CARBON COUNTY COURT OF COMMON PLEAS
CIVIL DIVISION
MOTION COVER SHEET
NO.
vs.
_____________
FILING OF:
Movant ( ) Respondent ( )
TYPE OF FILING (check one):
( ) 1. Pretrial Discovery Motion (432)
( ) 2. Motion for Discovery in Aid of Execution
(480)
( ) 3. Preliminary Objections to (576)
( ) 4. Motion for Summary Judgment (306)
( ) 5. Motion for Judgment on Pleadings (294)
( ) 6. Motion for Leave to Join Additional
Defendant (403)
( ) 7. Motion for TRO or Preliminary Injunction
(438)
( ) 8. Petition to Open or Strike Judgment (498)
( ) 9. Motion for Alternative Service (409)
( )10. Motion for
Leave to Amend (465)
( )11. Motion to
Consolidate Actions (424)
( )12. Petition
to Compromise Minor's Action (435)
( )13. Motion for
Leave to Withdraw (510)
( )14. Motion for
Reconsideration (441)
( )15. Motion for
Advancement on Trial List (404)
( )16. Other
Motion or Petition (specify):
________________
OTHER
PARTIES:
Attorney's Name (Typed)
Attorney for:
( )Movant ( )Respondent
N.B. The numbers
after the Motion or Petition above are docket codes used in the Court Computer
System. Please be precise when checking
your Motion or Petition.
Effective
7/26/04
Revision
effective 9/15/06
RULE 206.4
(c) - RULE TO SHOW CAUSE. ALTERNATIVE
PROCEDURES.
1. Carbon County
adopts the procedure under Pa.R.C.P.206.6.
2. The order
shall be pursuant to Pa.R.C.P.206.6(c) except that it shall be modified by
deleting paragraphs (4) and (5) and substituting a new paragraph (4) which
shall state: an evidentiary hearing on
disputed issues of material fact shall be held on ________________ day of
_____________, 20__, at _________ time, in Courtroom No. _______ of the Carbon County
Courthouse. Paragraph number 6 shall be
renumbered to number 5.
Effective 7/26/04
Revision effective 6/1/08
RULE
208.2(c)- MOTION. FORM.
CONTENT.
Motions
shall include a brief statement identifying the applicable procedural rule,
statute, or other authority relied upon for the relief requested.
Effective 7/26/04
RULE
208.2(d)- MOTION. FORM. CONTENT.
When
uncontested, motions shall include a certification stating that the motion is
uncontested.
Effective 7/26/04
RULE
208.2(e)- MOTION. FORM.
CONTENT.
Every
motion relating to discovery shall include a certificate signed by counsel for
the moving party that counsel has conferred or attempted to confer with all
interested parties to resolve the matter and are unable to resolve the dispute
without court action.
Effective 7/26/04
RULE 208.3(a)-
ALTERNATIVE PROCEDURES.
(A)
MOTIONS
(1)
Pa.R.C.P.208.4 shall
govern motion procedure in Carbon County.
(2)
All motions shall be
in writing, except as permitted by the court or when made in open court during
a trial or hearing and shall comply with Pa.R.C.P. 208.2.
(3)
A motion shall
comply with the following requirements:
(a)
A brief statement of
applicable authority pursuant to CARB.R.C.P.208(c);
(b)
If uncontested, a
certification pursuant to CARB.R.C.P.208.2(d);
(c)
In discovery
motions, a certification that counsel has conferred or attempted to confer with
all interested parties to resolve the matter without court action pursuant to
CARB.R.C.P.208.2(e); and
(4)
The failure, in any
motion, to state a type of relief or a ground therefore shall constitute a
waiver of such relief or ground.
(5)
Any motion may
request such alternative relief as may be appropriate.
(B)
FILING
(1)
All written motions
and any written answers, and any notices, or documents for which filing is
required, shall be filed with the Prothonotary.
(2)
Self-addressed,
stamped envelopes for each attorney and unrepresented party shall be provided
with the filing of the motion to the Prothonotary’s Office for service of the
Order of Court.
(3)
Filing shall be by:
(a)
personal delivery to
the prothonotary; or
(b)
mail addressed to
the prothonotary. Except as provided by
law, filing by mail shall be timely only when actually received by the
prothonotary within the time fixed for filing.
(4)
The prothonotary
shall accept all written motions, answers, notices, or documents presented for
filing. When a document, which is filed
pursuant to paragraph (A)(1), is received by the prothonotary, the prothonotary
shall time stamp it with the date of receipt and make a docket entry reflecting
the date of receipt, and promptly shall place the document in the case file.
(5)
If a pro se party
submits a document to a judge without filing it with the prothonotary, and the
document requests some form of cognizable legal relief, the judge promptly
shall forward the document to the prothonotary for filing and processing in
accordance with this rule.
(C) SERVICE
(1)
All written motions and any
written answers, and notices or documents for which filing is required, shall
be served upon each party and the district court administrator concurrently
with filing.
