Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.orgPage 1 of 5 þ en-USen-USPetitioneren-USv. en-USRespondent Case No. þ en-US en-US Name: þ en-US Address: þ þ Street Address þ City þ State þ Zip Family member of the Respondent. The checked boxes show my relationship to the en-USRespondent: þ Spouse þ þ Parent þ þ Child þ þ Step-child Related by blood þ þ Related by present marriage þ þ Live with Respondent en-USOR þ þ Badge No.: þ Municipality: þ en-US Location: þ þ en-US Name: þ en-US Address:þ þ Street Address þ City þ State þ Zip en-US Resident of Illinois þ Respondent resides in þ en-US County, Illinoisen-USOR Respondent is a non-resident with limited contact with Illinois. Are you aware of any court case involving the Respondent? þ þ Yes þ þ No Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.orgPage 2 of 5en-USIf yes, please check the boxes and give as much information as you know about each case: þ en-US I request an Emergency Firearms Restraining Order. en-USen-USen-USen-USen-USen-USen-USen-US I request a Six Month Firearms Restraining Order. en-USen-USen-USen-USen-USen-USen-USen-US þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USen-USen-US en-USen-USen-USen-USen-USen-US Domestic Violence Order en-USof Protection Divorce, Parentage, Child en-USCustody Stalking No Contact Order Workplace Violence Civil No Contact Order Child or Elder Abuse Involuntary commitment þ Criminal Other (please specify) Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.orgPage 3 of 5 þ en-USen-USThe following facts cause me to believe that the Respondent is a danger to him/herself or others.en-USen-US I am informed, and on that basis believe, that Respondent poses an immediate and present en-USdanger of causing personal injury to him/herself or others.en-US þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USor another person.en-US þ þ þ þ þ þ þ þ þ Respondent has a history of using, attempting to use, or threatening to use physical force en-USagainst another person. Respondent has a prior felony arrest. Respondent has abused controlled substances and/or alcohol Respondent has recently threatened violence or committed violence toward him/herself, or en-USanother person. Respondent has violated an Emergency Order of Protection Respondent has a pattern of violent acts or violent threats toward him/herself and/or toward en-USsomeone else. Respondent has a history of mental illness or has previously been treated for mental illness. en-USen-USen-USen-US I am informed, and on that basis believe, that Respondent currently possesses or controls Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.orgPage 4 of 5en-USen-US223Intimate partner224 means a spouse, former spouse, a person who has or says they have a child with en-USthe Respondent, or a person who dates or used to date or be engaged to the Respondent. þ en-USen-USen-USen-USen-USen-USen-USen-USen-USen-USen-USen-USen-USen-USen-USen-USen-USen-USen-USHandgunen-USHandgunen-USHandgunen-USHandgunen-US1.en-US þ Custody/Control þ Purchased þ Possesses þ Received en-US Date: þ en-US Time: þ en-USen-US2.en-US þ Custody/Control þ Purchased þ Possesses þ Received en-US Date: þ en-US Time: þ en-USen-USen-USen-USen-USen-US1.en-US þ Custody/Control þ Purchased þ Possesses þ Received en-US Date: þ en-US Time: þ en-USen-US2.en-US þ Custody/Control þ Purchased þ Possesses þ Received en-US Date: þ en-US Time: þ en-US þ þ þ þ en-US1.en-US þ Custody/Control þ Purchased þ Possesses þ Received en-US Date: þ en-US Time: þ en-USen-US2.en-US þ Custody/Control þ Purchased þ Possesses þ Received en-US Date: þ en-US Time: þ en-USDorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.orgPage 5 of 5en-US en-USI have no information to believe that Respondent poses an immediate and present danger tointimate partneren-USAND/OR has made threats to an intimate partner. en-USOR Respondent IS an immediate and present danger to or has made threats to an intimate partner. þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USFirearms Restraining Order. en-USen-USen-USOR þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USasking for a Firearms Restraining Order. en-USen-US þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USdomestic violence and/or stalking resources.en-USen-USen-USen-USen-US þ Date: þ þ en-US þ þ en-USPrepared by: If Attorney, ARDC. No.: þ en-US Name: þ en-US Address: þ en-US City: þ þ State: þ þ Zip: þ en-US Phone: þ þ Fax: þ en-US Primary Email: þ en-US