State of Minnesota District Court County Judicial District: Court File Number: Case Type: Domestic Abuse In the Matter of: Petitioner Application for Extension of Order for Protection (Minn. Stat. § 518B.01, subd. 6a) vs. Respondent STATE OF MINNESOTA COUNTY OF ) ) SS ) I am the petitioner in the above named matter. I state the following: 1. An Order for Protection was issued on . (Date) 2. The Order for Protection will expire on . (Date) 3. I am requesting an extension of the Order for Protection because:     4. The respondent violated the Order for Protection. I am reasonably in fear of physical harm from the respondent. The respondent engaged in acts of harassment or stalking. The respondent is/was incarcerated and has been or is about to be released. Describe in detail the acts of the respondent that explain why you are asking for the extension. Give approximate dates and list the most recent incidents first. (Attach additional sheets if needed.) I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. § 358.116. Dated: Signature Name: Address: City/State/Zip: Telephone: ( ) E-mail address: OFP701 State ENG Rev 7/15 www.mncourts.gov/forms Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Notice of Hearing To the Above Named Respondent: The application of the petitioner for an extension of the Order for Protection will be heard on o’clock at (Date) .m. (Time) at (Address) Date: Deputy/Court Administrator FAILURE TO APPEAR AT THE HEARING WILL NOT BE A DEFENSE TO PROSECUTION FOR VIOLATION OF THE COURT'S ORDER. Distribution _______ Certified copy or original - Return to Court Administrator with Affidavit of Personal Service attached Copy for Petitioner(s) Copy for Respondent(s) Copy for file until original returned Copy for local police department Copy for Sheriff Other: _______ Dissolution File OFP701 State ENG Rev 7/15 www.mncourts.gov/forms Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com