Rule 17.10—Form 11: Petition for Relief from Domestic Abuse
Iowa Code chapter 236
November 2022 Petition for Relief from Domestic Abuse Page ... Domestic Abuse guide on the Iowa Judicial Branch
website at: www.iowacourts.gov/for-the-public/court-forms. The guide explains what domestic abuse is,
court procedures, and how to contact an attorney. You may want to, or should, see an attorney if:
• You do not know how to use this form, or
if you do not understand this form.
• You think Defendant will try to get
custody of your children.
• You think Defendant will hire an
attorney.
You may involve an attorney in this case at any time, although you are not required to. If you cannot afford
an attorney, the county attorney’s office or Iowa Legal Aid may be able to help you.
Caution: You must complete a separate Protected Information Disclosure form to provide confidential or
personal information the court requires but that cannot be listed in this Petition.
For other general information about domestic abuse, call the confidential Iowa Victim Service Call Center
at 1-800-770-1650, or text IOWAHELP to 20121.
In the Iowa District Court for ________________________County
County where Petition is filed
Civil no.
Plaintiff Leave blank – clerk of court will fill in
Full name of person seeking protection from domestic abuse
Petition for Relief from ... Abuse
vs. Iowa Code chapter 236
Defendant
Full name of Defendant as alleged domestic abuser
If you need assistance to participate in court due to a disability, call the
disability coordinator (information at www.iowacourts.gov/for-the-
public/ada). Persons who are hearing or speech impaired may call Relay
Iowa TTY (1-800-735-2942). Disability coordinators cannot provide
legal advice.
1. I am filing this action under Iowa Code chapter 236 because I am asking for
protection from domestic abuse for myself.
2. I live in _________________ County, Iowa.
3. I can receive mail about my case at the following address:
If you do not want Defendant to know where you live, you may use any of the following addresses: a
mailing address, the mailing address of a shelter or other agency, a public or private post office box,
or any other mailing address with permission of the resident of that address. Copies of court documents
may be sent to this address, so use an address where you are sure mail will be received.
_______________________________________________ ____________ _____ _________ _____________
Mailing address City State ZIP code County
You must tell the clerk of court if your mailing address changes. This will help make sure you get
information about your case as soon as possible. If you have an email account, the clerk of court can
help you sign up for electronic filing, or use this guide on the Iowa Judicial Branch website:
www.iowacourts.gov/efile/efile-instructions/.
Rule 17.10—Form 11: Petition for Relief from
Rule 17.10—Form 13: Petition for Relief from Domestic Abuse on Behalf of
Ward or Protected Person Iowa Code chapter ... 236
November 2022 Petition for Relief from Domestic Abuse on Behalf of Ward Page 1 of 16
Iowa Code chapter 236 ...
Before using this form, read the Protect Yourself from Domestic Abuse guide on the Iowa Judicial Branch
website at: www.iowacourts.gov/for-the-public/court-forms. The guide explains what domestic abuse is,
court procedures, and how to contact an attorney. You may want to, or should, see an attorney if:
• You do not know how to use this form, or
if you do not understand this form.
• You think Defendant will hire an
attorney.
You may involve an attorney in this case at any time, although you are not required to. If you cannot afford
an attorney, the county attorney’s office or Iowa Legal Aid may be able to help you.
Caution: You must complete a separate Protected Information Disclosure form to provide confidential of
personal information the court requires but that cannot be listed in this Petition.
For other general information about domestic abuse, call the confidential Iowa Victim Service Call Center
at 1-800-770-1650, or text IOWAHELP to 20121.
In the Iowa District Court for ________________________ County
County where Petition is filed
Civil no.
Leave blank – clerk of court will fill in
Plaintiff
Full name of parent or guardian seeking protection from
domestic abuse
on behalf of
Petition for Relief from
Rule 17.10—Form 12: Petition for Relief from Domestic Abuse on Behalf of a
Minor Child Iowa Code chapter 236 ...
November 2022 Petition for Relief from Domestic Abuse on Behalf of Minor Child Page 1 of 15
Iowa Code ... chapter 236
Before using this form, read the Protect Yourself from Domestic Abuse guide on the Iowa Judicial Branch
website at: www.iowacourts.gov/for-the-public/court-forms. The guide explains what domestic abuse is,
court procedures, and how to contact an attorney. You may want to, or should, see an attorney if:
• You do not know how to use this form, or
if you do not understand this form.
