Print Form Petition: 4 of 5 Pages W(1). W(2). X. Clear Form (11/29/06) CCG N800 D There is a threat to the safety and well-being of Petitioner's family or household when Respondent enters or remains on the premises while under the influence of alcohol or drugs. Respondent should be ordered to surrender any and all firearms to the local law enforcement agency. If Respondent is a law enforcement officer, any and all firearms must be surrendered to Respondent's employer. Respondent should be denied access to school or other records of the minor child/ren because: Respondent is or will be prohibited from having contact with the minor child/ren; or Petitioner's address is omitted pursuant to statute; or it is necessary to prevent abuse or wrongful removal or concealment of the minor child/ren. Y. Allegations for other injunctive relief: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Z. Disclosure of Petitioner's address would risk further abuse to her/him or to another protected person, or such disclosure would reveal the confidential location of a shelter for domestic violence victims. Additional Allegations for Emergency Orders Only (i) For requested remedies 1, 3, 5, 7, 8, 9, 11, 14, 15, and 17, the harm which that remedy is intended to prevent would be likely to occur if Respondent were given any prior notice, or greater notice than was actually given of Petitioner's efforts to obtain judicial relief. (ii) For requested remedy 2, the immediate danger of further abuse of Petitioner by Respondent if Petitioner chose or had chosen to remain in the household while Respondent was given any prior notice or greater notice than was actually given, outweighs the hardship to Respondent of an emergency order granting Petitioner exclusive possession of the residence or household. (iii) For requested remedy 10, improper disposition of the personal property would be likely to occur if Respondent were given any prior notice or greater notice than was actually given of Petitioner's effort to obtain judicial relief, or that Petitioner has an immediate and pressing need for possession of that property. REMEDIES REQUESTED PETITIONER REQUESTS THAT THE COURT FIND THAT THE FOLLOWING ARE PROTECTED PERSONS: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ WHEREFORE, PETITIONER REQUESTS THE ENTRY OF AN ORDER OF PROTECTION SETTING FORTH THE FOLLOWING REMEDIES: 1. With respect to Petitioner and other Protected Persons, Respondent should be prohibited from committing the following: Physical abuse; Harassment; Interference with personal liberty; Intimidation of a dependent; Willful deprivation; Neglect; Exploitation; Stalking. premises: (Address) 2. Petitioner should be granted exclusive possession of the residence and Respondent should be prohibited from entering or remaining at such ___________________________________________________________________________________________. 3. a. Respondent should be ordered to stay away from Petitioner and other protected persons; and/or b. Respondent should be prohibited from entering or remaining at c. ________________________________________________ _____________________________________________________________ while any Protected Person is present; and/or Respondent should be allowed access to the residence on (date) _________________ at (time) _____________ in the presence of (name) _________________________________________ to remove items of clothing, personal adornments, medications used exclusively by the Respondent and other items, as follows: ____________________________________________________. and/or 4. Respondent should be ordered to undergo counseling for a period of time to be determined by this court. (Not available in Emergency Order) 5. a. Petitioner should be granted physical care and possession of the minor child/ren; b. Respondent should be ordered to: return the minor child/ren _________________________________________________________ to the physical care of _____________________________________________________________________________________; and/or not remove the minor child/ren _________________________________________________________________ from the physical care of Petitioner or ____________________________________________________________________. 6. Petitioner should be granted temporary legal custody of the minor child/ren _______________________________________________. (Not available in Emergency Order) DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Case No. _________________________________ 1. CLERK OF THE CIRCUIT COURT Petition: 4 of 5 Pages W(1). W(2). X. (11/29/06) CCG N800 D There is a threat to the safety and well-being of Petitioner's family or household when Respondent enters or remains on the premises while under the influence of alcohol or drugs. Respondent should be ordered to surrender any and all firearms to the local law enforcement agency. If Respondent is a law enforcement officer, any and all firearms must be surrendered to Respondent's employer. Respondent should be denied access to school or other records of the minor child/ren because: Respondent is or will be prohibited from having contact with the minor child/ren; or Petitioner's address is omitted pursuant to statute; or it is necessary to prevent abuse or wrongful removal or concealment of the minor child/ren. Y. Allegations for other injunctive relief: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Z. Disclosure of Petitioner's address would risk further abuse to her/him or to another protected person, or such disclosure would reveal the confidential location of a shelter for domestic violence victims. Additional Allegations for Emergency Orders Only (i) For requested remedies 1, 3, 5, 7, 8, 9, 11, 14, 15, and 17, the harm which