IN THE IOWA DISTRICT COURT FOR COUNTY (name of the county where you are filing this motion) : : : Civil No. Plaintiff, : (if you do not know, ask the clerk of court) (person who filed a Petition For : Relief From Domestic Abuse) : REQUEST TO CANCEL vs. : OR CHANGE A : CHAPTER 236 : PROTECTIVE ORDER : Defendant. : : Code ch. 236The Court issued a Chapter 236 Protective Order on the day of , 02. Pursuant to Iowa Code section 236.5(2)(e), I am asking that this Court cancel or change the Protective Order as follows: [ ] I REQUEST THAT THE COURT cancel the entire Chapter 236 Protective Order. OR [ ] I REQUEST THAT THE COURT leave in place the provision ordering the defendant to stop abusing me, but change the following provisions: (mark all that apply) [ ] Cancel the "no-contact" provision directing the defendant to stay away f rom my home, my work, or my school. [ ] Change the courts order regarding custody or visitation. [ ] Change the courts order regarding possession of the family home or othe r housing. [ ] Change the courts order regarding possession of the family car. [ ] Change the courts order regarding financial support. [ ] Change the courts order regarding counseling. [ ] Change the courts order regarding other provisions in the Protective Or der: (please explain any other requested change) Do you believe you will be safe if the Protective Order is changed as yo u have asked? (please explain) >>>> 2I REQUEST THAT THE COURT set a hearing on this Motion; direct the sheriff to serve the defendant a copy of this Motion along with a copy of the Order for Heari ng; and following the hearing, cancel or change the Protective Order as I requested. I request that th e judge order the sheriff to serve thedefendant with a copy of any new order issued. READ BEFORE SIGNING. Please check each line after you have read it. I understand that there will be a court hearing after I file this motion, which I mu st attend. I understand that the hearing is my opportunity to tell the judge why I want the Pro tective Order cancelled or changed. I understand the Protective Order stays in effect until the judge cancels or changes it. Therefore, I should follow the order until the judge cancels or changes it. STATE OF IOWA ) ) ss: COUNTY OF ) [name of county where Notary Public is located] PLAINTIFF [Sign only in front of a Notary Public]Subscribed and sworn to before me this day of , 02. Notary Public A booklet entitled "How to Protect Yourself from Domestic Abuse Without a Lawyer" is available at the clerk of courts office and from the nearest domestic abuse shelter. It explains court procedure and gives information about how to contact a lawyer. FOR OTHER GENERAL INFORMATION ABOUT DOMESTIC ABUSE, CALL THE (CONFIDENTIAL) IOWA DOMESTIC ABUSE HOTLINE: 1-800-942-0333 -2- [Request to Cancel or Change a Chapter 236 Protective Order - IDOJ0793]