IN THE DISTRICT COURT OF ______________ COUNTY, KANSAS ____________________, Plaintiff vs. Case No. _______________ ____________________, Defendant PETITION FOR PROTECTION FROM STALKING ORDER (Pursuant to K.S.A. 60-31a01, et seq.) 1. My name is ________________________. I live in the City of _________________, in the County of __________________, Kansas. 2. I am seeking protection for: (check all that apply) _____ myself _____ my minor child (under age 18) _____ a minor child who lives with me 3. The following minor children are involved in this matter: (give full names and ages) Name DOB Mother’s Name Father’s Name 4. The defendant’s name is _________________________________. 5. I am seeking a protection from stalking order because the defendant has: (Briefly describe the specific facts about why you are seeking a protection from stalking order) 6. The defendant’s conduct has caused me to feel: 7. The acts complained of occurred on these dates: in the county of _______________, Kansas. 8. The defendant can be found at: (give all available addresses, if known) 07/10/04 American LegalNet, Inc. www.FormsWorkflow.com HOME: street city ______________________ state ______________ zip code phone number times when defendant is usually there WORK: street city ______________________ state ______________ zip code phone number times when defendant is usually there OTHER: street city ______________________ state ______________ zip code phone number times when defendant is usually there from: WHEREFORE, plaintiff requests that the Court issue an order of protection restraining defendant _____ _____ _____ _____ a) following, harassing, telephoning, contacting or otherwise communicating with the victim b) abusing, molesting or interfering with the privacy rights of the victim c) entering upon or in the victim’s residence or the immediate vicinity thereof. d) other ______________________________________________________ Plaintiff further requests that copies of orders be given to the appropriate law enforcement agencies; that a date, time and place for a hearing on this matter be set; and that summons be issued to defendant, notifying the defendant of this action and the relief requested. Plaintiff further requests that upon hearing of this cause, the Court issue a final order of protection from stalking, enjoining defendant from any acts of stalking against the plaintiff and/or the minor child, and that the Court award to plaintiff the following additional relief: _____ _____ a) attorney' fees, if represented by counsel; and costs s b) other, please specify: ________________________________________ __________________________________________________________ __________________________________________________________ and for such other and further relief, all as appropriate and as the Court deems necessary. __________________________________________ Plaintiff's signature 07/10/04 American LegalNet, Inc. www.FormsWorkflow.com (If attorney represents the plaintiff, the attorney' address and phone number s must be provided.) ___________________________ ___________________________ ___________________________ VERIFICATION STATE OF KANSAS ) ) COUNTY OF __________ ) ss: _____________________________, of lawful age, being first duly sworn states that (she)(he) is the plaintiff in the above action; that (she)(he) has read the foregoing Petition and knows the contents of it and that the declarations in it are true and correct to the best of plaintiff' knowledge and belief. s __________________________________________ Plaintiff's signature SIGNED AND SWORN to (or affirmed) before me on this _____ day of _______________, ______. __________________________________________ Clerk of the District Court/Notary Public My Appointment Expires: ___________________ 07/10/04 American LegalNet, Inc. www.FormsWorkflow.com