You must provide a government-issued ID in order to have your signature notarized. Petitions will not be filed without a notarized signature. GENERAL INSTRUCTIONS FOR THOSE SEEKING A PROTECTION FROM STALKING ORDER NOTICE The protection from stalking process is designed to provide quick and immediate protection. However, the process may require time, expertise, or more than one hearing. If you have questions, you should seek help from an attorney or victim services advocate. The Kansas Crisis Hotline (1-888-363-2287) or Kansas Legal Services (1-800-723-6953) may be able to help you find an attorney or advocate. These are basic forms and they do not cover every situation. The Clerk of the District Court cannot help you with these forms. The Clerk cannot give legal advice to you or tell you about your rights or responsibilities. The Clerk can only provide very limited information about the protection order process. You can find more information about protection from stalking at http://www.kcsdv.org/pfs.html. 1. You may seek a protection from stalking order: a. For yourself; or, b. For your minor child; or, c. For a minor child who resides with you. 2. For each person for whom protection is sought, Kansas Law requires that stalking must have occurred. “Stalking” is an intentional harassment of another person that places the other person in reasonable fear for that person’s safety. “Harassment” is a knowing and intentional course of conduct directed at a specific person that seriously alarms, annoys, torments or terrorizes the person and that serves no legitimate purpose. “Course of conduct” is conduct consisting of two or more separate acts over a period of time, however short, that show a continuity of purpose which would cause a reasonable person to suffer substantial emotional distress. 3. You must file the petition for protection from stalking in the county where the stalking has occurred. 4. You must notify the defendant by personal service that you have filed a Petition for a Protection from Stalking Order. To obtain personal service, you must fill out a Request for Service Form, requesting that the sheriff deliver the Petition for Protection from Stalking to the defendant. 05/27/09 1 American LegalNet, Inc. www.FormsWorkFlow.com 5. If the defendant is a minor, you must complete the Minor Defendant Addendum. Petitions, Motions and Temporary Protection from Stalking Orders filed against a minor defendant must be served by serving the minor and: a. The minor’s guardian or conservator, if any; or, b. The minor's father or mother; or, c. A person having the minor's care or control; or, d. A person with whom the minor resides. If service cannot be made upon any of these people, then service may be obtained as provided by order of the judge. 6. You should be available to testify at future hearings as set by the judge. If you fail to appear, the case may be dismissed. 7. A Final Protection from Stalking Order will expire after one year or on the date stated in the order, unless you request an extension or modification from the court. 05/27/09 2 American LegalNet, Inc. www.FormsWorkFlow.com IN THE DISTRICT COURT OF DOUGLAS COUNTY, KANSAS ____________________, Plaintiff vs. Case No. _______________ ____________________, Defendant PROTECTION FROM STALKING CONFIDENTIAL ADDRESS FORM (K.S.A. 60-31a04(e)) NOTE: THIS FORM WILL BE SHOWN ONLY TO AUTHORIZED COURT OR LAW ENFORCEMENT PERSONNEL. THIS FORM WILL NOT BE DISCLOSED TO THE PUBLIC OR TO THE DEFENDANT. IT IS THE PLAINTIFF’S RESPONSIBILITY TO NOTIFY THE COURT OF ANY CHANGE IN ADDRESS OR TELEPHONE NUMBER. Name of Plaintiff: Confidential Address: Street Zip Code City ________________________ State Phone Number ________________________________ 05/27/09 3 American LegalNet, Inc. www.FormsWorkFlow.com ___________________________________ Plaintiff vs. Case No. _______________ Div. No. ________________ ___________________________________ Defendant PERSONAL AND SERVICE DATA SHEET The purpose of this sheet is to provide the Sheriff’s Department with the necessary information to effect service on Defendant and to provide essential information for the safety of the Sheriff’s Deputy. Information about Defendant is voluntary on the part of the Plaintiff, except physical description and information. In addition, this page establishes a contact number for returning keys to the residence, re-entering the house, or obtaining custody of any children involved. This page is for the Court and Sheriff’s use only and will not be part of the packet served to Defendant. PRINT CLEARLY. PLAINTIFF’S INFORMATION (YOU) Plaintiff’s Name: ________________________________________________________ Plaintiff’s Address: ______________________________________________________ _____________________________________________________________________ Phone Number where Plaintiff can be contacted: ______________________________ Does Defendant have keys to your current residence? ______________________ Do you want your address kept confidential so Defendant cannot obtain this information?_____________________________________________ Physical Description of PLAINTIFF (You): Race: _____________ Sex: _______ Age: ______ Date of Birth: ______________ Height: _________ Weight: ________ Hair: ________________ Eyes: __________ 05/27/09 4 American LegalNet, Inc. www.FormsWorkFlow.com DEFENDANT’S INFORMATION Defendant’s Name:______________________________________________________ Other name(s) Defendant may go by/be known as:______________________________ _____________________________________________________________________ Defendant’s Social Security Number (if known):________________________________ Name of Defendant’s Employer: ____________________________________________ Defendant’s Work Hours: _________________________________________________ Does Defendant Operate a Business from his/her Home? ______________ Does Defendant require a language interpreter? ___ Yes ___ No If so, what language? ____________________________________________________ Physical Description of Defendant: (Please attach current photo if available) Race: _____________ Sex: _______ Age: ______ Date of Birth: ______________ Height: _________ Weight: ________ Hair Color/Length: _____________________ Eye Color: __________ Glasses?