CONFIDENTIAL LAW ENFORCEMENT INFORMATION SHEET Notice to Petitioner: You must supply the respondent's name and birth date, if known. Give as much information as possible. This information will NOT be given to the respondent. Notice to Law Enforcement: This information is confidential and supplied to assist you in serving the protective order. After serving (or failing to serve) the order, notify petitioner and complete the return of service section on the DV-125. A. PETITIONER INFORMATION Full name: Date of birth: Petitioner's residence address: Yes Is this the address respondent is to stay away from? Yes Do you want to be notified when respondent is served? work Contact phone(s): home B. RESPONDENT INFORMATION Full name: Nicknames: Residence Address: Yes Is this the address respondent is to stay away from? Other Addresses: work Contact phone(s): home Where is respondent now (what street address)? Petitioner is a child. No No cell msg Respondent is a child. No Last four digits of SSN cell msg Other information about respondent: Sex Race Eyes *Date of Birth* HT WT ST Friends / relatives / phone numbers / hangouts: Hair State ID / Driver's Lic. # Other Identifiers (facial hair, piercings, scars, tattoos, marks, etc.) Hazards at respondent's home (dogs, traps, guns): Describe respondent's house: 1 story 2 story Garage: separate Respondent's employer Employer address log 3+ story attached frame apartment single family main color trim color none 4x4 needed to access address? Respondent's vehicle information Model Make State Plate No. Year van pickup canopy toolbox car 2 door SUV other duplex Y N Work phone Work hours Respondent's position Supervisor C. OFFICER SAFETY INFORMATION Previous contact with police by respondent? No camper 4 door Other vehicles respondent is known to drive: Yes Explain: Any threats by respondent toward petitioner, family, police? Describe: Weapons accessible to respondent (pistol, rifle, knife, other): Expected mental state or history of respondent (include alcohol or drug use): Is a divorce or other legal action pending that involves the respondent (child custody, eviction, bankruptcy, repossession of property)? Draw a map on the back of this form if it will help law enforcement. DV-127 (5/10)(cs) CONFIDENTIAL LAW ENFORCEMENT INFORMATION SHEET (DOMESTIC VIOLENCE OR STALKING) Civil Rule 65.1 American LegalNet, Inc. www.FormsWorkFlow.com