(2)
Service on the parties shall be
by:
(a)
personal delivery of a copy to a
party’s attorney, or the party if unrepresented; or
(b)
personal delivery of a copy to
the party’s attorney employee at the attorney’s office; or
(c)
mailing a copy to a party’s
attorney or leaving a copy for the attorney at the attorney’s office; or
(d)
in those judicial districts that
maintain in the courthouse assigned boxes for counsel to receive service, when
counsel has agreed to receive service by this method, leaving a copy for the
attorney in the attorney’s box; or
(e)
sending a copy to an
unrepresented party by certified, registered, or first class mail addressed to
the party’s residence, business, or confinement; or
(f)
sending a copy by facsimile
transmission or other electronic means if the party’s attorney, or the party if
unrepresented, has agreed to this type of service or the attorney has provided
a facsimile signature on any pleading authorizing this method of service for
the document; or
(g)
delivery to the party’s attorney,
or the party if unrepresented, by carrier service.
(3)
Service on the district court
administrator shall be by:
(a)
mailing a copy to the district
court administrator; or
(b)
leaving a copy for the district
court administrator at the district court administrator’s office; or
(c)
delivery to the district court
administrator by carrier service.
Effective 7/26/04
RULE 210 - FORM OF BRIEFS
1.
Each brief shall contain:
(a)
A history of the case;
(b)
A statement of the pertinent facts;
(c)
A statement of the questions involved; and
(d)
The argument.
2.
The statement of questions involved shall be so drawn that the
Court may quickly determine all the legal questions requiring determination.
3.
The argument shall be divided into as many parts as there are
questions involved. Opinions of an
Appellate Court, of this or any other jurisdiction shall be cited from the
National Reporter's System and/or to the official reports of Pennsylvania
Appellate Courts, if published therein.
4.
Briefs shall refer specifically, by page number or other
appropriate means, to any portion of the record relied upon in support of the
argument.
5.
Copies of all Non-Pennsylvania State cases and Non-3rd
Circuit Federal cases shall be attached as Exhibits to said Brief.
6.
Counsel for the
moving party shall in all matters file an original and two (2) copies of a
brief in the Office of the Prothonotary and forthwith serve one (1) copy of a
brief upon each adverse party or counsel of record. Pa.R.C.P.440 governs service. Service shall be required on the District
Court Administrator.
7.
Each adverse party
or his counsel of record shall file in the Office of the Prothonotary an
original and two (2) copies of a brief in answer, not later than three (3)
weeks before the date of argument and forthwith serve a copy thereof upon all
opposing parties or their counsel of record.
Pa.R.C.P.440 governs service.
Service shall be required on the District Court Administrator.
8.
Except as provided
in (6), and (7) no untimely briefs shall be filed unless upon special allowance
or within such time as shall be set by the Court.
Effective 7/26/04
RULE 212.1- CIVIL
ACTIONS TO BE TRIED BY JURY. NOTICE OF
EARLIEST TRIAL DATE. TIME FOR COMPLETING
DISCOVERY AND FILING PRE-TRIAL STATEMENT.
Every party
shall simultaneously file and serve upon opposing counsel a Pre-Trial Statement
on or before the date established in the management review order or the order
of court granting a motion to extend milestones.
Any
motion to extend milestones shall be in compliance with CARB.R.C.P.208.2(d) and
CARB.R.C.P.208.3(a). The proposed order
shall list the current milestones and the recommended milestones to be
established.
Effective 7/26/04
At
the Pre-Trial Conference, the parties or representatives of their insurance
carriers are expected to attend having realistic settlement authority.
Effective 7/26/04
RULE 430 - SERVICE PURSUANT TO SPECIAL ORDER OF
COURT. PUBLICATION.
The Carbon County Law Journal shall be designated by the
Carbon County Court of Common Pleas to be the legal publication for service of
process by publication.
Effective 7/26/04
As required by Pa.R.C.P.1018.1(c), the
following shall be designated in the notice to defend as the person from whom
legal referral can be obtained:
North Penn Legal Services
1203 North Street
Jim Thorpe, PA
18229-0131
(570) 325-5050
Effective 7/26/04
Revision effective 10/1/08
RULE 1028(c) -
PRELIMINARY OBJECTIONS
A.
Preliminary
Objections pursuant to Pa.R.C.P.1028(a)(1), (5), or (6):
1.
A proposed order
shall be attached to all preliminary objections.
2.
A notice to plead
shall be attached to the preliminary objections.
3.
If the parties agree
to the relief sought, the preliminary objections shall be accompanied by a
stipulation signed by all affected counsel or unrepresented parties.
4.
The moving party
shall simultaneously file a brief in support of the preliminary
objections. See CARB.R.C.P.210 for form,
content of brief, service and filing requirements.
5.
If an amended
complaint is not filed within twenty (20) days of service of the preliminary
objections, the matter shall be scheduled for hearing.
6.
The adverse party
shall file a brief in response to the preliminary objections within twenty (20)
days of service. See CARB.R.C.P.210 for
form, content of brief, service and filing requirements.
7.
