Form Center • Bexar County, TX • CivicEngage

It is very important that you answer everything truthfully.

Before submitting this application to the Bexar County Criminal District Attorney’s Office for review, you will be asked to affirm that the information provided in it is true and correct to the best of your knowledge. A person commits the crime of perjury “if, with intent to deceive and with knowledge of the statement’s meaning, he or she makes a false statement under oath or swears to the truth of a false statement previously made, and the statement is required or authorized by law to be made under oath or he/she makes a false declaration.” PROTECTIVE ORDERS are a serious matter. The law limits who is eligible to even apply for one, which includes victims of: domestic violence, family violence, dating violence, human trafficking, stalking, and/or sexual assault. Our office will investigate each application thoroughly and will seek, on behalf of the State of Texas, a protective order for those that qualify based on the law and evidence. Failure to provide the requested information will delay your case and could even result in automatic rejection of your application. Providing the correct legal assistance requires the Bexar County Criminal District Attorney’s Office to be aware of your current legal circumstances, including any pending legal litigation. The following questions are for that purpose.

I understand and agree to the above acknowledgment as stated.*

Yes

Current Residence*

YOUR SAFETY

Please understand that your safety is of the utmost importance to our office. Taking steps to protect yourself from the Adverse Party can be dangerous. In fact, studies show that it is the most dangerous time in an abusive relationship. Help protect yourself by providing contact information that is not accessible to the adverse party.

Work Address

Alternate safe mailing address (should you move from current address)

Please List Two Close Friends Or Relatives Who Will Know How To Get In Touch With You:

Home Address

Do you have any of the following types of cases pending with the adverse party?

Divorce
Child Custody
Child Support
Open Child Protective Service Case

Are you currently on active duty in the U.S. Armed Forces?*

Yes
No

Are you currently a member of the State Military Forces (Texas Army National Guard, Texas Air National Guard, or Texas State Guard)? *

Yes
No

Information About Your Relationship:

What is your relationship to the adverse party?*

For the District Attorney's Office to assess your case, we need to understand the nature of the violence that happened to you and / or your child(ren). Please answer the following questions to the best of your knowledge:

Has the Adverse Party ever done any of the following to you? Please check all that apply.*

If the adverse party currently has firearm(s), please identify the gun type that best describes them:

Please describe each firearm with as much detail as possible including size, color, any distinguishing features, and where the Adverse Party keeps it.

***Please be advised that using any profanity, curse words, foul or vulgar language will result in an error message upon submission and your application will NOT be submitted. *** Starting with the most recent incident, please indicate all of the incidents of violence you have experienced. This should include those that are not very recent and those that did not involve law enforcement. Please give the month, day and year of each incident and explain what the adverse party did. A general period is sufficient if you do not remember the exact dates. Do the same if the violence occurred constantly over a period of time, and you cannot recall a specific incident. Please document the long-term abuse and give the frequency with which it happened. Please note if there are police reports and give case numbers if they are available.

PLEASE DESCRIBE THE VIOLENCE IN YOUR OWN WORDS (less than 100 words)*

Please be brief on your responses, as an interview will take place and you can go into further detail on each of the incidents you list below.

Has your abusive partner ever made any threats to kill you? If so, briefly state dates (if known) and any reports that may have been made.

Address of Last Incident (if you recall)

If charges are pending, please list the charges below?

Was a Magistrate Emergency Protective Order issued against the adverse party? *

Yes
No
Unknown

Information About Your Children and People Who Live with You Now

Please list your children (whether or not they live with you). Please also list ANYONE who lives with you.

Person 2

Child Exchange

If the protective order is granted you may need to designate someone to coordinate the exchange of children. Please identify a person (third-party) who you are comfortable "having do this for you".

Name and Phone Number of the person you wish to designate:

Bexar County Forms

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English Protective Order Electronic Application

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