NHJB-2960-Se (07/01/2018) Page 1 of 2 THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) COMPLAINT FOR RESTRAIN IN G ORDER 1. Plaintiff222s Name(s) Residence Address Mailing Address (if different) Telephone Number (Home) (Mobile) 2. Defendant222s Name(s) Residence Address Mailing Address (if different) 3. What is your relationship to the defendant? (Examples: neighbor, co-worker, roommate, acquaintance, etc.) In the space below, describe what happened to you and the reasons why you are requesting that the Court issue a restraining order against the defendant. Use a separate paragraph for each allegation. Be specific - include names, dates and places, etc. 4. First thing that happened (in one sentence): 5. Second thing that happened (in one sentence): 6. Third thing that happened (in one sentence): Continue on using separately numbered paragraphs (attach additional sheets if necessary). American LegalNet, Inc. www.FormsWorkFlow.com Case Name: Case Number: COMPLAINT FOR RESTRAINING ORDER NHJB-2960-Se (07/01/2018) Page 2 of 2 For the reasons stated in this Complaint, I request that the Court issue the following orders: A. Describe the orders you want the Court to make: 1. Restrain the defendant from threatening, harassing or intimidating me, or interfering with my liberty. 2. Restrain the defendant from having any contact with me, whether in person or through third persons, including but not limited to contact by telephone, letters, fax, texting, social media, e-mail, the sending or delivery of gifts or any other method, unless specifically authorized by the court. 3. Restrain the defendant from appearing in proximity to my residence, place of employment or school, or appearing at any other place where I may be. 4. Restrain the defendant from entering in or on the premises (including curtilage) where I reside, except with a peace officer for the purpose of removing defendant's personal possessions. 5. Restrain the defendant from taking, converting or damaging property in which I have a legal or equitable interest. 6. Ex Parte Motion. See attached. 7. Other relief: B. All other relief the Court deems fair and just. Name of Filer Signature of Filer Date Law Firm, if applicable Bar ID # of attorney Telephone Address E-mail City State Zip code American LegalNet, Inc. www.FormsWorkFlow.com