The Court shall
dispose of the matter within fifteen (15) days of argument.
B.
Preliminary
Objections pursuant to Pa.R.C.P.1028(a)(2), (3), or (4):
1.
A proposed order
shall be attached to all preliminary objections.
2.
If the parties agree
to the relief sought, the preliminary objections shall be accompanied by a
stipulation signed by all affected counsel or unrepresented parties.
3.
The moving party
shall simultaneously file a brief in support of the preliminary
objections. See CARB.R.C.P.210 for form,
content of brief, service and filing requirements.
4.
If an amended
complaint is not filed within twenty (20) days of service of the preliminary
objections, the matter shall be scheduled for argument.
5.
The adverse party
shall file a brief in response to the preliminary objections within twenty (20)
days of service. See CARB.R.C.P.210 for
form, content of brief, service and filing requirements.
6.
The Court shall
dispose of the matter within fifteen (15) days of argument.
Effective 7/26/04
RULE 1034(a) - MOTION FOR JUDGMENT ON THE PLEADINGS.
1. The moving party shall file the motion,
proposed order and a supporting brief simultaneously. If a brief is not filed
with the motion, the motion shall be deemed withdrawn, without prejudice, upon
motion of the opposing party. A
certificate of service in conformance with Pa.R.C.P.208.2(a)(5) shall be
attached to the motion. Pa.R.C.P.440
governs service. Service shall be
required on the District Court Administrator.
For form of briefs, see CARB.R.C.P.210.
2. Any party opposing the motion shall file a
responsive brief within twenty (20) days of service of the motion and provide service
in accordance with number one above.
Failure to file a brief shall be deemed to have no opposition to the
motion.
3. Upon service of
the motion on the District Court Administrator, argument shall be scheduled
allowing for sufficient time to file the response briefs.
4. The Court shall
dispose of the matter within fifteen (15) days of argument.
Effective 7/26/04
RULE
1035.2(a) – MOTION
1. The moving party shall file the motion for
summary judgment, proposed order and a supporting brief simultaneously. If a
brief is not filed with the motion, the motion shall be deemed withdrawn,
without prejudice, upon motion of the opposing party. A certificate of service in conformance with
Pa.R.C.P.208.2(a)(5) shall be attached to the motion. Pa.R.C.P.440 governs service. Service shall be required on the District
Court Administrator. For form of briefs,
see CARB.R.C.P.210.
2. Any party opposing the motion shall file a
responsive brief within thirty (30) days of service of the motion and provide
service in accordance with number one above.
Failure to file a brief shall be deemed to have no opposition to the
motion and the court shall grant the motion.
3. Upon service
of the motion on the District Court Administrator, argument shall be scheduled
allowing for sufficient time to file the response briefs.
4. The Court
shall dispose of the matter within fifteen (15) days of argument.
Effective 7/26/04
All civil cases where the amount in controversy (exclusive
of interest and costs) shall be Fifty Thousand ($50,000.00) Dollars or less,
except those involving title to real estate, shall first be submitted to a
Board of Arbitrators in accordance with Section 7361 of the Judicial Code, 42
Pa.C.S.A. §7361. The amount in
controversy shall be determined from the pleadings. The Court may on its own motion or upon the
motion of any parties strike from the trial list and certify for arbitration
any case which should have been arbitrated in the first instance.
Effective 3/23/06
Revision effective 9/15/06
Any attorney interested in serving
on Arbitration cases shall complete and return to the District Court
Administrator a “Consent to Serve as Arbitrator” as attached hereto.
This information shall be entered
into the Court database for maintenance and selection of available arbitrators.
Effective
7/26/04
CONSENT TO SERVE AS ARBITRATOR
The undersigned hereby
consents to serve as an Arbitrator under the Pennsylvania Rules of Compulsory
Arbitration, and asks that his/her name remain on the active roll of
Arbitrators to continue to serve in such capacity when called upon until
further notice.
_______________________________________ _______________________________
SIGNATURE DATE
|
PLEASE TYPE OR PRINT CLEARLY:
NAME:
_______________________________________________________________________
Date Admitted to the Carbon
County Bar _____________ Email:
_______________________
FIRM:
_______________________________________________________________________
ADDRESS:
___________________________________________________________________
_____________________________________________________________________________
MAILING ADDRESS: (if different than above) ______________________________________
_______________________________________________________________________________
Telephone
No. _____________________________ Fax No.
___________________________
Identification
No.
______________________________________________________________
(This number appears on the lower left corner of card issued
by the State Court Administrator)
|
|
I am associated in the Practice of Law with: (Please indicate associates Identification
No.)
___________________________________________________ #_________________________
___________________________________________________ #_________________________
___________________________________________________ #_________________________
___________________________________________________ #_________________________
|
|
I am related to the following members of the Bar who are not
associated with me in the Practice of Law.
___________________________________________________ # _________________________
___________________________________________________ # _________________________
|
NOTE: Any
change in your status of practicing with or being associated with any other lawyer
or lawyers shall immediately be reported to the District Court Administrator.
