Form C-3 "Application for Order for Protection of Children (Nrs 33.400)" - Nevada

What Is Form C-3?

This is a legal form that was released by the Supreme Court of Nevada - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 30, 2007;
  • The latest edition provided by the Supreme Court of Nevada;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form C-3 by clicking the link below or browse more documents and templates provided by the Supreme Court of Nevada.

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Download Form C-3 "Application for Order for Protection of Children (Nrs 33.400)" - Nevada

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Case No. ___________________
Dept. No. ___________________
2
IN THE JUSTICE COURT OF _____________ TOWNSHIP
3
COUNTY OF __________________, STATE OF NEVADA
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5
6
APPLICATION FOR ORDER FOR
7
_____________________________________
PROTECTION OF CHILDREN
(NRS 33.400)
Applicant(s)
)
8
)
)
9
vs.
)
_____________________________________
)
10
Adverse Party(s)
)
(must be Age 18 or older)
.
)
11
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- In addition to any other remedy provided by law, the parent
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ORDER FOR PROTECTION OF CHILDREN
or guardian of a child may petition any court of competent jurisdiction on behalf of the child for a
temporary or extended Order against a person who is 18 years of age or older and who the parent or
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guardian reasonably believes has committed or is committing a crime involving:
(a) Physical or mental injury to the child of a nonaccidental nature; or
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(b) Sexual abuse or sexual exploitation of the child. (NRS 33.400)
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PLEASE TYPE OR PRINT CLEARLY.
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COMPLETE THE APPLICATION TO THE BEST OF YOUR KNOWLEDGE.
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I am applying for protection (check all that apply):
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For my minor child
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For my ward
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For my minor child and other person(s)
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For my ward and for other person(s)
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Form C3 Application for Order for Protection of Children (NRS 33.400)
©2007 Nevada Supreme Court
June 30, 2007
Page 1 of 7
1
Case No. ___________________
Dept. No. ___________________
2
IN THE JUSTICE COURT OF _____________ TOWNSHIP
3
COUNTY OF __________________, STATE OF NEVADA
4
5
6
APPLICATION FOR ORDER FOR
7
_____________________________________
PROTECTION OF CHILDREN
(NRS 33.400)
Applicant(s)
)
8
)
)
9
vs.
)
_____________________________________
)
10
Adverse Party(s)
)
(must be Age 18 or older)
.
)
11
12
- In addition to any other remedy provided by law, the parent
13
ORDER FOR PROTECTION OF CHILDREN
or guardian of a child may petition any court of competent jurisdiction on behalf of the child for a
temporary or extended Order against a person who is 18 years of age or older and who the parent or
14
guardian reasonably believes has committed or is committing a crime involving:
(a) Physical or mental injury to the child of a nonaccidental nature; or
15
(b) Sexual abuse or sexual exploitation of the child. (NRS 33.400)
16
17
PLEASE TYPE OR PRINT CLEARLY.
18
COMPLETE THE APPLICATION TO THE BEST OF YOUR KNOWLEDGE.
19
20
I am applying for protection (check all that apply):
21
For my minor child
22
For my ward
23
For my minor child and other person(s)
24
For my ward and for other person(s)
25
Form C3 Application for Order for Protection of Children (NRS 33.400)
©2007 Nevada Supreme Court
June 30, 2007
Page 1 of 7
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Applicant states the following facts under penalty of perjury:
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I reasonably believe that the Adverse Party has committed and/or is committing a crime
3
against a child as defined above. The acts occurred as follows:
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(NOTE: BE SPECIFIC AS TO WHO COMMITTED WHAT ACTS, AGAINST WHOM,
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WHEN, WHERE, WHETHER COMMITTED OR THREATENED; INDICATE
APPROXIMATE DATE(S) AND LOCATION(S).)
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THIS FORM IS A PUBLIC RECORD
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______________________________________________________________________________
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______________________________________________________________________________
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______________________________________________________________________________
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______________________________________________________________________________
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______________________________________________________________________________
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______________________________________________________________________________
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______________________________________________________________________________
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______________________________________________________________________________
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______________________________________________________________________________
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______________________________________________________________________________
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______________________________________________________________________________
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______________________________________________________________________________
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______________________________________________________________________________
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______________________________________________________________________________
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NOTE: PLEASE DO NOT WRITE ON THE BACKS OF ANY PAGES;
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CHECK BOX IF YOU ARE USING ADDITIONAL PAGES.
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Check if you use a continuation page (to be incorporated by reference)
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Form C3 Application for Order for Protection of Children (NRS 33.400)
©2007 Nevada Supreme Court
June 30, 2007
Page 2 of 7
1
Has this matter been reported to law enforcement or child protective services?
Yes
No
2
3
If yes, approximate date(s):
4
_____________________________________________________________________
5
Name of agency:
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_____________________________________________________________________
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C
ase/Event number if known:
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_____________________________________________________________________
