Preview
FILED
2023 JAN 17
KING COUNTY
SUPERIOR COURT CLERK
CASE #: 23-2-00949-5 KNT
Superior Court of Washington, County of King
Case No.
Tulay Crosbie 06/03/1946
Petitioner (Person starting this case) DOB
Petition for Protection Order
vs. Clerk’s Action: 1
Ali Crosbie 07/09/1975
Respondent (Person responding to this case) DOB
Petition for Protection Order
What kind protection order do you want? There are different orders based on the type of
harm and how the parties know each other. See definitions in Attachments A and B.
1. Choose the type of protection order that best fits your situation. Check only one.
☒ Domestic Violence – Protection from an intimate partner or family or household
member who has committed domestic violence,
nonconsensual sexual conduct or penetration, unlawful
harassment, or stalking. (PTORPRT)
☐ Sexual Assault – Protection from someone who has committed sexual
assault. (PTORSXP)
☐ Stalking – Protection from someone who has committed stalking.
(PTORSTK)
☐ Vulnerable Adult – Protection from someone who has abandoned, abused,
financially exploited, or neglected a vulnerable adult (or
threatened to do so). (PTORVA)
Important! If you are asking for a Vulnerable Adult Protection Order, you
must complete Attachment B: Vulnerable Adult as part of this Petition.
☐ Anti-Harassment – Protection from someone who has committed unlawful
harassment. (PTORAH) (fee may be required)
Conduct also includes (check all that apply): ☐ stalking ☐ hate crime
☐ single act/threat of violence including malicious and intentional threat
or presence of firearm/weapon causing substantial emotional distress
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☐ family or household member engaged in domestic violence
☐ nonconsensual sexual conduct or penetration or a sex offense
2. If more than one of the protection order types listed above fits your situation, list
any additional order types here:
3. Who should the order restrain? ("Restrained Person")
Name: Ali Crosbie
Restrained Person's age: ☐ Under 13 ☐ 13 to 17 ☒ 18 or over ☐ unknown
Who should be protected? Check all that apply. Depending on the type of order, you can
protect yourself and/or children, or you can file on behalf of a vulnerable adult, or another
adult who cannot file for themselves.
4. Who should the order protect? (“Protected Person") (Check all that apply.)
☒ Me. My name is Tulay Crosbie
(You must be age 15 or older.)
☐ Minor Children.
☐ I am the minor’s ☐ parent ☐ legal guardian ☐ custodian.
☐ I am age 18 or older and the minor is a member of my family or household.
(For domestic violence petitions only.)
☐ I am age 15 to 17. The minor is a member of my family or household. I have been
chosen by the minor and am capable of pursuing their stated interest in this case.
Child's Name Age Sex Lives With How related to you How related to
Restrained Person
Important! If the restrained person is a parent of any of the children, complete Attachment C: Child Custody.
If you are not a parent of any of the children, complete Attachment D: Non-parents protecting children (ICWA).
You must include these Attachment/s with your Petition if they apply.
☐ Someone else. (List your name as Petitioner at the beginning of this form. Describe
who you are filing for here.) I am filing to protect:
☐ a vulnerable adult (name)
(See definition and complete Attachment B.)
☐ an adult (name)
who does not meet the definition of a vulnerable adult, but who cannot file the
petition themselves because of age, disability, health, or inaccessibility
(Do not check this for vulnerable adult or domestic violence petitions.).
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What is the age, disability, health or inaccessibility concern that makes the
adult unable to file themselves? (Examples: the adult is hospitalized,
temporarily incapacitated, or in jail/prison.)
5. Service address. What is your address for receiving legal documents? You have the
right to keep your residential address private. You may use a different mailing address
for receiving legal documents.
Mail: 32841 43rd Place Southwest, Federal Way WA 98023
Email (if you agree to receive legal documents by email): tulay.crosbie@hotmail.com
6. Interpreter
Do you need an interpreter? ☒ No ☐ Yes, Language:
Important! You may need to request an interpreter separately. You will get instructions with an order setting
your hearing.
How do the parties know each other?
7. Check all the ways the protected person is connected or related to the restrained person:
Intimate Partners – Protected person and restrained person are intimate partners
because they are:
☐ current or former spouses or domestic partners
☐ parents of a child-in-common (unless child was conceived through sexual assault)
☐ current or former dating relationship (age 13 or older) who
☐ never lived together ☐ live or have lived together
Family or household members - Protected person and restrained person are family or
household members because they are:
☒ parent and child ☐ stepparent and stepchild
☐ grandparent and grandchild ☐ parent’s intimate partner and child
☐ current or former cohabitants as roommates
☐ person who is or has been a legal guardian
☐ related by blood or marriage (specify how)
Other (examples: coworker, neighbor, acquaintance, stranger)
Connection to Washington State. This helps decide if the court has authority (jurisdiction).
8. Why are you filing in this county and state? Check all that apply.
☐ The protected person lives in this county now, or used to live in this county but left
because of abuse, or this is the nearest court to where I live or used to live.
RCW 7.105.100 Petition for Protection Order
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☒ An incident that made me want this protection order happened in this county or state.
9. Restrained Person's residence. Where does the restrained person live?
☒ In Washington State in (city or county): Federal Way King County
☐ Outside of Washington State ☐ Unknown
Are there other court cases involving the parties or any children?
10. Other court cases. Have there been any other court cases between any of the people
involved in this case or about any children? Include court cases happening now and in
the past and requests for protection that were denied or have expired. (Examples: criminal
no contact order, civil protection order, family law restraining order, protection order from another state,
tribal order, military orders, parenting plans, divorce, landlord-tenant, employment, property, assault, police
investigations. File copies in this court case of everything you want the court to review.)
☒ No ☐ Yes. If yes, fill out below.
Type of Case Court Location Court Type (Superior Case Number Status (active /
(see examples) (City or County / District / Municipal / (if known) dismissed / pending /
and State) Tribal / Military) expired, unknown)
Other details:
Do you need immediate protection? If needed, you can ask for a Temporary Protection
Order that starts now, before the restrained person gets notice. This protection can last up to
14 days or until the court hearing (whichever comes first).
11. Immediate Protection: Do you need a Temporary Protection Order to start immediately,
without prior notice to the restrained person? ☒ Yes ☐ No
12. Immediate Weapons Surrender: Do you want a temporary order that requires the
restrained person give up all firearms, other dangerous weapons, and concealed pistol
licenses right away, and prohibits the restrained person from getting more?
☐ Yes ☒ No
If Yes to 11 or 12, explain why: What serious immediate harm or irreparable injury could occur
if an order is not issued immediately without prior notice to the restrained person?
(Briefly explain how you or anyone else might be harmed if you do not get protection now.)
I am afraid to go inside of my house and live inside. I fear for my life and i feel like i am a prisoner in my
own home.
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PO 001
What protections do you need? Check everything you want the court to order.
13. I ask for a protection order with these restraints:
General Restraints
A. ☒ No Harm: Do not cause any physical harm, bodily injury, assault, nonconsensual
sexual conduct or nonconsensual sexual penetration, and do not harass, threaten, or
stalk ☒ protected person ☐ the minors named in section 4 above
☐ these minors only:
B. ☒ No Contact: Do not make any attempts or have any contact, including nonphysical
contact, directly, indirectly, or through third parties, regardless of whether those third
parties know of the order, except for service of court documents with
☒ protected person ☐ the minors named in section 4 above
☐ these minors only:
☐ Exception (if any): Only this type of contact is allowed:
Exceptions about minors, if any, provided in P below.
C. ☒ Exclude and Stay Away: Do not enter, return to, knowingly come within, or
knowingly remain within 1,000 feet or other distance (specify) 1000 feet
of
☒ the protected person ☒ protected person’s vehicle
☐ protected person’s school ☐ protected person’s workplace
☒ protected person’s residence ☐ protected person’s adult day program
☒ the shared residence
☐ the residence, daycare, or school of ☐ the minors named in section 4 above
☐ these minors only:
☒ other: My daughter’s house where I am staying t 8121 South 112th Street, Seattle WA
98178
Address: The protected person chooses to (check one)
☐ keep their address confidential ☒ list their address here:
32841 43rd Place Southwest, Federal Way WA 98023
D. ☒ Vacate shared residence: The protected person has exclusive right to the
residence that the protected person and restrained person share. The restrained
person must immediately vacate the residence. The restrained person may take the
restrained person’s clothing, personal items needed during the duration of the order,
and these items (specify): Their own belongings, clothes
from the residence while a law enforcement officer is present.
