CIRCUIT COURT OF ILLINOIS NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY  Independent  Criminal  Juvenile Petitioner’s Name (person desiring protection) Name(s) of other protected parties Check if filing on behalf of:  a minor child, or  an adult who because of age, disability, health, or inaccessibility cannot file the petition (list name(s) below) (file stamp) Case #: (to be completed by Court) vs. Respondent’s Name (person you want protection from) If the Respondent is under age 18 and if remedy #4 is requested the name(s) of minor  parent(s) or  legal guardian(s)  Notice to School Board(s) (if remedy #4 is requested) VERIFIED PETITION FOR CIVIL NO CONTACT ORDER (Sexual Conduct and/or Penetration) PETITIONER INFORMATION Petitioner’s Address: ____________ (Street/P.O. Box) (City) (State) (Zip Code)  Disclosure of Petitioner’s and/or protected party’(s) address would risk further abuse. The address listed above is Petitioner’s and/or protected party’(s) alternative address for service of notice. Other protected persons (persons to be included in the Civil No Contact Order), in addition to the Petitioner are: Name: Address: (Street/P.O. Box) (City) (State) (Zip Code) (Street/P.O. Box) (City) (State) (Zip Code) Name: Address: RESPONDENT INFORMATION (If known) Name: Sex: DOB:  Male Hair Color:  Female Race: Height: Eye Color: Social Security #: XXX-XX- Weight: (last 4 numbers) Form approved by the Conference of Chief Circuit Judges. Effective December 11, 2009 Use required after January 1, 2010 Page 1 of 4 – Petition for Civil No Contact Order 171-340 (R 01/10) American LegalNet, Inc. www.FormsWorkFlow.com Driver’s License #: License Plate #: Other Numeric Identifier: Description: (number - optional) (e.g. passport#, military serial# or other)  Home Address: (Street/P.O. Box) (City) Name of Workplace: (State) (Zip Code) Work Hours:  Work Address: (Street/P.O. Box) (City) (State) (Zip Code) Distinguishing Physical Features: (tattoos, scars, etc.) Respondent is incarcerated at:  Respondent’s address is unknown. Service by publication is requested (Section 2-206 (a) of the Code of Civil Procedure). {Reasonable efforts to accomplish actual service must be shown by evidence or affidavit. 740 ILCS 22/208(c)} Respondent may be:  Considered armed and/or dangerous  Suicidal  Considered armed, dangerous and suicidal I am requesting a Civil No Contact Order because on or about , at (date) , (location) the following occurred: (Be specific as to dates, events and locations) (Additional pages may be added) Venue is appropriate in this county because: (Check all that apply)  The Petitioner resides here;  The Respondent resides here;  The alleged non-consensual sexual conduct or non-consensual sexual penetration occurred here. REMEDIES SECTION (740 ILCS 22/213) Pursuant to the Civil No Contact Order Act, the Petitioner seeks the following remedies: 1.  That the Respondent be ordered to stay at least feet away from the Petitioner and/or other protected persons. That Respondent be prohibited from entering or remaining at the Petitioner’s and/or other protected persons’: Page 2 of 4 – Petition for Civil No Contact Order 171-340 (R 01/10) American LegalNet, Inc. www.FormsWorkFlow.com  place of residence, located at:  place(s) of employment, located at:  school(s) and/or daycare, located at:  and any of the following specified places, when Petitioner and/or other protected persons are present: 2.  That the Respondent refrain from contact with Petitioner and/or other protected persons in any way, directly, indirectly or through third parties, including, but not limited to, phone, written notes, mail, email, or fax. 3.  That Respondent stay away from and be prohibited from taking, transferring, encumbering, concealing, damaging, or otherwise disposing of the Petitioner and/or other protected persons’ real and/or personal property or animal(s). school 4.  That the Respondent be restrained from attending at {740 ILCS 22/213(b-6)} (address) attended by the Petitioner. 5.  Other injunctive relief as follows: WHEREFORE, Petitioner moves the Court to grant the relief requested in this petition. VERIFICATION UNDER THE PENALTIES OF PERJURY 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 HEREIN STATED TO BE ON INFORMATION AND BELIEF AND AS TO SUCH MATTERS THE UNDERSIGNED CERTIFIES AS AFORESAID THAT THE UNDERSIGNED VERILY BELIEVES THE SAME TO BE TRUE. Signature of Petitioner Petitioner’s Attorney or Petitioner (if not represented by an attorney) Name: Telephone Number: Address: City/State/Zip: Page 3 of 4 – Petition for Civil No Contact Order 171-340 (R 01/10) American LegalNet, Inc. www.FormsWorkFlow.com DEFINITION OF TERMS USED IN THIS PETITION 1. Civil No Contact Order: An emergency order or plenary order granted under this Act, which includes a remedy authorized by 740 ILCS 22/213 of this Act. 2. Family or Household Members: Include spouses, parents, children, stepchildren, and persons who share a common dwelling. 3. Non-consensual: A lack of freely given agreement. 4. Petitioner: May mean not only any named petitioner for the civil no contact order and any named victim of non-consensual sexual conduct or non-consensual sexual penetration on whose behalf the petition is brought, but also any other person sought to be protected by this Act. 5. Protected Persons: The following persons are protected by this Act: (a) any victim of non-consensual sexual conduct or non-consensual sexual penetration on whose behalf the petition is brought; (b) any family or household member of the named victim; and (c) any employee of or volunteer at a rape crisis center that is providing services to the petitioner or the petitioner's family or household member. 6. Respondent: May mean not only the person alleged to have committed an act of non-consensual sexual conduct or non-consensual sexual penetration against the petitioner, but also any other named person alleged to have aided and abetted such an act of non-consensual sexual conduct or nonconsensual sexual penetration. 7. Sexual Conduct: Any intentional or knowing touching or fondling by the Petitioner or the Respondent, either directly or through clothing, of the sex organs, anus, or breast of the Petitioner or the Respondent, or any part of the body of a child under 13 years of age, or any transfer or transmission of semen by the respondent upon any part of the clothed or unclothed body of the petitioner, for the purpose of sexual gratification or arousal of the Petitioner or the Respondent. 8. Sexual Penetration: Any contact, however slight, between the sex organ or anus of one person by an object, the sex organ, mouth or anus of another person, or any intrusion, however slight, of any part of the body of one person or of any animal or object into the sex organ or anus of another person, including but not limited to cunnilingus, fellatio or anal penetration. Evidence of emission of semen is not required to prove sexual penetration. 9. Stay Away: To refrain from both physical presence and nonphysical contact with the Petitioner directly, indirectly, or through third parties who may or may not know of the order. “Nonphysical contact” includes, but is not limited to, telephone calls, mail, e-mail, fax, and written notes. Page 4 of 4 – Petition for Civil No Contact Order 171-340 (R 01/10) American LegalNet, Inc. www.FormsWorkFlow.com