Notice of the
appointment of arbitrators and the date, time and place of arbitration in
accordance with Pa.R.C.P.1303 shall be made by the Prothonotary’s Office. The Notice shall include the following
language: “The matter will be heard by a
board of arbitrators at the time, date, and place specified but, if one or more
of the parties is not present at the hearing, the matter may be heard at the
same time and date before a judge of the court without the absent party or parties.
There is no right to a trial de novo on appeal from a decision entered by a
judge.”
All continuance
requests must be filed no later than seven (7) days before the scheduled
Arbitration hearing. The attorney/party
must notify all other attorneys/pro se parties and members of the panel of the
granting of the continuance motion. In
the event such notice is not provided and a panel member appears, the
defaulting party shall be responsible for paying the panel member the current
arbitration fee of $150.00. Any
continuances requested within the seven (7) days of the scheduled Arbitration
hearing shall require the personal appearance of the attorney/pro se party before
the Judge to explain the extenuating circumstances necessitating the late
filing.
Any appointed
arbitrator must notify Court Administration of their inability to serve within ten
(10) days of the scheduled event so that a suitable replacement can be secured.
If
a case is settled less than two (2) days before the Arbitration hearing, one of
the attorneys/pro se parties must appear before the Board of Arbitrators and
have an Award entered by agreement. If
it is settled more than two (2) days before the Arbitration hearing,
Plaintiff’s attorney/Plaintiff must file a praecipe to strike the case from the
arbitration list because the case is settled and must notify all other
attorneys/pro se parties and the panel members.
In the event counsel fails to appear and advise the Board of the
settlement award or to provide such notice and a panel member appears, the
defaulting party shall be responsible for paying the panel member the current
arbitration fee of $150.00.
Effective 7/26/04
Revision effective 3/1/09
RULE 1501 – CONFORMITY TO CIVIL ACTION.
When a praecipe for a writ of summons, a complaint or a
counterclaim is filed, the Prothonotary shall index the action as a lis pendens
against real property, if, but only if, the party filing the praecipe, the
complaint or the counterclaim, or his attorney:
(1) files a separate praecipe describing said real property by
metes and bounds or a sufficient description to identify it, and the volume and
page in the Recorder of Deeds Office of this county where a recorded
description of said property appears;
(2) directs in said separate praecipe that the action shall be
listed on a lis pendens against said real property; and
(3) files in said separate praecipe a certification that said
action:
(A) is a proceeding to revive and continue the lien of debts
against a decedent's property; or
(B) is a proceeding conveying or vesting title to real property in
this Commonwealth; or
(C) is a proceeding of which purchasers of the described real
property should have constructive notice; and
(4) files with said separate praecipe, a written verified
statement, as verified as defined in Pa. R.C.P. 76, setting forth the basis and
subject matter of the cause of action and that said action affects the title to
the real property so described or of any interest in said real property.
Effective 7/26/04
RULE 1530 – SPECIAL RELIEF. ACCOUNTING.
1. If
an auditor is appointed pursuant Pa.R.C.P.1530(d), the following procedures
shall govern:
(A) The auditor shall give two weeks notice in writing to the
parties or their attorneys of record of the time and place fixed for hearing
the matter.
(B) Testimony taken by the auditor at the hearing shall be
recorded stenographically. The notes of
the testimony shall not be transcribed unless exceptions are filed to the
auditor's report.
(C) Within forty-five (45) days after the conclusion of the
hearing the auditor shall file a written report which insofar as it is practicable
shall contain (i) a history of the proceedings before the auditor, (ii)
findings of fact, numbered consecutively, (iii) a concise discussion of the
evidence presented and the legal issues involved, (iv) conclusions of law,
numbered consecutively, and (v) a statement of the account.
(D) Upon filing of the report the auditor shall serve a copy of
the same on the parties in accordance with Pa.R.C.P. 440.
(E) Exceptions to the report of the auditor may be filed by any
party within ten (10) days after service of a copy of the report upon him. If such exceptions are filed, the Court shall
hear argument on the same and shall enter such order or judgment as may be
appropriate. If no timely exceptions are
filed, the account stated in the report of the auditor shall be final and
judgment may be entered thereon upon praecipe.
(F) The Court shall determine the compensation and reimbursement
for expenses to be allowed the auditor and stenographer, and shall direct that
such items be taxed in whole or in part against the fund available for
distribution or against any party or parties to the action as may be just and
equitable in the circumstances. Upon the
appointment of an auditor the moving party shall promptly deposit with the
Prothonotary such sum as the court may direct for the compensation and expenses
of the auditor and stenographer, and the moving party shall deposit such
additional sums for such purpose as the Court may from time to time
direct. Any sum so deposited which is
not required for such purposes shall be refunded to the moving party upon the
entry of the final order or decree.
Effective 7/26/04
If
an emergency order of a District Justice or a temporary or final order of a Judge
is violated, it shall be presumed that the Court of Common Pleas is unavailable
and the arresting police officer shall take the defendant before a District
Justice in the magisterial district in which the abuse for which relief is
requested occurred.
