Form 3F-P-304 "Petition for an Order for Protection on Behalf of a Family or Household Member" - Hawaii

This version of the form is not currently in use and is provided for reference only.
Download this version of Form 3F-P-304 for the current year.

What Is Form 3F-P-304?

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

Form Details:

  • Released on October 1, 2010;
  • The latest edition provided by the Hawaii Family Court;
  • 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 fillable version of Form 3F-P-304 by clicking the link below or browse more documents and templates provided by the Hawaii Family Court.

ADVERTISEMENT
ADVERTISEMENT

Download Form 3F-P-304 "Petition for an Order for Protection on Behalf of a Family or Household Member" - Hawaii

798 times
Rate (4.7 / 5) 48 votes
PETITION FOR AN ORDER
CASE NUMBER
IN THE FAMILY COURT
FOR PROTECTION ON
OF THE THIRD CIRCUIT
BEHALF OF A FAMILY OR
STATE OF HAWAI‘I
FC-DA No.
HOUSEHOLD MEMBER
Petitioner's name, address and telephone number:
PETITIONER,
on behalf of
SUBJECT
and, Petitioner’s Attorney’s name, address and telephone
number:
vs.
RESPONDENT.
I.
Petitioner alleges, under penalty of perjury, that:
1. This Petition is made pursuant to Hawai‘i Revised Statutes ("H.R.S.") Chapter 586 and H.R.S. section 134-7.
2. I (Petitioner) am submitting this petition on behalf of the following family or household member who is:
G
G
a minor;
an incapacitated adult.
Name (Subject):
G
G
The Subject is:
male
female
Year of Birth
The Subject of this Petition is my (for example, child, nephew, uncle, parent, etc.):
The legal parents/guardians of the Subject are:
3.
The Subject resides on the island of Hawai i.
G
Name(s) and species of the animal(s) belonging to household in need of protection, if any:
If the Subject has been declared incapacitated and/or is the subject of a guardianship ordered by a court, please complete the
following case information:
Case name:
Case number:
Location of court:
Type of case:
4. The Subject of this Petition has the following relationship with the Respondent named above:
length of their relationship:
day(s)
month(s)
year(s)
G
A.
they are married.
G
B.
they were married, but are now divorced.
G
C.
they are current or former reciprocal beneficiaries.
G
D.
they are or were dating (romantic, courting, or engaged).
G
E.
they are now living together.
G
F.
they used to live together.
G
G.
they are related by blood and
Respondent is the Subject’s
G
H.
they have a child/children together.
RevaComm 508 Certified
PE TITIO N FO R AN O R D ER FO R PR O TEC TIO N O N BEHALF
Page 1 of 6
Reprographics (10/10) 3F
3F-P-304
O F A FAM ILY O R HO U SEHO LD M EM BER
PETITION FOR AN ORDER
CASE NUMBER
IN THE FAMILY COURT
FOR PROTECTION ON
OF THE THIRD CIRCUIT
BEHALF OF A FAMILY OR
STATE OF HAWAI‘I
FC-DA No.
HOUSEHOLD MEMBER
Petitioner's name, address and telephone number:
PETITIONER,
on behalf of
SUBJECT
and, Petitioner’s Attorney’s name, address and telephone
number:
vs.
RESPONDENT.
I.
Petitioner alleges, under penalty of perjury, that:
1. This Petition is made pursuant to Hawai‘i Revised Statutes ("H.R.S.") Chapter 586 and H.R.S. section 134-7.
2. I (Petitioner) am submitting this petition on behalf of the following family or household member who is:
G
G
a minor;
an incapacitated adult.
Name (Subject):
G
G
The Subject is:
male
female
Year of Birth
The Subject of this Petition is my (for example, child, nephew, uncle, parent, etc.):
The legal parents/guardians of the Subject are:
3.
The Subject resides on the island of Hawai i.
G
Name(s) and species of the animal(s) belonging to household in need of protection, if any:
If the Subject has been declared incapacitated and/or is the subject of a guardianship ordered by a court, please complete the
following case information:
Case name:
Case number:
Location of court:
Type of case:
4. The Subject of this Petition has the following relationship with the Respondent named above:
length of their relationship:
day(s)
month(s)
year(s)
G
A.
they are married.
G
B.
they were married, but are now divorced.
G
C.
they are current or former reciprocal beneficiaries.
G
D.