• You think Defendant will try to get
custody of your minor child’s children.
• You think Defendant will hire an
attorney.
You may involve an attorney in this case at any time, although you are not required to. If you cannot afford
an attorney, the county attorney’s office or Iowa Legal Aid may be able to help you.
Caution: You must complete a separate Protected Information Disclosure form to provide confidential of
personal information the court requires but that cannot be listed in this Petition.
For other general information about domestic abuse, call the confidential Iowa Victim Service Call Center
at 1-800-770-1650, or text IOWAHELP to 20121.
In the Iowa District Court for ________________________ County
County where Petition is filed
Civil No.
Leave blank – clerk of court will fill in
Plaintiff
Full name of parent or guardian seeking protection from
domestic abuse
on behalf of
Petition for Relief from
If you are 18 or older, you can ask for protection for:
Yourself from an intimate partner or family member with a “Petition for Relief from Domestic Abuse.”
Your child who is under age 18 whose intimate partner is harming the child with a “Petition for Relief from Domestic Abuse on Behalf of a Minor.”
A child who is legally in your care, sometimes called a “ward” or “protected person,” who is harmed by the person’s intimate partner or family member with a “Petition for Relief from Domestic Abuse on Behalf of a Ward.”
Guide for information on how to file at https://www.iowacourts.gov/static/static/media/cms/E0002_569890E51EF7C.pdf.
If you cannot file electronically, you may go to your county courthouse for help with filing your Petition.
There are three Petitions, and you must use the correct Petition for you or the person you are helping:
If you need protection for yourself, use the “Petition for Relief from Domestic Abuse.”
If you want to protect your minor child, use the “Petition for Relief from Domestic Abuse on Behalf of a Minor.”
If you want to protect your ward or a person legally in your care, use the “Petition for Relief from Domestic Abuse on Behalf of a Ward.” ... To ask the court for help, prepare a “Petition” and file it with the Iowa District Court.
To prepare a Petition, there are free court forms on the Iowa Judicial Branch website at (https://www.iowacourts.gov/for-the-public/court-forms/). The free court forms are also available from the clerk of court office at the courthouse in the county where you live.
You may file your Petition electronically from your personal computer. If you file electronically, see the Iowa Judicial Branch eFile User
Document Type for Guardianship and Conservatorship Cases
This document type has been created to use with Adult and Juvenile Guardianship and Conservatorship case types.
The COURT VISITOR REPORT is used by a Court Visitor to file a confidential report.
3/25/22 New and Updated Domestic Abuse Forms
These forms are for self-represented litigants.
Petition for Relief from Domestic Abuse (1.78 MB)
Petition for Relief from Domestic Abuse on Behalf of a Minor (2.24 MB)
Petition for Relief from Domestic ... Abuse (2.14 MB)
Petition for Relief from Sexual Abuse on Behalf of a Minor Child (2.23 MB)
Petition for Relief from Sexual Abuse on Behalf of a Ward (2.17 MB)
Protected Information Disclosure Form (542.36 KB)
Information Sheet for Protective Order Registry & Service of Protective Orders (1.91 MB)
Affidavit to Start Contempt Proceedings (1.78 MB)
Request to Cancel or Change a Chapter 236A Protective Order (1.90 MB)
Firearms Compliance Affidavit (1.28 MB)
Firearms Transfer Affidavit (1.40 MB)
2/14/22 New and Updated Elder Abuse Forms
These forms are for self-represented litigants.
Petition for Relief from Elder Abuse 235F (1.78 MB)
Protected Information Disclosure (1,015.72 KB)
Information Sheet for Protective Order Registry & Service (DAIN Form) (1.91 MB)
Affidavit to Start Contempt Proceedings 235F (1.75 MB)
Request to Modify, Cancel, or Change a Final Protective Order 235F (1.29 MB)
Firearms Compliance Affidavit (1.29 MB)
Firearms Transfer Affidavit (1.40 MB)
2/7/22 New Email Address for Courtesy Notifications
Effective 2/9/22, email notifications that formerly came from helpdesk@iowacourts.gov will now come from noreply@iowacourts.gov.
