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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 operator's license no.: _____ State: _____ Year: _____

Vehicle registration no.: ___ State: ___ Year: ___ Type: ___

Abuser's place of birth: ___ Height: ___ Weight: ___

Describe any scars, marks, or tatto underset · os: _____

Eye color: ___ Hair color: ___ Skin tone: ___

Abuser's race: ___ American Indian/Alaskan Native ___ Black

- Asian/Pacific Islander ___ White

- Hispanic ___ Unknown

VICTIM/PLAINTIFF INFORMATION

Name: ___ Date of birth: ___

Address: ___ Your sex: M ___ F ___

.

Your race:

— American Indian/Alaskan Native

— Black

___ Asian/Pacific Islander

___ White

___ Hispanic

- ___ 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: _____



Address: ___

Sex: M__F__



Person's race:

American Indian/Alaskan Native



Asian/Pacific Islanders

___ Hispanic

___ Black

___ White

___ Unknown

Last Updated November 22, 2005