Restraining Order Declaration Template: What to Write

If you are in danger right now

A restraining order is court paperwork, not an emergency service. If you are in immediate danger, call 911 first. The steps below are for preparing your request once you are safe enough to do so.

Pick the right kind of order

The right order depends on your relationship to the person. Courts handle each type under different rules.

• Domestic violence order: a current or former spouse or partner, someone you dated, or a close family or household member
• Civil harassment order: a neighbor, coworker, acquaintance, or stranger who is harassing, stalking, or threatening you
• Many states also have workplace or elder-abuse orders for specific situations

Temporary and longer orders

Courts can often issue a temporary order quickly, based only on your written request, to protect you until a full hearing. At that hearing both sides can speak, and the judge decides whether to issue a longer order.

Sample declaration outline

The declaration is your sworn statement of what happened. It is the heart of your request. This is a general outline to show you what goes where. It is not an official court form. Many states and courts publish their own form, and if yours does, you usually must use it.

DECLARATION OF [YOUR NAME]

I, [your name], say:

1. The other person is [name], my
   [relationship].

2. Most recent incident: On [date] at about
   [time], at [place], [name] [exactly what
   happened and what was said].

3. Injuries or damage: [describe]. Photos are
   attached as Exhibit A.

4. Earlier incidents: On [date], [what
   happened]. (One paragraph each, newest
   first.)

5. Why I am afraid now: [threats, weapons,
   a pattern that is getting worse].

6. Evidence: [police report number, texts,
   voicemails, witnesses].

7. What I am asking for: [no contact, stay
   away, move out, protection for children].

[Sworn statement: use the exact wording on
your court's form.]
Dated: [date]       [Your signature]

What judges look for

Be specific and factual. Concrete details persuade more than general statements.

• Dates, times, and places of each incident, as best you can recall
• Exactly what was said or done, including specific threats
• Any injuries, property damage, or weapons
• Witnesses, police reports, photos, texts, or voicemails
• A pattern over time, if there is one

Steps to file

1. Decide which type of order fits your relationship to the other person.
2. Fill out your court’s request form and write a clear, dated declaration.
3. File with the court clerk. Fees are often waived for domestic violence orders, so ask.
4. Ask about a temporary order to protect you until the hearing.
5. Have the other person served as the rules require, and file proof of service.
6. Go to the hearing with all your evidence and any witnesses.

• Office on Violence Against Women, U.S. Department of Justice