DEFENDANT INFORMATION FORM IN RESTRAINING ORDER CASES (Provided by Plaintiff)
DEFENDANT'S NAME
DOCKET N0. COURT USE ONLY
5
EM Q V IET
I
ENSE
TRIAL COURT OF MASSACHUSETTS
DEFENDANT'S DOB COURT DIVISION
A
L
M
SVB
ATTENTION: PLEASE PROVIDE AS MUCH INFORMATION AS POSSIBLE. IF A PROTECTIVE ORDER IS ISSUED, THIS INFORMATION WILL HELP POLICE FIND THE DEFENDANT AND SERVE THE DEFENDANT WITH A COPY OF THE ORDER. OTHER NAMES USED BY THE DEFENDANT:
HOME ADDRESS ______________________________________________________________________________________________
Number Street City State Zip
IMPORTANT: Apartment No. ________Floor No. ________Name on Door/Mailbox _______________________________________ WORK ADDRESS ______________________________________________________________________________________________
Name of Company / Employer ________________________________________________________________________________________________________________________ Number Street City State Zip
Department ___________________________________________ Title ____________________________________________________ Tel. No. (_______)______________________________________ Work Hours ______________________________________________
OTHER PLACES DEFENDANT MAY BE FOUND (Friends, bars, relatives, hangouts)
BEST PLACE TO FIND DEFENDANT DEFENDANT UNDERSTANDS ENGLISH? DESCRIPTION FOR PURPOSES OF SERVICE
Yes No Male
BEST TIMES IF NO, WHAT LANGUAGES?:
Female Race __________________________________________
Eyes ____________________ Hair_____________________Height __________________Weight _________________Build ______________________ Other _______________________________________________________________________________(Beard, glasses, scars, tattoos, acne, hairstyle)
PHOTOGRAPH AVAILABLE?
Yes
No
(Photographs are very helpful to police in identifying Defendants.)
MOTOR VEHICLE: License Plate # __________________Year _________Make ___________________Model _____________Color______________ DOES DEFENDANT HAVE: (describe very briefly) I . A history of violence towards police officers? No Yes
2. A history of using/abusing drugs or alcohol?
No
Yes
What kind?
3. Access to guns, a license to carry, or possess a gun?
No
Yes
What kind?
4. Psychiatric/Emotional Problems? (Treated/Hospitalized?)
No
Yes
What kind?
ANY OTHER INFORMATION WHICH MIGHT BE HELPFUL IN LOCATING THE DEFENDANT
PLAINTIFF'S NAME ____________________________________________________________________________________________
DATE PLAINTIFF'S SIGNATURE
X
FA 5 (9/95)
B
I
ER
T AT
E
PL
PE TI T
A
C
D