Effective 7/26/04
RULE 1905 – FORMS FOR USE IN PFA ACTIONS. NOTICE AND HEARING. PETITION. TEMPORARY PROTECTION ORDER. FINAL PROTECTION ORDER.
The forms attached hereto shall be used to commence or
amend an action pursuant to Pa.R.C.P.1901.3(a).
Effective 7/26/04
IN THE COURT OF COMMON PLEAS OF CARBON
COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
_____ :
(Plaintiff) :
:
vs. : No._____________________
:
:
:
(Defendant)
NOTICE OF HEARING AND ORDER
YOU HAVE BEEN SUED IN COURT. If you wish
to defend against the claims set forth in the following papers, you must appear
at the hearing scheduled herein. If you fail to do so, the case may proceed
against you and a FINAL order may be entered against you granting the relief
requested in the Petition. In particular,
you may be evicted from your residence and lose other important rights. Any protection order granted by a court may
be considered in subsequent proceedings under Title 23 (Domestic Relations) of
the Pennsylvania Consolidated Statutes, including child custody proceedings
under Chapter 53 (relating to custody).
A hearing on the matter is scheduled for
the day of , 20_____,
at . M., in Courtroom at Carbon County
Courthouse, Jim Thorpe, Pennsylvania.
You MUST obey the Order that is attached
until it is modified or terminated by the Court after notice and hearing. If
you disobey this Order, the police may arrest you. Violation of this Order may
subject you to a charge of indirect criminal contempt, which is punishable by a
fine of up to $1,000.00 and/or up to six months in jail under 23 Pa.C.S. §
6114. Violation may also subject you to prosecution and criminal penalties
under the Pennsylvania Crimes Code. Under federal law, 18 U.S.C. § 2265, this
Order is enforceable anywhere in the United States, tribal lands, U.S.
Territories and the Commonwealth of Puerto Rico. If you travel outside of the
state and intentionally violate this Order, you may be subject to federal
criminal proceedings under the Violence Against Women Act, 18 U.S.C. §§
2261-2262.
YOU SHOULD
TAKE THIS PAPER TO YOUR LAWYER AT ONCE. YOU HAVE THE RIGHT TO HAVE A LAWYER
REPRESENT YOU AT THE HEARING. THE COURT WILL NOT, HOWEVER, APPOINT A LAWYER FOR
YOU. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH
BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS
OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY
OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FREE OR NO FEE. IF YOU CANNOT FIND A LAWYER, YOU MAY HAVE TO
PROCEED WITHOUT ONE.
COUNTY LAWYER REFERRAL SERVICE
NORTH PENN LEGAL SERVICES
122-124 IRON STREET
LEHIGHTON, PA 18235
(610) 377-5400
www.northpennlegal.org
IN THE COURT OF COMMON PLEAS OF CARBON
COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
:
(Plaintiff) :
:
vs. :
No. ______________________
:
:
(Defendant)
TEMPORARY PROTECTION
FROM ABUSE ORDER
Defendant's Name:__________________________________________________________________________
Defendant's Date of
Birth:____________________________________________________________________
Defendant's Social Security
Number:_________________________________________________________ __
Name of All Protected Persons, including Plaintiff and minor
child/ren:_______________________________ _
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
AND NOW, this___________ day of ____________________, 20_____, upon
consideration of the attached Petition for Protection from Abuse, the court
hereby enters the following Temporary Order:
( ) 1. Defendant
shall not abuse, harass, stalk or threaten any of the above persons in any
place where they might be found.
( ) 2.
Defendant is evicted and excluded from the residence at
____________________________________
__
____________________________________________________________________________________
(NONCONFIDENTIAL
ADDRESS FROM WHICH DEFENDANT IS EXCLUDED)
or any other
permanent or temporary residence where Plaintiff or any other person protected
under this Order may live. Plaintiff is
granted exclusive possession of the residence. Defendant shall have no right or
privilege to enter or be present on the premises of Plaintiff or any other
person protected under this Order.
( ) 3. Except as provided in Paragraph 5 of
this order, Defendant is prohibited from having ANY CONTACT with Plaintiff, or
any other person protected under this Order, at any location, including but not
limited to any contact at Plaintiff's school, business, or place of
employment. Defendant is specifically
ordered to stay away from the following locations for the duration of this
Order:
____________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
( ) 4. Except for such contact with the
minor child/ren as may be permitted under Paragraph 5 of this Order, Defendant
shall not contact Plaintiff, or any other person protected under this Order, by
telephone or by any other means, including through third persons.
( ) 5. Pending the outcome of the final
hearing in this matter, Plaintiff is awarded temporary custody of the following
minor child/ren:
_____________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Until the final hearing, all
contact between Defendant and the child/ren shall be limited to the following:
___________________________________________________________________________________
The local law
enforcement agency in the jurisdiction where the child/ren are located shall
ensure that the child/ren are placed in the care and control of the Plaintiff
in accordance with the terms of this Order.
