SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY Downtown Superior Court, 201 W. Jefferson, Phoenix, AZ 85003 Southeast Adult Court, 222 E. Javelina, First Floor, Mesa, AZ 85210 Northeast Regional Court Center, 18380 N. 40th St., Phoenix, AZ 85032 Northwest Regional Court Center, 14264 W. Tierra Buena Lane, Surprise, AZ 85374 All Courts in Arizona/NCIC#/ AZ007035J FOR CLERK’S USE ONLY DPS# 0700 Case No. Plaintiff / Plaintiff Employer (Work Injunction ONLY) Birth Date: Defendant [ ] Order of Protection [ ] Injunction Against Harassment [ ] Workplace Injunction Address Agent’s Name (Work Injunction ONLY) PETITION for City, State, Zip Code, Phone DIRECTIONS: Please read the Plaintiff’s Guide Sheet before filling out this form. 1. Defendant/Plaintiff Relationship: [ ] Married now or in the past [ ] Live together now or lived together in the past [ ] Child in common [ ] One of us pregnant by the other [ ] Related (Parent, In-law, Brother, Sister or Grandparent) [ ] Romantic or sexual relationship (current or previous) [ ] Dating but not a romantic or sexual relationship [ ] Other: 2. [ ] If checked, there is a pending action involving maternity, paternity, annulment, legal separation, dissolution, custody, parenting time or support in (COUNTY) Superior Court, Case #: . 3. Have you or the Defendant been charged or arrested for domestic violence OR requested a Protective Order? [ ] Yes [ ] No [ ] Not sure If yes or not sure, explain: 4. I need a Court Order because: (Explain below. PRINT both the date(s) and briefly describe what happened): Date(s) Describe what happened (Attach additional paper if necessary – Do not write on back) DVOP15f Superior Court of Arizona in Maricopa County Effective: September 30, 2009 Page 1 of 2 Adopted by Administrative Directive No. 2009-26 American LegalNet, Inc. www.FormsWorkFlow.com Case No. ____________________ 5. The following persons should also be on this Order. As stated in number 4, the Defendant is a danger to them: ___/___/_____ Name ___/___/_____ Birth Date Name ___/___/_____ Name Birth Date ___/___/_____ Birth Date Name Birth Date 6. Defendant should be ordered to stay away from these locations, at all times, even when I am not present: [ ] Home [ ] Work [ ] School/Others 7. [ ] If checked, because of the risk of harm, order the defendant NOT to possess firearms or ammunition. 8. [ ] If checked, request an order for the Defendant to participate in domestic violence counseling or other counseling. 9. Other: Under penalty of perjury, I swear or affirm the above statements are true to the best of my knowledge, and I request an Order / Injunction granting relief as allowed by law. Plaintiff Attest: Judicial Officer/ Clerk / Notary DVOP15f Superior Court of Arizona in Maricopa County Effective: September 30, 2009 ___/___/_____ Date Page 1 of 2 Adopted by Administrative Directive No. 2009-26 American LegalNet, Inc. www.FormsWorkFlow.com