E. ☒ Stalking Behavior: Do not harass, follow, monitor, keep under physical or electronic
surveillance, cyber harass (as defined in RCW 9A.90.120), or use phone, video,
audio or other electronic means to record, photograph, or track locations or
communication, including digital, wire, or electronic communication of
☒ the protected person ☐ the minors named in section 4 above
☐ these minors only:
☐ these members of the protected person's household :
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F. ☐ Intimate Images: Do not possess or distribute intimate images of a protected person,
as defined in RCW 9A.86.010. The restrained person must take down and delete all
intimate images and recordings of a protected person in the restrained person’s
possession or control and cease any all disclosure of those intimate images.
G. ☐ Electronic Monitoring: The restrained person must submit to electronic monitoring.
Example: location tracking via ankle bracelet. (Restrained person must be age 18 or
older.)
H. ☒ Evaluation: The restrained person shall get an evaluation for:
☒ mental health ☒ chemical dependency (drugs)
I. ☒ Treatment: The restrained person shall participate in state-certified treatment for:
☐ sex offender ☒ domestic violence perpetrator
J. ☒ Personal Belongings: The protected person shall have possession of essential
personal belongings, including the following:
My clothes until I can come back to
The house when he has left.
K. ☐ Assets: Do not transfer jointly owned assets.
☐ Finances: Provide the following financial relief:
L. ☒ Vehicle: The protected person shall have use of the following vehicle:
Year, Make & Model 2015 Mercedes-Benz CLA License No. AUF0643
M. ☒ Restrict Abusive Litigation: Do not engage in abusive litigation as set forth in
chapter 26.51 RCW or in frivolous filings against the protected person, making
harassing or libelous communications about the protected person to third parties, or
making false reports to investigative agencies.
N. ☒ Pay Fees and Costs: The restrained person must pay fees and costs of this action.
This may include administrative court costs, service fees, and the protected person’s
costs including lawyer fees.
Firearms and Other Dangerous Weapons
O. ☐ Surrender Weapons: The restrained person must immediately surrender to law
enforcement and not access, possess, have in their custody or control, purchase,
receive, or attempt to purchase or receive firearms, other dangerous weapons, or
concealed pistol licenses.
Important! The court may be required to order the restrained person to surrender firearms, other dangerous
weapons, or concealed pistol licenses even if you do not request it.
Does the restrained person have or own firearms?
☐ Yes ☐ No ☒ Unknown
Complete Attachment E: Firearms Identification if Yes or Unknown.
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Would the restrained person’s use of firearms or other dangerous weapons be a serious
and immediate threat to anyone's health or safety?
☐ Yes ☒ No ☐ Unknown
Even if the restrained person does not have firearms now, has the restrained person
ever used firearms, other weapons or objects to threaten or harm you?
☐ Yes ☒ No
If Yes, describe what happened.
Is the restrained person already not allowed to have firearms?
☒ Yes ☐ No ☐ Unknown
If Yes, why?
Has a full lifetime domestic violence protection order against him
Minors
P. ☐ Custody: The protected person is granted temporary care, custody and control of
☐ the minors named in section 4 above
☐ these minors only:
Exceptions for Visitation and Transportation (including exchanges, meeting location,
and pickup and dropoff) of Minors (if any):
Visitation listed here is an exception to any No Contact provision in B above.
(Only for children the protected and restrained person have together.)
Q. ☐ Interference: Do not interfere with the protected person's physical or legal custody of
☐ the minors named in section 4 above
☐ these minors only:
R. ☐ Removal from State: Do not remove from the state:
☐ the minors named in section 4 above
☐ these minors only:
S. ☐ School: Do not attend the elementary, middle, or high school, that a protected person
attends. (name of school)
(Only if both the restrained person and a protected person are students at the same
school. Can apply to students 18 or older. Includes public and private schools.)
Describe any continuing physical danger, emotional distress, or educational
disruption to a protected person that would happen if the restrained person attends
the same school.
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Pets
T. ☐ Custody: The protected person shall have exclusive custody and control of the
following pet/s owned, possessed, leased, kept, or held by the protected person,
restrained person, or a minor child who lives with either the protected or restrained
person. (Specify name of pet and type of animal.):
U. ☐ Interference: Do not interfere with the protected person’s efforts to get the pet/s
named above.
V. ☐ Stay Away: Do not knowingly come within, or knowingly remain within
(distance)
of the following locations where the pet/s are regularly found:
☐ Protected person's residence (home address may be kept confidential.)
☐ Other (specify):
Vulnerable Adult
W. ☐ Safety: Do not commit or threaten to commit acts of abandonment, neglect, financial
exploitation, or abuse, including sexual abuse, mental abuse, physical abuse, personal
exploitation, and improper use of restraints, against the vulnerable adult.
X. ☐ Accounting: Provide an accounting of the disposition of the vulnerable adult’s income
or other resources.
Y. ☐ Property Transfer: Do not transfer the property of ☐ the vulnerable adult ☐ the
restrained person. This restraint can last for up to 90 days.
Other
Z.
Do you need help from law enforcement? They may help you get the things you asked for.
14. Law Enforcement Help: Do you want the court to order the appropriate law
enforcement agency to help you with any of the things listed below?
Check all that apply.
☒ Possession of my residence.
☒ Possession of the vehicle I asked for in section L above.
☒ Possession of my essential personal belongings that are located at
☒ the shared residence
☐ the restrained person’s residence
☐ other location
☐ Custody of ☐ the minors named in section 4 above
☐ these minors only
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☒ Other: passport, car title, important documents
How long do you need this order to last?
15. Length of Order
(The order will last for at least one year unless you ask for something different. Orders
restraining a parent from contacting their own children may not exceed one year.)
I need this order to last for: ☒ 1 year ☐ more than 1 year ☐ less than 1 year (specify
how long):
If you checked more or less than one year, briefly explain why.
Why do you need a protection order? What happened? This is your statement, where you
tell your experience.
Be as specific and descriptive as possible. Put the date, names, what happened and where.
Use names rather than pronouns (he/she/they) as much as possible. If you cannot remember
the date, put the time of year it happened (around a holiday, winter, summer, how old your
child was) or about how long ago.
For all of the questions below, include details:
Who did what?
When did this happen?
How were any statements made? (in person, mail, text, phone, email, social media)
How did this make you, the minor, or the vulnerable adult feel?
If you need more space to answer any of the questions below, use form PO 010 Statement or
attach additional pages.
Privacy Warning! The restrained person will see this Petition and any other evidence you file
with the court. This information is also available to the public for anyone to see.
16. Most Recent Incident. What happened most recently that made you want a protection
order? This could include violent acts, fear or threats of violence, coercive control,
nonconsensual sexual conduct or penetration, sexual abuse, harassment, stalking, hate
crimes. For a vulnerable adult, include incidents or threats of abandonment, abuse,
neglect and/or financial exploitation. Include specific date/s and details of the incident.
January 13th 2023 was the most recent incident where he pushed. I went to my house because I
was staying with my daughter since I do not feel safe to stay at my home. Ali got angry with me
because I needed my car to go to a Dr. appointment. He threw my car key at me and pushed me
telling me go ahead and go. I got scared. I left my house called my daughter. She came and picked
me up and, we called the police. He sent us threatening text messages. (Exhibit 2&3)
When I started filling out the petition the 23rd was the most recent incident. However, over the
course of the weekend January 13th-16th more incidents happened. I was too afraid to return to my
RCW 7.105.100 Petition for Protection Order
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home that I own because Ali was there, and continually sending me threatening messages
(Exhibit 4). During the weekend Ali went to the phone company and had me suspended as the
head person of the phone lines I pay for. He also bought a new I-watch on that account. I had to
go to the phone company and prove I am the person that pays for all the phone lines, have him
removed from the phone, and reported fraud for the watch as I did not approve this purchase. Ali
sent me more threatening messages angry that I did this. He also sent messages showing that he
knew whom I was calling showing that he is stalking my phone. (Exhibit 5)
17. Past Incidents. What happened in the past that makes you want a protection order?
This could include violent acts, fear or threats of violence, coercive control,
nonconsensual sexual conduct or penetration, sexual abuse, harassment, stalking, hate
crimes. For a vulnerable adult, include incidents or threats of abandonment, abuse,
neglect and/or financial exploitation. Include specific date/s and details of the incidents.
