CIRCUIT COURT DISTRICT COURT OF MARYLAND FOR Court Address City/County Located at Case No. vs. Petitioner Respondent REQUEST TO SHIELD DENIED OR DISMISSED PEACE ORDER RECORDS (Courts and Judicial Proceedings § 3-1510(b)(1)) 1. On , a Petition for Peace Order was denied or dismissed at the Date Interim Temporary Final Peace Order stage of a proceeding and at least three (3) years have passed since the date of the denial or dismissal or a General Waiver and Release of all related tort claims is attached. 2. A Final Peace Order or Protective Order has not been previously issued against the Respondent in any proceeding between the Petitioner and Respondent. 3. The Respondent has not been found guilty of a crime arising from an act described in CJ § 3-1503(a) against the Petitioner. 4. At the time of the hearing, there is not an interim or temporary peace order or protective order pending against the Respondent in a proceeding between the Petitioner and Respondent. 5. At the time of the hearing, there are no criminal charges pending against this Respondent arising from an alleged act against the Petitioner, as described in CJ § 3-1503(a). 6. I request that the Court schedule a hearing and after the hearing order the shielding of all court records relating to the proceeding. Date Petitioner / Respondent Signature Address City, State, Zip Telephone Number CERTIFICATE OF SERVICE I certify that I served a copy of this Petition upon the following party or parties by class mail, postage prepaid hand delivery, on to: Date Name Name Address Address mailing first Date Signature of Party Serving OR I have filed the attached Motion for Service by Clerk. Date Signature CC-DC-PO-016A (Rev. 10/2014) American LegalNet, Inc. www.FormsWorkFlow.com