IN THE MAGISTRATE/FAMILY COURT OF
First Middle Last
COUNTY, WEST VIRGINIA
Petitioner
v. Magistrate Court Case No. Family Court Civil Action No.
First
Middle
Last
Respondent Address
APPEAL: DENIAL OF PETITION FOR EMERGENCY PROTECTIVE ORDER / TEPO Petitioner in this case appeals to the family court:
(check one)
an order denying a petition for an emergency protective order issued on
(date order issued)
.
OR
an order denying a petition for a temporary emergency protective order issued on
(date order issued)
where the order was denied on grounds other than a temporary order had not been issued in a divorce annulment or separate maintenance proceeding.
Petitioner's/Attorney's Signature
Date
NOTICE: · · · YOUR REQUEST FOR APPEAL, USING THIS FORM, MUST BE FILED, IN THE MAGISTRATE CLERK'S OFFICE, WITHIN 5 DAYS OF THE DATE OF THE ORDER DENYING THE PETITION. THE FAMILY COURT IS REQUIRED TO HEAR THIS APPEAL WITHIN 10 DAYS OF ITS FILING. THE MAGISTRATE CLERK WILL NOT CHARGE A FILING FEE IF YOU FILE AN APPEAL.
DV Civil Proceeding Rules 4 and 18
SCA-DV-FC/M-1210 / 3-05
ORIGINAL RESPONDENT COPY PETITIONER - COPY