Name of Violator
☐ Mark this box if this form contains Restricted Information.
| ☐ CIRCUIT COURT ☐ DISTRICT COURT OF MARYLAND FOR |   | 
| Located at |   | Telephone | City/County | 
| Court Address |   | 
|   | Case No. |   | 
|   |   |   | 
NOTE: Respondent will be served a copy of this completed document. Petitioner does not need to give an address if doing so risks further harm.
|  | Name of Petitioner on Original Court Order | vs. | Name of Respondent on Original Court Order |   | 
|  | Street Address, Apt. No. | Home |   | Street Address, Apt. No. | Home |   | 
|  | City, State, Zip |   | City, State, Zip |   | 
|  | Work |   | Work |   | 
|  | E-mail | Telephone | E-mail | Telephone | 
|  |   |   | 
PETITION FOR CONTEMPT (Violation of Protective Order)
MDEC counties only: If this submission contains Restricted Information (confidential by statute, rule or court order) you must file a Notice Regarding Restricted Information Pursuant to Rule 20-201.1 (form MDJ-008) with this submission, and check the Restricted Information box on this form.
|  | I, | Name | , state that: | 
|  | 1. On | ☐ the court ordered the following: | 
|  | Date | 
|  |   |   | 
|   |   | OR | 
| ☐ a copy of a protective order issued by the following out-of-state (or Native American) court: | 
|   |   | was filed with this court. | 
| 2. Regarding that court order, I am the ☐ petitioner ☐ respondent ☐ other (explain) | 
| 3. | Name of Violator | has violated the court order as follows: (state in detail when, where, and how the | 
|   |   | 
| violation occurred) |   | 
I request the court grant an order finding that
is in contempt of court and grant any other relief necessary in this case.
☐I request that the court send the respondent to jail until the court's order is obeyed.
|   | Date |   |   | Signature | 
|   |   |   |   | 
| Telephone Number |   | Fax |   | Printed Name | 
|   |   |   | 
|   | E-mail |   |   | Street Address (unless confidential) | 
|   |   |   |   | 
|   |   |   | CERTIFICATE OF SERVICE | City, State, Zip | 
|   |   |   |   | 
I certify that I served a copy of this petition upon the following party or parties by ☐ mailing first-class mail, postage prepaid
| ☐ hand delivery, on |   | Date |   | to: |   |   |   | 
|   |   |   |   |   |   |   |   |   | 
|   |   | Name |   |   |   |   |   | Address |   | 
|   |   |   |   |   |   |   |   | City, State, Zip |   | 
|   |   | Name |   |   |   |   |   | Address |   | 
|   |   |   |   |   |   |   |   | City, State, Zip |   | 
|   |   | Date |   |   |   |   | Signature of Party Serving |   | 
| Home Address: |   | DESCRIPTION OF ALLEGED VIOLATOR |   | 
|   |   |   |   |   |   |   |   | 
| Home Telephone: |   |   | Work Address: |   |   |   | 
| Work Telephone: |   |   | Employer: |   |   |   | 
| Work Hours: |   | Other Places/Times They Can Be Found: |   |   | 
| DESCRIPTION: Driver’s License # |   | State | Race | Sex | Ht | 
| Wt | Hair | Eyes | DOB |   | FBI # | SID # | SSN XXX-XX- | 
| Complexion | Tattoos, Marks, Scars |   | Other |   | 
| CC-DC-DV-007 (Rev. 04/2022) |   |   | Reset |   |   |   | PECDV |