2023 Laws of Puerto Rico › TITLE EIGHT - Public Welfare and Charitable Institutions (§§ 1 — 1422) › Chapter 29 - Domestic Abuse Prevention and Intervention Act (§§ 601 — 664) › Subchapter V - Supplementary Provisions (§§ 661 — 664) › § 664 - Forms

The forms that must be provided by the Office of the Clerks of the court of justice to the persons who requested protective orders shall be designed so that the information, circumstances and data contained in the forms identified as I, II, III and IV may be substantially consigned or stated. However, the Office of Court Administration may modify them when deemed convenient to achieve the purposes of this chapter.
The forms that are hereby incorporated into this chapter are the following:
FORM I AT THE COURT OF PUERTO RICO PART __________ Petitioner vs. NO. _____ RE: Order for Protection __________ Petitioned Party REQUEST FOR ORDER FOR PROTECTION TO THE HONORABLE COURT: The petitioning party hereby appears and respectfully states and requests that: 1. The petitioned party resides at (Street, No., Urbanization or Ward, Municipality) and is _____ years old. 2. I was married to the petitioned party on ___ __ of __; or I have __ or have sustained __ a consensual relationship with the petitioned party since ____ and until ____; or I have procreated _____ children with the petitioned party. 3. I am a victim of abuse provoked by the petitioned party, consisting in that through the use of force, violence, intimidation or threat he/she has: [] Caused me physical injury. [] Attempted to cause me physical injuries. [] Caused me serious emotional harm. [] Provoked fear of suffering physical injury. [] Provoked fear of harming my assets. [] Provoked fear of harming other persons. [] Deprived me of my freedom of movement. [] Deprived me of adequate rest. [] Forced me to sustain sexual relations through the use of force, violence, threat, intimidation. 4. The abuse that I have suffered occurred on or during on (days, month and year) at (Place) 5. There is [] is not [] a suit for divorce, separation, custody or alimony or a criminal suit pending at the Court, ________ Part, between the petitioned party and the subscribing party, at present. 6. There is [] is not [] an order pending on the custody of the sons and daughters procreated by me with the petitioned party at present. 7. I request this Court to grant the following remedies to me: [] Order the petitioned party to vacate the residence and prohibit him/her to return to it. [] Order the petitioned party to abstain from bothering, intimidating, threatening or otherwise interfering with me, my sons and daughters, or with the minors under my custody. [] To order the petitioned party to abstain from entering my: Home [] Place of Employment [] School [] Relatives’ home [] [] Business [] Other __________ (indicate which) [] Determine that the provisional custody of the following minors be adjudicated to me: Minor’s Name Date of Birth _______________ _______________ _______________ _______________ _______________ _______________ During the last six (6) months said minors have resided at: (Street No., Urbanization, Ward and Municipality) with the following persons: (Name and Kinship or Relationship) [] Order the petitioned party to pay child support for our children whose custody has been adjudicated to me. Said child support must be in the amount of _______ to be paid _______ and to be deposited at the Clerk Office of this Honorable Court. [] Order the petitioned party to pay alimony to me in the amount of _______ to be paid _______ and to be deposited at the [Clerk Office] of this Court. [] Order provisional measures with regard to the personal property I share with the petitioned party. [] Order the petitioned party to pay me reasonable financial compensation for the damages suffered by me as a result of conjugal abuse. Said losses and damages consist of: Therefore, the petitioner respectfully requests that the remedies requested in paragraph eight (8) of this Petition be granted as well as any other remedy that the Court deems pertinent. Petitioner Address at which I can be notified: Telephone: FORM II AT THE COURT OF PUERTO RICO PART __________ Petitioner v. NO. _____ RE: Protective Order __________ Petitioned Party REQUEST BY EMPLOYER FOR PROTECTIVE ORDER IN FAVOR OF HIS/HER WORKPLACE TO THE HONORABLE COURT: The petitioning party hereby appears and respectfully states and requests that: 1. The petitioning party (name) __________ is a ____ natural person ____ partnership ____ corporation ____ another (specify) __________ that is being represented by (name) __________. The petitioning party is requesting this civil remedy in favor of the female and male employees and visitors and of any other person found at his/her workplace. 2. The address of the petitioning party is __________ (Street, Number, Urbanization or Barrio, Municipality). 3. (Name) __________ is [an] employee of the petitioning party. 4. The petitioned party resides at __________ (Street, Number Urbanization or Barrio, Municipality). 5. The employee is a victim of domestic violence or of conduct constituting a crime as typified in Act No. 54 of August 15, 1989, as amended [§§ 601–604 of this title], known as the Domestic Abuse Prevention and Intervention Act. 6. The acts of conduct constituting domestic violence ____ have occurred at the workplace, or ____ it is believed that they may responsibly [reasonably] occur at the workplace. 7. The employee ____ is or ____ has been victim of domestic violence at his/her place of work provoked by the petitioned party, consisting that through the use of force, violence, intimidation or threat the latter has: [] Caused physical harm. [] Intended to cause physical harm. [] Caused serious emotional harm. [] Provoked fear of suffering physical harm. [] Provoked fear of causing damage to his/her property. [] Deprived him/her from his/her freedom of movement. [] Deprived him/her from proper rest. [] Forced him/her to have sexual relations through the use of force, violence, threat, intimidation. 