and shoot me."
  3. Start with the most recent incident.
  4. Include information about injuries, if children were present or hurt, police involvement, medical treatment, other help you got, or destruction of property
  • Page 5 is the Plaintiff Confidential Information Form. Write your name, home address, home telephone number, workplace name, address, telephone number, and school. This information is confidential. The defendant, the defendant’s attorney, and the public are not allowed to see it. Only certain authorized persons who ask for this information can see it. But first they must file a Request for Access to Confidential Information form.
  • Page 6 is Defendant Information Form. The court gives this information to the police so they can find the defendant to deliver the order. Include any information that will help the police find the defendant
  • Affidavit Disclosing Care or Custody Proceeding Involving a Child This form asks about other family court cases that involve your child. The form tells the court if there are already any court orders about your child. It also tells the court if you are asking the judge to make decisions about your child in the 209A order judge. See sample Affidavit Disclosing Care or Custody Proceedings.

See a Sample 209A Abuse Prevention Order - page 1 and page 2. If the order is granted, the court will type up your order on this form. It is signed by a judge

Other forms you may also need in a 209A restraining order case

pdf icon Plaintiff’s Affidavit in Support of Request for Child Support Order

You can ask the court to order the defendant to pay child support. 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.

PDF icon 209A Affidavit Seeking Child Support

PDF icon Defendant's Affidavit in Connection with Request for a Child Support Order: This form is for the defendant to fill out basic information about their 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.

pdf icon Motion for Impoundment
Use this form to ask the court to keep any information in your application a secret from the defendant, the defendant's lawyer, prosecutor, and court staff. You must explain on the form why it is important to keep this information confidential. Your reasons to keep this information confidential must be more than simply to protect your privacy. The reasons must show that you need the court to keep the information confidential so nobody can use it to harm you.

  • if there is anything in your 209A papers that you need to keep from people who are allowed to see it. You might need to keep people who can look at your Plaintiff Confidential Information Form from seeing it.
  • Or if you need to keep other information in your court papers confidential.

PDF icon 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.

pdf icon Translation of Affidavit Use this form if you file an affidavit that is not written in English. The person who translates your affidavit writes the English translation on this form. The translator also signs and prints their 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.”

pdf icon Petition Filed Pursuant to G.L. c. 209A, § 11 Relative To Domesticated Animal(s) Use this form if your pets need protection from abuse.

PDF icon Plaintiff's Motion to Modify or Terminate Abuse Prevention Order Fill out this form to change or end an abuse prevention order. Also see How do I change or end my 209A Restraining Order?

PDF icon 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. 

PDF icon 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.

PDF icon Sample 209A Complaint form seeking protection at school

PDF icon Sample 209A Order providing protection at school

PDF icon Sample District Court 209A Child Support Order

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