(
) 6. Defendant shall immediately relinquish the following weapons to the
Sheriff's Office or a designated local law enforcement agency for delivery to the
Sheriff’s Office.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Defendant is prohibited from
possessing, transferring or acquiring any other weapons for the duration of
this order.
( ) 7. The following additional relief is
granted: ___________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
( )
8. A certified copy of this Order shall be provided to the police department
where Plaintiff resides and any other agency specified hereafter [insert name
of agency]:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
(
) 9. THIS ORDER SUPERSEDES
(
) ANY PRIOR PFA ORDER
AND
( )
ANY PRIOR ORDER RELATING TO CHILD CUSTODY.
10. THIS ORDER APPLIES IMMEDIATELY TO DEFENDANT
AND SHALL REMAIN IN EFFECT UNTIL
_____________________________________________________
OR UNTIL OTHERWISE MODIFIED OR
TERMINATED BY THIS COURT
AFTER NOTICE AND HEARING.
NOTICE TO THE DEFENDANT
Defendant is hereby notified that
violation of this Order may result in arrest for indirect criminal contempt,
which is punishable by a fine of up to $1,000.00 and/or up to six months in
jail. 23 Pa.C.S. § 6114. Consent of the
Plaintiff to Defendant's return to the residence shall not invalidate this
Order, which can only be changed or modified through the filing of appropriate
court papers for that purpose. 23 Pa.C.S. § 6113. Defendant is further notified that violation
of this Order may subject him/her to state charges and penalties under the
Pennsylvania Crimes Code and to federal charges and penalties under the
Violence Against Women Act, 18 U.S.C. §§ 2261-2262.
NOTICE TO LAW ENFORCEMENT OFFICIALS
This Order
shall be enforced by the police who have jurisdiction over the plaintiff's
residence OR any location where a violation of this order occurs OR where the
defendant may be located. If defendant violates Paragraphs 1 through 6 of this
Order, defendant shall be arrested on the charge of Indirect Criminal
Contempt. An arrest for violation of
this Order may be made without warrant, based solely on probable cause, whether
or not the violation is committed in the presence of law enforcement.
Subsequent to
an arrest, the law enforcement officer shall seize all weapons used or
threatened to be used during the violation of this Order OR during prior
incidents of abuse. Weapons must
forthwith be delivered to the Sheriff's office of the county which issued this
Order, which office shall maintain possession of the weapons until further
Order of this court, unless the weapon/s are evidence of a crime, in which
case, they shall remain with the law enforcement agency whose officer made the
arrest.
BY
THE COURT:
By:_______________________________________
Judge
_______________________________________
Date
IN THE COURT OF COMMON PLEAS OF CARBON COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
:
(Plaintiff) :
:
vs. :
No. __________________
:
________________________ :
(Defendant)
PETITION FOR PROTECTION FROM ABUSE
1. Plaintiff's
name is:
_____________________________________________________________________________
2. I am filing this Petition on behalf of:
( ) Myself and/or (
) Another Person
If
you checked "myself", please answer all questions referring to
yourself as "Plaintiff".
If you checked "another person",
please answer all questions referring to that person as the
“Plaintiff",
and provide your address here, unless confidential:
_____________________________________
__________________________________________________________________________________
If you checked "Another Person",
indicate your relationship with Plaintiff:
( ) parent of minor
Plaintiff(s)
( ) applicant for appointment
as guardian
ad litem of minor Plaintiff(s)
( ) adult household member
with ( ) court appointed guardian of
minor Plaintiff(s) incompetent Plaintiff(s)
3. Name(s) of ALL
person(s), including Plaintiff and minor children, who seek protection from
abuse:
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
4. ( ) Plaintiff's address is confidential
or
( ) Plaintiff's address is:
_______________________________________________________________________
________________________________________________________________________________________
5. Defendant is believed to live at the
following address:
__________________________________________________________________________________________
Defendant's
Social Security Number (if known) is:
____________________________________________________
Defendant's date of birth is:
______________________________________________________________________
Defendant's place of employment
is:________________________________________________________________
[
] Check here if Defendant is 17 years old or younger.
6. Indicate the relationship
between Plaintiff and Defendant.
(
) Spouse (
) Current or former ( ) Other relationship
sexual/intimate partner by blood or marriage:
_________________________
(
) Ex-spouse ( ) Parent/Child _________________________
( ) Persons who live ( ) Parents of
the same ( ) Brother/Sister
or have lived like children
spouses
7. Have Plaintiff and
Defendant been involved in any of the following Court actions?
( )
Divorce ( ) Custody ( ) Support ( ) Protection from Abuse
If you
checked any of the above, briefly indicate when and where the case was filed
and the court number, if known:
8. Has the Defendant been involved in any criminal court action? ________________________________________
If you answered yes, is the
Defendant currently on probation?
________________________________________
9. Plaintiff and Defendant
are the parents of the following minor child/ren:
Name(s) Age(s) who reside at (list address unless
confidential):
_______________________ _________ ____________________________________________
_______________________ _________ ____________________________________________
_______________________ _________ ____________________________________________
_______________________ _________ ____________________________________________
10. If Plaintiff and
Defendant are parents of any minor child/ren together, is there an existing
court Order regarding
their
custody?