they are or were dating (romantic, courting, or engaged).
G
E.
they are now living together.
G
F.
they used to live together.
G
G.
they are related by blood and
Respondent is the Subject’s
G
H.
they have a child/children together.
RevaComm 508 Certified
PE TITIO N FO R AN O R D ER FO R PR O TEC TIO N O N BEHALF
Page 1 of 6
Reprographics (10/10) 3F
3F-P-304
O F A FAM ILY O R HO U SEHO LD M EM BER
C ASE N U M BER
PETITION FOR AN ORDER FOR PROTECTION ON BEHALF
OF A FAMILY OR HOUSEHOLD MEMBER (continued)
FC-DA No.
5. The Respondent has abused the Subject and/or the listed family/household member(s) as follows:
A. FIRST INCIDENT OF ABUSE
G
Respondent abused
Subject and/or
G
G
on (date)
by
doing or
threatening to do this:
G
G
G
G
G
G
G
G
G
G
choke
force to have sex
grab
hit
kick
slap
punch
push
shove
other
briefly describe this incident:
G
G
This was:
physical harm;
threat of imminent physical harm, bodily injury, assault;
G
G
extreme psychological abuse;
malicious property damage.
These children were in the home, were close by, or were present when the above incident occurred:
G
B. MOST RECENT INCIDENT OF ABUSE (check here if same as above
)
G
Respondent abused
Subject and/or
G
G
on (date)
by
doing or
threatening to do this:
G
G
G
G
G
G
G
G
G
G
choke
force to have sex
grab
hit
kick
slap
punch
push
shove
other
briefly describe this incident:
G
G
This was:
physical harm;
threat of imminent physical harm, bodily injury, assault;
G
G
extreme psychological abuse;
malicious property damage.
These children were in the home, were close by, or were present when the above incident occurred:
C. OTHER INCIDENT(S) OF ABUSE (attach continuation page(s) if needed)
G
Respondent abused
Subject and/or
G
G
on (date)
by
doing or
threatening to do this:
G
G
G
G
G
G
G
G
G
G
choke
force to have sex
grab
hit
kick
slap
punch
push
shove
other
briefly describe this incident:
G
G
This was:
physical harm;
threat of imminent physical harm, bodily injury, assault;
G
G
extreme psychological abuse;
malicious property damage.
These children were in the home, were close by, or were present when the above incident occurred:
RevaComm 508 Certified
PE TITIO N FO R AN O R D ER FO R PR O TEC TIO N O N BEHALF
Page 2 of 6
Reprographics (10/10) 3F
3F-P-304
O F A FAM ILY O R HO U SEHO LD M EM BER
C ASE N U M BER
PETITION FOR AN ORDER FOR PROTECTION ON BEHALF OF A
FAMILY OR HOUSEHOLD MEMBER (continued)
FC-DA No.
6.
The Respondent:
G
A.
may be mentally ill.
G
B.
may use illegal drugs.
G
G
C.
is a member of the Armed Services
is deployed or has received deployment orders.
G
D.
may need supervised visitation with the children because:
G
E.
may own/possess/have access to a weapon (describe):
7.
Firearms (check all that apply and fill in the blanks):
A. The Respondent:
G
G
G
G
G
owns
possesses
has access to
intends to obtain
intends to transfer ownership of
firearm(s), which may be used to threaten, injure or abuse a person as follows:
1) Description of firearm(s):
2) Location of firearm(s): (give street address and describe specific place where firearm is located)
G
B.
The Respondent is a member of the police department, a sheriff, a law enforcement officer, a member of the
armed forces of the State of Hawai i or the United States, a mail carrier, or is employed by the State, or subdivisions thereof,
or the United States, and may be required to be armed while on duty.
8.
Other court cases:
The Subject and/or my family and household members and/or the Respondent are or have been involved in other court
cases (check all that apply and list the case number if you know it):
G
G
Divorce
Paternity
G
Restraining Order/Protective Order
G
G
Juvenile
C.P.S.
G
G
Child Support
Criminal
G
Others:
G
G
9.
The address I live in is
owned
rented by:
10. The social worker or police officer or other official from this agency told me to file this Petition (identify the agency):
RevaComm 508 Certified
PE TITIO N FO R AN O R D ER FO R PR O TEC TIO N O N BEHALF
Page 3 of 6
Reprographics (10/10) 3F
3F-P-304
O F A FAM ILY O R HO U SEHO LD M EM BER
C ASE N U M BER
PETITION FOR AN ORDER FOR PROTECTION ON BEHALF OF A
FAMILY OR HOUSEHOLD MEMBER (continued)
