P.R. Laws tit. 33, § 4026
The forms provided by the clerks of the courts of justice to the persons that request a restraining order, shall be designed in such a way that the information, circumstances, and data contained in the models included herein, may be consigned or declared. Said forms shall be available in Spanish and English to comply with the requirements established by §§ 2261, 2261A, 2262 and 2265 of the Violence Against Women Act (VAWA), Title IV, P.L. 103-322 of the Violent Crime Control and Law Enforcement Act. However, the Office of Court Administration may modify them when it deems convenient, in order to achieve the purposes of this §§ 4013—4026 of this title.
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FORM I GENERAL COURT OF JUSTICE Trial Court Part: __________ PETITIONER NUMBER ____ vs. RE: __________ RESTRAINING ORDER RESPONDENT Stalking No. _____ PETITION FOR RESTRAINING ORDER TO THE HONORABLE COURT: The Petitioner hereby appears and his/her representative respectfully alleges, states and requests that: 1. My name is _______________, I am ____ years old, my Social Security Number is __________, [my driver’s license number is] __________, I reside at (Street, Number, Urbanization, Ward, Municipality) 2. The Respondent’s Party’s name is ____________, who is ____ years old, his/her Social Security Number is __________, his/her driver’s license number is __________, resides at (Street, Number, Urbanization, Ward, Municipality) 3. I am a victim of stalking by the respondent, consisting in that intentionally, or knowing that I could reasonably feel intimidated, has demonstrated a pattern of conduct consisting of threats, persecution and harassment, addressed to terrorize me to the extent that I could be harmed, could cause damage to my property, could harm a member of my family or [cause damage] to their property. 4. The stalking of which I have been a victim occurred on, or during the __________ day(s) of __________ at 5. The stalking incidents consisted of 6. At present there ____ is ____ is not pending court action related to these acts. 7. I request this Court to grant me the following remedies: ___ Direct the respondent party to desist from disturbing, harassing, pursuing, intimidating, or threatening the Plaintiff and/or any member of his/her family. ___ Direct the respondent party to abstain from entering my ___ home ___ place of business ___ the home of the members of my family ___ its surroundings ___ place of business ___ school, and/or other places such as ___ Direct the respondent party to pay me reasonable compensation for the damages I have suffered as a result of the ____ stalking, without prejudice to other civil actions I am entitled to. Said losses and damages consist of: moving expenses $______; lodging $______; repairs to property $______; legal expenses $______; medical, psychiatric, psychological, counseling and/or guidance services $______; others $______, for a total of $__________. Therefore, I, ____________ the Petitioner, respectfully request that the remedies requested in clause (7) of this Petition, and any other remedy that the Court deems pertinent, be granted to me. _______________ Petitioner’s Signature Date Address at which I may be notified: (Street, Number, Urbanization, Ward, Municipality). Telephone: ____________
o FORM II GENERAL COURT OF JUSTICE Court Part Office of Municipal Court Judge of _______________ ____________ NUMBER _____ Petitioner vs. RE: RESTRAINING ORDER ____________ Respondent RESTRAINING ORDER The Petitioner filed an action against the Respondent pursuant to Act No. ______ of ________ stating the following: 1. The Petitioner, whose Social Security Number is __________, is ______ years old, resides at and his/her telephone number is __________. 2. The Respondent, whose Social Security Number is __________, is ______ years old, resides at and his/her telephone number is __________. 3. The Petitioner is a victim [of] stalking provoked by the Respondent who repeatedly and intentionally has shown a pattern of conduct addressed to intimidate him/her, or knowing that he/she could reasonably feel intimidated, through persecution, threats, and/or harassment, to the effect that the petitioner or a member of his/her family could suffer harm either personally or of his/her belongings. 4. The stalking incidents occurred on or during __________ (place) 5. At present, ___ there is ___ there is no criminal action pending concerning these facts before the Court of __________, ________ Part, between the Petitioner and the Respondent. The number of the case is __________. Upon summons issued to the Respondent, the corresponding hearing was held, to which: ___Both parties appeared. ___Only the party of the __________ appeared. After having heard the party/the parties and its/their witness(es) and having studied all of the evidence, this Court has reached the following FINDINGS OF FACT: By virtue of the previous findings of facts, the Court establishes the following: ___ The Respondent is hereby ordered to abstain from stalking, chasing, intimidating, threatening or otherwise interfere with the Petitioner and the members of his/her family. ___ The Respondent is hereby ordered to abstain from entering: ___ The home of the Petitioner, or his/her permanent or provisional living quarters; ___ The school to which the Petitioner attends, as well as its surroundings; ___ The place of business of the Petitioner, as well as its surroundings; ___ The workplace of the Petitioner, as well as its surroundings. ___ The Respondent is hereby ordered to pay financial indemnity for damages sustained by the Petitioner due to the stalking, without prejudice to other civil actions to which the Petitioner is entitled. Said losses and damages consist of: lodging expenses $______; expenses for repair of property $______; moving expenses $______; medical, psychiatric, psychological, guidance and/or counseling expenses $______; others $______; Total $__________ The Court hereby orders the following provisional measures concerning the parties: Any person who violates any of the terms of this Order shall be found to be in Contempt of Court, which may lead to punishment by imprisonment, fine, or both. FOR REGISTRATION AND NOTICE Given in ____________, Puerto Rico, on ____, ______ at ______________ hours. This Order is effective from ________________ to ________________ Judge I hereby CERTIFY That both parties have been given notice and a copy of the previous RESTRAINING ORDER. In ____________, Puerto Rico ___, on _____ ____________ Clerk
History —Aug. 21, 1999, No. 284, § 16; Sept. 8, 2000, No. 394, § 4.