IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT ) ) ) ) ) ) ) ) ) ) Petitioner v. Date of Birth Male Female CASE NO. PETITION FOR PROTECTIVE ORDER Stalking Sexual Assault Respondent Date of Birth Male Female I swear or affirm under penalty of perjury that all the information I provide in this petition is true to the best of my knowledge and belief. I am requesting the following protective order(s). NOTE: If there is any chance you might need protection for more than 20 days, you should request both a longterm order (6 months) and an ex parte order (20-day). To do this, check both boxes. 1. an ex parte protective order (20 day order). (This order can take effect immediately based on only the petition and the petitioner's testimony, without the respondent knowing about the ex parte petition. The police will serve the ex parte order if granted.) I certify that I have not tried to notify the respondent that I am filing this petition. notified or tried to notify the respondent as follows: a long-term protective order (6 month order). (This order can only be issued after notice to the respondent and a court hearing. This order will last for 6 months, unless the court ends it sooner. The police will notify the respondent of the hearing.) 2. The respondent is a (check all that apply): (former) friend neighbor classmate other (describe): co-worker client or former client legal guardian of petitioner correctional facility employee I do not know and have never been acquainted with the respondent 3. I (petitioner) am a minor: Age ________ an adult This is Not a Court Order Page 1 of 5 CIV-752 (10/13)(cs) PETITION FOR STALKING OR SEXUAL ASSAULT PROTECTIVE ORDER AS 18.65.850-.870 Civil Rule 65.1 American LegalNet, Inc. www.FormsWorkFlow.com v. Case No. 4. The respondent is (or appears to be) a minor: Age an adult 5. a. Respondent has stalked or sexually assaulted me as described below and this conduct has placed me in fear of: death or physical injury to me Name of family member: Relationship to me: b. I am afraid of physical injury or death, or further sexual assault, because further sexual assault the death or physical injury of the following family member of mine: 6. Description of respondent's conduct. (Explain what respondent is doing or did, including when, where and how often the stalking or sexual assault occurred. Be specific. Include dates and places.) This is Not a Court Order Page 2 of 5 CIV-752 (10/13)(cs) PETITION FOR STALKING OR SEXUAL ASSAULT PROTECTIVE ORDER AS 18.65.850-.870 Civil Rule 65.1 American LegalNet, Inc. www.FormsWorkFlow.com v. Case No. 7. I request an order from the court directing (check all that apply) a. respondent not to follow, approach, confront, watch or stalk me in any other way or threaten to do so. b. respondent not to contact me by telephone, e-mail or U.S. mail or otherwise communicate directly or indirectly by any means with me or the following members of my household: c. respondent to stay away from my residence. Is this also respondent's current residence? Respondent's residence is approximately Describe: d. respondent to stay away from my school. Name and location of school: Is this also respondent's school? yes unknown to me within my apartment complex yes no feet/miles from my residence no e. respondent to stay away from my place of employment. Name and location of place of employment: Is this also respondent's place of employment? If yes, list the hours respondent works (if known) f. respondent to stay away from the following places I go to: yes no g. respondent not to have sexual contact with me. You do not have to provide this information if you do not want the respondent to know the location of your school or place of employment. This is Not a Court Order Page 3 of 5 CIV-752 (10/13)(cs) PETITION FOR STALKING OR SEXUAL ASSAULT PROTECTIVE ORDER AS 18.65.850-.870 Civil Rule 65.1 American LegalNet, Inc. www.FormsWorkFlow.com v. Case No. 8. Other cases. The following are all the pending civil cases or criminal cases, in this or another state, involving either me or respondent (that I know of): Type of Case Court Location Petitioner or Respondent The following are other court cases (civil or criminal) involving the respondent that I want the court to know about: Type of Case Court Location Both petitioner and respondent have the responsibility to tell the court of any criminal or civil lawsuits involving either of you that arise while a petition for protective order is pending. AS 18.65.865(d) 9. Information about respondent (if known). Respondent's full legal name and any nicknames or other names used: Respondent's mailing address: Respondent's home phone: Work phone: This is Not a Court Order Page 4 of 5 CIV-752 (10/13)(cs) PETITION FOR STALKING OR SEXUAL ASSAULT PROTECTIVE ORDER AS 18.65.850-.870 Civil Rule 65.1 American LegalNet, Inc. www.FormsWorkFlow.com v. Case No. 10. Petitioner information. [The court needs your mailing address to send court papers, including notices of hearing, to you. If you believe it is not safe for the respondent to know where you live, write a "message" address where you can be sure you will receive court papers. If you do not have an address and telephone number that can safely be revealed to the respondent, ask the court clerk how you can provide this information so that it will be kept confidential and not revealed to the respondent. Civil Rule 65.1] My mailing/message address Street or Box No. My message phone: My full legal name: Any nicknames or other names: City State Zip Date Petitioner's Signature Print Name Subscribed and sworn to or affirmed before me at . (date) , Alaska on (SEAL) Clerk of Court, Notary Public or other person authorized to administer oaths My commission expires: This is Not a Court Order Page 5 of 5 CIV-752 (10/13)(cs) PETITION FOR STALKING OR SEXUAL ASSAULT PROTECTIVE ORDER AS 18.65.850-.870 Civil Rule 65.1 American LegalNet, Inc. www.FormsWorkFlow.com