1/26/22 Multiple Changes Effective Wednesday, 1/26/22
New and updated document types for abuse cases
Three new document types have been established for use with civil and criminal abuse cases:
APPLICATION TO MODIFY SEX OFFENDER REGISTRY – 692A.128
FIREARMS COMPLIANCE AFFIDAVIT
FIREARMS TRANSFER AFFIDAVIT
A new document type was created for use with civil abuse cases:
APPLICATION/INITIATE CONTEMPT – ABUSE
A document type was renamed because it could be used in any case type where a protective order was issued:
New name: INFO SHEET PROTECTIVE/NO CONTACT ORDER REGISTRY/SERVICE
Old name: DOMESTIC & ... Abuse on Behalf of a Ward (2.24 MB)
Protected Information Disclosure Form (542.36 KB)
Information Sheet for Protective Order Registry & Service of Protective Orders (1.91 MB)
Affidavit to Start Contempt Proceedings (3.40 MB)
Request to Cancel or Change a Chapter 236 Protective Order (3.55 MB)
Firearms Compliance Affidavit (1.29 MB)
Firearms Transfer Affidavit (1.40 MB)
3/25/22 New and Updated Sexual Abuse Forms
These forms are for self-represented litigants.
Petition for Relief from Sexual
Protect Yourself from Domestic Abuse
©Iowa Judicial Branch 2019
1
Iowa Code Chapter 236—Domestic Abuse
Protect Yourself from Domestic Abuse
1 What is
domestic abuse?
Domestic abuse, also called domestic violence, is when an intimate partner or family member assaults or injures,
attempts to assault or injure, or threatens to harm you or the person you’re trying to protect, and that person’s
actions:
Are meant to cause pain or injury or result in physical contact that offends you;
Place you in fear of immediate physical contact;
Involve pointing any firearm towards you, or displaying a dangerous weapon in threatening manner at you; or
Make it hard for you to breathe normally or limit your blood flow circulation.
2 How can I
protect myself
or someone else
from domestic
abuse?
You can ask the court to help protect you, your minor child, or a minor child in your care from domestic abuse. The
court does this with a “Protective Order.”
“You” means you, your minor child, or a minor child legally in your care (also called a “ward” or “protected person”). If
you need help with this process, you should contact an attorney. Additional places to get help are on page 6.
You or the person you are seeking protection from (the defendant) must live in Iowa.
3 Who can ask for
protection?
If you are 18 or older, you can ask for protection for:
Yourself from an intimate partner or family member with a “Petition for Relief from ... Abuse on Behalf of a Ward.”
4 Do I have to
know the
defendant?
You or your minor child or a minor child legally in your care, must have suffered domestic abuse from a person (the
defendant), and you must be one of the following:
Married to or divorced from the defendant,
Separated from the defendant,
Adult relatives living together,
Living together,
Have lived together within one year of the assault, but not at the time of the assault,
Parents of the same minor child or children under age 18,
In an intimate or romantic relationship (the relationship does not have to be a sexual relationship), or
Have been in an intimate relationship and have had contact within one year of the assault.
Protect Yourself from Domestic Abuse
©Iowa Judicial Branch 2019
2
5 What help can I
get?
You can ask the court to help protect you and order the person who hurt you to:
Stop the abuse.
Not contact you in any way, including in-person, by phone, in writing, through social media, or by another person.
Stay away from your home or the family home.
Provide housing, transportation, and financial support.
6 How do I ask the
court for help?
To ask the court for help, prepare a “Petition” and file it with the Iowa District Court.
To prepare a Petition, there are free court forms on the Iowa Judicial Branch website at
(https://www.iowacourts.gov/for-the-public/court-forms/). The free court forms are also available from the clerk
of court office at the courthouse in the county where you live.
You may file your Petition electronically from your personal computer. If you file electronically, see the Iowa
Judicial Branch eFile User Guide for information on how to file at
https://www.iowacourts.gov/static/static/media/cms/E0002_569890E51EF7C.pdf.
If you cannot file electronically, you may go to your county courthouse for help with filing your Petition.
There are three Petitions, and you must use the correct Petition for you or the person you are helping:
If you need protection for yourself, use the “Petition for Relief from ... Abuse
on Behalf of a Ward.”
7 What if I do not
understand how
to do this?
