OFP102 State ENG Rev 12/15www.mncourts.gov/formsPage 1 of 10State Of Minnesota District Court County of: Select County Judicial District: Court File Number: Case Type: Domestic AbuseIn the Matter of: Petitioner (first, middle, last)On behalf of: Other persons needing protection (first, middle, last) and for her/himselfvs. Respondent (first, middle, last)Petitioner's Affidavit and Petition For Order for Protection (Minn. Stat. 247 518B.01) I, , state that:I am the Petitioner (the person requesting the order) in this action. This affidavit supports my request for an Order for Protection (OFP). (Minn. Stat. 247 518B.01).1. Who needs protection? Me (Petitioner) My minor child(ren) A person for whom I am the legal guardian (attach Guardianship Order) A minor child who is not my child, but is a family or household member of mine Other 2. Petitioner Information (You) Name: (first, middle, last) My address or phone is confidential. (Give the confidential information to courtadministration on a separate sheet of paper.) My Address: Apt. # City State Zip American LegalNet, Inc. www.FormsWorkFlow.com OFP102 State ENG Rev 12/15www.mncourts.gov/formsPage 2 of 10 Telephone: Date of birth: (month/day/year) Race:(for federal reporting purposes)Gender: male female3. Email Notification of ServiceBy providing my email address below, I am indicating that I want to be notified by email when the respondent is served with the OFP. I understand that this is the only email I will receive from the court about the OFP unless I have signed up to receive other court notices via email. I understand that it will only be possible for the court to notify me by email when service information is received by the court. I understand that a technical or other error could occur preventing the successful delivery of the email, and that I have other options to learn of the service of the OFP on the respondent, including contacting law enforcement directly. I understand I must provide a valid email address in order to receive this notification of service, and that THIS EMAIL ADDRESS WILL BE SEEN BY THE RESPONDENT: Email address:4. Respondent Information: (person you want protection from) Name: (first, middle, last) Address: Apt. # City State Zip Telephone: Date of birth: (month/day/year) If DOB unknown, age or approximate age Race:(for federal reporting purposes)Gender: male femaleIf Respondent is under 18 years old, service must be made on Respondent and Respondent's parent or guardian. Parent or Guardian Name: Parent or Guardian address:5. List all persons needing protection, other than you. None Name (first, middle, last) Race Date of Birth Gender Lives with you? How is this person related to you? How is this person related to the Respondent? M F YES NO M F YES NO American LegalNet, Inc. www.FormsWorkFlow.com OFP102 State ENG Rev 12/15www.mncourts.gov/formsPage 3 of 10 Name (first, middle, last) Race Date of Birth Gender Lives with you? How is this person related to you? How is this person related to the Respondent? M F YES NO M F YES NO M F YES NO 6. List all minor children you and Respondent have together (biological and adopted) not listed at #5. None Name (first, middle, last) Date of Birth Who has the child now? Me Respondent Other Me Respondent Other Me Respondent Other Me Respondent Other Me Respondent Other7. List all minor children living with you, not listed at #5 or #6. None Name (first, middle, last) Date of Birth How is this child related to you? How is this child related to Respondent? 8. What is your relationship to Respondent? (Check all that apply) Married Divorced Marriage Date: Marriage Date: Divorce Date: Living together since Lived together from (date) (date)to (date) American LegalNet, Inc. www.FormsWorkFlow.com OFP102 State ENG Rev 12/15www.mncourts.gov/formsPage 4 of 10 Have a child together Have an unborn child together Parent/Child Related by blood Significant romantic or sexual relationshipThe relationship lasted from (date)to (date). How often did you have contact with Respondent during that time? Parent/Child Have an unborn child together Have a child together(If a temporary order expired because law enforcement was not able to serve Respondent with OFP, you do not have to list it here.) Provide the following details:9. Is there an Order for Protection in effect now between you (or anyone else listed #5) and Respondent? Yes No10. Orders for Protection no longer in effect:Have you, or any of the people listed at #5, had an Order for Protection against Respondent in the past? Yes No(If no, skip to #11.)11. Now, or in the past, have you (or other persons at #5) and Respondent been jointly involved in other family court, domestic abuse criminal cases, or harassment restraining order cases? Yes NoCheck the box if you and Respondent have a current or closed Court Case of this type: Divorce Custody Paternity Child Support Child Protection Domestic Abuse criminal charges Domestic Abuse criminal conviction Harassment Restraining OrderFor each box checked, provide the following case information, if known:Case Type Case Number State/County Year Filed Names of children involved 12. Why do you (or the persons listed at #5) need an Order for Protection?Describe the abuse by answering the questions below. If there are several dates, use the Description of Abuse Attachment to describe what happened on the other dates. American LegalNet, Inc. www.FormsWorkFlow.com OFP102 State ENG Rev 12/15www.mncourts.gov/formsPage 5 of 10 Date of most recent abuse:Who was there?: Describe what Respondent did to physically harm you (or others at #5) or make you afraid. If you were injured, also describe the injuries. Was medical treatment received for any injuries? Yes NoDescribe any use or threatened use of guns or other weapons: During the incident, did Respondent interfere with a 911 or emergency call? Yes NoDescribe the interference: Did the police/sheriff come? Yes NoIf Yes, list dates and other details. 13. (Optional) If there is a history of abuse by Respondent and person at #5, in addition to therecent indcidents, you may briefly explain the history here: 14. Do you believe that the domestic violence will continue and that you or other persons at #5 are in immediate danger? Yes NoWhy? 15. Does Respondent work or attend school at the same place as Petitioner or any other protected persons? Yes NoREQUESTS FOR RELIEF16. Relief that does not require a hearing:I ask the court to order the things I checked below in (a) through (k). I understand that requesting these things does not require a hearing to be held. I understand that if the court issues an Ex Parte Order, the judge may set a hearing and/or the Respondent may request a hearing. I understand that if the court does not issue an Ex Parte Order, the judge may dismiss the matter, or may set a hearing, unless I do not want a hearing (indicate by checking the box below). I DO NOT want a hearing. If the court does not issue an Ex Parte Order, I ask thatno hearing be scheduled and that the matter be dismissed. I understand that this means there will be no Order issued and no further proceedings.Based on this affidavit, I am asking the court to make the following orders: American LegalNet, Inc. www.FormsWorkFlow.com OFP102 State ENG Rev 12/15www.mncourts.gov/formsPage 6 of 10a. Issue an Ex Parte Order for Protection to protect me all persons listed at #5. (These are the protected persons.)b. Restrain and enjoin Respondent from causing the protected person(s) any physical harm, or fear of immediate physical harm.c. Order Respondent to have no contact with the protected person(s) whether in person, with or through other persons, by telephone, mail, e-mail, through electronic devices, social media, through a third party, or by any other means, except as follows: d. Exclude Respondent from:i. My home or the home Respondent and I share. My address is confidential OR My home address is: City State ZipAnd a reasonable area surrounding my home, specifically as follows: Except as follows: ii. The home of (protected person(s)). The address is confidential OR Home address is: City State ZipAnd a reasonable area surrounding the home, spe