On January 10th 2023, Ali pushed through my bedroom door. He had a hammer in his hand. He
was angry with me because I had told his girlfriend that she needed to leave my house because
they do not pay rent. After he came into my room with the hammer, he put my hands behind my
head and pushed my head onto the bed. He then smashed my table and laptop. (Exhibit 1) He left
the room. I was afraid to call the police because he would come after me.
In the past he has told me he would take to court saying I am delusional and lying. He tells me he
won’t let me sell my house. I try explaining that it will go into foreclosure, and he says he does not
care he will squat in it.
He continually verbally abuses me. I have to hide my phone because I am afraid, he will smash it. I
safety pin my pockets with my phone and credit cards in it so he can’t steal them and use them.
My daughter calls me every night to see if I am ok because we are worried what Ali will do to me.
He continually blames everyone and does not take any responsibility.
Ali has threatened me multiple times that he won’t leave my house so that I won’t be able to sell
the house. He has taken my passport and has sold my belongings. He repeatedly threatens me
that if I evict him or his girlfriend, he will take me to court. He has pushed me multiple times.
18. Medical Treatment. Describe any medical treatment you received for issues related to
your request for protection.
19. Suicidal Behavior. Describe any threats of self-harm or suicide attempts by the
restrained person.
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Approximately November 2022, Ali threatened to kill himself. He said he was going to take my car
and drive off the cliff. He has also sent threats of suicide to my daughter.
20. Restrained Person’s Substance Abuse
Is substance abuse involved? ☐ Yes ☐ No ☒ Unknown
If yes, what type of substance abuse? ☐ Alcohol ☐ Drugs ☐ Other
21. Minors Needing Protection, if any (If the information is not already included above.)
Has there been any violence or threats towards children? How have the children been
affected by the restrained person’s behavior? Were the children present during any of
the incidents described above? Describe and give details.
22. Supporting Evidence (Include anything else you want the court to see that helps prove
what you are saying is true. You are responsible for filing your supporting evidence,
including police reports, if any. Before you file any attachments, you can black out
(redact) any sensitive information. Examples: your home address and account numbers
(leave last four digits). If you have audio or video evidence, contact the court for how to
submit.)
☒ I am attaching the following evidence to this Petition (check all that apply):
☒ Pictures
☒ Text / email / social media messages
☐ Voice messages (written transcript)
☐ Written notes / letters / mail
☐ Police report
☐ Declaration or statement from witness (name/s):
☐ Other (describe):
I certify under penalty of perjury under the laws of the state of Washington that all the
information provided in this petition and any attachments is true and correct.
[ ] I have attached (number):____ pages.
Signed at (City and State): Kent, WA Date: 01/13/2023
Tulay Crosbie
Sign here Print name
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PO 001
Attachment A: Definitions (Always include with petition.)
"Domestic violence" means: Evidence of emission of semen is not required to
(a) Physical harm, bodily injury, assault, or the prove sexual penetration.
infliction of fear of physical harm, bodily injury, or "Stalking" means any of the following:
assault; nonconsensual sexual conduct or (a) Any act of stalking as defined under RCW
nonconsensual sexual penetration; coercive 9A.46.110;
control; unlawful harassment; or stalking of one
intimate partner by another intimate partner; or (b) Any act of cyber harassment as defined under
RCW 9A,90.120; or
(b) Physical harm, bodily injury, assault, or the
infliction of fear of physical harm, bodily injury, or (c) Any course of conduct involving repeated or
assault; nonconsensual sexual conduct or continuing contacts, attempts to contact,
nonconsensual sexual penetration; coercive monitoring, tracking, surveillance, keeping under
control; unlawful harassment; or stalking of one observation, disrupting activities in a harassing
family or household member by another family or manner, or following of another person that:
household member. (i) Would cause a reasonable person to feel
"Sexual conduct" means any of the following: intimidated, frightened, under duress,
significantly disrupted, or threatened and that
(a) Any intentional or knowing touching or fondling of actually causes such a feeling;
the genitals, anus, or breasts, directly or indirectly,
including through clothing; (ii) Serves no lawful purpose; and
(b) Any intentional or knowing display of the genitals, (iii) The respondent knows, or reasonably should
anus, or breasts for the purposes of arousal or know, threatens, frightens, or intimidates the
sexual gratification of the respondent; person, even if the respondent did not intend
to intimidate, frighten, or threaten the person.
(c) Any intentional or knowing touching or fondling of
the genitals, anus, or breasts, directly or indirectly, "Unlawful harassment" means:
including through clothing, that the petitioner is (a) A knowing and willful course of conduct directed
forced to perform by another person or the at a specific person that seriously alarms, annoys,
respondent; harasses, or is detrimental to such person, and
(d) Any forced display of the petitioner's genitals, that serves no legitimate or lawful purpose. The
anus, or breasts for the purposes of arousal or course of conduct must be such as would cause a
sexual gratification of the respondent or others; reasonable person to suffer substantial emotional
distress, and must actually cause substantial
(e) Any intentional or knowing touching of the clothed emotional distress to the petitioner; or
or unclothed body of a child under the age of 16, if
done for the purpose of sexual gratification or (b) A single act of violence or threat of violence
arousal of the respondent or others; or Any directed at a specific person that seriously alarms,
coerced or forced touching or fondling by a child annoys, harasses, or is detrimental to such
under the age of 16, directly or indirectly, including person, and that serves no legitimate or lawful
through clothing, of the genitals, anus, or breasts purpose, which would cause a reasonable person
of the respondent or others. to suffer substantial emotional distress, and must
actually cause substantial emotional distress to
"Sexual penetration" means any contact, however the petitioner. A single threat of violence must
slight, between the sex organ or anus of one person include:
by an object, the sex organ, mouth, or anus of another
person, or any intrusion, however slight, of any part of (i) A malicious and intentional threat as
the body of one person or of any animal or object into described in RCW 9A.36.080(1)(c); or
the sex organ or anus of another person including, but (ii) the presence of a firearm or other weapon.
not limited to, cunnilingus, fellatio, or anal penetration.
RCW 7.105 Petition for Protection Order
(1/2023) Attachment A: Definitions
PO 001 p. 1 of 1
Attachment B: Vulnerable Adult
Only complete this attachment if your case involves a vulnerable adult. If not, skip or
remove this attachment.
1. What qualifies the adult as a vulnerable adult? The adult (check all that apply):
☐ Is over 60 years old and does not have the functional, mental, or physical ability to
care for himself or herself.
☐ Is an individual subject to guardianship under RCW 11.130.265 or an individual
subject to conservatorship under RCW 11.130.360.
☐ Has a developmental disability as defined in RCW 71A.10.020.
☐ Self-directs their own care and receives services from a personal aide under RCW
74.39.
☐ Is receiving services from a home health, hospice, or home care agency licensed or
required to be licensed under RCW 70.127.
☐ Is receiving in-home services from an individual provider under contract with DSHS.
☐ Has been admitted to an assisted living facility, nursing home, adult family home,
soldiers’ home, residential habilitation center or any other facility licensed by DSHS.
2. Does the vulnerable adult know you will be filing this petition?
☐ Yes ☐ No If no, what efforts did you make to notify the vulnerable adult?
3. Connection to Washington. Does the vulnerable adult live in Washington State?
☐ Yes ☐ No If no, are you asking to protect any family members of the vulnerable
adult who:
Live in Washington State, and
Have been affected by the restrained person's actions
☐ Yes ☐ No
4. What is your relationship to the vulnerable adult?
☐ DSHS is filing this petition for a vulnerable adult who ☐ has consented ☐ lacks
capacity or ability to consent to this petition.
☐ I am the vulnerable adult’s guardian/conservator, or limited guardian/conservator.
I was appointed in (county and state)
in Case Number
on or about (date)
(Attach a copy of your letters or order appointing guardian/conservator, if available.)
☐ To protect the vulnerable adult, I imposed an emergency restriction on the
vulnerable adult’s right to associate with the restrained person on (date)
RCW 7.105.100, .110 Petition for Protection Order
(1/2023) Attachment B: Vulnerable Adult
PO 001 p. 3 of 3
☐ I am the vulnerable adult’s legal fiduciary. I was appointed ☐ trustee ☐ power of
attorney on or about (date) .
(Attach a copy of your relevant documents, if available.)
☐ I am interested in the welfare of the vulnerable adult. I have a good faith belief that
the court’s intervention is necessary and that the vulnerable adult is unable at this
time to protect their own interests, due to incapacity, undue influence, or duress.
