Domestic Violence Protection Order - Pennsylvania

IMPORTANT: THIS IS A PREPARATION GUIDE — NOT THE OFFICIAL COURT FORM

Pennsylvania requires the use of standardized Protection From Abuse (PFA) forms
prescribed by Pa.R.C.P. Rule 1905 for all PFA proceedings. This template provides
the substantive legal content to help you prepare — but you must transfer your
content to the official forms before filing. The official forms are available at
https://www.pacourts.us or through your county prothonotary's office.
Do not file this document directly with the court.

COMMONWEALTH OF PENNSYLVANIA

COURT OF COMMON PLEAS — FAMILY DIVISION

[COUNTY] COUNTY

PROTECTION FROM ABUSE ORDER

(“PFA Order”)
Docket No.: [DOCKET NO.]

Effective Date: [EFFECTIVE DATE]
Expiration Date: [EXPIRATION DATE – NOT TO EXCEED THREE (3) YEARS UNLESS EXTENDED BY THE COURT]

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions
4. Representations & Warranties
5. Covenants & Restrictions
6. Default & Remedies
7. Risk Allocation
8. Dispute Resolution
9. General Provisions
10. Execution Block

1. DOCUMENT HEADER

1.1 Parties
(a) Petitioner: [PETITIONER FULL LEGAL NAME] (“Petitioner”).
(b) Respondent: [RESPONDENT FULL LEGAL NAME], DOB ☐, SSN (last 4) ☐ (“Respondent”).

1.2 Jurisdiction & Governing Law
This PFA Order is issued pursuant to the Pennsylvania Protection From Abuse Act, 23 Pa. Cons. Stat. §§ 6101 et seq. (the “PFAA”) and is enforceable in every county within the Commonwealth and in all other states, territories, and tribal lands pursuant to 18 U.S.C. § 2265.

1.3 Recitals
WHEREAS, Petitioner has filed a Petition alleging abuse as defined in Section 6102 of the PFAA;
WHEREAS, this Court finds, after hearing and/or stipulation, that Respondent has engaged in such abuse and that immediate and continued relief is necessary;
NOW, THEREFORE, it is hereby ORDERED, ADJUDGED, and DECREED as follows:

2. DEFINITIONS

For purposes of this PFA Order, the following capitalized terms shall have the meanings set forth below:

“Abuse” – Conduct as defined in 23 Pa. Cons. Stat. § 6102.
“Covered Location” – Any location specified in § 3.2(a)(ii) from which Respondent is prohibited.
“Custodial Child(ren)” – Minor child(ren) identified in § 3.5.
“Firearm” – As defined in 23 Pa. Cons. Stat. § 6102 (incorporating the definition in 18 Pa. Cons. Stat. § 6105(i)) and 18 U.S.C. § 921(a)(3).
“Prohibited Contact” – Any direct or indirect contact including, but not limited to, in-person, telephone, electronic, social media, or third-party communications.
“Qualified Officer” – Any law-enforcement officer with jurisdiction to enforce this Order.

3. OPERATIVE PROVISIONS

3.1 No Abuse & No Prohibited Contact
Respondent SHALL NOT abuse, threaten, harass, stalk, or have Prohibited Contact with Petitioner or any other protected person named herein.

3.2 Stay-Away / Exclusion
(a) Respondent SHALL:
(i) Immediately vacate and remain away from the residence located at [ADDRESS];
(ii) Maintain a minimum distance of [100] yards from Petitioner, Custodial Child(ren), and the following Covered Locations: [WORKPLACE], [SCHOOL], [CHILDCARE FACILITY], and any other location where Petitioner may reasonably be present.

(b) Law-Enforcement Assistance. A Qualified Officer is authorized to accompany Petitioner to the above residence to secure possession and to supervise Respondent in the removal of personal belongings within [30] minutes. Respondent may make one subsequent visit, with police escort and upon 24-hour advance written notice to Petitioner’s counsel, to retrieve additional belongings.

3.3 Firearms, Weapons & Licenses
(a) Respondent SHALL, within 24 hours of service of this Order, relinquish all Firearms, ammunition, and any firearm licenses to the [SHERIFF / POLICE DEPARTMENT] pursuant to 23 Pa. Cons. Stat. § 6108(a)(7).
(b) Respondent SHALL file a proof of relinquishment on the court docket within 48 hours thereafter.
(c) Failure to relinquish constitutes an immediate violation subject to arrest under 23 Pa. Cons. Stat. § 6113 and indirect criminal contempt under § 6114 of the PFAA, and may trigger federal felony exposure under 18 U.S.C. § 922(g)(8).

3.4 Temporary Support (Optional)
Respondent SHALL pay temporary child and/or spousal support in the amount of $[AMOUNT] per [week/ month], commencing [DATE], through the Pennsylvania State Collection and Disbursement Unit (PA SCDU).

3.5 Custody / Visitation (If Applicable)
(a) Primary physical custody of Custodial Child(ren): [CHILD NAME, DOB] is awarded to Petitioner.
(b) Visitation is:
☐ Suspended ☐ Supervised as follows: [TERMS].

3.6 Police Information Sheet
The Prothonotary SHALL transmit a certified copy of this Order, together with Respondent’s identifiers, to the Pennsylvania State Police Statewide Registry of Protection Orders (and thereby to the National Crime Information Center Protection Order File) so that it is received within 24 hours of entry, pursuant to 23 Pa. Cons. Stat. § 6105(e), and to all relevant law-enforcement agencies.