_______ _ Other Identifying Characteristics (i.e. scars, tattoos, etc.) ____________________________________________________ Description of Defendant’s Vehicle: _________________________________________ Places Defendant is likely to be found:_______________________________________ Has Defendant been arrested? ____________ If so, why? ____________________________________________________________ _____________________________________________________________________ Does Defendant own any weapons? ____________ If so, what kinds? _______________________________________________________ ______________________________________________________________________ Does Defendant have a history of drug or alcohol abuse? _____________ If so, please explain: _____________________________________________________ ______________________________________________________________________ Does Defendant have a history of domestic violence? ____________ If so, please explain: _____________________________________________________ ______________________________________________________________________ Does Defendant have a history of mental illness? ___________ If so, please explain: _____________________________________________________ ______________________________________________________________________ 05/27/09 5 American LegalNet, Inc. www.FormsWorkFlow.com The defendant can be found at: (give all available addresses) 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: Please explain ____________________________________________________ Street ___________________________________________________________ City ________________________ State ______________ Zip Code _________ Phone number ____________________________________________________ Times when defendant is usually there _________________________________ 05/27/09 6 American LegalNet, Inc. www.FormsWorkFlow.com IN THE DISTRICT COURT OF DOUGLAS COUNTY, KANSAS ______________________________, Plaintiff vs. Case No. _______________ ______________________________, Defendant PETITION FOR PROTECTION FROM STALKING ORDER (K.S.A. 60-31a01 et seq.) 1. Plaintiff seeks an order for protection from stalking for: myself; or my minor child (under age 18); or a minor child who lives with me. 2. The minor child for whom Plaintiff seeks protection is: (give full name and year of birth) NAME 3. YOB Defendant, ______________________________ (name), can be served at: (please provide all available addresses) city HOME: street 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 city OTHER: street state zip code phone number times when defendant is usually there 05/27/09 7 American LegalNet, Inc. www.FormsWorkFlow.com 4. Describe the incidents of stalking. Include specific facts, dates and locations: Incident #1: Incident #2: Additional Incident(s), if any: (Attach additional pages as needed.) 5. Plaintiff needs a protection from stalking order because: 6. The stalking occurred in this county. 7. Plaintiff requests that the Court issue an Ex Parte Temporary Order of Protection and Final Order of Protection restraining defendant from: following, harassing, telephoning, contacting or otherwise communicating with the protected person abusing, molesting or interfering with the privacy or rights of the protected person entering or coming on or around the premises or the residence of the protected person located at: , and the workplace located at: . (Give address or other description of residence and workplace from which Defendant is to be excluded. DO NOT include the residential address if it is to remain confidential.) 8. 05/27/09 The court shall give copies of orders to the appropriate law enforcement agencies; set a date, time and hearing on this matter; and issue summons to Defendant, notifying Defendant of this action and the relief requested. 8 American LegalNet, Inc. www.FormsWorkFlow.com 9. After a hearing, the court should issue a final order of protection prohibiting Defendant from committing any acts of stalking against the protected person; order Defendant to pay court costs and attorney fees if appropriate; and order any other relief necessary for the safety of the protected person including: __________________________________________ Plaintiff's signature Plaintiff’s Name: (DO NOT include the residential address of the Plaintiff in this petition if it is to remain confidential. If the address is to remain confidential, Plaintiff must complete the Protection from Stalking Confidential Address Form and include it with this petition.) Attorney representing Plaintiff (if any) Attorney’s Name: Address 1: Address 2: City, State, Zip: Telephone: VERIFICATION STATE OF ____________________ ) ) ss: COUNTY OF __________________ ) I swear or affirm that the statements made in this Petition are true and correct to the best of my knowledge and belief and that I am the person filing this petition. __________________________________________ Plaintiff’s signature SUBSCRIBED AND SWORN to before me, a Notary Public, this ______ day of _______________________________ 20 . __________________________________________ Notary Public My Appointment Expires: ___________________ 05/27/09 9 American LegalNet, Inc. www.FormsWorkFlow.com COMPLETE IF SERVING DEFENDANT AT PLACE OF EMPLOYMENT IN THE DISTRICT COURT OF DOUGLAS COUNTY, KANSAS ______________________________ Plaintiff Vs. Case No. _________ Div. No. ___________ ______________________________ Defendant AFFIDAVIT AND REQUEST FOR SERVICE AT PLACE OF EMPLOYMENT STATE OF KANSAS ) ) ss: COUNTY OF DOUGLAS ) I, ____________________________________________, Plaintiff, having been duly sworn on oath, state as follows: I request that the defendant be served at his place of employment because: [Please check one] _____ the defendant is a non-resident who is employed in the State. _____ the defendant’s place of residence is unknown. Please serve the defendant by personal service only at: Name of employer:________________________________________________ Address of employer:_______________________________________________ ________________________________________________________________ _____________________________ Plaintiff’s signature Subscribed and sworn to before me this _______ day of ___________________,20____ __________________________________ Deputy Clerk of District Court/Notary Public My Appointment Expires: _____________ 05/27/09 10 American LegalNet, Inc. www.FormsWorkFlow.com