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 TO MODIFY OR ) DISSOLVE PROTECTIVE ORDER ) (ONE PETITIONER) Note: This request does not, by itself, change the terms of the protective order. All parties must continue to obey the existing order until a judge modifies or dissolves the order in writing. If you fail to appear for a hearing about this request, your request may be denied. I am the petitioner respondent in this case. I ask the court to: dissolve the short-term protective order and withdraw any long-term petition in this case. dissolve the long-term protective order issued in this case. modify the short-term long-term protective order issued in this case as follows: The reason(s) for this request are: Other Party's Telephone Numbers (if known): Home Date Work Signature A mailing address and message phone number are necessary for contacting you about the hearing. Victims are not required to disclose their personal addresses or phone numbers. A safe alternative way to contact you on short notice must be given to the court. Safe Mailing Address Work Phone: I certify that on Petitioner Respondent Clerk: City Home Phone: State ZIP a copy of this request was given mailed to: Person signing for minor petitioner Person signing for minor respondent Clerk: For requests to modify or dissolve ST, add petition MDMPOE. For requests to modify or dissolve LT, add petition MDMPOL. DV-135 (8/14)(cs) Civ. R. 65.1, AS 18.66.100 - .990; 18.65.850-.870 REQUEST TO MODIFY OR DISSOLVE PROTECTIVE ORDER (ONE PETITIONER) American LegalNet, Inc. www.FormsWorkFlow.com