Relief from Abuse Affidavit

“Plaintiff” and “defendant” are words that courts use for people involved in law suits. The “plaintiff” is the person who starts 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 who has abused you.

Write your name and information in the plaintiff’s box and your abuser’s name and information in the defendant’s box.

Leave the “Docket No.” blank. The docket number is the case number that the court will give your case. The court will add the docket number later.

Superior Court Unit

Under the words “Superior Court,” enter the name of the county where you are handing in your forms. Either you or your abuser must live in that county.

In the next sections of the form, you will write your sworn statement or affidavit. Before you start writing, we suggest that you read this whole web page and think about the most important things to say. You might want to write out your statements before filling in the form. You can add more pages if you need more space.

The next steps on this web page will describe what kinds of information you should put in your affidavit. Your affidavit is your chance to tell the judge what your abuser did that makes you afraid for your safety or the safety of your child. It lets you explain why you need a Relief from Abuse Order.

The affidavit form asks you to report on the “most recent incident” of abuse. Describe what your abuser did most recently to make you afraid. Include exact dates and times if you can. If you can’t remember exact dates and times, 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. Be sure to say where it happened and who else was there to see it. The judge will be most interested in information that you heard or saw and what was done to you.

Physical Harm

Describe any pain or injury that your abuser caused you or your children. Do you have bruises, scrapes or other injuries? Describe the 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. It is okay if you never received medical treatment.

Threats

Describe anything your abuser said or did that scared you. For example, did your abuser threaten to hurt you? Write that down. Did your abuser make 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 the date and time was. What if you don’t know the exact date and time? It’s okay to give your best guess. If you are guessing or estimating, say so.

Weapons

Was there a weapon involved in the violence or threats? Include that in your description.

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 you 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. It is okay if you don’t know what the charges are.

Alcohol and Drugs

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

Stalking

Has your abuser stalked or followed you? 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 been in the same room when you were being abused? 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 the abuse. Describe how the abuse changed the children. Focus on what you saw about the children’s behavior. For example, “my children have difficulty sleeping,” ”my child looked scared,” or “my child started wetting his bed.”

Often, abusers have been abusive for a long time. Are there things that your abuser did in the past that hurt you or your children or made you afraid? It’s important to write this in your affidavit.

The form asks you to describe the “most serious incident” that you’ve been through. If you already described it in the first section of the form, then you can skip this section. If you haven’t already described the worst abuse, write about it here.

The next section asks you to describe “other past incidents” of abuse. 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 2012” or “almost every week” or “it felt like every day.”

• 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 in the past to make you afraid. If your abuser hurt pets, broke objects, damaged property or made threats to hurt you or the children or to damage property, describe what the abuser did.
• Were the police involved? Describe what the police did.

The next section of the affidavit form asks about other court actions.

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 a “protection order” or “restraining order” from another state? Include information about this. If you have the title of the case, docket number, county and state, include that. It is okay if you do not have all that information.

Criminal Cases

Is there a current criminal case involving you, your abuser and/or your children?  If so, write in the name of the case (for example, State v. Smith), the state where it was filed and the date and docket number, if you know.

Have there been criminal charges against your abuser for actions against you or your children in the past? Write about that in the section called “other past incidents.” The State’s Attorney 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.

Divorce or Guardianship

Fill in the information about any divorce, parentage or guardianship cases that include you, your children or your abuser.

Don’t sign your affidavit until you are in front of a notary public. A notary public must watch you sign it because your affidavit is your sworn statement to the truth of what happened as best as you know. The notary public will also sign the affidavit.

The family court clerks are notary publics. You can bring your completed affidavit to the Family Division court. A clerk will watch you sign your affidavit. The clerk may also ask you if your affidavit is true.

If you are at court, with a network advocate, or filing an emergency request after hours, someone there will be able to notarize your affidavit. You will not need to arrange for a separate notary.

Notaries are often available in banks, and town clerk’s and lawyer’s offices. Ask if someone is willing to notarize your document at no charge.

After your affidavit is notarized, you need to file your complaint and affidavit with family court. To find out more, go to our Relief from Abuse Order page.