What is the nature of your relationship to the vulnerable adult? How long has this
relationship lasted? (Describe)
What is the incapacity, undue influence, or duress that makes the vulnerable
adult unable to protect their own interests? (Describe)
Definitions For Vulnerable Adult Protection Orders:
"Vulnerable adult" includes a person: vulnerable adult. In instances of abuse of a vulnerable
(a) Sixty years of age or older who has the adult who is unable to express or demonstrate
functional, mental, or physical inability to care for physical harm, pain, or mental anguish, the abuse is
himself or herself; or presumed to cause physical harm, pain, or mental
anguish.
(b) Subject to a guardianship under RCW
11.130.265 or adult subject to conservatorship "Abuse" includes sexual abuse, mental abuse,
under RCW 11.130.360; or physical abuse, personal exploitation, and improper
use of restraint against a vulnerable adult, which
(c) Who has a developmental disability as defined have the following meanings:
under RCW 71A.10.020; or
(a) "Improper use of restraint" means the
(d) Admitted to any facility; or inappropriate use of chemical, physical, or
(e) Receiving services from home health, hospice, or mechanical restraints for convenience or
home care agencies licensed or required to be discipline, or in a manner that:
licensed under chapter 70.127 RCW; or (i) Is inconsistent with federal or state licensing
(f) Receiving services from a person under contract or certification requirements for facilities,
with the department of social and health services hospitals, or programs authorized under
to provide services in the home under chapter chapter 71A.12 RCW;
74.09 or 74.39A RCW; or (ii) is not medically authorized; or
(g) Who self-directs his or her own care and receives (iii) otherwise constitutes abuse under this
services from a personal aide under chapter section.
74.39 RCW.
(b) "Mental abuse" means an intentional, willful, or
"Abuse," for the purposes of a vulnerable adult reckless verbal or nonverbal action that
protection order, means intentional, willful, or reckless threatens, humiliates, harasses, coerces,
action or inaction that inflicts injury, unreasonable intimidates, isolates, unreasonably confines, or
confinement, intimidation, or punishment on a punishes a vulnerable adult. "Mental abuse" may
RCW 7.105.100, .110 Petition for Protection Order
(1/2023) Attachment B: Vulnerable Adult
PO 001 p. 3 of 3
include ridiculing, yelling, swearing, or income, resources, or trust funds of the
withholding or tampering with prescribed vulnerable adult for the benefit of a person or
medications or their dosage. entity other than the vulnerable adult; or
(c) "Personal exploitation" means an act of forcing, (c) Obtaining or using a vulnerable adult's property,
compelling, or exerting undue influence over a income, resources, or trust funds without lawful
vulnerable adult causing the vulnerable adult to authority, by a person or entity who knows or
act in a way that is inconsistent with relevant past clearly should know that the vulnerable adult
behavior, or causing the vulnerable adult to lacks the capacity to consent to the release or
perform services for the benefit of another. use of the vulnerable adult's property, income,
(d) "Physical abuse" means the intentional, willful, or resources, or trust funds.
reckless action of inflicting bodily injury or "Neglect" means:
physical mistreatment. "Physical abuse" includes, (a) A pattern of conduct or inaction by a person or
but is not limited to, striking with or without an entity with a duty of care that fails to provide the
object, slapping, pinching, strangulation, goods and services that maintain the physical or
suffocation, kicking, shoving, or prodding. mental health of a vulnerable adult, or that fails to
(e) "Sexual abuse" means any form of avoid or prevent physical or mental harm or pain
nonconsensual sexual conduct including, but not to a vulnerable adult; or
limited to, unwanted or inappropriate touching, (b) an act or omission by a person or entity with a
rape, molestation, indecent liberties, sexual duty of care that demonstrates a serious
coercion, sexually explicit photographing or disregard of consequences of such a magnitude
recording, voyeurism, indecent exposure, and as to constitute a clear and present danger to the
sexual harassment. "Sexual abuse" also includes vulnerable adult's health, welfare, or safety
any sexual conduct between a staff person, who including, but not limited to, conduct prohibited
is not also a resident or client, of a facility or a under RCW 9A.42.100.
staff person of a program authorized under
chapter 71A.12 RCW, and a vulnerable adult
living in that facility or receiving service from a
program authorized under chapter 71A.12 RCW,
whether or not the sexual conduct is consensual.
"Financial exploitation" means the illegal or
improper use of, control over, or withholding of, the
property, income, resources, or trust funds of the
vulnerable adult by any person or entity for any
person's or entity's profit or advantage other than for
the vulnerable adult's profit or advantage. "Financial
exploitation" includes, but is not limited to:
(a) The use of deception, intimidation, or undue
influence by a person or entity in a position of
trust and confidence with a vulnerable adult to
obtain or use the property, income, resources,
government benefits, health insurance benefits,
or trust funds of the vulnerable adult for the
benefit of a person or entity other than the
vulnerable adult;
(b) The breach of a fiduciary duty, including, but not
limited to, the misuse of a power of attorney,
trust, or a guardianship or conservatorship
appointment, that results in the unauthorized
appropriation, sale, or transfer of the property,
RCW 7.105.100, .110 Petition for Protection Order
(1/2023) Attachment B: Vulnerable Adult
PO 001 p. 3 of 3
Attachment C: Child Custody
Only complete this attachment if you are asking to protect any of the restrained
person’s children. If not, skip or remove this attachment.
Does a Washington Court have authority over the children? Before the court can protect
a child, you must tell the court about the children's connection to Washington State. See
instructions for help.
1. Children’s Home/s
At any time during the past 5 years have the children lived:
on an Indian reservation,
outside Washington state,
in a foreign country, or
with anyone who is not a party to this case?
☐ No. (Skip to 2)
☐ Yes. (Fill out below to show where the children have lived during the last 5 years.)
In which state,
Dates Children Lived with Indian reservation,
or foreign country
From: ☐ All children ☐ Petitioner ☐ Respondent
To: ☐ (Initials): ☐ Other (name):
From: ☐ All children ☐ Petitioner ☐ Respondent
To: ☐ (Initials): ☐ Other (name):
From: ☐ All children ☐ Petitioner ☐ Respondent
To: ☐ (Initials): ☐ Other (name):
From: ☐ All children ☐ Petitioner ☐ Respondent
To: ☐ (Initials): ☐ Other (name):
From: ☐ All children ☐ Petitioner ☐ Respondent
To: ☐ (Initials): ☐ Other (name):
2. Other people with a legal right to spend time with the children
Do you know of anyone besides yourself and Respondent who has or claims to have a
legal right to spend time with the children?
☐ No.
☐ Yes. (Name/s) has or claims to have
a legal right to spend time with the children because:
3. Authority over the children (Jurisdiction) (RCW 26.27.201 – .221, .231, .261, .271)
The court can make an order protecting the children because:
RCW 7.105.100, Petition for Protection Order
26.27.201-.291 Attachment C: Child Custody
(1/2023) p. 1 of 2
PO 001
☐ Exclusive, continuing jurisdiction – A Washington court has already made a
custody order or parenting plan for the children, and the court still has authority to
make other orders for the children.
☐ Home state jurisdiction – Washington is the child’s home state because
(check all that apply):
☐ The children lived in Washington with a parent or someone acting as a parent
for at least the 6 months just before this case was filed, or if a child is less than
6 months old, the child has lived in Washington with a parent or someone
acting as a parent since birth.
☐ There were times the children were not in Washington in the 6 months
just before this case was filed (or since birth if a child is less than 6
months old), but those were temporary absences.
☐ The children do not live in Washington right now, but Washington was the
children’s home state sometime in the 6 months just before this case was
filed, and a parent or someone acting as a parent of the children still lives in
Washington.
☐ The children do not have another home state.
☐ No home state or home state declined – No court of any other state (or tribe) has
the jurisdiction to make decisions for the children or a court in the children’s home
state (or tribe) decided it is better to have this case in Washington and:
The children and a parent or someone acting as a parent have ties to
Washington beyond just living here; and
There is a lot of information (substantial evidence) about the children’s care,
protection, education, and relationships in this state.
☐ Other state declined – The courts in other states (or tribes) that might be the
children’s home state have refused to take this case because it is better to have this
case in Washington.
☐ Temporary emergency jurisdiction – The court can make decisions for the
children because the children are in this state now and were abandoned here or
need emergency protection because the children (or their parent, brother, or sister)
were abused or threatened with abuse. (Check one):
☐ A custody case involving the children was filed in the children’s home state
(name of state or tribe): . Washington
should take temporary emergency jurisdiction over the children until the
Petitioner can get a court order from the children’s home state (or tribe).