_________________________________________________________________________
If you
answered yes, describe the terms of the Order (e.g., primary, shared, legal
and/or physical custody):
_____________________________________________________________________________________
_____________________________________________________________________________________
If you
answered Yes, in what county and state was the order issued?
____________________________ __
_____________________________________________________________________________________
If you are now
seeking an Order of child custody as part of this petition, list the following
information:
(a) Where has each child resided during the past five
years?
Child's Name Person(s) child lives with Address, unless confidential When
_________________ ________________________ ________________________ ___________
_________________ ________________________ ________________________ ___________
_________________ ________________________ ________________________ ___________
_________________ ________________________ ________________________ ___________
(b) List any other persons who are known to have or claim
a right to custody of each child listed above:
Name Address Basis
of Claim
_______________________ _____________________________ ________________________
_______________________ _____________________________ ________________________
_______________________ _____________________________ ________________________
_______________________ _____________________________ ________________________
11. The following other minor
child/ren presently live with Plaintiff:
Name(s) Age(s) Plaintiff's relationship to
child/ren
______________________ _________ ___________________________________________________
______________________ _________ ___________________________________________________
______________________ _________
___________________________________________________
______________________ _________ ___________________________________________________
12. The facts of the most
recent incident of abuse are as follows:
Approximate Date:
____________________ Place: _____________________________________________
Approximate Time:
____________________
Describe in detail what happened,
including any physical or sexual abuse, threats, injury, incidents of stalking,
medical treatment sought, and/or calls to law enforcement (attach additional
sheets of paper if necessary):
___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________
13. If the
Defendant has committed prior acts of abuse against Plaintiff or the minor
child/ren, describe these prior incidents, including any threats, injuries, or
incidents of stalking, and indicate approximately when such acts of abuse
occurred (attach additional sheets of paper if necessary):
___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________
14. List the weapon(s) that Defendant has used or
threatened to use against Plaintiff or the minor child/ren:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
15. Identify
the police department or law enforcement agency in the area in which Plaintiff
lives that should be provided with a copy of the protection order:
_
______________________________________________________________________________________
16. There is an immediate and
present danger of further abuse from the Defendant.
CHECK THE FOLLOWING BOXES ONLY IF THEY APPLY TO YOUR CASE
AND PROVIDE THE REQUESTED INFORMATION
( ) Plaintiff is asking the Court to
evict and exclude the Defendant from the following residence:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
( ) owned by (list owners, if known):
_____________________________________________________ ____
__________________________________________________________________________________________
( ) rented
by (list all names, if known):
_________________________________________________________
( )
Defendant owes a duty of support to Plaintiff and/or the minor child/ren.
( ) Plaintiff has suffered out-of-pocket
financial losses as a result of the abuse described above. Those losses are:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
FOR THE REASONS SET FORTH
ABOVE, I REQUEST THAT THE COURT ENTER A TEMPORARY ORDER, and AFTER HEARING, A
FINAL ORDER THAT WOULD DO THE FOLLOWING (CHECK ALL FORMS OF RELIEF REQUESTED):
( ) A. Restrain Defendant from abusing, threatening,
harassing, or stalking Plaintiff and/or
minor child/ren in any place
where Plaintiff may be found.
( ) B. Evict/exclude Defendant from
Plaintiff's residence and prohibit Defendant from
attempting to enter any temporary
or permanent residence of the Plaintiff.
( ) C. Require Defendant to provide
Plaintiff and/or minor child/ren with other suitable
housing.
( ) D. Award Plaintiff temporary custody of
the minor child/ren and place the following
restrictions on contact between
Defendant and child/ren:
___________________________________________________________________
___________________________________________________________________
( ) E. Prohibit Defendant from having any contact
with Plaintiff and/or minor child/ren,
either in person, by telephone,
or in writing, personally or through third persons,
including but not limited to any
contact at Plaintiff's school, business, or place of
employment, except as the court
may find necessary with respect to partial custody
and/or visitation with the minor
child/ren.
( ) F. Prohibit Defendant from having any
contact with Plaintiff's relatives and Plaintiff's
children listed in this Petition,
except as the court may find necessary with respect
to partial custody and/or
visitation with the minor child/ren.
( ) G. Order Defendant to temporarily turn
over weapons to the Sheriff of this County and
prohibit Defendant from
transferring, acquiring or possessing any such weapons for
the duration of the Order.
( ) H.
Order Defendant to pay temporary support for Plaintiff and/or the minor
child/ren,
including medical support and
[ ] payment of the rent or
mortgage on the residence.
( ) I. Direct Defendant to pay Plaintiff
for the reasonable financial losses suffered as the
result of the abuse, to be
determined at the hearing.
( ) J. Order Defendant to pay the costs of
this action, including filing and service fees.
( ) K. Order Defendant to pay Plaintiff's
reasonable attorney's fees.