8. The abuse suffered occurred on or during the (day, month, and year) in _______________. 9. I request that this Court grant the following remedies: [] Order the petitioned party to abstain from harassing, intimidating, threatening or in any other way interfering with the female and male employees and visitors and with any other person found at my place of work. [] Order the petitioned party to abstain from entering my place of work. [] Order the petitioned party to abstain from making phone calls directed to creating situations of violence among the employees. [] Other __________ (specify) For which the petitioning party respectfully requests that the remedies solicited in paragraph (9) of this Petition and any other remedy which the Court may deem pertinent be granted to him/her. Petitioning Party Address at which to notify me: Telephone President......................... President FORM III AT THE COURT OF PUERTO RICO PART __________ Petitioner vs. NO. _____ RE: Order for Protection __________ Petitioned Party PROTECTION ORDER The petitioner filed an action against the petitioned party under the provisions of Act No. _______ of _______, known as the “Domestic Abuse Prevention and Intervention Act” stating the following: The summons for the petitioned party having been issued, the corresponding hearing was held to which both parties appeared [], only the __________ party appeared [] The petitioned party alleged: After hearing the party(ies) and the(ir) witness(es) and studying all the evidence the Court reaches the following: FINDINGS OF FACTS By virtue of the proceeding findings of facts the Court establishes the following: [] It orders the petitioned party to vacate the residence he/she shares with the petitioner and prohibits him/her to return to it. [] It orders the petitioned party to abstain from bothering, intimidating, threatening or otherwise interfering with the party or with the exercise of the provisional custody of their sons and daughters. [] It orders the petitioned party to abstain from entering [] the home of the petitioner, or his/her place of permanent or provisional dwelling, [] the school attended by the petitioner and its premises, [] the petitioner’s business and its premises, [] It adjudicates to the ________ party the custody of the following minors: ____________ ____________ [] It orders the ____________ party to pay child support for the sons and daughters of the parties in the amount of _____ to be paid _____ and to be deposited at the [Clerk Office] of this Court. [] It orders the _________ party to pay alimony to the ______ party in the amount of _____ to be paid _____ and to be deposited in the [Clerk Office] of this Court. [] It orders the following provisional measures with respect to the assets of the parties: [] It orders the ________ party to pay a financial compensation for the damages suffered as a result of the conjugal abuse. Said losses and damages consist of: Every person who violates any of the terms of this Order will incur a misdemeanor. BE IT RECORDED AND SERVED: Given at _______________, Puerto Rico on the ____________ of 19 ___. Judge I HEREBY CERTIFY: That both parties were served with a copy of the preceding ORDER FOR PROTECTION. At ________, Puerto Rico on the ____ of ______, 19___. Secretary
FORM IV GUIDE FOR VICTIMS OF DOMESTIC ABUSE If your husband or wife, ex-husband or ex-wife, the person with whom you cohabit or have cohabited, or the person with whom you sustain or have sustained a consensual relationship or the person with whom you have procreated a daughter or a son, has struck, threatened, intimidated, or deprived you of your freedom, or has exposed you to serious physical or emotional harm, or has forced you to engage in unwanted sexual behavior, you can go to the Police station and ask that a complaint be filed against the person who assaulted or abused you. You may also go before any judge without the assistance of any attorney (male or female) and request an order that provides you with the following remedies: 1. That the male or female aggressor be ordered to abstain from abusing, intimidating or threatening you again. 2. That the male or female aggressor be ordered to vacate the dwelling he/she shares with you. 3. That the male or female aggressor be prohibited from entering your residence, school, business, or place of work and their premises. 4. That you be granted custody of your minor children. 5. That you be permitted to enter your home to gather your personal belongings, or the place where they are found, and that the Police be ordered to accompany you at all times. 6. That the male or female aggressor be prohibited from molesting, intimidating or intervening in any way with your minor children or other member of the family nucleus. 7. That the male or female aggressor be ordered to pay child support for your minor children, and/or for you when he/she has a legal obligation to do so. 8. That the male or female aggressor be ordered to abstain from marauding the premises of your home, place of work or place of study. NOTE: A copy of the Order for Protection issued by a judge must be delivered to the police station in your jurisdiction. If you are married to the male or female aggressor, you may also file a divorce suit in the Family Relations Part of the Court of First Instance and request the same measures indicated above. If you have procreated children with the male or female aggressor, even though you are not married to him/her, you can file a claim for child support and custody. To obtain more information concerning your rights and the shelter and counselling services, you may communicate with:.
History —Aug. 15, 1989, No. 54, p. 199, § 5.4; Sept. 30, 2004, No. 538, § 3, eff. 60 days after Sept. 30, 2004.