Filling Out Your Affidavit for Relief from Abuse

We hope this page will help you organize your statement or "affidavit." What if a section doesn't make sense for your situation? Skip to the next section. You can put more information in your affidavit if you want the judge to know more.

If you want to read about how to file for a Relief from Abuse Order? Go to our I Want to Get a Relief from Abuse Order. What Do I Do? page

What Is an "Affidavit"?
"Plaintiff" and "Defendant"
Docket Number
Sworn Statement
Your Statement or Affidavit
1. Describe What Your Abuser Did Recently That Makes You Afraid for Your Safety.
2. Did Your Abuser Abuse You in the Past? Describe the Abuse.
3. Describe Other Information About Your Abuser
4. Describe Why You Need a Relief from Abuse Order.
Signing Your Affidavit and Next Steps

What Is an "Affidavit"?

An affidavit is a sworn statement. It is a statement that the person swears is the truth as best as the person knows or believes. An affidavit has to be signed in front of a notary public.

"Plaintiff" and "Defendant"

"Plaintiff" and "Defendant" are words courts use to describe people in law suits. The "plaintiff" is the person who brings the law suit. The "defendant" is the person who is defending against the law suit. Since you are filing the complaint, you are the "plaintiff." The "defendant" is the person that you are afraid of. Write your name in the plaintiff box and your abuser's name in the defendant's box.

Docket Number

The "Docket Number" is the case number that the Court will give your case. Your case doesn't have a docket number yet because you haven't filed it yet. Leave this box blank. Later, the court will add this number.

Sworn Statement

Right after the Plaintiff and Defendant boxes, the form explains what an affidavit is. An affidavit is your sworn statement. This means that everything your write in the affidavit is the truth as best as you know and believe. Don't sign your affidavit until you are in front of a notary public. To find out more, go to our I Want to Get a Relief from Abuse Order. What Do I Do? page

Your Statement or Affidavit

Right after the explanation of what an affidavit is, there is a page of blank lines. This is where you write your sworn statement or affidavit. You can use more pages if you need to.

Next on this web page we describe what kinds of information you should put in your affidavit. We also say which order to put the information in. We suggest that you read this whole page and think about the most important things to say before you start writing your affidavit. Your affidavit is your chance to tell the judge what your abuser did that makes you afraid for your safety and why you need a Relief from Abuse Order.

1. Describe What Your Abuser Did Recently That Makes You Afraid for Your Safety.

Describe what your abuser did to make you afraid. Include exact dates and times if you can. If you can't remember exact times and dates, it's okay to guess or estimate. For example, it's okay to say "at about 3 p.m.," or "about two weeks ago." If you are guessing or estimating, write that it's your best guess or estimate.

Describe what your abuser did to you or your children. If your abuser used weapons, say so.

Physical Harm Describe any pain or injury that your abuser caused you or your children. Do you have bruises, scrapes, or other injuries? Describe your injuries here. Also describe any soreness, strain or discomfort that you have. Have you gone to the doctor or hospital for an injury your abuser caused? Write that here. Briefly describe how you felt about what your abuser did.

Threats Describe anything your abuser said that scared you. For example, did your abuser threaten to hurt you? Write that down. Did your abuser made threatening gestures (for example, shaking a fist at you)? Did your abuser block you from leaving a room? Include a description of what your abuser did and what date and time was. What if I don't know the exact date and time? It's okay to give your best guess. If you are guessing or estimating, say so.

Damaging Property and Hurting Pets Describe anything else your abuser did to make you afraid. Did your abuser hurt pets, break objects, damage property, or threaten to damage property? Describe this. Include a description with a date and time. What if I don't know the exact date and time? It's okay to give your best guess. If you are guessing or estimating, say so.

Police
Were the police involved? Describe what the police did. Did they arrest your abuser? Include this information. Are there criminal charges against your abuser right now? Include what the charges are.

2. Did Your Abuser Abuse You in the Past? Describe the Abuse.

Past Abuse
Often, abusers have been abusive for a long time. Are there things that your abuser did in the past that caused you or your children fear or pain? It's important to write this in your affidavit. It's important to say when these events took place, but it's okay to estimate. For example, it's okay to say "last winter," or "about a year and a half ago," or "about March, 2002," or "almost weekly," or "it felt like every day."

Previous Orders
Have you had a Relief From Abuse Order against your abuser in the past? Write when you got the Relief From Abuse Order and which court gave the order. Did you have an "order of protection" or "restraining order" from another state? Include information about this.

Getting Back Together
Many people try to get back together or "reconcile" with their abuser. For example, people try to go to therapy together or seek counseling from their church. Did you got back together with your abuser? You can still ask for a Relief From Abuse Order. Explain why you tried to continue your relationship with your abuser. Include any promises your abuser made. Also, if you or your abuser tried anger management counseling, marital therapy, or other treatment, include a brief description of this.

Past Criminal Charges
Have there been past criminal charges against your abuser for actions against you or your children? Write when the criminal charge happened. Also say what the punishment for your abuser was. Does your abuser has "conditions of release" or "conditions of probation"? List these conditions. The State's Attorney's Office that charged your abuser with the crime has a special person called a "Victim’s Advocate." The Victim's Advocate can help you get information about your abuser's past criminal charges.

• Describe what your abuser did to you or your children in the past.
• Describe any pain or injury that your abuser caused you or your children in the past.
• Describe how what your abuser did made you feel in the past.
• Describe anything your abuser said that scared you in the past.
• Describe anything else your abuser did to make you afraid in the past. If your abuser hurt pets, broke objects, damaged property, or made threats to damage property, describe this here.
• Were the police involved in the past? Describe what the police did.

3. Describe Other Information About Your Abuser

Alcohol and Drugs
Has your abuser used alcohol or drugs before making you scared? It's okay for you to say so.

Mental Illness Does your abuser have a mental illness? Say so. Does your abuser gets Social Security for mental illness? Say so.

Warnings Has anyone contacted you to warn you about your abuser? Include this.

Stalking Has your abuser stalked or followed you? Did your abuser made you feel that you were being watched regularly? Is your abuser trying to find out where you are and what you are doing? Include this. It is important to include any of these things in your affidavit if they happened.

Children Have your children ever seen your abuser abuse you? Were your children at home when your abuser abused you? Did your abuser abuse your children in any way? Include all of these in your affidavit if they happened.

Describe how the children reacted to your abuser’s abuse. You can describe what the children said. But it's better to describe how the abuse changed the children. Focus on what you saw about the children's behavior. For example, my children looked "stressed out" or scared. Or my child started wetting his bed.

4. Describe Why You Need a Relief from Abuse Order.

Describe how the abuse has affected you. Describe why you are afraid. Ask the Court for a Relief from Abuse Order to protect you.

Your Fear How has the abuse made you feel? Are you are afraid right now? Are you afraid of more abuse? Describe how your feel and why you are afraid.

Your Living Situation Did you have to leave your home because of the abuse? Do you need to move back into your home and have your abuser stay out? This is very important information to include. Explain to the Court why you don't feel like you can move out of your home right now. Explain to the Court why you can’t live in the same household as your abuser.

At the end of your affidavit, briefly tell the judge why you want a restraining order.

Signing Your Affidavit and Next Steps

Don't sign your affidavit until you are in front of a notary public. After your affidavit is notarized, you need to file your complaint and affidavit with Family Court. To find out more, go to our I Want to Get a Relief from Abuse Order. What Do I Do? page.