400-00845 – Motion for Emergency Relief (10/2010) Page 1 of 2
MOTION FOR EMERGENCY RELIEF
I have filed a motion for _________________________ with the Court. In addition to what I have
requested in my motion, I am also requesting that the Court take the following emergency action:
☐ I am asking the Court to schedule a hearing as soon as possible on my motion.
☐ I am asking the Court to immediately issue the following emergency order for the protection of
myself or my children until the Court holds a hearing on my motion:
_______________________________________________________________________________
☐ I am asking the Court to immediately issue the following emergency order for the protection of my
property until the Court hold a hearing on my motion:
_______________________________________________________________________________
SUPPLEMENTAL AFFIDAVIT IN SUPPORT OF EMERGENCY REQUEST
Under penalty of perjury, I hereby swear that the facts I have written below are true to the best of my
knowledge and belief.
1. There is an immediate threat of personal injury to myself or my child? ☐ YES ☐ NO
If yes, please describe why you believe this is true.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
2. There is an immediate threat of damage or injury to my financial ☐ YES ☐ NO
Interests of property.
If yes, please describe why you believe this is true.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
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