Print Form 0012 Petition for Stalking No Contact Order Clear Form (7/23/10) CCG 0812 A IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS People ex rel. _________________________________________________________ _____________________________________________________ on behalf of ________________________________________________ self and/or on behalf of ______________________________________________________________ Petitioner v. Case No. _______________________________________ Independent Proceeding Criminal Proceeding Juvenile Proceeding ______________________________________________________________ Respondent PETITION FOR STALKING NO CONTACT ORDER Emergency Plenary Now comes the Petitioner ________________________________________________________________ on his/her own behalf or on behalf of _____________________________________________________________________, a minor child, or on behalf of __________________________ ____________________________________________________ , an adult who cannot file a petition because of age, health, disability or inaccessibility on his/her own behalf, pursuant to the Stalking No Contact Order Act and moves this Honorable Court to issue a Stalking No Contact Order in this cause and in support thereof states as follows: ALLEGATIONS PETITIONER INFORMATION Disclosure of the Petitioner’s address would risk abuse to the Petitioner or family or household. The address listed is Petitioner’s alternative address for service of Notice. NAME ____________________________________________________________________________________________________________ ADDRESS CITY _______________________________________________________________________________________________________________ ______________________________________________ STATE ________________________________ ZIP ______________________ RESPONDENT INFORMATION NAME ____________________________________________________________________________________________________________ ADDRESS CITY DOB _______________________________________________________________________________________________________________ ______________________________________________ _______ /_______ /_______ SEX DISTINGUISHING CHARACTERISTICS MALE STATE FEMALE ________________________________ RACE ______________________ HEIGHT ZIP ______________________ __________ WEIGHT__________ ________________________________________________________________________________________ RESPONDENT EMPLOYMENT INFORMATION: WORKS AT ADDRESS _________________________________________________________________________________________________________________ ___________________________________________________CITY ______________________ STATE _______________ ZIP __________ PETITIONER ALLEGES AS TO RESPONDENT THAT: The following individuals are alleged to be persons who need to be protected from stalking by Respondent: _______________________________________________________________________________________________________________________ Respondent has acted in the following manner towards the Petitioner: [State details of incident(s) of stalking (including time and place), as well as effects of incident on Petitioner.] First Incident Date:________________________ Time: ____________ a.m/p.m. Location: _________________________________________________ _______________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ Description: DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS (7/23/10) CCG 0812 B [State details of incident(s) of stalking (including time and place), as well as effects of incident on Petitioner, continued] Second Incident Date:_______________________ Time: ____________ a.m/p.m. Location: _________________________________________________ _______________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ Additional Incident(s) Date:_______________________ Time: ____________ a.m/p.m. Location: ____________________________________________ Description: _______________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ Police report not made Police report made Police report No. _________________________ Description: REMEDIES REQUESTED PETITIONER REQUESTS THAT THE COURT FIND THAT THE FOLLOWING ARE PROTECTED PERSONS: _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ WHEREFORE, PETITIONER REQUESTS THE ENTRY OF A STALKING NO CONTACT ORDER SETTING FORTH THE FOLLOWING REMEDIES: (b) (1) The Respondent is prohibited from threatening to commit stalking or committing stalking. _____________________________________________________. The Respondent is prohibited from knowingly coming within, or knowingly remaining within, __________ feet of Petitioner’s residence school day care place of employment or _________________________________________________________________________________ Said addresses are:__________________________________________________________________________________________________ (b) (2) The Respondent is prohibited from having any contact with Petitioner and/or (b) (3) ________________________________________________________________________________________________________________ (b) (3) (Actual notice to Respondent required) The Respondent is prohibited from remaining at Respondent’s own residence school _______________________________________________________________________________ ________________________________________________________________________________________________________________ place of employment. Said addresses are: (b) (4) The Respondent is prohibited from possessing a Firearm Owner’s Identification Card or possessing or buying firearms. _____________________________________________________________________________ ________________________________________________________________________________________________________________ (b) (5) The following other injunctive relief is granted: (c) That the Respondent be ordered to pay the Petitioner’s costs, including attorney fees. (Remedy available only if Stalking No Contact Order is granted) _________________________________________________________ ______________________________________________________ Signature of Attorney or State’s Attorney Signature of Petitioner UNDER PENALTIES OF PERJURY AND AS PROVIDED BY LAW PURSUANT TO SECTION 1-109 OF THE CODE OF CIVIL PROCEDURE, THE UNDERSIGNED CERTIFIES THAT THE STATEMENTS SET FORTH IN THIS INSTRUMENT ARE TRUE AND CORRECT, EXCEPT AS TO MATTERS STATED TO BE ON INFORMATION AND BELIEF, AND AS TO SUCH MATTERS THE UNDERSIGNED BELIEVES THE SAME TO BE TRUE. Date: _____________________________________, ___________ Signature of Petitioner___________________________________________________ Atty. No. ___________________ Pro Se 99500 __________________________________ Address: _______________________________________________________ State/City/Zip: __________________________________________________ Telephone: (__________) _________________________________________ Attorney (or Pro Se Petitioner) Name: An initial knowing violation of a Stalking No Contact Order is A Class A Misdemeanor. Any second or subsequent knowing violation is a Class 4 Felony. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS