STATE OF MICHIGAN 6th CIRCUIT COURT OAKLAND COUNTY Court address 1200 N. Telegraph Road, Pontiac, MI 48341-1043 ADDENDUM TO PETITION FOR PERSONAL PROTECTION ORDER (DOMESTIC) CASE NO. page of Court telephone no. (248) 975-9511 Age Petitioner's name Age V Respondent's name Check if non-public mailing address filed with Court I need a personal protection order because respondent: Entered onto my property. Assaulted, attacked, beat, molested, or wounded me on or about the following dates: Threatened to kill or physically injure me on or about the following dates: Removed minor child(ren) from the individual having physical custody of the child(ren) without a court order. Interfered with me at my job or is threatening my job relationship or environment. Interfered with my efforts to remove my child(ren) or personal property from defendant's property. Did the following things which make me fear violence or interfere with my freedom: 1. When Where What 2. When Where What 3. When Where What 4. When Where What (Attach extra sheets if necessary) VERIFICATION UNDER MCR 2.114(2)(b): I declare that the statements above are true to the best of my information, knowledge and belief. DATED: Signature of moving party ADDENDUM-DOMESTIC American LegalNet, Inc. www.FormsWorkFlow.com