☐ There is no valid custody order or open custody case in the children’s home
Preview
FILED 2023 JAN 17 KING COUNTY SUPERIOR COURT CLERK CASE #: 23-2-00949-5 KNT Superior Court of Washington, County of King Case No. Tulay Crosbie 06/03/1946 Petitioner (Person starting this case) DOB Petition for Protection Order vs. Clerk’s Action: 1 Ali Crosbie 07/09/1975 Respondent (Person responding to this case) DOB Petition for Protection Order What kind protection order do you want? There are different orders based on the type of harm and how the parties know each other. See definitions in Attachments A and B. 1. Choose the type of protection order that best fits your situation. Check only one. ☒ Domestic Violence – Protection from an intimate partner or family or household member who has committed domestic violence, nonconsensual sexual conduct or penetration, unlawful harassment, or stalking. (PTORPRT) ☐ Sexual Assault – Protection from someone who has committed sexual assault. (PTORSXP) ☐ Stalking – Protection from someone who has committed stalking. (PTORSTK) ☐ Vulnerable Adult – Protection from someone who has abandoned, abused, financially exploited, or neglected a vulnerable adult (or threatened to do so). (PTORVA) Important! If you are asking for a Vulnerable Adult Protection Order, you must complete Attachment B: Vulnerable Adult as part of this Petition. ☐ Anti-Harassment – Protection from someone who has committed unlawful harassment. (PTORAH) (fee may be required) Conduct also includes (check all that apply): ☐ stalking ☐ hate crime ☐ single act/threat of violence including malicious and intentional threat or presence of firearm/weapon causing substantial emotional distress RCW 7.105.100 Petition for Protection Order (01/2023) p. 1 of 11 PO 001 ☐ family or household member engaged in domestic violence ☐ nonconsensual sexual conduct or penetration or a sex offense 2. If more than one of the protection order types listed above fits your situation, list any additional order types here: 3. Who should the order restrain? ("Restrained Person") Name: Ali Crosbie Restrained Person's age: ☐ Under 13 ☐ 13 to 17 ☒ 18 or over ☐ unknown Who should be protected? Check all that apply. Depending on the type of order, you can protect yourself and/or children, or you can file on behalf of a vulnerable adult, or another adult who cannot file for themselves. 4. Who should the order protect? (“Protected Person") (Check all that apply.) ☒ Me. My name is Tulay Crosbie (You must be age 15 or older.) ☐ Minor Children. ☐ I am the minor’s ☐ parent ☐ legal guardian ☐ custodian. ☐ I am age 18 or older and the minor is a member of my family or household. (For domestic violence petitions only.) ☐ I am age 15 to 17. The minor is a member of my family or household. I have been chosen by the minor and am capable of pursuing their stated interest in this case. Child's Name Age Sex Lives With How related to you How related to Restrained Person Important! If the restrained person is a parent of any of the children, complete Attachment C: Child Custody. If you are not a parent of any of the children, complete Attachment D: Non-parents protecting children (ICWA). You must include these Attachment/s with your Petition if they apply. ☐ Someone else. (List your name as Petitioner at the beginning of this form. Describe who you are filing for here.) I am filing to protect: ☐ a vulnerable adult (name) (See definition and complete Attachment B.) ☐ an adult (name) who does not meet the definition of a vulnerable adult, but who cannot file the petition themselves because of age, disability, health, or inaccessibility (Do not check this for vulnerable adult or domestic violence petitions.). RCW 7.105.100 Petition for Protection Order (01/2023) p. 2 of 11 PO 001 What is the age, disability, health or inaccessibility concern that makes the adult unable to file themselves? (Examples: the adult is hospitalized, temporarily incapacitated, or in jail/prison.) 5. Service address. What is your address for receiving legal documents? You have the right to keep your residential address private. You may use a different mailing address for receiving legal documents. Mail: 32841 43rd Place Southwest, Federal Way WA 98023 Email (if you agree to receive legal documents by email): tulay.crosbie@hotmail.com 6. Interpreter Do you need an interpreter? ☒ No ☐ Yes, Language: Important! You may need to request an interpreter separately. You will get instructions with an order setting your hearing. How do the parties know each other? 7. Check all the ways the protected person is connected or related to the restrained person: Intimate Partners – Protected person and restrained person are intimate partners because they are: ☐ current or former spouses or domestic partners ☐ parents of a child-in-common (unless child was conceived through sexual assault) ☐ current or former dating relationship (age 13 or older) who ☐ never lived together ☐ live or have lived together Family or household members - Protected person and restrained person are family or household members because they are: ☒ parent and child ☐ stepparent and stepchild ☐ grandparent and grandchild ☐ parent’s intimate partner and child ☐ current or former cohabitants as roommates ☐ person who is or has been a legal guardian ☐ related by blood or marriage (specify how) Other (examples: coworker, neighbor, acquaintance, stranger) Connection to Washington State. This helps decide if the court has authority (jurisdiction). 8. Why are you filing in this county and state? Check all that apply. ☐ The protected person lives in this county now, or used to live in this county but left because of abuse, or this is the nearest court to where I live or used to live. RCW 7.105.100 Petition for Protection Order (01/2023) p. 3 of 11 PO 001 ☒ An incident that made me want this protection order happened in this county or state. 9. Restrained Person's residence. Where does the restrained person live? ☒ In Washington State in (city or county): Federal Way King County ☐ Outside of Washington State ☐ Unknown Are there other court cases involving the parties or any children? 10. Other court cases. Have there been any other court cases between any of the people involved in this case or about any children? Include court cases happening now and in the past and requests for protection that were denied or have expired. (Examples: criminal no contact order, civil protection order, family law restraining order, protection order from another state, tribal order, military orders, parenting plans, divorce, landlord-tenant, employment, property, assault, police investigations. File copies in this court case of everything you want the court to review.) ☒ No ☐ Yes. If yes, fill out below. Type of Case Court Location Court Type (Superior Case Number Status (active / (see examples) (City or County / District / Municipal / (if known) dismissed / pending / and State) Tribal / Military) expired, unknown) Other details: Do you need immediate protection? If needed, you can ask for a Temporary Protection Order that starts now, before the restrained person gets notice. This protection can last up to 14 days or until the court hearing (whichever comes first). 11. Immediate Protection: Do you need a Temporary Protection Order to start immediately, without prior notice to the restrained person? ☒ Yes ☐ No 12. Immediate Weapons Surrender: Do you want a temporary order that requires the restrained person give up all firearms, other dangerous weapons, and concealed pistol licenses right away, and prohibits the restrained person from getting more? ☐ Yes ☒ No If Yes to 11 or 12, explain why: What serious immediate harm or irreparable injury could occur if an order is not issued immediately without prior notice to the restrained person? (Briefly explain how you or anyone else might be harmed if you do not get protection now.) I am afraid to go inside of my house and live inside. I fear for my life and i feel like i am a prisoner in my own home. RCW 7.105.100 Petition for Protection Order (01/2023) p. 4 of 11 PO 001 What protections do you need? Check everything you want the court to order. 13. I ask for a protection order with these restraints: General Restraints A. ☒ No Harm: Do not cause any physical harm, bodily injury, assault, nonconsensual sexual conduct or nonconsensual sexual penetration, and do not harass, threaten, or stalk ☒ protected person ☐ the minors named in section 4 above ☐ these minors only: B. ☒ No Contact: Do not make any attempts or have any contact, including nonphysical contact, directly, indirectly, or through third parties, regardless of whether those third parties know of the order, except for service of court documents with ☒ protected person ☐ the minors named in section 4 above ☐ these minors only: ☐ Exception (if any): Only this type of contact is allowed: Exceptions about minors, if any, provided in P below. C. ☒ Exclude and Stay Away: Do not enter, return to, knowingly come within, or knowingly remain within 1,000 feet or other distance (specify) 1000 feet of ☒ the protected person ☒ protected person’s vehicle ☐ protected person’s school ☐ protected person’s workplace ☒ protected person’s residence ☐ protected person’s adult day program ☒ the shared residence ☐ the residence, daycare, or school of ☐ the minors named in section 4 above ☐ these minors only: ☒ other: My daughter’s house where I am staying t 8121 South 112th Street, Seattle WA 98178 Address: The protected person chooses to (check one) ☐ keep their address confidential ☒ list their address here: 32841 43rd Place Southwest, Federal Way WA 98023 D. ☒ Vacate shared residence: The protected person has exclusive right to the residence that the protected person and restrained person share. The restrained person must immediately vacate the residence. The restrained person may take the restrained person’s clothing, personal items needed during the duration of the order, and these items (specify): Their own