0008 Petition for Civil No Contact Order 3601 Petition for Temporary Civil No Contact Order IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Case No. himself/herself and/or on behalf of Petitioner (02/17/16) CCG N807 A Independent Proceeding Criminal Proceeding Delinquency Petition v. Respondent PETITION FOR CIVIL NO CONTACT ORDER Emergency Plenary (Fill in lines and check boxes as applicable) Now comes the Petitioner _____________________________________ on his/her own behalf or on behalf of ______________________________, a minor child or on behalf of __________________________________, an adult who cannot file a Petition because of age, health, disability or inaccessibility on his/her own behalf, pursuant to the Civil No Contact Order Act and moves this Honorable Court to issue a Civil No Contact Order in this cause and in support thereof states as follows: Petitioner Information The address listed below is the Petitioner's residence. Disclosure of the Petitioner's address would risk abuse of the Petitioner or any member of the Petitioner's family; therefore, the address listed below is the Petitioner's alternative address for service of Notice and is not Petitioner's resident address. Name: Address: City: ______________________________________________________ State: ____ Respondent Information Name: Address: City: ______________________________________________________ State: ____ Year of Birth: _______ Sex: Male Female Race: ______________ Distinguishing characteristics: Respondent Employment Information Works at: Address: City: ______________________________________________________ State: ____ Petitioner alleges as to respondent that: The following individuals are alleged to be persons who need to be protected from stalking by Respondent (If minor child, list only intitials): Respondent has committed the following acts, which contitute non-consensual/sexual conduct, or non-consensual/sexual penetration [State details of incident(s) of abuse (including time and place), as well as effects of incident(s) on Petitioner.] Incident(s): DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 1 of 2 Zip Code: __________ Zip Code: __________ Weight: _____ Height: _____ Zip Code: __________ 0008 Petition for Civil No Contact Order 3601 Petition for Temporary Civil No Contact Order (02/17/16) CCG N807 B Police report not made Police report made Police Report no.: ____________________ For Emergency Petitions Only: The harm will be likely to occur if the Respondent were given any prior notice, or greater notice than was actually given, of the Petitioner's efforts to obtain judicial relief. Remedies Requested Petitioner requests that the court find that the following are protected persons: Wherefore, Petitioner requests the entry of a Civil No Contact Order setting forth the following remedies: 1. 2. 3. 4. The Respondent is to stay away from the Petitioner. "Stay away" means for the Respondent to refrain from both physical presence and nonphysical contact with the Petitioner whether direct, indirect (including, but not limited to, telephone calls, mail, email, faxes, and written notes), or through third parties who may or may not know about the Order of Protection. The Respondent is to stay away from any other person protected under a Civil No Contact Order entered in this matter. The Respondent is prohibited from physical abuse, harassment, intimidation of a dependent, interference with personal liberty, or stalking any person protected under a Civil No Contact Order entered in this matter. The Respondent is prohibited from entering or remaining present at the school and/or place of employment of any person protected under a Civil No Contact Order entered in this matter Signature of Attorney or State's Attorney Signature of Petitioner Under the penalties of perjury and as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct, except as to matters stated to be on information and belief and as to such matters the undersigned believes the same to be true. Date: ______________ Atty. No.: ________________ Name: Atty for: Address: City: ______________________ Primary Email: Secondary Email: Tertiary Email: Any knowing violation of a Civil No Contact Order is a Class A misdemeanor. Any second or subsequent violation is a Class 4 Felony. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 2 of 2 Pro Se 99500 Signature of Petitioner State: ____ Zip: ________ Telephone: ________________________