LPOR O Page 1 of 6 v.10 PETITIONER V. DEFENDANT Parent/Guardian name if defendant is a minor COURT PARISH/CITY OF STATE OF LOUISIANA DIVISION: NUMBER: FILED: CLERK: PETITION FOR TEMPORARY RESTRAINING ORDER, PRELIMINARY AND PERMANENT INJUNCTION Pursuant to La. Code of Civil Procedure Article 3601 et seq. This petition is: Initial Petition Supplemental and Amending Petition The petition of , born , your name month/day/year a resident of the full age of majority of the Parish/City of , respectfully represents: Paragraph 1 Petitioner files this petition on behalf of: a. Petitioner, and/or b. Minor child(ren) as follows: (Name, Date of Birth, Relationship to Petitioner) c. Alleged incompetent: (Name, Date of Birth, Relationship to Petitioner) Paragraph 2 a. Petitioners current address: No. & Street Apt. No. City State Zip Code b. The minor child(ren)s or alleged incompetents current address: No. & Street Apt. No. City State Zip Code Paragraph 3 , defendant, resides in Parish Defendants Name at No. & Street Apt. No. City State Zip Code American LegalNet, Inc. www.FormsWorkFlow.com LPOR O Page 2 of 6 v.10 Paragraph 4 This Court is the proper venue for this action because: The defendant is domiciled in Parish/city. The behavior sought to be enjoined is likely to occur in Parish/city. Other: Paragraph 5 a. Domestic abuse or dating violence: The protected person(s) is related to the defendant as: (check all that apply) Current or former spouse Current or former dating partner Current or former intimate cohabitant Parent, stepparent, or foster parent Child, stepchild, or foster child Grandparent C Grandchild OR b. Stalking or sexual assault: The defendant is an acquaintance of or stranger/unknown to the protected person(s). Paragraph 6 Defendant has abused and/or harassed protected person(s) and protected person(s) fears for her/his safety and believes that irreparable injury, loss, or damage may otherwise result to protected person(s) if defendant is not prohibited from committing certain acts through the rendition of a temporary restraining order, without notice, and thereafter a preliminary and permanent injunction to the same effect. Paragraph 7 a. Domestic abuse or dating violence: Defendant abused protected person(s) in the following manner: Slapped protected person(s) Threatened protected person(s) with bodily harm Punched protected person(s) Choked protected person(s) Threatened protected person(s) with a weapon Shoved protected person(s) Sexually abused protected person(s) Kicked protected person(s) incompetent Stalked protected person(s) Other: b. Stalking: Defendant intentionally and repeatedly engaged in the following behavior(s) which caused the protected person to feel alarmed or to suffer emotional distress: Followed protected person(s) Implied or threatened protected person(s) with bodily injury Harassed protected person(s) Used tracking device to monitor protected person(s) Stalked, harmed/threatened to harm protected person(s) or protected person(s) Uninvited presence at other places Implied or threatened protected person(s) with kidnapping Made/sent telephone calls, texts, emails or other electronic communications to protected person(s) Implied or threatened protected person(s) with sexual assault Sent messages via a third party, letters, pictures, public posts to social media Possessed a dangerous weapon during any of the foregoing behaviors Sent unwanted gifts to protected person(s) Threatened protected person(s) with a dangerous weapon Other: American LegalNet, Inc. www.FormsWorkFlow.com LPOR O Page 3 of 6 v.10 c. Sexual assault: Defendant intentionally assaulted the protected person in the following manner: part(s) or other objects, without consent. ) using pr objects. Displayed genitals, anus, and/or female breast nipples to protected person without consent, in a public place or prison/jail. Deceived the protected person into engaging in anal, oral or vaginal i ntercourse with the defendant by misrepresenting themselves as someone else known to the protected person. Sent an electronic communication, letter, photograph, or drawing containing sexually explicit materials or content to the protected person without consent. Exposed the protected person to the HIV/AIDS virus through sexual contact without the knowing and lawful consent of the protected person. Viewed or spied on the protected person at a private residence without consent for defendan Used an image or video recording device to view or observe the protected person without consent for a lewd or lascivious purpose. Electronically transferred an image or video of the protected person obtained by the above without the consent of the protected person. Gave a drug, narcotic, anesthetic, intoxicant agent or other controlled dangerous substance to the protected person without her/his consent. Possessed a dangerous weapon at the time of any of the foregoing behaviors. Threatened the protected person with a dangerous weapon during any of the foregoing behaviors. Other: d. The facts and circumstances of the abuse, stalking or sexual assault are as follows: The most recent incident of abuse, stalking or sexual assault which caused petitioner to file this petition happened on or about the (month/day/year), at which time the defendant did Past incidents: American LegalNet, Inc. www.FormsWorkFlow.com LPOR O Page 4 of 6 v.10 Paragraph 8 Because of the immediate and present danger of abuse, stalking or sexual assault, petitioner requests that an ex parte Temporary Restraining Order be issued immediately without prior notice: a. prohibiting defendant from abusing, harassing, assaulting, stalking, following, tracking, monitoring, or threatening the protected person(s) in any manner whatsoever. This prohibition includes the use, attempted use, or threatened use of physical force that would reasonably be expected to cause bodily injury. b. prohibiting the defendant from contacting the protected person(s) personally, through a third party, or via public posting, by any means, including written, telephone, or electronic (text, email, messaging, or social media) communication without the express written permission of this court. c. prohibiting defendant from going within one hundred (100) yards of the residence, apartment complex, or multiple family dwelling of the protected person(s) located at: No. & Street Apt. No. City State Zip Code d. ordering the defendant to stay away from the protected person(s) place of employment/school and not to interfere in any manner with such employment/school located at: Employment/school Address City State Zip Code Employment/school Address City State Zip Code e. ordering the defendant not to damage any belongings of the protected person(s), not to shut off any utilities, telephone service, or mail delivery to the protected person(s), or in any way interfere with the living conditions of the protected person(s). f. ordering the defendant not to contact family members or acquaintances of the protected person(s). Paragraph 9 Petitioner desires that a Rule Nisi issue herein ordering defendant to show cause why the temporary restraining order requested in Paragraph 8 should not be made a preliminary injunction and thereafter a permanent injunction and further why defendant should not be ordered: to pay all costs of court in this matter. to pay attorney fees. American LegalNet, Inc. www.FormsWorkFlow.com LPOR O Page 5 of 6 v.10 PRAYER WHEREFORE, petitioner prays that service and citation issue herein, and: (check all that apply) that ex parte temporary restraining order requested in Paragraph 8 be granted. a rule issue to show cause why a preliminary injunction and thereafter a permanent injunction as requested in Paragraph 9 should not be granted. defendant be cast with costs. defendant be advised of penalties for violating Abuse Prevention Orders. all other equitable relief as the court deems proper and necessary. Respectfully submitted by: PETITIONER, IN PROPER PERSON Street Address Apt. No. City Sta te Zip Code Telepho n e PLEASE SERVE DEFENDANT: personally at his/her home or place of employment at the following address: O r American LegalNet, Inc. www.Fo