Form CC 377PETITION FORPERSONAL PROTECTION ORDER(NONDOMESTIC)Use this form if you want an order to restrain another person over the age of 18 and you do not have adomestic relationship to this person. American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR COMPLETING "PETITION FOR PERSONAL PROTECTION ORDER (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 H 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 age. Write the name, address, and telephone number of the person you want restrained in the"Respondent" box; if he or she is under 18 years of age, write in his/her age. If you want your address andtelephone number to be kept from the respondent, do not write your address here. Put in the addressof a relative or friend or a post office box where the court can contact you.BCheck the box if the respondent is required to carry a firearm while at work. If you aren't sure, check the box"unknown."CCheck 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.DExplain 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.ECheck 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 4 that support an order against stalking.FAn "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.GIf 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.HWrite 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.You must read the booklet "Instructions for Personal Protection Orders" for directions on the legal process. American LegalNet, Inc. www.FormsWorkFlow.com 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.2.The respondent is required to carry a firearm in the course of his/her employment.Unknown.3.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.4.I need a personal protection order because:5.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.6.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.7.I have a next friend petitioning for me. I certify that the next friend is not disqualified by statute and is an adult.CC 377 (4/14) PETITION FOR PERSONAL PROTECTION ORDER (NONDOMESTIC) MCL 600.2950a, MCR 3.703 Petitioner's/Next friend's signature Date Court telephone no.Court address 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 FORPERSONAL PROTECTION ORDER (NONDOMESTIC) Explain what has happened (attach additional sheets). GFHCase numberName of court, county, and state or provinceName of judgeCase numberName of court, county, and state or provinceName of judge CD E BAPetitioner's name AgeRespondent's name, address, and telephone no. Age American LegalNet, Inc. www.FormsWorkFlow.com PROOF OF SERVICE TO PROCESS SERVER: You must serve the copies of the petition for personal protection order and file proof of service with thecourt clerk. If you are unable to complete service, you must return this original and all copies to the court clerk.OFFICER 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 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 on .ACKNOWLEDGMENT OF SERVICE Petition for Personal ProtectionOrder (Nondomestic)Case No. Day, date, timeComplete address of serviceRespondent nameI served a copy of the petition for personal protection order by:personal serviceregistered mail, delivery restricted to the respondent (return receipt attached)on: MCR 2.105(A) Day, date, time Signature of respondentI have personally attempted to serve a copy of the petition for personal protection order on the following respondent and havebeen unable to complete service. Complete address of serviceRespondent name SignatureTitle Name (type or print)I declare that the statements above are true to the best of my information, knowledge, and belief. $$Service feeMiles traveledFeeIncorrect address f