Clark County Superior Court Petition for Order for Protection under RCW 26.50

Note: This Petition is as submitted to the court except that all identifying information for my wife has been replaced with her first name, Karyn, as the normal references on my web pages are to first name only. Other identifying information has been XXXXX out.

Hand written form entries are shown in italics. The actual scanned text (slower to download and harder to search and read) is also available. The image quality is quite poor, but the copy I received was very poor quality.

The context for this Petition can be found at: http://brian.carr.name/legal.htm.

DENIED
NOV 12 2004

SUPERIOR COURT OF WASHINGTON
FOR THE COUNTY OF CLARK

Brian P. Carr

11/XX/XX

Petitioner

DOB

Karyn

XX/XX/XX

Respondent

DOB

CASE NUMBER: 04-2-08908-9

PETITION FOR ORDER
FOR PROTECTION
(PTORPRT) (Domestic Violence)

1. I am A member of my family or household is the victim of domestic violence committed by the respondent as described in the statement below.

I live in this county.
I left my residence because of abuse and this is the county of my new or former residence.

3. My age is:
Under 16 16 or 17 18 over

Respondent's age is:
Under 16 16 or 17 18 over

4. My relationship with the respondent is: (Mark ALL that apply.)

Spouse
Former spouse
Have child in common

Reside together currently
Resided together in past
Related by blood

Presently dating
Dated in the past
In-law

5. Identification of Minors (If applicable) No Minors Involved.

Name (First, Middle Initial, Last)

Age

Race

Sex

How child is related to

Petitioner

Respondent

Resides with

Alexander XXXXX

PETITION FOR ORDER FOR PROTECTION (PTORPRT) - Page 1 of 4
WPF DV-1.015 (9/2001) - RCW 26.50.030
H:\FORMS\DV\Petition for Order of Protection.doc

6. Other court cases or restraining, protection, or no-contact orders involving me or the minors, and the respondent:

CASE NAME	Karyn V Carr	Karyn V Carr
CASE NUMBER	04-2-08824-4	04-3-02728-9
COURT/COUNTY	District/Clark	Superior/Lincoln

REQUEST FOR TEMPORARY ORDER: AN EMERGENCY EXISTS as described in statement below: I need a temporary restraining order issued immediately without notice to the respondent until a hearing to avoid irreparable injury. I request a Temporary Order for Protection that will:

I REQUEST AN ORDER FOR PROTECTION following a hearing that will:

Mark each column to indicate the items you would like included in each order.

X	X	¹ RESTRAIN respondent from causing any physical harm, bodily injury, assault, including sexual assault, and from molesting, harassing, threatening, or stalking me the minors named in paragraph 5 above these minors only:
X	X	² RESTRAIN respondent from coming near and from having any contact whatsoever, in person or through others, by phone, ---------, directly or indirectly, except for mailing of court documents, with me the minors named in paragraph 5 above, subject to any court-ordered visitation these minors only, subject to any court-ordered visitation: e-mail OK
X	X	³ EXCLUDE respondent from our shared residence my residence my work place my school the day care or school of the minors in paragraph 5 above these minors only: other: ___________________ my address is: 11301 NE 7th St; AptJ5; Vancouver, WA 98684 I choose to observe my right to keep my residential address confidentia1.
		⁴ DIRECT respondent to vacate our shared residence and restore it to me. The address is:
X	X	⁵ PROHIBIT respondent from knowingly coming within, or knowingly remaining within 300 (feet) of our shared residence my residence my workplace my school; the day care or school of the minors named in paragraph 5 above. these minors only: other: Mandarin House 50SW 2nd Ave; Portland, OR 97204 Work AtOnce 309 SW 6th Ave, #900 Portland, OR 97204
		⁶ GRANT me possession of essential personal belongings, including the following:
		⁷ Grant me use of the following vehicle: Year_______ Make & Model _________________ Color ________ License No______
		⁸ Other: ___________________________________

PETITION FOR ORDER FOR PROTECTION (PTORPRT) - Page 2 of 4
WPF DV-1.015 (9/2001) - RCW 26.50.030
H:\FORMS\DV\Petition for Order of Protection.doc