belongings, clothes from the residence while a law enforcement officer is present. E. ☒ Stalking Behavior: Do not harass, follow, monitor, keep under physical or electronic surveillance, cyber harass (as defined in RCW 9A.90.120), or use phone, video, audio or other electronic means to record, photograph, or track locations or communication, including digital, wire, or electronic communication of ☒ the protected person ☐ the minors named in section 4 above ☐ these minors only: ☐ these members of the protected person's household : RCW 7.105.100 Petition for Protection Order (01/2023) p. 5 of 11 PO 001 F. ☐ Intimate Images: Do not possess or distribute intimate images of a protected person, as defined in RCW 9A.86.010. The restrained person must take down and delete all intimate images and recordings of a protected person in the restrained person’s possession or control and cease any all disclosure of those intimate images. G. ☐ Electronic Monitoring: The restrained person must submit to electronic monitoring. Example: location tracking via ankle bracelet. (Restrained person must be age 18 or older.) H. ☒ Evaluation: The restrained person shall get an evaluation for: ☒ mental health ☒ chemical dependency (drugs) I. ☒ Treatment: The restrained person shall participate in state-certified treatment for: ☐ sex offender ☒ domestic violence perpetrator J. ☒ Personal Belongings: The protected person shall have possession of essential personal belongings, including the following: My clothes until I can come back to The house when he has left. K. ☐ Assets: Do not transfer jointly owned assets. ☐ Finances: Provide the following financial relief: L. ☒ Vehicle: The protected person shall have use of the following vehicle: Year, Make & Model 2015 Mercedes-Benz CLA License No. AUF0643 M. ☒ Restrict Abusive Litigation: Do not engage in abusive litigation as set forth in chapter 26.51 RCW or in frivolous filings against the protected person, making harassing or libelous communications about the protected person to third parties, or making false reports to investigative agencies. N. ☒ Pay Fees and Costs: The restrained person must pay fees and costs of this action. This may include administrative court costs, service fees, and the protected person’s costs including lawyer fees. Firearms and Other Dangerous Weapons O. ☐ Surrender Weapons: The restrained person must immediately surrender to law enforcement and not access, possess, have in their custody or control, purchase, receive, or attempt to purchase or receive firearms, other dangerous weapons, or concealed pistol licenses. Important! The court may be required to order the restrained person to surrender firearms, other dangerous weapons, or concealed pistol licenses even if you do not request it. Does the restrained person have or own firearms? ☐ Yes ☐ No ☒ Unknown Complete Attachment E: Firearms Identification if Yes or Unknown. RCW 7.105.100 Petition for Protection Order (01/2023) p. 6 of 11 PO 001 Would the restrained person’s use of firearms or other dangerous weapons be a serious and immediate threat to anyone's health or safety? ☐ Yes ☒ No ☐ Unknown Even if the restrained person does not have firearms now, has the restrained person ever used firearms, other weapons or objects to threaten or harm you? ☐ Yes ☒ No If Yes, describe what happened. Is the restrained person already not allowed to have firearms? ☒ Yes ☐ No ☐ Unknown If Yes, why? Has a full lifetime domestic violence protection order against him Minors P. ☐ Custody: The protected person is granted temporary care, custody and control of ☐ the minors named in section 4 above ☐ these minors only: Exceptions for Visitation and Transportation (including exchanges, meeting location, and pickup and dropoff) of Minors (if any): Visitation listed here is an exception to any No Contact provision in B above. (Only for children the protected and restrained person have together.) Q. ☐ Interference: Do not interfere with the protected person's physical or legal custody of ☐ the minors named in section 4 above ☐ these minors only: R. ☐ Removal from State: Do not remove from the state: ☐ the minors named in section 4 above ☐ these minors only: S. ☐ School: Do not attend the elementary, middle, or high school, that a protected person attends. (name of school) (Only if both the restrained person and a protected person are students at the same school. Can apply to students 18 or older. Includes public and private schools.) Describe any continuing physical danger, emotional distress, or educational disruption to a protected person that would happen if the restrained person attends the same school. RCW 7.105.100 Petition for Protection Order (01/2023) p. 7 of 11 PO 001 Pets T. ☐ Custody: The protected person shall have exclusive custody and control of the following pet/s owned, possessed, leased, kept, or held by the protected person, restrained person, or a minor child who lives with either the protected or restrained person. (Specify name of pet and type of animal.): U. ☐ Interference: Do not interfere with the protected person’s efforts to get the pet/s named above. V. ☐ Stay Away: Do not knowingly come within, or knowingly remain within (distance) of the following locations where the pet/s are regularly found: ☐ Protected person's residence (home address may be kept confidential.) ☐ Other (specify): Vulnerable Adult W. ☐ Safety: Do not commit or threaten to commit acts of abandonment, neglect, financial exploitation, or abuse, including sexual abuse, mental abuse, physical abuse, personal exploitation, and improper use of restraints, against the vulnerable adult. X. ☐ Accounting: Provide an accounting of the disposition of the vulnerable adult’s income or other resources. Y. ☐ Property Transfer: Do not transfer the property of ☐ the vulnerable adult ☐ the restrained person. This restraint can last for up to 90 days. Other Z. Do you need help from law enforcement? They may help you get the things you asked for. 14. Law Enforcement Help: Do you want the court to order the appropriate law enforcement agency to help you with any of the things listed below? Check all that apply. ☒ Possession of my residence. ☒ Possession of the vehicle I asked for in section L above. ☒ Possession of my essential personal belongings that are located at ☒ the shared residence ☐ the restrained person’s residence ☐ other location ☐ Custody of ☐ the minors named in section 4 above ☐ these minors only RCW 7.105.100 Petition for Protection Order (01/2023) p. 8 of 11 PO 001 ☒ Other: passport, car title, important documents How long do you need this order to last? 15. Length of Order (The order will last for at least one year unless you ask for something different. Orders restraining a parent from contacting their own children may not exceed one year.) I need this order to last for: ☒ 1 year ☐ more than 1 year ☐ less than 1 year (specify how long): If you checked more or less than one year, briefly explain why. Why do you need a protection order? What happened? This is your statement, where you tell your experience. Be as specific and descriptive as possible. Put the date, names, what happened and where. Use names rather than pronouns (he/she/they) as much as possible. If you cannot remember the date, put the time of year it happened (around a holiday, winter, summer, how old your child was) or about how long ago. For all of the questions below, include details: Who did what? When did this happen? How were any statements made? (in person, mail, text, phone, email, social media) How did this make you, the minor, or the vulnerable adult feel? If you need more space to answer any of the questions below, use form PO 010 Statement or attach additional pages. Privacy Warning! The restrained person will see this Petition and any other evidence you file with the court. This information is also available to the public for anyone to see. 16. Most Recent Incident. What happened most recently that made you want a protection order? This could include violent acts, fear or threats of violence, coercive control, nonconsensual sexual conduct or penetration, sexual abuse, harassment, stalking, hate crimes. For a vulnerable adult, include incidents or threats of abandonment, abuse, neglect and/or financial exploitation. Include specific date/s and details of the incident. January 13th 2023 was the most recent incident where he pushed. I went to my house because I was staying with my daughter since I do not feel safe to stay at my home. Ali got angry with me because I needed my car to go to a Dr. appointment. He threw my car key at me and pushed me telling me go ahead and go. I got scared. I left my house called my daughter. She came and picked me up and, we called the police. He sent us threatening text messages. (Exhibit 2&3) When I started filling out the petition the 23rd was the most recent incident. However, over the course of the weekend January 13th-16th more incidents happened. I was too afraid to return to my RCW 7.105.100 Petition for Protection Order (01/2023) p. 9 of 11 PO 001 home that I own because Ali was there, and continually sending me threatening messages (Exhibit 4). During the weekend Ali went to the phone company and had me suspended as the head person of the phone lines I pay for. He also bought a new I-watch on that account. I had to go to the phone company and prove I am the person that pays for all the phone lines, have him removed from the phone, and reported fraud for the watch as I did not approve this purchase. Ali sent me more threatening messages angry that I did this. He also sent messages showing that he knew whom I was calling showing that he is stalking my phone. (Exhibit 5) 17. Past Incidents. What happened in the past that makes you want a protection order? This could include violent acts, fear or threats of violence, coercive control, nonconsensual sexual conduct or penetration, sexual abuse, harassment, stalking, hate crimes. For a vulnerable adult, include incidents or threats of abandonment, abuse, neglect and/or financial exploitation. Include specific date/s and details of the incidents. On January 10th 2023, Ali pushed through my bedroom door. He had a hammer in his hand. He was angry with me because I had told his girlfriend that she needed to leave my house because they do not pay rent. After he came into my room with the hammer, he put my hands behind my head and pushed my head onto the bed. He then smashed my table and laptop. (Exhibit 1) He left the room. I was afraid to call the police because he would come after me. In the past he has told me he would take to court saying I am delusional and lying. He tells me he won’t let me sell my house. I try explaining that it will go into foreclosure, and he says he does not care he will squat in it. He continually verbally abuses me. I have to hide my phone because I am afraid, he will smash it. I safety pin my pockets with my phone and credit cards in it so he can’t steal them and use them. My daughter calls me every night to see if I am ok because we are worried what Ali will do to me. He continually blames everyone and does not take any responsibility. Ali has threatened me multiple times that he won’t leave my house so that I won’t be able to sell the house. He has taken my passport and has sold my belongings. He repeatedly threatens me that if I evict him or his girlfriend, he will take me to court. He has pushed me multiple times. 