STATE OF INDIANA ) ) SS: COUNTY OF ___________) _______________________, ) Petitioner ) vs. ) _______________________, ) Respondent ) IN THE ________________COURT ____ (_____________ DIVISION, ROOM ____) CASE NO._________________________ ORDER DISMISSING PETITION AND/OR AN ORDER FOR PROTECTION The Petitioner filed, on the _____ day of ________, 20__, a Petition for an Order for Protection. ___ Hearing conducted on the _______ day of ___________, 20___, at which the ______ Petitioner and ______ Respondent was/were present. The Court, being duly advised, hereby finds as follows: _____ Petitioner failed to appear for the hearing and failed to present evidence. _____ Petitioner has filed a written request for dismissal. _____ Petitioner has requested dismissal under oath and on the record. _____ An Ex Parte Order for Protection/Order for Protection was issued on ______________. _____ Other reason (specify): ___________________________________________________. ___ IT IS THEREFORE ORDERED BY THE COURT that the Petition for an Order for Protection is hereby dismissed. --OR-- ___ IT IS THEREFORE ORDERED BY THE COURT that the Petition for Order of Protection is dismissed and the Order for Protection issued on ____________________ is terminated. DATE: ______________ Recommended for approval by, if applicable: _____________________________________ ____________, COMMISSIONER/REFEREE Approved and ordered by: _____________________________________ ________________, JUDGE/MAGISTRATE Copies to: American LegalNet, Inc. www.FormsWorkFlow.com TCM-PO-0109 Approved 07/02 Rev. by State Ct. Admin. 07/15