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Rule 1905 Forms for Use in PFA Actions. Notice and Hearing. Petition. Temporary Protection Order. Final Protection Order

Chapter 1900: Actions Pursuant to the Protection from Abuse Act

(a) The Notice of Hearing and Order required by Pa.R.C.P. No. 1901.3 shall be substantially in the following form:

(Caption) 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, prohibited from possessing any firearm, other weapon, ammunition, or any firearm license, and lose other important rights, including custody of your children. A 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) and Child Protective Services Law proceedings under Chapter 63 (related to juvenile matters).

A hearing on the matter is scheduled for the day of , 20 , at .m., in Courtroom at Courthouse, Pennsylvania.

If an order of protection has been entered, you MUST obey the order until it is modified or terminated by the court after notice and hearing. If you disobey this order, the police or sheriff may arrest you. Violation of this order may subject you to a charge of indirect criminal contempt 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.

If this order directs you to relinquish any firearm, other weapon, ammunition, or any firearm license to the sheriff or the appropriate law enforcement agency, you may do so upon service of this order. As an alternative, you may relinquish any firearm, other weapon, or ammunition listed herein to a third party provided you and the third party first comply with all requirements to obtain a safekeeping permit. 23 Pa.C.S. § 6108.3. You must relinquish any firearm, other weapon, ammunition, or any firearm license listed in the order no later than 24 hours after service of the order. If, due to their current location, firearms, other weapons, or ammunition cannot reasonably be retrieved within the time for relinquishment, you must provide an affidavit to the sheriff or the appropriate law enforcement agency listing the firearms, other weapons, or ammunition and their current location no later than 24 hours after service of the order. Failure to timely relinquish any firearm, other weapon, ammunition, or any firearm license shall result in a violation of this order and may result in criminal conviction under the Uniform Firearms Act, 18 Pa.C.S. § 6105.

NOTICE: Even if this order does not direct you to relinquish firearms, you may be subject to federal firearms prohibitions and federal criminal penalties under 18 U.S.C. § 922(g)(8) or state firearms prohibitions and state criminal penalties under 18 Pa.C.S. § 6105.

YOU HAVE THE RIGHT TO HAVE A LAWYER REPRESENT YOU AT THE HEARING, HOWEVER, THE COURT WILL NOT APPOINT A LAWYER FOR YOU. YOU HAVE THE RIGHT TO PRESENT EVIDENCE AT THE HEARING, INCLUDING SUBPOENAING WITNESSES TO TESTIFY ON YOUR BEHALF.

YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. 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 FEE OR NO FEE. IF YOU CANNOT FIND A LAWYER, YOU MAY HAVE TO PROCEED WITHOUT ONE.

County Lawyer Referral Service [ Insert Street Address ] [ Insert City, State, Zip Code ] [ Insert Phone ]

(b) The petition in an action filed pursuant to the Act shall be substantially in the following form, but the first page (paragraphs 1 through 4), following the Notice of Hearing and Order, shall be exactly as set forth in this rule:

5. Indicate the relationship between Plaintiff and Defendant:

CHECK ALL THAT APPLY:

spouse or former spouse of Defendant

parent of a child with Defendant

current or former sexual or intimate partner with Defendant

child of Plaintiff

child of Defendant

family member related by blood (consanguinity) to Defendant

family member related by marriage or affinity to Defendant

sibling (person who shares parenthood) of Defendant

Check here if Defendant is 17 years old or younger.

6. 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:

7. Has Defendant been involved in any criminal court action?

If you answered Yes, is Defendant currently on probation?

Has Defendant been determined to be a perpetrator in a founded or indicated report under the Child Protective Services Law, 23 Pa.C.S. § § 6301— 6386?

If you answered Yes, what county’s court or child protective services agency issued the founded or indicated report?

8. Plaintiff and Defendant are the parents of the following minor child/ren:

Name(s)Age(s)who reside at (list address unless confidential)

9. 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 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 namePerson(s) child lived withAddress, unless confidentialWhen

(b) List any other persons who are known to have or claim a right to custody of each child listed above.

NameAddressBasis of Claim

10. The following other minor child/ren presently live with Plaintiff:

Name(s)Age(s)Plaintiff’s relationship to child/ren

11. The facts of the most recent incident of abuse are as follows:

Approximate Date: Approximate Time: Place:

Describe in detail what happened, including any physical or sexual abuse, threats, injury, incidents of stalking, medical treatment sought, or calls to law enforcement. (attach additional sheets of paper if necessary):

12. If 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):

13.(a) Has Defendant used or threatened to use any firearms or other weapons against Plaintiff or the minor child/ren? If so, please describe the use or threatened use below and list on Attachment A to Petition, which is incorporated by reference into this petition, any firearms, other weapons, or ammunition Defendant used or threatened to use against Plaintiff or the minor child/ren:

(b) Other than the firearms, other weapons, or ammunition Defendant used or threatened to use against Plaintiff or the minor child/ren, does Defendant, to the best of your knowledge or belief, own or possess any additional firearm, other weapon, ammunition, or any firearm license?