18. Medical Treatment. Describe any medical treatment you received for issues related to your request for protection. 19. Suicidal Behavior. Describe any threats of self-harm or suicide attempts by the restrained person. RCW 7.105.100 Petition for Protection Order (01/2023) p. 10 of 11 PO 001 Approximately November 2022, Ali threatened to kill himself. He said he was going to take my car and drive off the cliff. He has also sent threats of suicide to my daughter. 20. Restrained Person’s Substance Abuse Is substance abuse involved? ☐ Yes ☐ No ☒ Unknown If yes, what type of substance abuse? ☐ Alcohol ☐ Drugs ☐ Other 21. Minors Needing Protection, if any (If the information is not already included above.) Has there been any violence or threats towards children? How have the children been affected by the restrained person’s behavior? Were the children present during any of the incidents described above? Describe and give details. 22. Supporting Evidence (Include anything else you want the court to see that helps prove what you are saying is true. You are responsible for filing your supporting evidence, including police reports, if any. Before you file any attachments, you can black out (redact) any sensitive information. Examples: your home address and account numbers (leave last four digits). If you have audio or video evidence, contact the court for how to submit.) ☒ I am attaching the following evidence to this Petition (check all that apply): ☒ Pictures ☒ Text / email / social media messages ☐ Voice messages (written transcript) ☐ Written notes / letters / mail ☐ Police report ☐ Declaration or statement from witness (name/s): ☐ Other (describe): I certify under penalty of perjury under the laws of the state of Washington that all the information provided in this petition and any attachments is true and correct. [ ] I have attached (number):____ pages. Signed at (City and State): Kent, WA Date: 01/13/2023 Tulay Crosbie Sign here Print name RCW 7.105.100 Petition for Protection Order (01/2023) p. 11 of 11 PO 001 Attachment A: Definitions (Always include with petition.) "Domestic violence" means: Evidence of emission of semen is not required to (a) Physical harm, bodily injury, assault, or the prove sexual penetration. infliction of fear of physical harm, bodily injury, or "Stalking" means any of the following: assault; nonconsensual sexual conduct or (a) Any act of stalking as defined under RCW nonconsensual sexual penetration; coercive 9A.46.110; control; unlawful harassment; or stalking of one intimate partner by another intimate partner; or (b) Any act of cyber harassment as defined under RCW 9A,90.120; or (b) Physical harm, bodily injury, assault, or the infliction of fear of physical harm, bodily injury, or (c) Any course of conduct involving repeated or assault; nonconsensual sexual conduct or continuing contacts, attempts to contact, nonconsensual sexual penetration; coercive monitoring, tracking, surveillance, keeping under control; unlawful harassment; or stalking of one observation, disrupting activities in a harassing family or household member by another family or manner, or following of another person that: household member. (i) Would cause a reasonable person to feel "Sexual conduct" means any of the following: intimidated, frightened, under duress, significantly disrupted, or threatened and that (a) Any intentional or knowing touching or fondling of actually causes such a feeling; the genitals, anus, or breasts, directly or indirectly, including through clothing; (ii) Serves no lawful purpose; and (b) Any intentional or knowing display of the genitals, (iii) The respondent knows, or reasonably should anus, or breasts for the purposes of arousal or know, threatens, frightens, or intimidates the sexual gratification of the respondent; person, even if the respondent did not intend to intimidate, frighten, or threaten the person. (c) Any intentional or knowing touching or fondling of the genitals, anus, or breasts, directly or indirectly, "Unlawful harassment" means: including through clothing, that the petitioner is (a) A knowing and willful course of conduct directed forced to perform by another person or the at a specific person that seriously alarms, annoys, respondent; harasses, or is detrimental to such person, and (d) Any forced display of the petitioner's genitals, that serves no legitimate or lawful purpose. The anus, or breasts for the purposes of arousal or course of conduct must be such as would cause a sexual gratification of the respondent or others; reasonable person to suffer substantial emotional distress, and must actually cause substantial (e) Any intentional or knowing touching of the clothed emotional distress to the petitioner; or or unclothed body of a child under the age of 16, if done for the purpose of sexual gratification or (b) A single act of violence or threat of violence arousal of the respondent or others; or Any directed at a specific person that seriously alarms, coerced or forced touching or fondling by a child annoys, harasses, or is detrimental to such under the age of 16, directly or indirectly, including person, and that serves no legitimate or lawful through clothing, of the genitals, anus, or breasts purpose, which would cause a reasonable person of the respondent or others. to suffer substantial emotional distress, and must actually cause substantial emotional distress to "Sexual penetration" means any contact, however the petitioner. A single threat of violence must slight, between the sex organ or anus of one person include: by an object, the sex organ, mouth, or anus of another person, or any intrusion, however slight, of any part of (i) A malicious and intentional threat as the body of one person or of any animal or object into described in RCW 9A.36.080(1)(c); or the sex organ or anus of another person including, but (ii) the presence of a firearm or other weapon. not limited to, cunnilingus, fellatio, or anal penetration. RCW 7.105 Petition for Protection Order (1/2023) Attachment A: Definitions PO 001 p. 1 of 1 Attachment B: Vulnerable Adult Only complete this attachment if your case involves a vulnerable adult. If not, skip or remove this attachment. 1. What qualifies the adult as a vulnerable adult? The adult (check all that apply): ☐ Is over 60 years old and does not have the functional, mental, or physical ability to care for himself or herself. ☐ Is an individual subject to guardianship under RCW 11.130.265 or an individual subject to conservatorship under RCW 11.130.360. ☐ Has a developmental disability as defined in RCW 71A.10.020. ☐ Self-directs their own care and receives services from a personal aide under RCW 74.39. ☐ Is receiving services from a home health, hospice, or home care agency licensed or required to be licensed under RCW 70.127. ☐ Is receiving in-home services from an individual provider under contract with DSHS. ☐ Has been admitted to an assisted living facility, nursing home, adult family home, soldiers’ home, residential habilitation center or any other facility licensed by DSHS. 2. Does the vulnerable adult know you will be filing this petition? ☐ Yes ☐ No If no, what efforts did you make to notify the vulnerable adult? 