RESPONDENT=S IDENTIFYING FACT SHEET Complete the Following Information Regarding the Respondent. In order to have this order placed in the National Crime Information Center Registry and the Protective Order Registry of this state, in addition to the Respondent=s name, at least one of these three items MUST be listed. 1. Social Security Number; or 2. Date of Birth; Respondent=s Name 1. Social Security Number 2. Date of Birth Gender 3. Driver=s License # & State: Eye Color: Race: [ ] Male [ ] Blue [ ] Caucasian [ ] Female [ ] Brown [ ] African American [ ] Green [ ] Hispanic [ ] Light skinned [ ] Gray [ ] Hazel [ ] Dark Skinned [ ] American Indian/Alaskan [ ] Multi Racial [ ] Asian/Pacific Islander Color Hair Height Weight License Tag of Vehicle Usually Driven Make & Model of Vehicle(s) Usually Driven Color Vehicle Home Address: City, State & Zip Home Phone Work Phone Name of Employer Address of Employer Cell Phone Normal Work Hrs. Normal Work Days Best Time & Location to Serve Weapons Possessed & Usual Locations Distinguishing scars, tattoos, etc. Q:\MAGFORMS\MAG 60-10 Respondent=s & Petitioner=s Identifying Info American LegalNet, Inc. www.FormsWorkflow.com PETITIONER=S IDENTIFYING INFORMATION List the Names of All Protected Parties, Petitioner & Petitioner=s children who are under the age of 18 years NAME OF PROTECTED PARTY Race: For data entry, please use one of these racial categories: DOB SEX Race (See below) C, Caucasian; AA, African American; H, Hispanic A, Asian AI, American Indian; MR, Multi Racial; PI, Pacific Islander Q:\MAGFORMS\MAG 60-10 Respondent=s & Petitioner=s Identifying Info American LegalNet, Inc. www.FormsWorkflow.com