DV-001, Rev. 1/05 PERSONAL DESCRIPTION OF PETITIONER AND RESPONDENT IN A DOMESTIC VIOLENCE ORDER PETITIONER: CASE NO. _______________________________ RESPONDENT: ________________________________ ****************************************************************************************************** Petitioner Information: (NOTE: IF YOU WANT YOUR ADDRESS, PHONE NUMBER, DATE OF BIRTH, AND EMPLOYMENT INFORMATION TO REMAIN CONFIDENTIAL, DO NOT INCLUDE THIS INFORMATION HERE. SUPPLY THIS INFORMATION ON THE APETITIONER=S CONFIDENTIAL INFORMATION FORM.@) Petitioner=s Name: Permanent Address: ________________________ City: State: Zip Code: _____________________ Daytime Phone No. ( )____________________ Address where staying if different than above: _________________________________ City: State: Zip Code: __________________________ Contact Number if different than above: ( )______________________ Race: Sex: Height: Weight: Hair Color: Relationship to Respondent:________________________________ Eye Color: ___________ Employer Name: Employer Address: ________________________ City: State: Zip Code: _________________________ Employer Phone No. ( ) Occupation: _________________________ How long have you lived with the Respondent?: If separated, how long?: ___________________ Are there minor children in your household ? 9 Yes 9 No Divorce or Dissolution: 9 not planned 9 intend to file 9 now pending 9 already granted Attorney Name: ________________________________________  Referred by CSB Name of person making referral from CSB:_______________________________ Why was petitioner referred by CSB?:__________________________________________________________ __________________________________________________________________________________________. ****************************************************************************************************** Respondent Information: Respondent=s Name: City Daytime Phone No. ( ) Race: Eye Color: Height: ___________ Weight: Hair Color:__________________ Identifying Marks: ________________________________________________________ Sex: State: Employer Name: City: Employer Phone No. ( State: ) Address:___________________________ Zip Code:____________________________ Hangouts:______________________________ Employer Address: _________________________ Zip Code: ________________________ Occupation: _____________________________ Normal work hours/days: Vehicle License No.: Type of auto owned or used: ______________________ State: License Year: License Type: _____________ History of Mental Illness? Carries Weapons?____________ Type of Weapons: ___________________________________ Remarks:_____________________________________________________________________________________ _____________________________________________________________________________________________ __________________________________________________________________________________________. American LegalNet, Inc. www.USCourtForms.com