IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT ) ) Case No. F) ) ) ) ) CI PETITIONER (protected person), Birthdate: M Petitioner is a child. Who is signing for the child? Birthdate: Name: Relationship to child: PETITIONER (protected person), Birthdate: M ) ) Case No. F) ) ) ) ) CI Petitioner is a child. Who is signing for the child? Birthdate: Name: Relationship to child: PETITIONER (protected person), Birthdate: M ) ) Case No. F) ) ) ) ) CI Petitioner is a child. Who is signing for the child? Birthdate: Name: Relationship to child: PETITIONER (protected person), Birthdate: M ) ) Case No. F) ) ) ) ) CI Petitioner is a child. Who is signing for the child? Birthdate: Name: Relationship to child: PETITIONER (protected person), Birthdate: M ) ) Case No. F) ) ) ) ) CI Petitioner is a child. Who is signing for the child? Birthdate: Name: Relationship to child: v. RESPONDENT (restrained person), Birthdate M Respondent is a child. Who is signing for the child? Name: Birthdate: Relationship to child: ) ) ) ) F) ) ) ) ) ) PETITION FOR DOMESTIC VIOLENCE PROTECTIVE ORDER(S) (MULTIPLE PETITIONERS) This is Not a Court Order Page 1 of 8 DV-100-M (7/17)(cs) PETITION FOR DOMESTIC VIOLENCE PROTECTIVE ORDER(S) (MULTIPLE PETITIONERS) American LegalNet, Inc. www.FormsWorkFlow.com AS 18.66.100-.990 Civil Rule 65.1 1. TYPE OF ORDER. Select the type of order being requested. Select both the 20-day order and the long-term order if petitioners want a protective order for more than 20 days 20-day protective order A 20-day order can take effect immediately and without prior notice to the respondent. Did you notify respondent before filing this petition? yes no Describe your efforts, if any, to notify respondent before filing this petition: Long-term protective order A long-term order may be issued after notice to respondent and a court hearing, and will usually last for one year. 2. HOW ARE PETITIONERS AND RESPONDENT RELATED? (Check all that apply.) a. b. c. d. e. f. g. Married to each other now or in the past Child together Living together now or in the past (but not also dating or sexual relationship) Dating or sexual relationship now or in the past (but not also living together) Living together and dating or sexual relationship now or in the past Related by marriage now or in the past (such as in-laws) Other family relationship, respondent is petitioners' child or step-child parent step-parent grandchild grandparent first cousin uncle or aunt niece or nephew brother or sister other relative (describe) h. Petitioner is a child of a person in a relationship described in (a) through (g) above yes no 3. Are there children in petitioners' household? 4. DESCRIBE THE DOMESTIC VIOLENCE. Attach additional pages if necessary. a. Describe what happened, when it happened, where it happened, and whether children were involved. Please be specific. This is Not a Court Order Page 2 of 8 DV-100-M (7/17)(cs) PETITION FOR DOMESTIC VIOLENCE PROTECTIVE ORDER(S) (MULTIPLE PETITIONERS) American LegalNet, Inc. www.FormsWorkFlow.com AS 18.66.100-.990 Civil Rule 65.1 b. Was a weapon involved? yes no (If yes, describe.) c. Was anyone injured? yes no (If yes, describe.) d. Has respondent been involved in other instances of domestic violence with petitioners or anyone else? yes no (If yes, describe.) 5. PROTECTIONS REQUESTED. (Check all that apply.) a. Respondent not to threaten or commit acts of domestic violence, stalking, or harassment. b. Respondent not to telephone, contact, or communicate in any other way, directly or indirectly, with petitioners. Exceptions where it would be safe for the respondent to contact petitioners: no exceptions by email to through an attorney by telephone to through a third person (such as a grandparent) named other c. Respondent to leave and stay away from petitioners' residence at this street address: Check this box if you want to keep this address confidential. Does respondent live in this residence too? yes no Does respondent know this address? yes no This is Not a Court Order Page 3 of 8 DV-100-M (7/17)(cs) PETITION FOR DOMESTIC VIOLENCE PROTECTIVE ORDER(S) (MULTIPLE PETITIONERS) American LegalNet, Inc. www.FormsWorkFlow.com AS 18.66.100-.990 Civil Rule 65.1 d. Respondent to stay away from and not telephone or contact the following places that petitioner(s) or members of petitioners' household go to: Place Street Address Distance to Stay Away Petitioner's school ft. mi. Children's school ft. mi. Place of employment ft. mi. ft. mi. ft. mi. Exceptions: e. Respondent not to enter, follow, or interfere with the operation of any vehicle occupied by one or more petitioner or in petitioners' possession. f. Respondent not to possess or use controlled substances. temporary possession and use of and everything in it. (street address) g. Award the following, regardless of ownership: (1) Residence located at (2) Vehicle and all keys to it. License plate number Vehicle Description (3) Essential personal items (check all that apply): house keys garage door opener children's belongings mailbox keys clothes medicine children's medicine toiletries Medicare/Medicaid coupons food stamps pet(s) named birth certificates belonging to passports belonging to immigration documents belonging to ANCSA Corp. ID Tribal enrollment card Certificate of Indian blood other h. Respondent to pay spousal support to petitioner How much monthly spousal support is requested and why is support necessary? i. Respondent not to sell or dispose of any personal property of the petitioners, any property jointly held, or any disputed property. Other requests for short-term protection: j. This is Not a Court Order Page 4 of 8 DV-100-M (7/17)(cs) PETITION FOR DOMESTIC VIOLENCE PROTECTIVE ORDER(S) (MULTIPLE PETITIONERS) American LegalNet, Inc. www.FormsWorkFlow.com AS 18.66.100-.990 Civil Rule 65.1 6. LONG-TERM PROTECTIONS REQUESTED. In addition to the protections listed above, petitioners request that the following be included in the long-term protective order. Note that these requirements cannot be included in the 20-day order. (Check all that apply.) a. Respondent not to use or possess a deadly weapon, including a firearm. b. Respondent to surrender any firearm owned or possessed by respondent. c. Respondent to pay to fees petitioner(s) paid in bringing this action, in the amount of $ the costs and d. Respondent to pay petitioners or the person(s) named below for expenses associated with the domestic violence (such as medical