All Courts in Arizona/NCIC#/DPS# Plaintiff v. Address City, Arizona Zip Code Telephone Number REQUEST: [ ] HEARING [ ] DISMISS ORDER [ ] CANCEL HEARING AND ORDER Case No. OP/ IAH/ IAWH Issue Date: ___/___/_____ (mm/dd/ccyy) Defendant [ ] Defendant requests: [ ] a hearing. [ ] that the Court cancel the hearing requested by the defendant in this case. [ ] that the Court continue the scheduled hearing on ___/___/_____ (Date). If the Plaintiff is:  a current or former spouse, or  someone with whom you live/lived, or  the child of an intimate partner, or  a parent of your child AND the Order remains in effect or is changed after the hearing, You will be prohibited from possessing or purchasing firearms or ammunition until the Order expires one year after the service of the original Order. By making this request, if you fail to appear for the hearing, the prohibition against you possessing or purchasing firearms or ammunition will apply. [ ] Plaintiff requests: [ ] the protective order listed above be dismissed. [ ] that the Court cancel the hearing set prior to the issuance of the protective order in this case. [ ] that the Court continue the scheduled hearing on ___/___/_____ (Date). List the reasons for your request: Date Requesting Person's Signature Address and telephone number if Defendant is the requesting party. CERTIFICATE OF TRANSMITTAL Copy mailed/delivered to [ ] Plaintiff [ ] Defendant on ___/___/_____ by Effective: December 2008 Page 1 of 1 Adopted by Administrative Directive No. 2008-04 American LegalNet, Inc. www.FormsWorkFlow.com