If you need help with these instructions, you may contact:
A private attorney.
Iowa Legal Aid at 800.532.1275 (M – F, 8:30 am – 4:30 pm) or at www.iowalegalaid.org.
The Iowa State Bar Association “Find-A-Lawyer” at https://www.iowafindalawyer.com/.
Your local domestic violence victim advocacy program. If you are not sure who provides services in your area, call
the Iowa Victim Service Call Center Hotline at 800.770.1650, or text IOWAHELP to 20121 (available 24/7).
The county attorney where you are filing your petition may provide help.
Note: Clerks of court cannot give legal advice or tell you what to write on court forms.
8 Will I have to
pay to file the
Petition?
In Iowa, you cannot be charged any money for asking the court for protection from domestic abuse. The court may
order the defendant to pay costs in some cases.
https://www.iowacourts.gov/for-the-public/court-forms/
https://www.iowacourts.gov/static/media/cms/E0002_569890E51EF7C.pdf
http://www.iowalegalaid.org/
https://www.iowafindalawyer.com/
Protect Yourself from Domestic Abuse
©Iowa Judicial Branch 2019
3
What do I have to say in the Petition for Relief from
from the district court’s issuance of a domestic
abuse protection order. REVERSED AND REMANDED.
David A. Morse of Rosenberg, Stowers & Morse, Des Moines, for
appellant.
Joni Pierson, Waukee, pro se.
Considered by Vogel, P.J., and Miller and Eisenhauer, JJ.
2
EISENHAUER, J.
Matthew Mullenix appeals from the district court’s issuance of a domestic
abuse protection order. He contends there was insufficient evidence to show he
committed domestic abuse. He also contends the court improperly acted as an
advocate for a pro se litigant. Our review is de novo. Knight v. Knight, 525
N.W.2d 841, 843 (Iowa 1994).
A petition for relief from ... abuse was filed by Joni Pierson under
Iowa Code section 236(2)(d) (2005). Domestic abuse occurs when an assault
takes place between persons who have been in an intimate relationship and
have had contact within the past year of the assault. Iowa Code § 236.2(2)(d).
There is no question the relationship existed within the year preceding the
allegations. A person commits assault when, without justification, they do any of
the following:
1. Any act which is intended to cause pain or injury to, or which is
intended to result in physical contact which will be insulting or
offensive to another, coupled with the apparent ability to execute
the act.
2. Any act which is intended to place another in fear of immediate
physical contact which will be painful, injurious, insulting, or
offensive, coupled with the apparent ability to execute the act.
3. Intentionally points any firearm toward another, or displays in a
threatening manner any dangerous weapon toward another.
Iowa Code § 708.1.
We conclude there is insufficient evidence to show Mullenix assaulted
Pierson. The only acts alleged by Pierson in support of her petition for relief from ... abuse are a series of phone calls in which Mullenix stated, “You’re
going to pay for this” or “You’re going to get it.” A mere threat, without more, is
not necessarily an assault by placing another in fear. State v. Law, 306 N.W.2d
3
756, 759 (Iowa 1981), overruled on other grounds by State v. Wales, 325 N.W.2d
87 (Iowa 1982). “It is well settled that mere words, even at short range, do not
constitute an assault. The fact that the words were spoken over the telephone
line would of itself quite negative the theory of assault.” Kramer v. Ricksmeier,
159 Iowa 48, 51, 139 N.W. 1091, 1091 (Iowa 1913) (citations omitted). We
reverse the protection order and remand for dismissal of the petition for relief
from
appeals the district court’s orders dismissing her petition
for relief from domestic abuse and granting Bassam Kadura’s ... cross-petition for
relief from domestic abuse. AFFIRMED IN PART AND REVERSED IN PART.
Melody J. Butz of Butz ... appeals the district court’s order denying her
petition for relief from domestic abuse and granting the petition filed
dismissing her petition for relief
from domestic abuse. AFFIRMED.
Michelle Mackel-Wiederanders, Iowa Legal Aid ...
BEEGHLY, S.J.
I. Background Facts
On August 29, 2008, Susan Osho filed a pro se petition for relief from
domestic abuse under ... from the Iowa District Court for Polk County, Martha L. Mertz,
Judge.
Plaintiff appeals the district court order