3. Connection to Washington. Does the vulnerable adult live in Washington State? ☐ Yes ☐ No If no, are you asking to protect any family members of the vulnerable adult who: Live in Washington State, and Have been affected by the restrained person's actions ☐ Yes ☐ No 4. What is your relationship to the vulnerable adult? ☐ DSHS is filing this petition for a vulnerable adult who ☐ has consented ☐ lacks capacity or ability to consent to this petition. ☐ I am the vulnerable adult’s guardian/conservator, or limited guardian/conservator. I was appointed in (county and state) in Case Number on or about (date) (Attach a copy of your letters or order appointing guardian/conservator, if available.) ☐ To protect the vulnerable adult, I imposed an emergency restriction on the vulnerable adult’s right to associate with the restrained person on (date) RCW 7.105.100, .110 Petition for Protection Order (1/2023) Attachment B: Vulnerable Adult PO 001 p. 3 of 3 ☐ I am the vulnerable adult’s legal fiduciary. I was appointed ☐ trustee ☐ power of attorney on or about (date) . (Attach a copy of your relevant documents, if available.) ☐ I am interested in the welfare of the vulnerable adult. I have a good faith belief that the court’s intervention is necessary and that the vulnerable adult is unable at this time to protect their own interests, due to incapacity, undue influence, or duress. What is the nature of your relationship to the vulnerable adult? How long has this relationship lasted? (Describe) What is the incapacity, undue influence, or duress that makes the vulnerable adult unable to protect their own interests? (Describe) Definitions For Vulnerable Adult Protection Orders: "Vulnerable adult" includes a person: vulnerable adult. In instances of abuse of a vulnerable (a) Sixty years of age or older who has the adult who is unable to express or demonstrate functional, mental, or physical inability to care for physical harm, pain, or mental anguish, the abuse is himself or herself; or presumed to cause physical harm, pain, or mental anguish. (b) Subject to a guardianship under RCW 11.130.265 or adult subject to conservatorship "Abuse" includes sexual abuse, mental abuse, under RCW 11.130.360; or physical abuse, personal exploitation, and improper use of restraint against a vulnerable adult, which (c) Who has a developmental disability as defined have the following meanings: under RCW 71A.10.020; or (a) "Improper use of restraint" means the (d) Admitted to any facility; or inappropriate use of chemical, physical, or (e) Receiving services from home health, hospice, or mechanical restraints for convenience or home care agencies licensed or required to be discipline, or in a manner that: licensed under chapter 70.127 RCW; or (i) Is inconsistent with federal or state licensing (f) Receiving services from a person under contract or certification requirements for facilities, with the department of social and health services hospitals, or programs authorized under to provide services in the home under chapter chapter 71A.12 RCW; 74.09 or 74.39A RCW; or (ii) is not medically authorized; or (g) Who self-directs his or her own care and receives (iii) otherwise constitutes abuse under this services from a personal aide under chapter section. 74.39 RCW. (b) "Mental abuse" means an intentional, willful, or "Abuse," for the purposes of a vulnerable adult reckless verbal or nonverbal action that protection order, means intentional, willful, or reckless threatens, humiliates, harasses, coerces, action or inaction that inflicts injury, unreasonable intimidates, isolates, unreasonably confines, or confinement, intimidation, or punishment on a punishes a vulnerable adult. "Mental abuse" may RCW 7.105.100, .110 Petition for Protection Order (1/2023) Attachment B: Vulnerable Adult PO 001 p. 3 of 3 include ridiculing, yelling, swearing, or income, resources, or trust funds of the withholding or tampering with prescribed vulnerable adult for the benefit of a person or medications or their dosage. entity other than the vulnerable adult; or (c) "Personal exploitation" means an act of forcing, (c) Obtaining or using a vulnerable adult's property, compelling, or exerting undue influence over a income, resources, or trust funds without lawful vulnerable adult causing the vulnerable adult to authority, by a person or entity who knows or act in a way that is inconsistent with relevant past clearly should know that the vulnerable adult behavior, or causing the vulnerable adult to lacks the capacity to consent to the release or perform services for the benefit of another. use of the vulnerable adult's property, income, (d) "Physical abuse" means the intentional, willful, or resources, or trust funds. reckless action of inflicting bodily injury or "Neglect" means: physical mistreatment. "Physical abuse" includes, (a) A pattern of conduct or inaction by a person or but is not limited to, striking with or without an entity with a duty of care that fails to provide the object, slapping, pinching, strangulation, goods and services that maintain the physical or suffocation, kicking, shoving, or prodding. mental health of a vulnerable adult, or that fails to (e) "Sexual abuse" means any form of avoid or prevent physical or mental harm or pain nonconsensual sexual conduct including, but not to a vulnerable adult; or limited to, unwanted or inappropriate touching, (b) an act or omission by a person or entity with a rape, molestation, indecent liberties, sexual duty of care that demonstrates a serious coercion, sexually explicit photographing or disregard of consequences of such a magnitude recording, voyeurism, indecent exposure, and as to constitute a clear and present danger to the sexual harassment. "Sexual abuse" also includes vulnerable adult's health, welfare, or safety any sexual conduct between a staff person, who including, but not limited to, conduct prohibited is not also a resident or client, of a facility or a under RCW 9A.42.100. staff person of a program authorized under chapter 71A.12 RCW, and a vulnerable adult living in that facility or receiving service from a program authorized under chapter 71A.12 RCW, whether or not the sexual conduct is consensual. "Financial exploitation" means the illegal or improper use of, control over, or withholding of, the property, income, resources, or trust funds of the vulnerable adult by any person or entity for any person's or entity's profit or advantage other than for the vulnerable adult's profit or advantage. "Financial exploitation" includes, but is not limited to: (a) The use of deception, intimidation, or undue influence by a person or entity in a position of trust and confidence with a vulnerable adult to obtain or use the property, income, resources, government benefits, health insurance benefits, or trust funds of the vulnerable adult for the benefit of a person or entity other than the vulnerable adult; (b) The breach of a fiduciary duty, including, but not limited to, the misuse of a power of attorney, trust, or a guardianship or conservatorship appointment, that results in the unauthorized appropriation, sale, or transfer of the property, RCW 7.105.100, .110 Petition for Protection Order (1/2023) Attachment B: Vulnerable Adult PO 001 p. 3 of 3 Attachment C: Child Custody Only complete this attachment if you are asking to protect any of the restrained person’s children. If not, skip or remove this attachment. Does a Washington Court have authority over the children? Before the court can protect a child, you must tell the court about the children's connection to Washington State. See instructions for help. 1. Children’s Home/s At any time during the past 5 years have the children lived: on an Indian reservation, outside Washington state, in a foreign country, or with anyone who is not a party to this case? ☐ No. (Skip to 2) ☐ Yes. (Fill out below to show where the children have lived during the last 5 years.) In which state, Dates Children Lived with Indian reservation, or foreign country From: ☐ All children ☐ Petitioner ☐ Respondent To: ☐ (Initials): ☐ Other (name): From: ☐ All children ☐ Petitioner ☐ Respondent To: ☐ (Initials): ☐ Other (name): From: ☐ All children ☐ Petitioner ☐ Respondent To: ☐ (Initials): ☐ Other (name): From: ☐ All children ☐ Petitioner ☐ Respondent To: ☐ (Initials): ☐ Other (name): From: ☐ All children ☐ Petitioner ☐ Respondent To: ☐ (Initials): ☐ Other (name): 2. Other people with a legal right to spend time with the children Do you know of anyone besides yourself and Respondent who has or claims to have a legal right to spend time with the children? ☐ No. ☐ Yes. (Name/s) has or claims to have a legal right to spend time with the children because: 3. Authority over the children (Jurisdiction) (RCW 26.27.201 – .221, .231, .261, .271) The court can make an order protecting the children because: RCW 7.105.100, Petition for Protection Order 26.27.201-.291 Attachment C: Child Custody (1/2023) p. 1 of 2 PO 001 ☐ Exclusive, continuing jurisdiction – A Washington court has already made a custody order or parenting plan for the children, and the court still has authority to make other orders for the children. ☐ Home state jurisdiction – Washington is the child’s home state because (check all that apply): ☐ The children lived in Washington with a parent or someone acting as a parent for at least the 6 months just before this case was filed, or if a child is less than 6 months old, the child has lived in Washington with a parent or someone acting as a parent since birth. ☐ There were times the children were not in Washington in the 6 months just before this case was filed (or since birth if a child is less than 6 months old), but those were temporary absences. ☐ The children do not live in Washington right now, but Washington was the children’s home state sometime in the 6 months just before this case was filed, and a parent or someone acting as a parent of the children still lives in Washington. ☐ The children do not have another home state. ☐ No home state or home state declined – No court of any other state (or tribe) has the jurisdiction to make decisions for the children or a court in the children’s home state (or tribe) decided it is better to have this case in Washington and: The children and a parent or someone acting as a parent have ties to Washington beyond just living here; and There is a lot of information (substantial evidence) about the children’s care, protection, education, and relationships in this state. ☐ Other state declined – The courts in other states (or tribes) that might be the children’s home state have refused to take this case because it is better to have this case in Washington. ☐ Temporary emergency jurisdiction – The court can make decisions for the children because the children are in this state now and were abandoned here or need emergency protection because the children (or their parent, brother, or sister) were abused or threatened with abuse. (Check one): ☐ A custody case involving the children was filed in the children’s home state (name of state or tribe): . Washington should take temporary emergency jurisdiction over the children until the Petitioner can get a court order from the children’s home state (or tribe). ☐ There is no valid custody order or open custody case in the children’s home