Equality Wheel
This wheel illustrates types of non-violent behavior which promote equality within a relationship.
Power and Control Wheel
The power and control wheel explains some types of behavior and tactics used by batterers to isolate, control and overpower victims of domestic violence.
Personalized Safety Plan
Being prepared may mean the difference between life and severe injury, or even death. This plan will help you think ahead about things such as: * what you can do during a violent incident; * safety if you have time to plan to leave; * safety even when your partner is not living there; * safety on the job, at school, in public; and * safety through the courts.
Child Support Guidelines Worksheet
Form and sample. The worksheet helps you to figure out how much money the father of your children will owe in child support based on his income and your income. Be sure to check the second page, for instructions.
Order for Support, Health Insurance, and Income Assignment
This form is more often called a "wage assignment form." You fill this form out and file it with the court if you want the father of your children to have child support taken directly out of his check and mailed to you.
Complaint for Modification - Child Support - sample
This is a copy of the Probate and Family Court Complaint for Modification Form. It has been filled out for an increase in child support case.
Complaint for Modification and Answer - Visitation - sample
These are samples of a Probate and Family Court Complaint for Modification form and an Answer to a Complaint for Modification.
Complaint for Contempt - Child Support - sample
This is a copy of the Probate and Family Court Complaint for Contempt Form. It has been filled out for a non-payment of child support case.
Complaint for Contempt - Visitation - samples
These are samples of a Probate and Family Court Complaint for Contempt form and an Answer to a Complaint for Contempt.
Motion for Visitation - sample forms
Here are several samples of forms that are used in motions for visitation: A Motion for Specific Visitation Schedule and a Proposed Order (filled out for a case in which the mother wants the court to issue a very specific visitation with a third party to pick up and drop off). A Supplemental Order - Visitation Issues (an example of a Probate and Family Court form which can be used to propose a specific visitation order for the judge to approve. It give an idea of the options the judge has in ordering visitation. The form may look different from court to court). Agreement of Parties and Temporary Order (an example of a Probate and Family Court form that can be used for writing up an agreement on visitation and other issues. The agreement becomes a temporary order of the court. This form may look different from court to court.).
Motion to Suspend Visitation - sample
This is an example of a motion you would file if you needed to stop visitation. You must also file a Proposed Order, and a sample is included.
Motion for Temporary Support and Proposed Order - sample
This is an example of the Probate and Family Court's Motion Form. You also need to file a Proposed Order for the Judge to sign; an example is included. This particular form is filled in so that it asks for an order that the father of the children pay child support. But you can make a motion for almost anything you need.
Financial Statement sample
This is the Probate and Family Court's Financial Statement Form. It is filled out for a mother of two children, who has custody. The father would have to fill out a form, too.
Request Financial Statement sample
This is a Request for a Financial Statement Form, with an accompanying letter. You can type up your own identical form with your own Certificate of Service, and mail it to the father of the children with a Financial Statement Form. Then you will find out how much he is making. You should know that if you Request a Financial Statement in this way, under a court rule (Supplemental Rule 401), you cannot request another financial statement until after ninety days have passed, unless the court orders it. And, under this same rule, in cases involving financial issues in Probate Court, unless the court orders otherwise, both parties are required to file a financial statement with the court and with each other within 45 days of service of the summons, or, if something is
scheduled in court before the 45 days passes, two days before the hearing.
Subpoena - blank form, sample, and affidavit of service
A subpoena is a written, notarized demand which makes a person come into court to testify on a case. The example is filled out to subpoena the father's wage records. You can take the blank form, fill it out with your own information, and bring it to a notary. It will be an official subpoena once it is notarized. The affidavit of service is a certification that tells the court the subpoena has been properly served.
Motion to Compel Financial Statement and Proposed Order - sample
This is an example of a Motion you can file to ask the Court to make the other party file a financial statement if you are having difficulty getting him to do so. You must also file a Proposed Order; an example is included.
Motion to Impound Plaintiff's Address, supporting affidavit, proposed order - sample
This is an example of a Probate and Family Court Motion to Impound (remove) your address from all court papers so that your abuser cannot find out from court papers where you are living. The second page shows an example of a supporting affidavit. The supporting affidavit can be handwritten.
Chapter 209A Instructions
This form is included in the Complaint for Protection from Abuse you will receive from the clerk. It should help you fill out the form.
Chapter 209A Affidavit - sample
This form is actually on the back side of the complaint you will get from the clerk. This is what the judge will read when he first hears your case. So be sure to fill this out carefully. You may want to start by telling the judge about the most recent incident, why you came to court to get a protective order. Then you might want to tell the judge about any history of abuse, why you are afraid, etc.
Chapter 209A Confidential Information form
On this form you write your name, residential address, residential telephone number, workplace name, address, and telephone number. This information is confidential. It may be obtained by certain authorized persons who request it on a Request for Access to Confidential Information form.
Affidavit Disclosing Care or Custody Proceedings - sample
If you are asking for protection, custody, or support for the children, you will have to fill this form out. The court must be informed if there were ever any other court actions about the care or custody of the children.
Chapter 209A Defendant Information form - sample
The court will need this so that the police can find your abuser to serve him his copy of the order. Be sure to include any and all information that will help the police in finding him.
Chapter 209A Abuse Prevention Order - sample
This is a sample chapter 209A abuse prevention order form. After your hearing, if the order is granted, the court will type up your order on this form. It is signed by a judge.
Domestic Relations Protective Order
This is a copy of the Domestic Relations Protective Order form. Probate and Family Court judges issue Domestic Relations Protective Orders on this form.
Complaint for Support - sample
If you are married you can use this form of complaint to seek a suitable amount of support for yourself and the children, as well as health insurance benefits.
Complaint for Separate Support - sample
This form of complaint has provisions for establishing that you are living apart from your spouse for justifiable cause and for custody and support.
Complaint for Custody - sample
This form of complaint has provisions for the care, custody, visitation, education, support, and maintenance of your children.
Joint Petition for Divorce - sample
This court form is used when both spouses participate in seeking a joint "no fault" divorce, called a "1A" divorce. They also file a notarized separation agreement and a sworn affidavit that the marriage has irretrievably broken down.
Complaint for Divorce - sample
This form of complaint is used for "fault" divorces and for "no fault" divorces ("1B" divorces) where the parties do not file a joint petition.
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Complaint for Support - Custody - Visitation
where the parents are not married to each other
Produced by
Western Mass. Legal Services/Americorps
Last updated
March, 2006
