IN THE COURT OF COMMON PLEAS COUNTY, OHIO Petitioner : Case No. Address : Judge City, State, Zip Code : PETITION FOR CIVIL STALKING PROTECTION ORDER (CSPO)(R.C. 2903.214) Date Of Birth: : v. : : Respondent Notice to Petitioner: Throughout this form, check every that applies. Do NOT write your address at left or below if you are requesting confidentiality. : Address : The Respondent does NOT have to be related to Petitioner in any way in order for Petitioner to be eligible for relief. City, State, Zip Code : Date Of Birth: 1. Petitioner seeks relief on Petitioner’s own behalf. 2. Petitioner seeks relief on behalf of the following family or household members: NAME DATE OF BIRTH HOW RELATED TO PETITIONER Ohio law defines Menacing by Stalking as follows: “No person by engaging in a pattern of conduct shall knowingly cause another person to believe that the offender will cause physical harm to the other person or cause mental distress to the other person.” R.C. 2903.211(A)(1). “No person, through the use of any electronic method of remotely transferring information, including, but not limited to, any computer, computer network, computer program, or computer system, shall post a message with purpose to urge or incite another to commit a violation of division (A) (1) of this section (above)“ R.C. 2903.211 (A)(2). FORM 10.03-D PETITION FOR CIVIL STALKING PROTECTION ORDER (CSPO) REVISED 9/1/04 Discard all previous versions of this form American LegalNet, Inc. www.USCourtForms.com [Side 2 of Form 10.03-D] 3. Petitioner states that Respondent has engaged in the following act(s) which create an immediate and present danger. Describe the nature and extent of two or more threats or other pattern of conduct which causes you to believe the Respondent will cause physical harm or causes or has caused mental distress to you or a family or household member. Also describe any previous convictions of Respondent for the crime of Menacing by Stalking, if known. Attach additional paper if you need more room: 4. Petitioner requests that the Court grant relief under Ohio Revised Code 2903.214 for the safety and protection of the Petitioner and the family or household members named in this Petition by granting a Civil Stalking Protection Order that: (a) Requires Respondent not to abuse the Petitioner and the family or household members named in this Petition by harming, attempting to harm, threatening, molesting, following, stalking, bothering, harassing, annoying, contacting, or forcing sexual relations upon them. (b) Requires Respondent to refrain from entering the residence, school, business, place of employment, or day care centers of Petitioner and the family or household members named in this Petition, including the buildings, grounds and parking lots at those locations. (c) Requires Respondent not to interfere with Petitioner's right to occupy the residence including, but not limited to canceling any utilities, insurance, interrupting phone service, mail delivery, or the delivery of any other documents or items. (d) Requires Respondent not to remove, damage, hide or dispose of any property or pets owned or possessed by the Petitioner and Petitioner's family or household members named in this Petition. (e) Requires Respondent not to possess, use, carry, or obtain any deadly weapon. (f) Includes the following additional provisions: 5. Petitioner further requests that the Court issue an ex parte (emergency) protection order under Ohio Revised Code 2903.214(D) and this Petition. 6. Petitioner further requests that the Court not issue any mutual protection orders or other orders against Petitioner unless all of the conditions of R.C. 2903.214(E)(3) are met. 7. Petitioner further requests that if Petitioner has a victim advocate, the court permit the victim advocate to accompany Petitioner at all stages of these proceedings as required by R.C. 2903.214(L). 8. Petitioner further requests that the Court grant such other relief as the Court considers equitable and fair. FORM 10.03-D PETITION FOR CIVIL STALKING PROTECTION ORDER (CSPO) REVISED 9/1/04 Discard all previous versions of this form American LegalNet, Inc. www.USCourtForms.com [Side 3 of Form 10.03-D] 9. The following is a list of all present and past court cases involving Respondent, that Petitioner knows of: CASE NAME CASE NUMBER COURT/COUNTY OUTCOME OF CASE I hereby swear or affirm that the answers above are true, complete and accurate to the best of my knowledge. I understand that falsifying this document may result in a contempt of court finding against me which could result in a jail sentence and fine, and that falsifying this document may also subject me to criminal penalties for perjury under Ohio Revised Code 2921.11. Sworn to and subscribed before me on this of , day . SIGNATURE OF PETITIONER Address where Petitioner can be contacted: NOTARY PUBLIC Signature of Attorney for Petitioner (if applicable) Name Address Attorney Registration Number Telephone Number FORM 10.03-D PETITION FOR CIVIL STALKING PROTECTION ORDER (CSPO) REVISED 9/1/04 Discard all previous versions of this form American LegalNet, Inc. www.USCourtForms.com