IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT ) ) F) ) ) ) ) PETITIONER (protected person), Birthdate: M Petitioner is a child. Who is signing for the child? Name: Birthdate: Relationship to child: v. RESPONDENT (restrained person), Birthdate: M Respondent is a child. Who is signing for the child? Name: Birthdate: Relationship to child: ) ) Case No. CI ) F) REQUEST FOR SERVICE AND ) PEACE OFFICER'S RETURN OF ) SERVICE (ONE PETITIONER) ) Court Date: ) Court Fax ) and Please immediately serve the following documents on respondent The next court hearing is scheduled for Petition for Domestic Violence Protective Order(s) Emergency Protective Order (72 hours) 20-Day Ex Parte Protective Order Long-Term Domestic Violence Protective Order Stalking Order (20 days) Reassignment Order Order Extending Ex Parte Protective Order Order on Petition for Protective Order(s) Notice of Hearing Stalking Order (6 months) A return of service must be filed with or faxed to the court at the number shown above before the hearing. RETURN OF SERVICE I certify that I: Served the document(s) listed above on respondent and by handing to, and leaving a true and correct copy with him (address) in , Alaska, on (date) Turned custody of the minor child(ren) , them, personally, at at .m. over to her Removed respondent from petitioner's residence located at Explained direct / indirect contact and communication to the person(s) served. Explained effective dates of the protective order (section B) to the person(s) served. Entered into DV Registry by DSN Did not serve the above-listed documents on the respondent named above because Return Date Signature Time Spent Print Name and Title Distribution: 1. Original to law enforcement agency with jurisdiction where respondent is located. 2. Copy to court file. DV-125 (4/12)(cs) REQUEST FOR SERVICE AND PEACE OFFICER'S RETURN OF SERVICE (ONE PETITIONER) American LegalNet, Inc. www.FormsWorkFlow.com