( ) L. Order the following additional
relief, not listed above:
__________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
( ) M. Grant such other relief as the court
deems appropriate.
( ) N. Order the police or other law
enforcement agency to serve the Defendant with a
copy of this Petition, any Order
issued, and the Order for Hearing. The petitioner
will inform the designated authority
of any addresses, other than Defendant's
residence, where Defendant can be
served.
VERIFICATION
I verify that I am the petitioner as
designated in the present action and that the facts and statements contained in
the above Petition are true and correct to the best of my knowledge. I understand that any false statements are
made subject to the penalties of 18 Pa.C.S. § 4904, relating to unsworn
falsification to authorities.
____________________________________
SIGNATURE
____________________________________
DATE
PSP Data Sheet
Information
Defendant Information:
____________________________________________________________________
First Middle Last Suffix
(Jr, Sr,)
Defendant’s
Alias: ______________________________________________________________________ _
Defendant’s
Sex: Male / Female Home Phone: __________________________ _____
Defendant’s
Race: Caucasian / African American / Hispanic /
Latino /
Asian American / Pacific Islander / Other
______________________________
Defendant’s Date of Birth: __________ _________ __________ Age: ________________ ___
Month Day Year (20___)
Defendant’s Address (if known):
City/State/Zip__________________________________________________________________________ __
Defendant’s State of Birth:
Defendant’s Skin Tone: Fair
/ Light / Medium / Dark / Other ___________________________ _____
Defendant’s Height (approx.): ______________ Defendant’s Weight (in
pounds):__________________ _
Defendant’s Eye Color: ___________________ Defendant’s Hair Color:
______________________ ___
Defendant’s Scars, Marks, Tattoos:
_______________________________________________________ ___
Defendant’s Social Security
Number:_____________________________________________________ ____
FBI Number:
____________________________________________________________________________
Defendant’s Miscellaneous
Number:_______________________________________________________ __
Defendant Spends Time (Bars, Friends, etc.): ____
Defendant’s
Operator’s License Number: ____________________________________________________ _
Defendant’s Operator’s License State: __________ Operator’s License Year:
_______________________ _
Defendant’s
Vehicle Registration Number:
____________________________________________________
Defendant’s
Vehicle Registration State:
______________________________________________________
Defendant’s
Vehicle Registration Year:
______________________________________________________
Defendant’s
Vehicle Registration Type: ______________________________________________________
Defendant’s
Vehicle Identification Number: ___
Defendant’s
Vehicle Year: _________________________________________________________________
Vehicle
Model: __________________________________________________________________________
Defendant’s
Vehicle Style:
_________________________________________________________________
First
Color of Vehicle:
____________________________________________________________________
Second Color of Vehicle:
__________________________________________________________________
Miscellaneous
Information (vehicle):
_________________________________________________________
______________________________________________________________________________________
Defendant’s Place of Employment:
___________________________________________________________
Employer’s Address:
___________________________________________________________________
City / State / Zip Code
Employer’s Telephone Number:
________________________ Shift worked__________________________
Does
Defendant have access to any weapons?
Yes / No
Is this an eviction? Yes
/ No Hearing
Date:
Plaintiff Information:
_____________________________________________________________________________________
First Middle Last
Suffix (Jr, Sr, etc.)
Sex:
Male / Female Race: Caucasian / African American / Hispanic /
Latino /
Asian American / Pacific Islander / Other
_____________________
Date
of Birth: / /
Plaintiff
Telephone Number:
______________________________________________________________
____
Address is confidential
Address is:
___________________________________________________________________________
City
/State /Zip Code
Attorney Name:
Phone No.:
Other Protected Person(s):
1.
_________________________________________________________________________________
First Middle Last Suffix (Jr, Sr, etc.)
Sex: Male / Female Race: Caucasian / African American / Hispanic /
Latino /
Asian American / Pacific Islander / Other
____________________
Date of Birth:
_____/______/________
Telephone
Number: ____________________________________________________________________
_________Same
Address of Person Above
Address:
____________________________________________________________________________
City
/ State / Zip Code
2.
__________________________________________________________________________________
First Middle Last Suffix (Jr, Sr, etc.)
Sex:
Male / Female Race:
Caucasian / African American / Hispanic / Latino /
Asian American / Pacific Islander /
Other ______________________
Date
of Birth: _____/______/_________
Telephone Number: ____________________________________________________________________
____Address
is same as the Person above.
Address:
____________________________________________________________________________
City
/ State /
Zip Code
IN THE
COURT OF COMMON PLEAS OF CARBON COUNTY, PENNSYLVANIA
CIVIL
DIVISION
PLAINTIFF NAME: ________________________________
ADDRESS: ________________________________
TELEPHONE NO. ________________________________
DATE OF BIRTH: ________________________________
VS. NO: ___________________
DEFENDANT’S NAME: ____________________________
ADDRESS: _______________________________
TELEPHONE NO. _______________________________
DATE OF BIRTH: _______________________________
PROTECTION FROM ABUSE
