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PFA Data Sheet
The following information is needed that your protection order can be entered into the statewide registry of protection orders. If you do not know an answer, leave it blank.
ABUSER/DEFENDANT INFORMATION
Abuser's name: ___ Abuser's sex: M F Address: ___ Date of birth: ___ Soc.Sec.No.: ___
Abuser's name(DSForm)
F
M
Address [1](DSForm)
Date of birth(DSForm)
Address [2](DSForm)
Soc.Sec.No(DSForm)
Abuser's operator's license no.: _____ State: _____ Year: _____
Abuser's operator's license no(DSForm)
at
State(DSForm)
Vehicle registration no.: ___ State: ___ Year: ___ Type: ___
Vehicle registration no(DSForm)
at
Type(DSForm)
State1(DSForm)
Abuser's place of birth: ___ Height: ___ Weight: ___
Weight(DSForm)
Height(DSForm)
Abuser's place of birth(DSForm)
Describe any scars, marks, or tatto underset · os: _____
Describe any scars, marks, or tattoos(DSForm)
Eye color: ___ Hair color: ___ Skin tone: ___
Skin tone(DSForm)
Hair color(DSForm)
Eye color(DSForm)
Abuser's race: ___ American Indian/Alaskan Native ___ Black
Asian/Pacific Islander ___ White
Hispanic ___ Unknown
American Indian/Alaskan Native
Black
Asian/Pacific Islander
White
__ Hispanic
Unknown
VICTIM/PLAINTIFF INFORMATION
Name: ___ Date of birth: ___
Date of birth(DSForm)
Name(DSForm)
Address: ___ Your sex: M ___ F ___
Address(DSForm)
F
F
Address Line 2(DSForm)
Your race:
— American Indian/Alaskan Native — Black
American Indian/Alaskan Native
Black
___ Asian/Pacific Islander
Asian/Pacific Islander
___ White
White
___ Hispanic
__ Hispanic
- ___ Unknown
Unknown
IF YOU ARE SEEKING A PROTECTION ORDER FOR ANOTHER PERSON (SUCH AS A
CHILD), PLEASE GIVE THE FOLLOWING INFORMATION FOR THAT PERSON
Person's name: _____ Date of birth: _____
Person's name(DSForm)
Date of birth: ___
Date of birth(DSForm)
Address: ___
Address(DSForm)
Sex: M__F__
undefined(DSForm)
Sex: M__F__
birth:
F
Person's race: American Indian/Alaskan Native
— American Indian/Alaskan Native — Black
American Indian/ Alaskan Native
Black
Asian/Pacific Islanders
Asian/Pacific Islanders
___ White
_·_· _ · White
___ Hispanic
__ Hispanic
___ Unknown
Unknown
Last Updated November 22, 2005