		⁹ DIRECT the respondent to participate in appropriate treatment or counseling services.
		¹⁰ REQUIRE the respondent to pay the fees and costs of this action.
		¹¹ REMAIN EFFECTIVE longer than one year because respondent is likely to resume acts of domestic violence against me if the order expires in a year.
Complete the following boxes only if you are requesting protection involving a minor child.
I/We DO have a custody order/parenting plan. I/We DO NOT have a custody order/parenting plan.
		¹² Subject to any court-ordered visitation, GRANT me the care, custody and control of the minors named in paragraph 5 above these minors only:
		¹³ RESTRAIN respondent from interfering with my physical or legal custody of the minors named in paragraph 5 above these minors only:
		¹⁴ RESTRAIN the respondent from removing from the state: the minors named in paragraph 5 above these minors only:

REQUEST FOR SPECIAL ASSISTANCE FROM LAW ENFORCEMENT AGENCIES:

I request the court order the appropriate law enforcement agency to assist me in obtaining:
Possession of my residence. Use of designated vehicle above.
Possession of my essential personal belongings at the shared residence respondent's residence at: _____________
Custody of the minors named in paragraph 5 above these minors only (If applicable):
Other: _______________________

Domestic violence includes physical harm, bodily injury, assault, stalking, OR inflicting fear of imminent physical harm, bodlily injury or assault between family or household members.

STATEMENT: The respondent has committed acts of domestic violence as follows.
(Give a response to every question. Describe specific acts of domestic viloence or threats against you and their approximate dates; begin with the most recent event. You may want to include police responses and the outcomes.)

Describe the most recent incident or threat of violence and date: Harrassment: at 6:05PM on Nov 5, 2004, Karyn had police arrest me for violating Order for Protection. Her firend had told her where I was (Mandarin House restaurant) and she came to restaurant and called police without entering. I had no knowledge she was present until the police asked me to leave. I regularly go to that restaurant at that time.
Describe past incidents when you experienced violence, when you were afraid of injury, or when the respondent threatened to harm or kill you (and dates): No other incidents.
In march 2004 Karyn threw a cup of coffee at me. The cup (ceramic) and coffee struck me. I went to phone to me and she apologized. I did not call. Alexander was not present. In December 2003 Karyn threw a cup of coffee at me. Coffee and cup struck me. Minor child, Alexander, was present. I told her that such behaviour was unacceptable and next time I would call 911. In November 2003, Karyn struck a plate of food I was holding and continued on to strike me! I told her such behaviour was unacceptable and would not happen again. Alexander was present at the time.

PETITION FOR ORDER FOR PROTECTION (PTORPRT) - Page 3 of 4
WPF DV-1.015 (9/2001) - RCW 26.50.030
H:\FORMS\DV\Petition for Order of Protection.doc

Describe violence or threats toward the children: No threats toward children. No children involved.
None, Alexander witnessed violence towards me.
Describe medical treatment you received for injuries, for what, and when: No treatinent received.
None ____________
Describe any threats of suicide or suicidal behavior by respondent: Does not apply.
Karyn has been seeing a neurologist and taking serious psychotropic medications since before I met her in Nov 2002. She does not take her medications regularly and as result has serious emotional outbreaks.
Describe firearms owned /possessed by respondent, and their location, if known: No firearms
45 semi-automatic hand gun is residence master bed room closet, not properly secured from minor child, Alexander.
Has the respondent used firearms, weapons or objects to threaten or harm you? Does not apply.
If requesting the protection order for longer than one year, describe the reasons: Does not apply.
Check box if substance abuse is involved alcohol controlled drugs other ________________ None

I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.

Dated November 12, 2004 at 10:30AM, Washington.
________Brian P. Carr_______
Signature of Petitioner

You have a, right to keep your residential address confidential. If you do, please provide an address, other than your home, where you can receive legal documents: N / A

PETITION FOR ORDER FOR PROTECTION (PTORPRT) - Page 4 of 4
WPF DV-1.015 (9/2001) - RCW 26.50.030
H:\FORMS\DV\Petition for Order of Protection.doc

This page was last updated on April 1, 2007.