FC-DA No.
II.
Based on the foregoing statements and information, Petitioner requests the following:
1
.
A Temporary Restraining Order enjoining the Respondent and any other person acting on the Respondent's behalf from:
G
A.
contacting, threatening or physically abusing the
and the
's
family and household members (no contact inclu
des no meetings, email, pho
ne calls, messaging, mail).
G
B.
entering or visiting
's residence.
G
C.
contacting, threatening, or physically abusing
at his/her place of work.
Employer’s name and address:
G
D.
contacting, threatening, or physically abusing the children at school. School's name and address:
G
E.
maliciously/intentionally damaging
's property or the property of the Subject's family and household
members.
G
F.
psychologically abusing
and
's family and household members.
G
G.
taking, concealing, removing, threatening, physically abusing, or otherwise disposing of any animal previously
identified in section I, #3, as belonging to the household.
G
2.
An order requiring that Respondent immediately vacate
's residence.
3. An order requiring Respondent to appear in court and show cause as to why the Order should not be continued.
4. A Protective Order continuing the Temporary Restraining Order and including:
G
temporary visitation and custody orders.
G
temporary prohibition of visitation with (children’s names):___________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __________
G
supervised visitation with (children’s names):
G
to be supervised by: _______________________________ who:
does not yet know of this request
G
has agreed to this
G
requiring the Respondent to participate in domestic violence intervention services and/or other counseling.
G
G
5. The Protective Order should last for at least
m onth(s) or
year(s).
I HEREBY SOLEMNLY AND SINCERELY DECLARE UNDER PENALTY OF PERJURY THAT THE STATEMENTS
MADE HEREIN ARE TRUE AND CORRECT TO THE BEST OF MY BELIEF, INFORMATION, AND
KNOWLEDGE.
Petitioner’s Signature
Dated: Island of Hawai‘i,
.
RevaComm 508 Certified
PE TITIO N FO R AN O R D ER FO R PR O TEC TIO N O N BEHALF
Page 4 of 6
Reprographics (10/10) 3F
3F-P-304
O F A FAM ILY O R HO U SEHO LD M EM BER
PETITION FOR AN ORDER FOR PROTECTION ON BEHALF OF
C ASE N U M BER
A FAMILY OR HOUSEHOLD MEMBER (continued)
(court cases continuation sheet)
FC-DA No.
Attach this page after page two of the petition
. OTHER INCIDENT(S) OF ABUSE (attach continuation page(s) if needed)
G
Respondent abused
the Subject and/or
G
G
on (date)
by
doing or
threatening to do this:
G
G
G
G
G
G
G
G
G
G
choke
force to have sex
grab
hit
kick
slap
punch
push
shove
other
briefly describe this incident:
G
G
This was:
physical harm;
threat of imminent physical harm, bodily injury, assault;
G
G
extreme psychological abuse;
malicious property damage.
These children were in the home, were close by, or were present when the above incident occurred:
. OTHER INCIDENT(S) OF ABUSE (attach continuation page(s) if needed)
G
th
e Subject a
nd/o
r
Respondent abused
G
G
on (date)
by
doing or
threatening to do this:
G
G
G
G
G
G
G
G
G
G
choke
force to have sex
grab
hit
kick
slap
punch
push
shove
other
briefly describe this incident:
G
G
This was:
physical harm;
threat of imminent physical harm, bodily injury, assault;
G
G
extreme psychological abuse;
malicious property damage.
These children were in the home, were close by, or were present when the above incident occurred:
. OTHER INCIDENT(S) OF ABUSE (attach continuation page(s) if needed)
G
Respondent abused
th S
e ubject and/o
r
G
G
on (date)
by
doing or
threatening to do this:
G
G
G
G
G
G
G
G
G
G
choke
force to have sex
grab
hit
kick
slap
punch
push
shove
oth
er
briefly describe this incident:
G
G
This was:
physical harm;
threat of imminent physical harm, bodily injury, assault;
G
G
extreme psychological abuse;
malicious property damage.
These children were in the home, were close by, or were present when the above incident occurred:
CLEAR FORM
RevaComm 508 Certified
PE TITIO N FO R AN O R D ER FO R PR O TEC TIO N O N BEHALF
Pag
e 5 of 6
Reprographics (10/10) 3F
3F-P-304
O F
A FAM ILY O R HO U SEHO LD M EM BER
Page of 6