Petitioners Verified Request For Dismissal
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Petitioners Verified Request For Dismissal Form. This is a Indiana form and can be use in Protective Order Statewide.
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Tags: Petitioners Verified Request For Dismissal, PO-0108, Indiana Statewide, Protective Order
PO-0108
Approved 07-01-02
Revised
07-01-08
STATE OF INDIANA
)
) SS:
COUNTY OF ___________ )
IN THE ________________COURT ____
(_____________ DIVISION, ROOM ____)
CASE NO._________________________
_______________________, )
Petitioner
)
vs.
)
_______________________, )
Respondent
)
PETITIONER’S VERIFIED REQUEST FOR DISMISSAL
On ______________________________, I, the Petitioner, filed a Petition for an Order
for Protection and Request for a Hearing.
Check appropriate paragraph:
____ At this time, I am requesting this Verified Request for Dismissal pursuant to
Indiana Code § 34-26-5-12. I respectfully request that the Court grant this Request
without delay or any conditions, and dismiss the case without prejudice.
____ At this time, I am filing this Verified Request for Dismissal for an Order of
Protection to terminate an Order of Protection issued on ________________________.
I affirm, under the penalties for perjury, that the foregoing representations are true.
DATE: ________
Petitioner’s Signature __________________________
Printed
_________________________
Petitioner’s Address ___________________________
___________________________
Respondent’s Address __________________________
___________________________
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