IN THE ______ JUDICIAL CIRCUIT COURT, ____________________________, MISSOURI Judge or Division: Petitioner: vs. Respondent: Alias/Nicknames: Respondent's DOB: Age: SSN (if known, last four digits): Race: Home Phone Number: Respondent's Work Address: Case Number: Court ORI Number: MSHP Number: Responsible Law Enforcement ORI: Related Cases: Respondent's Home Address: (Date File Stamp) Sex: F M Work Phone Number: Work Hours: Other Locations Where Respondent May Be Served: Petitioner's Relationship to Respondent pursuant to 18 U.S.C. §§ 921(a)(32) and 922(g)(8) determination: Spouse Child(ren) in common Former spouse Intimate residing/resided together Are/were in a continuing social relationship of a romantic/intimate nature Related by blood. Define relationship: Related by marriage. Define relationship: Residing/resided together; no intimacy Stalking. Define relationship: Adult Abuse/Stalking Motion for Renewal of Full Order of Protection The Petitioner requests that the court renew the Full Order of Protection that was issued against Respondent on _______________________ (date) and terminates on ________________________ (date) for the reason that: The expiration of the full order will place me in immediate and present danger of domestic violence or stalking. The circumstances forming the basis for the initial order continue to exist. The following incidents of domestic violence or stalking have occurred since the date the petition was filed: Other reasons: Pursuant to 455.040 RSMo, Petitioner requests that the court renew the full order of protection for not less than 180 days and not more than one year. A finding by the court of a subsequent act of domestic violence or stalking is not required for a renewal order of protection. I swear/affirm under penalty of perjury that these facts are true according to my best knowledge and belief. NOTICE: Section 455.030.3 RSMo provides that a Petitioner seeking protection under the Domestic Violence Act is not required to reveal any current address or place of residence on this motion. Do not provide this information if doing so will endanger you. ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ Telephone City, State and Zip Address (Optional) Petitioner's Signature Date ______________________________________________ ______________________________________________ ______________________________________________ _______________________________________________ Telephone 1 of 1 455.030.3, 455.040 RSMo American LegalNet, Inc. www.FormsWorkFlow.com Attorney's Name, Missouri Bar No., if Applicable Address City, State and Zip OSCA (07-13) AA25 (ASMR)