Rev. Dec 2016 dvmspr-p SUPERIOR COURT OF THE DISTRICT OF COLUMBIA Domestic Violence Unit, Room 4510 500 Indiana Avenue, N.W. Washington, D.C. 20001 Telephone (202) 879-0157 Case No.: Petitioner Hearing Type: v Hearing Date: Respondent RETURN OF SERVICE ADDRESS OF PETITIONER : Physical Description of Petitioner: Date of Birth: Hair Color: Age: Eye Color: Race: Height: Sex: Weight: TO: INSTRUCTIONS : PLACE YOUR INITIALS BESIDE EACH DOCUMENT SERVED AND COMPLETE EACH SECTION. Initial s Documents Serve d Initial s Documents Serve d Petition and Affidavit for a Civil Protection Order Temporary Protecti on Order Motion to Modify/Extend Civil Protection Order Motion to Adjudicate Contempt Notice of Hearing and Order to Appear Other: I personally served the above documents on Name of Person Served Petitioner or A person of suitable age and discretion who currently resides with Petitioner at : (please write full address where service was done or provide detailed description of location) on (date) at (time) a.m. / p.m. month, date, year I, reside / w ork at : (Please print full name of Server) (circle one) (Please write full address) a competent person eighteen years of age with no interest in the subject matter of this lawsuit, affirm under penalty of perjury that the information in this document is true and correct to the best of my knowledge, information and belief. Law Enforcement Officer222s Badge# OR CAD # Server222s Signature Date ( Person who served the documents) FAILURE TO COMPLETE THIS FORM IN ITS ENTIRETY COULD BE CONSIDERED INCOMPLETE SERVICE AND MAY DELAY YOUR CASE American LegalNet, Inc. www.FormsWorkFlow.com Rev. Dec 2016 dvmspr-p Petitioner 222s Name: Case No.: SPECIAL SERVICE INSTRUCTIONS Check the HEARING DATE: on the front upper left-hand corner of the face of this sheet; (DO NOT SERVE AFTER THIS DATE). The Case Number is on the front upper right hand corner. Personally Serve the SERVICE PACKET on PETITIONER named on the front by giving him/her attached documents; Personal service can be accomplished by serving a person of suitable age and discretion living at the petitioner222s address (see front of the form for other person; note relationship and age of the individual served and whether the person served resides at the address with the Petitioner). Indicate Service at the bottom of this sheet by signing as SERVING OFFICER and BADGE NUMBER; Return signed cover sheet to your Supervisor , who shall sign in the space designated on the front and deliver this cover sheet to the CJIS CLERK or the STATION CLERK in your District for Deliver to: DC SUPERIOR COURT, Domestic Violence Unit, Room 4510. FAILURE OF SERVICE I hereby certify that after a diligent investigation, I am unable to serve the individual named as the Petitioner on this Service Packet. Dates of Endeavor : Time : Investigator222s Signature: Badge #: Date: Supervisor222s Signature: Badge #: Date: American LegalNet, Inc. www.FormsWorkFlow.com Rev. Dec 2016 dvmspr-p METROPOLITAN POLICE DEPARTMENT CPO/TPO UNIT PETITIONER DESCRIPTION SHEET Respondent 222s Name: Case No.: If you would like MPD to serve your order, please complete as much information as known. If unknown please write UNKNOWN. If not applicable, please write N/A. Petitioner 222s Information Petitioner222s Name: Nickname / Alias: Date of Birth: Social Security #: Sex: Race: Complexion: Height: Weight: Hair Style/Color: Eye Color: Primary Language: Scars/Tattoo or other unique features: Home or Primary Address: Apt. #: Apartment Complex or Community: City: State: Zip Code: Home Phone #: Cell Phone #: Best time to serve P etitioner at home or work ? a m / pm Other locations or hangouts for Petitioner : Work Address: Name of Business: Occupation: Work Phone #: Days Off: Vehicle Information: Make: Model: Color: Tag #: Weapons: If P etitioner is known to carry weapons, please describe: Type: (firearm / knife) Model: Color: Location of where weapon is kept: ( On Person / Inside Vehicle / Inside House ) (circle) CONFIDENTIAL RESPONDENT INFORMATION: THIS INFORMATION IS FOR MPD USE ONLY!!! MPD CPO/TPO Unit will only contact you in the event that additional information is required to serve, i.e., information or questions not on this sheet. Respondent 222s contact numbers: Home (No message will be left) Work ( No message will be left) Cell (Is message ok? Yes No) Alternate Contact Person Name: Number: Advocate222s Name: Number: THIS INFORMATION WILL REMAIN CONFIDENTIAL AT ALL TIMES Clerk222s Office Box: Bench Warrant on file? Yes No PDID: Photo Available Yes No Was an Alternative Service Package Given to Petitioner? Yes No American LegalNet, Inc. www.FormsWorkFlow.com