0012 Petition for Stalking No Contact Order IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS People ex rel. on behalf of self and/or on behalf of Petitioner Case No. Independent Proceeding Criminal Proceeding Juvenile Proceeding (03/16/16) CCG N812 A v. Respondent PETITION FOR STALKING 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 __________________________________, on his/her own behalf, pursuant to the Stalking No Contact Order Act and moves this Honorable Court to issue a Stalking No Contact Order in this cause and in support thereof states as follows: Petitioner Information Disclosure of the Petitioner's address would risk abuse of the Petitioner or family or household. The address listed is the Petitioner's alternative address for service of Notice. Name: Address: ______________________________________________ Name: Address: ______________________________________________ DOB: ____________ Sex: Male Distinguishing characteristics: Respondent Employment Information Works at: Address: ______________________________________________ Petitioner alleges as to respondent that: The following individuals are alleged to be persons who need to be protected from stalking by Respondent Respondent has acted in the following manner towards the Petitioner: [State details of incident(s) of stalking (including time and place), as well as effects of incident(s) on Petitioner.] First Incident Date: ___________ Description: Time: _______ AM PM Location: _________________________________________ City: ____________________ State: ____ Zip: __________ City: ____________________ State: ____ Zip: __________ Female Race: ______________________ Height: _____ Weight: _____ City: ____________________ State: ____ Zip: __________ Respondent Information Second Incident Date: ___________ Description: Time: _______ AM PM Location: _______________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 0012 Petition for Stalking No Contact Order (03/16/16) CCG N812 B Additional Incident Date: ___________ Description: Time: _______ AM PM Location: ____________________________________ Police report not made Police report made Police Report no.: ____________________ Remedies Requested Petitioner requests that the court find that the following are protected persons: Wherefore, Petitioner requests the entry of a Stalking No Contact Order setting forth the following remedies: (b) (1) The Respondent is prohibited from threatening to commit stalking or committing stalking. (b) (2) The Respondent is prohibited from having any contact with Petitioner and/or (If minor child, list only initials): (b) (3) The Respondent is prohibited from knowingly coming within, or knowingly remaining within, _____ feet of Petitioner's Residence Said addresses are: (b) (3) (Actual notice to Respondent required) The Respondent is prohibited from remaining at Respondent's own School (b) (b) (c) Place of employment. Said addresses are: Residence School Day care Place of employment or ____________________________________ (4) The Respondent is prohibited from possessing a Firearm Owner's Identification Card or possessing or buying firearms. (5) The following other injunctive relief is granted: ___________________________________________________________ That the Respondent be ordered to pay the Petitioner's costs, including attorney fees. (Remedy available only if Stalking No Contact Order is granted.) 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. Atty. No.: ________________ Name: Atty for: Address: City: ______________________ Primary Email: Secondary Email: Tertiary Email: DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Pro Se 99500 Date: ______________ State: ____ Zip: ________ Signature of Petitioner Telephone: ________________________