4. REPRESENTATIONS & WARRANTIES

4.1 Petitioner represents under oath that each allegation in the underlying Petition is true and correct to the best of Petitioner’s knowledge.

4.2 Respondent is deemed to have been afforded due process, including (i) notice of the Petition and hearing, and (ii) an opportunity to be heard, consistent with Pa. R.C.P. 1901 et seq.

4.3 Survival. The representations herein survive the entry and any modification of this Order.

5. COVENANTS & RESTRICTIONS

5.1 Respondent covenants to comply fully with every term of this PFA Order and with all law-enforcement directives issued in connection herewith.

5.2 Respondent shall immediately notify the Court in writing of any change in residence, employment, or contact information.

5.3 Petitioner shall not knowingly invite or consent to conduct by Respondent that would violate this Order. Any such consent shall not invalidate or waive the terms herein and shall not be a defense to enforcement proceedings.

6. DEFAULT & REMEDIES

6.1 Events of Default
A “Default” occurs if Respondent violates any provision of this Order or fails to perform any covenant herein.

6.2 Notice & Arrest Authority
No prior written notice is required before arrest. A Qualified Officer SHALL arrest Respondent upon probable cause of violation under 23 Pa. Cons. Stat. § 6113.

6.3 Graduated Remedies
(a) Indirect Criminal Contempt – Punishable, per 23 Pa. Cons. Stat. § 6114(b)(1), by a fine of not less than $300 nor more than $1,000, together with either imprisonment up to six (6) months or supervised probation not to exceed six (6) months, for each violation. No jury trial applies, but Respondent is entitled to counsel (§ 6114(b)(3)).
(b) Bail Revocation or Modification under Pa.R.Crim.P. 523.
(c) Extension of this Order for an additional term, which the court SHALL grant on a plaintiff’s request upon a conviction for indirect criminal contempt (23 Pa. Cons. Stat. § 6114(b)(4)), or otherwise under § 6108(e).
(d) Referral for criminal prosecution under pertinent statutes (e.g., 18 Pa. Cons. Stat. §§ 2701, 2705).

6.4 Attorney’s Fees & Costs
Upon a finding of Default, Respondent SHALL pay Petitioner’s reasonable attorney’s fees, costs, and expenses incurred in enforcement.

7. RISK ALLOCATION

[NOT APPLICABLE. No indemnification, liability limitation, or insurance provisions are appropriate for a PFA Order.]

8. DISPUTE RESOLUTION

8.1 Governing Law
This PFA Order is governed exclusively by the PFAA and other applicable Pennsylvania and federal domestic-violence statutes.

8.2 Forum Selection
Any action regarding enforcement, modification, or extension shall be filed in the Court of Common Pleas, Family Division, [COUNTY] County, Pennsylvania.

8.3 Arbitration
Arbitration is not available for matters arising under this PFA Order.

8.4 Jury Trial
No right to a jury trial exists in PFA proceedings.

8.5 Injunctive Relief
This Order constitutes injunctive relief. The Court expressly retains jurisdiction to enter supplemental or injunctive orders as justice requires.

9. GENERAL PROVISIONS

9.1 Amendments & Extensions
This Order may be modified or extended only by subsequent written order of this Court upon petition and after notice and hearing as required by law.

9.2 Severability
If any provision herein is held invalid, the remainder shall remain in full force to the maximum extent permitted by law.

9.3 Integration
This PFA Order, together with any attachments or schedules referenced herein, constitutes the entire order of the Court regarding the subject matter and supersedes all prior PFA orders between the parties.

9.4 Service & Entry
The Prothonotary/Sheriff SHALL serve certified copies on Respondent and law-enforcement agencies forthwith and SHALL docket proof of service within [24] hours.

9.5 Counterparts & Electronic Signatures
This Order may be issued in multiple counterparts, each deemed an original. Facsimile, scanned, or electronic signatures of the Court shall be treated as original signatures for all purposes.

10. EXECUTION BLOCK

ENTERED this ___ day of __________, 20___, at ___:___ ☐ a.m. ☐ p.m.

_______________________________
JUDGE [FULL NAME]
Court of Common Pleas — Family Division
[COUNTY] County, Pennsylvania

ATTEST:
_______________________________
Prothonotary / Clerk of Courts

ACKNOWLEDGMENT OF RECEIPT BY RESPONDENT
I, [RESPONDENT NAME], hereby acknowledge receipt of a certified copy of this PFA Order and understand its terms.

_______________________________ Date: __________
Respondent Signature

NOTARIZATION (if county-specific rules require):
State of Pennsylvania )
County of __________ )

On this ___ day of __________, 20___, before me, a Notary Public in and for said State, personally appeared ________________________, known to me or satisfactorily proven to be the person whose name is subscribed above and acknowledged that he/she executed the same for the purposes therein contained.

_______________________________
Notary Public
My Commission Expires: __________

NOTICE TO LAW-ENFORCEMENT OFFICERS
Full faith and credit shall be given to this Order pursuant to 18 U.S.C. § 2265. Any violation SHALL be enforced as provided in § 6 above. The National Crime Information Center (NCIC) entry has been ordered.