Form CC 377MPETITION FORPERSONAL PROTECTION ORDERAGAINST A MINOR(NONDOMESTIC)Use this form if you want an order to restrain a person under the age of 18 but at least 10 years of age andyou do not have a domestic relationship to this person. American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR COMPLETING "PETITION FOR PERSONAL PROTECTION ORDERAGAINST A MINOR (NONDOMESTIC)"Please print neatly. Press firmly because you are printing on five copies.By filling in this form, you are asking for a personal protection order that tells the respondent not to do certain thingsyou don't want him or her to do. If you are in immediate danger, you should ask the judge for an "ex parte" order,which will be issued without waiting for a hearing.Items A through G must be completed before your petition can be filed with the court. Please read the instruction foreach item. Then fill in the correct information for that item on the form.AWrite your name, address, and telephone number in the "Petitioner" box. If you are under 18 years of age,write in your date of birth. Write the name, address, and telephone number and date of birth or age of the personyou want restrained in the "Respondent" box. If you want your address and telephone number to be keptfrom the respondent, do not write your address here. Put in the address of a relative or friend or apost office box where the court can contact you.BCheck whether there is a pending action between you and the respondent. If there is, fill in the case number,the name of the court, the county, and the state or province where the action was filed, and the name of the judge.Check whether there are any court orders or judgments between you and the respondent. If there are, fill inthe case number, the name of the court, the county, and the state or province where the order or judgment wasentered, and the name of the judge that signed the order.CExplain in as much detail as possible why you are asking for a personal protection order. Describe what hashappened or what has been threatened so the judge has enough facts to decide if a personal protection ordershould be signed. If you want to prohibit stalking, you must detail two or more separate instances of harassment(unconsented contact) that caused you to feel terrorized, frightened, intimidated, threatened, harassed, ormolested. Include dates and places. Write on a separate sheet of paper and attach it to this form. If you onlywant to prohibit the posting of a message through the use of any medium of communication, including theInternet or a computer or any electronic medium, you must detail what caused you to feel terrorized, frightened,intimidated, threatened, harassed, or molested.DCheck only those boxes you need because you must be able to convince the judge you need all the protectionyou are requesting. Check box a only if you provided details in item 3 that support an order against stalking.EAn "ex parte order" means you do not have to let the other party know in advance that you are asking thecourt for an order and you do not have to wait for a court hearing to get the order. Check the box for an"ex parte order" if you believe the other party might hurt you or threaten you if he or she found out you weregetting an ex parte personal protection order.If you do not check the box for an ex parte order, you must have a court hearing. Fill out form CC 381.FIf you are under 18 years old, you may need an adult (called a "next friend") to petition for you. Check thisbox if you have a next friend helping you file this form, and have the next friend sign the petition.GWrite in today's date and sign the form. Hand the form to the county clerk. The clerk will fill in the rest of theinformation and will give you your copies.NOTE: There are only five copies of this form. You will need to make extra copies of this form for each parent, guardian,or custodian of the respondent.You must read the booklet "Instructions for Personal Protection Orders" for directions on the legal process. American LegalNet, Inc. www.FormsWorkFlow.com CC 377M (4/14) PETITION FOR PERSONAL PROTECTION ORDER AGAINST A MINOR (NONDOMESTIC)MCL 600.2950a, MCL 712A.2(h), MCR 3.703 Petitioner's/Next friend's signature Date Approved, SCAOCASE NO.STATE OF MICHIGANJUDICIAL CIRCUITCOUNTYOriginal - Court1st copy - Judge/Assignment clerk (green)2nd copy - Respondent (blue) Address and telephone no. where court can reach petitioner v3rd copy - Petitioner (pink)4th copy - Return (yellow)PETITION FOR PERSONAL PROTECTIONORDER AGAINST A MINOR(NONDOMESTIC)GAPetitioner's nameDOBRespondent's name, address, and telephone no.DOB or age B FE D 1.The petitioner and respondent have never been husband and wife, resided in the same household together, had a child incommon, 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.Thereareare notother pending actions in this or any other court regarding the parties.b.Thereareare notorders/judgments entered by this or any other court regarding the parties.3.I need a personal protection order because:4.I make this petition under the authority of MCL 600.2950a(1) and ask the court to grant a personal protection order prohibitingthe respondent froma.stalking me as defined by MCL 750.411h and MCL 750.411i, which includes but is not limited tofollowing 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:b.posting a message through the use of any medium of communication, including the Internet or a computer or anyelectronic medium, pursuant to MCL 750.411s.5.I request an ex parte order because immediate and irreparable injury, loss, or damage will occur between now and ahearing 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. Explain what has happened (attach additional sheets).Case numberName of court, county, and state or provinceName of judgeCase numberName of court, county, and state or provinceName of judge C Court telephone no.Court address American LegalNet, Inc. www.FormsWorkFlow.com Petition for Personal Protection OrderAgainst a Minor (Nondomestic)Case No.Subscribed and sworn to before me on , County, Michigan.My commission expires: Signature:Notary public, State of Michigan, County of DateDateDeputy court clerk/Notary publicI acknowledge that I have received a copy of the petition for personal protection order against a minor on .ACKNOWLEDGMENT OF SERVICE Day, date, timeComplete address of serviceName of respondent Day, date, timeComplete address of serviceName of parent/guardian/custodianDay, date, timeComplete address of serviceName of parent/guardian/custodianOFFICER CERTIFICATEAFFIDAVIT OF PROCESS SERVERI certify that I am a sheriff, deputy sheriff, bailiff, appointedcourt officer, or attorney for a party [MCR 2.104(A)(2)], andthat:(notarization not required)Being first duly sworn, I state that I am a legally competentadult who is not a party or an officer of a corporate party, andthat:(notarization required)OR CERTIFICATE / AFFIDAVIT OF SERVICE / NONSERVICE I served a copy of the petition for personal protection order against a minor by:personal serviceregistered mail, delivery restricted to the respondent and the parent(s), guardian(s), orcustodian(s) of the respondent (return receipt attached) on: TO PROCESS SERVER: You must serve the copies of the petition for personal protection order against a minor and file proof ofservice with the court clerk. If you are unable to complete service, you must return this origi