Original – Court 1st copy – Judge/Assignment clerk (green) 2nd copy – Respondent (blue) Approved, SCAO STATE OF MICHIGAN 6th JUDICIAL CIRCUIT OAKLAND COUNTY 3rd copy – Petitioner (pink) 4th copy – Return (yellow) PETITION FOR PERSONAL PROTECTION ORDER AGAINST STALKING BY A MINOR (NON DOMESTIC) CASE NO. Court address 1200 N. Telegraph Road, Pontiac, MI 48341-1043 Petitioner name Court telephone no. (248) 858-0581 DOB Address and telephone no. where court can reach petitioner Respondent name, address, and telephone no. DOB or age v 1. The petitioner and respondent have never been husband and wife, resided in the same household together, had a child in common, or had a dating relationship with one another. The respondent is not the unemancipated minor child of the petitioner. The petitioner is not the unemancipated minor child of the respondent. The respondent is between 10 and 17 years of age. 2. a. There are are not Case number b. There other pending actions in this or any other court regarding the parties. Name of court and county are Case number are not Name of judge orders/judgements entered by this court or any other court, regarding the parties. Name of court and county 3. I need a personal protection order because: Name of judge Explain what has happened (attach additional sheets) 4. I make this petition under the authority of MCL 600.2950a and ask the court to grant a personal protection order prohibiting the respondent from stalking me as defined under MCL 750.411h and MCL 750.411i which includes but is not limited to: following me or appearing within my sight. appearing at my workplace or residence. approaching or confronting me in a public place or on private property. entering onto or remaining on property owned, leased, or occupied by me. sending mail or other communications to me. contacting me by telephone. placing an object on or delivering an object to property owned, leased, or occupied by me. threatening to kill or physically injure me. purchasing or possessing a firearm. other: 5. I ask the court to grant a personal protection order against stalking: I request an ex parte order because immediate and irreparable injury, loss, or damage will occur between now and a hearing or because notice itself will cause irreparable injury, loss, or damage before the order can be entered. 6. I have a next friend petitioning for me. I certify that the next friend is not disqualified by statute and is an adult. Date Petitioner’s signature MCL 600.2950a, MCL 712A.2h, MCR 3.703 CC 377M (3/09) PETITION FOR PERSONAL PROTECTION ORDER AGAINST STALKING BY A MINOR (NON DOMESTIC) American LegalNet, Inc. www.FormsWorkFlow.com