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Petitioner is in reasonable fear for Petitioner's own safety and/or the safety of the
minor child/ren.
5. At other times Respondent has committed other such acts, including but not
limited to (approximate dates and what happened):
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6. There is a substantial likelihood that Respondent will commit such acts of
violence against Petitioner and the minor child/ren in the immediate future if
relief is not granted as provided pursuant to O.C.G.A. § 19-13-4.
Check the paragraphs below that apply to your case. Fill in the information
needed by each paragraph you check.
____ 7. Petitioner and Respondent have ____ child/ren under the age of 18. Their names,
years of birth, sex, and ages are _______________________________________
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These child/ren have lived only with Petitioner and Respondent for the past five
(5) years. (If the child/ren have not resided only with Petitioner and Respondent
for the last five years, give the names of the persons, their addresses, and the dates
the child/ren resided with them _______________________________________