Petition for ex Parte temPorary restraining order and for injunction against Harassment; declaration of Petitioner; temPorary restraining order against Harassment; and notice of Hearing in tHe district court of tHe tHird circuit division state of Hawai`i Petitioner(s) Form# 3DC51 Reserved for Court Use Civil No. Respondent(s) (if known, list Address, Telephone, DOB and SSN for each respondent) Petitioner(s)/Petitioner(s)' Attorney (Name, Attorney Number, Firm Name (if applicable), Address, Telephone and Facsimile Numbers) petition for ex parte temporary restraining order and for injunction against harassment This Petition is made pursuant to Hawai`i Revised Statutes section §604-10.5 and the following statement: 1. The Petitioner(s) is a resident(s) of the Division of the above District and Circuit, State of Hawai`i. 2. Based upon the attached Declaration of Petitioner(s), Petitioner(s) ask(s) for a. An ex parte temporary restraining order not to exceed a period of ninety (90) days for protection enjoining Respondent(s) and any other person(s) acting on Respondent(s)' behalf from: contacting, threatening, or physically harming Petitioner(s) Any person(s) residing at Petitioner(s) residence telephoning the Petitioner(s) entering or visiting Petitioner(s)' residence, including yard and garage and place of employment. b. An order of an Injunction not to exceed a period of three (3) years, enjoining Respondent(s) and any other person(s) acting on Respondent(s)' behalf from committing those acts set forth in paragraph 2a. hereof. c. An order prohibiting Respondent(s) from owning or possessing firearm(s) and/or ammunition. d. An order awarding reasonable attorney's fees and costs to Petitioner(s) and such further relief as the Court deems just and appropriate. Signature of Petitioner(s): Date: tro Print/Type Name(s): I certify that this is a full, true and correct copy of the original on file in this office. ______________________________________________________ Clerk, District Court of the Above Circuit, State of Hawai`i Reprographics (07/11) Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com 3d-P-250 page 2 of 3 declaration of petitioner(s) Petitioner(s) states the following is true: Recent or past act(s) of harassment occurred; and/or Threats of harassment make it probable that acts of harassment may occur soon. Respondent(s) own; possess, or intend to obtain or possess firearm(s) and or ammunition that may be used to threaten or injure Petitioner(s). Describe the firearm(s)/ammunition: ______________________________________________________________________ . Location of the firearm(s)/ammunition: ____________________________________________________________________ . Date last seen: ________________ . Street address/specific location where last seen: ___________________________________________________________________ . (Explain in detail recent or past acts or threats of harassment, using additional sheets, if necessary. Please include dates of events.) Unless Respondent(s)' wrongful conduct is stopped or prevented by order of the Court, Petitioner(s) will suffer substantial emotional distress. I have read the Petition and Declaration, know their contents, and verify that the statements contained therein are true to my personal knowledge and belief. i declare under penalty of perjury under the laWs of the state of haWai`i that the facts and circumstances stated in the petition and declaration are true and correct. Signature of Petitioner(s): Date: Reprographics (07/11) Print/Type Name: Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com 3d-P-250 page 3 of 3 temporary restraining order against harassment (reserved for Court use only) Based upon the attached Petition for Ex Parte Temporary Restraining Order and Declaration of Petitioner(s) and pursuant to hawai`i revised statutes §604-10.5, the Court finds there is probable cause to believe: Recent or past acts of harassment by Respondent(s) have occurred. Threats of harassment by Respondent(s) make it probable that acts of harassment may be imminent against Petitioner(s). It appears to the Court that a Temporary Restraining Order should be granted and is necessary to prevent acts of harassment. Accordingly, IT IS ORDERED that Respondent(s) shall appear before the Judge in the above-entitled proceeding at the date, time and place indicated in the Notice of Hearing below. Pending the hearing on this Petition, Respondent(s) is/are ordered as follows: to the respondent: you and anyone acting on your Behalf are ordered as folloWs: Do not contact, threaten, or physically harass Petitioner(s) and any person(s) residing at Petitioner(s) residence Do not telephone Petitioner(s) Do not enter or visit Petitioner(s)' residence, including yard and garage, and place of employment pursuant to haWai`i reVised statutes §134-7, you shall not possess or control any firearm(s) and/or ammunition for the duration of this temporary restraining order. you shall immediately turn over for safekeeping all firearms and/or ammunition in your possession and control to the hawai`i county police department (any District Police Station in Hawai`i County), for the duration of this order or any extension thereof. this order becomes effective upon its signing and filing and shall remain in effect for fifteen (15) days, unless extended or terminated by the court. any KnoWing or intentional Violation of this temporary restraining order against harassment is a misdemeanor punishaBle By a jail sentence of up to one year and/or up to a $2,000 fine. a sentence of 48 hours jail for a second conViction and 30 days jail for any suBseQuent conViction(s) is mandatory. [haWai`i reVised statutes §604-10.5, §706-663 and §706-640]. Date: TO Judge of the above-entitled Court notice of hearing _________________________________________________________________________ __________________________________________________________________________________________________________________ NOTICE IS GIVEN that the Petitioner(s) above named has/have filed the foregoing Petition for Ex Parte Temporary Restraining Order and for Injunction Against Harassment. YOU ARE COMMANDED to appear before the Presiding Judge of the above-entitled Court, the District Court of the above Circuit. at _____________________________________________________________________________________________________________, on ____________________________________________________________________________ , 20 _____ a