(c) If the answer to (b) above is ‘‘yes,’’ list any additional firearm, other weapon, or ammunition owned by or in the possession of Defendant on Attachment A to Petition, which is incorporated by reference into this petition.

(d) Plaintiff (check one) DOES DOES NOT request that the court order Defendant to relinquish firearms, other weapons, or ammunition listed on Attachment A to Petition. If Plaintiff does seek relinquishment, identify on Attachment A to Petition the firearms, other weapons, or ammunition Plaintiff requests the court to order Defendant to relinquish.

14. Identify the sheriff, police department, or law enforcement agency in the area in which Plaintiff lives that should be provided with a copy of the protection order:

15. There is an immediate and present danger of further abuse from 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 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 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, harassing, stalking, threatening, or attempting or threatening to use physical force against Plaintiff or the minor child/ren in any place where Plaintiff or the child/ren may be found.

B. Evict/exclude Defendant from Plaintiff’s residence and prohibit Defendant from attempting to enter any temporary or permanent residence of Plaintiff.

C. Require Defendant to provide Plaintiff or the 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 the child/ren:

E. Prohibit Defendant from having any contact with Plaintiff or the minor child/ren, 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 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 with the minor child/ren. The following persons are Plaintiff’s relatives or family and household members that Plaintiff believes require protection from stalking and harassment by Defendant.

Name Address (optional) Relationship to Plaintiff

G. Order Defendant to temporarily relinquish the firearms, other weapons, or ammunition listed on Attachment A to Petition, under Defendant’s control, or in Defendant’s possession, or any firearm license to the sheriff or the appropriate law enforcement agency.

H. Prohibit Defendant from acquiring or possessing firearms for the duration of the order.

I. Order Defendant to pay temporary support for Plaintiff or the minor child/ren, including medical support and payment of the rent or mortgage on the residence.

J. Direct Defendant to pay Plaintiff for the reasonable financial losses suffered as the result of the abuse, to be determined at the hearing.

K. Order Defendant to pay the costs of this action, including filing and service fees.

L. Order Defendant to pay Plaintiff’s reasonable attorney’s fees.

M. Order the following additional relief, not listed above:

N. Grant such other relief as Plaintiff requests or the court deems appropriate.

O. Order the police, sheriff, or other law enforcement agency to serve Defendant with a copy of this petition, any order issued, and the order for hearing. Plaintiff will inform the designated authority of any addresses, other than Defendant’s residence, where Defendant can be served.

P. Direct the Pennsylvania State Police, the municipal police, or the sheriff to accompany Plaintiff to his or her residence to retrieve personal belongings or accompany Plaintiff while the petition or order is served on Defendant, if Plaintiff has reason to believe his or her safety is at risk. 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 (Caption) ATTACHMENT A TO PETITION FIREARMS, OTHER WEAPONS, OR AMMUNITION INVENTORY

I, , Plaintiff in this Protection From Abuse Action, hereby

(a) state that Defendant used or threatened to use the following firearms, other weapons, or ammunition against Plaintiff or the minor child/ren (include addresses or locations, if known, such as ‘‘front seat of blue truck,’’ ‘‘gun cabinet,’’ ‘‘bedroom closet,’’ etc.):

Firearm/Other Weapon/Ammunition Location

1.

2.

3.

4.

5.

(b) state that Defendant, to the best of my knowledge or belief, owns or possesses the following firearms, other weapons, or ammunition not set forth in (a) above (include addresses or locations if, known):

Firearm/Other Weapon/Ammunition Location

1.

2.

3.

4.

5.

(c) request that the court order Defendant to relinquish the following firearms, other weapons, or ammunition (include addresses or locations, if known):

Firearm/Other Weapon/Ammunition Location

1.

2.

3.

4.

5.

All firearms, other weapons, or ammunition owned or possessed by Defendant. If more space is needed, more sheets may be attached to this document.

Name

Date

Notice: This attachment will be withheld from public inspection in accordance with 23 Pa.C.S. § 6108(a)(7)(v).

Amendment history: The provisions of this Rule 1905 adopted March 9, 1998, effective July 1, 1998, 28 Pa.B. 1391; amended June 2, 2000, effective immediately, 30 Pa.B. 3027; amended October 27, 2000, effective immediately, 30 Pa.B. 5837; amended October 31, 2002, effective immediately, 32 Pa.B. 5632; amended March 18, 2004, effective June 16, 2004, 34 Pa.B. 1754; amended May 2, 2006, effective May 9, 2006, 36 Pa.B. 2369; amended February 6, 2007, effective May 7, 2007, 37 Pa.B. 929; amended August 13, 2008, effective in 90 days, 38 Pa.B. 4729; amended February 10, 2015, effective in 30 days on March 12, 2015, 45 Pa.B. 1250; amended January 5, 2018, effective January 6, 2018, 48 Pa.B. 477; amended June 1, 2018, effective July 1, 2018, 48 Pa.B. 3520; amended March 5, 2019, effective April 10, 2019, 49 Pa.B. 1342. Immediately preceding text appears at serial pages (392604), (390073) to (390074), (337857) to (337860), (392605) to (392606), (337863) to (337870), (376541) to (376542), (337873) to (337874), (350109) to (350110), (337877) to (337878) and (392607).