(IF YOU HAVE A REPORT AVAILABLE, PLEASE ATTACH A COPY OR
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BRING IT TO THE COURT HEARING.)
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For purposes of this form, a “TPO Action” is defined to include the following Justice Court
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actions:
(1) An Order for Protection Against Stalking and Harassment (NRS 200.591);
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(2) An Order for Protection of Children (NRS 33.400);
(3) An Order for Protection Against Harassment in the Workplace (NRS 33.270). A
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“TPO Action” is also defined to include the following Justice/Family/District Court action:
(a) An Order for Protection Against Domestic Violence (NRS 33.020)
14
Please Check the Appropriate Box Below:
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In the last 2 years, Applicant or any party seeking protection has not filed a TPO action
against the Adverse Party anywhere in the State of Nevada, and the Adverse Party has not
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filed a TPO action against Applicant or any party seeking protection anywhere in the
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State of Nevada.
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In the last 2 years, the following TPO action(s) in the State of Nevada have been filed
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involving Applicant and the Adverse Party:
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Case #
Court
Place of
Approx.
Outcome (TPO
(if known)
(Justice/Family)
Filing
Date Filed
granted, denied,
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rescinded, etc.)
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Form C3 Application for Order for Protection of Children (NRS 33.400)
©2007 Nevada Supreme Court
June 30, 2007
Page 3 of 7
1
Has the Adverse Party ever been involved in any other relevant Court actions (e.g.,
2
eviction, divorce, custody, criminal, etc.)?
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Yes
No If yes, please explain: ________________________________
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_____________________________________________________________________
_____________________________________________________________________
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_____________________________________________________________________
6
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Applicant must be at least 18 years of age. If not 18 years of age, consult with the Clerk.
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1.
a) Applicant’s Name
Age
____________________________________________
_______
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(Last)
(First)
(Middle)
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Minor’s Name
b) Protected
Age
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____________________________________________
_______
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(Last)
(First)
(Middle)
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c) Protected Minor’s relationship to Applicant: _______________________________
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Protected Minor’s relationship to Adverse Party: ___________________________
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d) Applicant’s relationship to Adverse Party: _________________________________
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e) Provide names below of those for whom you are additionally seeking protection,
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including family and household members that need this protection. Indicate the relationships of
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all persons listed to the minor and to the Adverse Party (i.e., spouse, intimate partner, friend,
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roommate, neighbor, relative, acquaintance, co-worker, stranger):
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NAME OF OTHERS
AGE
RELATIONSHIP
RELATIONSHIP
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SEEKING PROTECTION
TO PROTECTED
TO ADVERSE
MINOR
PARTY
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Form C3 Application for Order for Protection of Children (NRS 33.400)
©2007 Nevada Supreme Court
June 30, 2007
Page 4 of 7
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Explain why protection is needed for the individuals listed above:
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______________________________________________________________________________
3
______________________________________________________________________________
4
______________________________________________________________________________
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(NOTE: YOUR APPLICATION WILL NOT BE DENIED BASED UPON A
PARTICULAR RELATIONSHIP. HOWEVER, DEPENDING UPON YOUR
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RELATIONSHIP, YOU MAY ALSO BE ELIGIBLE TO APPLY FOR AN ORDER OF
PROTECTION AGAINST DOMESTIC VIOLENCE PURSUANT TO NRS CHAPTER
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33.)
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2.
Have the minor and the Adverse Party ever lived together?
Yes
No
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If so, for how long? _______________________________________________________
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3.
Is anyone listed on Page 4 living with the Adverse Party now?
Yes
No
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If so, who? ___________________________________
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4.
Are there other children involved?
Yes
No. If so, how are they involved?
________________________________________________________________________
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________________________________________________________________________
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5.
Residence(s) where protection is needed:
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CONFIDENTIAL (If confidential, check and move to the next question) or,
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If not confidential, list address, city, state and zip code:
________________________________________________________________________
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________________________________________________________________________
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6.
Place(s) of employment where protection is needed:
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CONFIDENTIAL (If confidential, check and move to the next question) or,
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If not confidential, list name, address, city, state and zip code:
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______________________________________________________________________________
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______________________________________________________________________________
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Form C3 Application for Order for Protection of Children (NRS 33.400)
©2007 Nevada Supreme Court
June 30, 2007
Page 5 of 7
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