HAR104 State ENG Rev 7/15www.mncourts.gov/formsPage 1 of 1State Of Minnesota District Court County of: Select County Judicial District: Court File Number: Case Type: Harassment Petitioner (first, middle, last) Respondent (first, middle, last)vs.Petitioner's Request to Keep Address/Phone ConfidentialIn a Harassment case, the court must keep your address and telephone number confidential, if you ask. Under Minn. R. Pub. Access 4, subd. 1(a)(2), if your address or phone is confidential the information will not be accessible to the public and may be disclosed only to court personnel or law enforcement for purposes of service of process, conducting an investigation, or enforcing an order. Your request only affects the case you are currently starting. There may be other cases in the court records involving you, where your address is public.I am asking for a Harassment Restraining Order. My name is: I request a court order to keep my phone number confidential and not accessible to the public My phone number is:Can court personnel leave messages at this number? Yes No I request a court order to keep my home address confidential and not accessible to the publicMy address is: Street Apt. # City State Zip C/O(If staying at a shelter or someone else's home, you can put their name here to make sure the post office delivers mail to you at this address.)Notice: The Court needs your full mailing address and phone number to be able to send you notices and orders on your case. American LegalNet, Inc. www.FormsWorkFlow.com