OSCA (02-16) CP51 1 of 1 SCR 130.13; 455.528 RSMo IN THE JUDICIAL CIRCUIT, , MISSOURI Request to Dismiss Petition for Order of Protection 226 Child Use this form when one child is involved with this case. Use CP57 for two to five children and CP54 for six to ten children. Judge or Division: Case Number: (Date File Stamp) Court ORI Number: Petitioner: Protected Child: Age of Protected Child: Sex: F M Race: vs. MSHP Number: Responsible Law Enforcement ORI: Related Ca ses: Protected Child222s Relationship to Respondent pursuant to 18 U.S.C. 247247 921(a)(32) and 922(g)(8) determination: Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify): Respondent: Alias/Nicknames: Respondent222s DOB: SSN (if known, last four digits): Respondent222s Home Address: Home Phone Number: Race: Sex: F M Respondent222s Work Address: Work Phone Number: Work Hours: Petitioner requests dismissal of the Petition for Order of Protection 226 Child. Petitioner understands that the court may examine the circumstances of the motion and may inquire of the Petitioner or others in order to determine if dismissal is voluntary. Date Petitioner222s Signature Judgment of Dismissal On motion of Petitioner, cause dismissed without prejudice. So Ordered: Date Judge Recommendation of Dismissal & Notice of Right to Rehearing On motion of Petitioner, it is recommended that case be dismissed without prejudice. The parties are notified that the foregoing Findings and Recommendations have been entered this date by a commissioner, and all papers relative to the case or proceedings, together with the Findings and Recommendations, have been transferred to a judge of the court. The Findings and Recommendations shall become the Judgment of the court upon adoption by order of the judge. Unless waived by the parties in writing, a party to the case or proceeding heard by a commissioner, within fifteen days after the mailing of notice of the filing of the Judgment of the court, may file a motion for rehearing by a judge of the court. If the motion for rehearing is not ruled on within forty-five days after the motion is filed, the motion is overruled for all purposes. SCR 130.13 Date Commissioner Order and Judgment Adopting Commissioner222s Findings and Recommendations It is hereby ordered, adjudged and decreed that the foregoing Findings and Recommendations entered by the commissioner are adopted and confirmed as a final Judgment of the court. Date Judge Instructions to Clerk The clerk shall forward a copy of this Judgment to the local law enforcement agency. American LegalNet, Inc. www.FormsWorkFlow.com