---"'c,"'"."'c---,,----- 8552 SECOND AVENUE . r-..J_/\ 2-5P 18'-l '2 - LocaL..a at SlLVER SPRINct Ml)iUDftDi Case o. Vl-V<..I 0 '7 . 'OTE. Fill in the DlIOl,ing. checking 1/-.e approprime boxes. p" iii neTS neednot gh'e an address ifdomg 50 ri51u WI - further abuse or ro?\."ea s confidential ddress ofa sheller. If.his Iri! c. c, cr.zck here Ifyau d add:tional _cI<!lr" ) r:::: ) hiuing .. ilb objecl 0 stabbing etainin!!: a!!:2.ins will -in!!. 0 biting - -- -- PETITION FOR PROTECTION FROM DOMESTIC VIOLENCE CHILD ABUSE VULNERABLE ADULT ABUSE I. I '3:1 heffu m .. I y e Respon 'mt mmirted me followi g acts ofab:I5e ag'il:> her" V1. on or a :J- -3-/3 ( hee' a.! mat a;Jply.) hoki g.suangling oar; o sla pi g shooting rape or ether _exual offense (or 2rre o shoving th eats of violen e i ; oi a hil G.tO ,er abUSe... Respoc. e .-\ his "-ime the v: 'm can be found at _ I am State's A omey DSS 0 a rela 've an a I In,;n=: i me me. 1. e er3 0(5) I ant pro ec ed are (include }ollrsdfifYau are ,,'c im): I -'ames(s) J ' B' " :: J 'JI.,Wthev/lvt I-/-J-04 J l[-.t4 -qq If - /6 - 80 CC-D VI (Re 10 _0] I) fi r he fnllowing period ohime during 4, the pe n()1 \ 'ant, rOlec ell n w li....es. or has Ii e ,'ith he R15 .1e the past _ There Dare 0 are not additional persons living in the home, 5. I k fme Col 0\ 'jng court cases in -01 ing me, or the P r!On I \":t, t 3; the Res nden (Exan:ples in;:1 c it support, divor e, 00 0 ', d.., .eslie ,-i Ie ceo ' ,min'll ases) Coun 'ind of Case .ear F:led Result or S il,US (if O!J kno \) 6, I ave recei oed a mal protectj 'e 0 er ag-" ..s: s::u::e abuse allege in is petition. and which" 'as 'ssued fi a ])ericd Ore l5med _ -e e. ueil _ 3 l . n where issue r has access to e ahuse.} Ell/off 10 go to The residencers)
9, . 'OT m go O' e schoo (s) aI '=: ! 'OT til go t e hild are pro,,'der{s) .,.------",.".--.-:--:__...,...,.---;-;-;-:::--------- CC-DCiD . HRe , to '20 II) 0<002S}=bI Bl.J :s20\ ::s C'!..i:! .-a:::. YLI\ND Locate 3t __""-===-=-=-_----=-. -..--__;=:;;;:;-;:;:;=- _ ,,1:1 Coun h;= 1. Of L - - PETITIO FOR PROTECTIONiPEACE ORDER CONTINUATJO SHEET I lw..v.e_ b.e-en s:-tpaY.e,,!ed aha!- 1- tn0 1. -Ih t.-Lo w, /Ie. bLe V( !-t, Y'CJ1.,/eJ,'lA. t-f-1. L ./-e/;; 'wj }Y( e r UAM'f .s;e- T kve- 6t- rJ,;/dveh llud i 1r1edcJg ,I!. he-SP'UAj rtA-fj e&-/dv-e IvoJYl 10 In.eOv See /?'I.e., !I.e I.e fh'ug rn..e- Jhev..e.- wheve- lie fold WI.- i:r: i w( LI t?j do L1L( fir. In . he u/i II Iud.. v I- h-7 -- Cl.-M- d 1- U/l II SN?k-. +Wi /! /w...jpeh jo .....,.e.-. !/-"7-/3