CIVIL CASE INFORMATION MONTGOMERY COUNTY COMMON PLEAS COURT GENERAL DIVISION Room 5, 41 North Perry Street, Dayton, OH 45422 This form must be completed and filed with all civil suits. Main Plaintiff Case Number Main Counsel for Plaintiff Attorney Registration Number Main Counsel for Defendant (If known) Main Defendant Jury Demanded: Yes No Deposit Amt: Prayer Amt: Type of Action (Select Only One) AA - Administrative Appeal OT - Other Torts A - Appropriation PI - Personal Injury DJ - Declaratory Judgment PL - Product Liability FE - Forcible Entry PT - Professional Tort WC - Worker's Compensation HC - Habeas Corpus I - Injunction AO - All Others - State Type MM - Medical Malpractice MF - Mortgage Foreclosure Refiling Information Is this a refiling of a previous related case? Yes If Yes, please complete the following: No Previous Case Number: vs Party (1) Assigned Judge Party (2) Suits Involving Like Issues and Similar Parties Are there any other cases pending that arise from the same incident or related parties? If Yes, please complete the following: Yes No Previous Case Number: vs Assigned Judge Signature of Attorney or Party Filing Suit Party (1) Party (2) Date American LegalNet, Inc. www.FormsWorkflow.com WARNING CONCERNING THE ATTACHED PROTECTION ORDER NOTE: Rule of Superintendence 10.03 requires this Warning to be attached to the FRONT of all protection orders issued pursuant to R.C. 2903.213 and 2903.214 by the courts of the State of Ohio. TO BE USED WITH FORMS 10.03-B, 10.03-E, and 10.03-F. WARNING TO RESPONDENT/ DEFENDANT Violating the attached Protection Order is a crime, punishable by imprisonment or fine or both, and can cause your bond to be revoked or result in a contempt of court citation against you. This Protection Order is enforceable in all 50 states, the District of Columbia, tribal lands, and U.S. Territories pursuant to the Violence Against Women Act, 18 U.S.C. Section 2265. Violating this Protection Order may subject you to federal charges and punishment. You may also be subject to federal penalty for possessing, transporting, or accepting a firearm under the Gun Control Act, 18 U.S.C. Section 922(g)(8). Only the Court can change this order. The Petitioner / Alleged Victim cannot give you legal permission to violate this order. If you go near the petitioner or other protected persons, even with their consent, you may be arrested. You act at your own risk if you disregard this WARNING. If you want to modify or dismiss the order you must ask the Court. WARNING TO PETITIONER / ALLEGED VICTIM You cannot change the terms of this order by your words or actions. This order cannot be changed by either party without obtaining a written court order. NOTICE TO ALL LAW ENFORCEMENT AGENCIES AND OFFICERS The attached Protection Order is enforceable in all jurisdictions. Violating this Protection Order, whether it is a criminal or civil Protection Order, is a crime under R.C. 2919.27. Law enforcement officers with powers to arrest for violations of the Ohio Revised Code must enforce the terms of this Protection Order as required by R.C. 2919.27, R.C. 2903.213 and R.C. 2903.214. If you have reasonable grounds to believe that Respondent / Defendant has violated this Protection Order, in Ohio under R.C. 2935.03, you should arrest and detain Respondent / Defendant until you can obtain a warrant. Federal and state laws prohibit charging a fee for service of this order. FORM 10.03-H WARNING CONCERNING THE ATTACHED PROTECTION ORDER REVISED May 1, 2007 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS FOR OBTAINING A CIVIL STALKING OR SEXUALLY ORIENTED OFFENSE PROTECTION ORDER (SSOOPO) These instructions are intended to assist you in preparing the Petition for a Civil Stalking or Sexually Oriented Offense Protection Order (SSOOPO), which can only be heard by the Common Pleas Court in your county. Throughout the petition you are called Petitioner and the person you are filing this petition against is called Respondent. SOME HINTS BEFORE YOU BEGIN • • • • • • All forms must be typed or printed. When you print your name on the Petition, use the same name you use when you write your signature. Write your name and Respondent's name the same way throughout the Petition. Fill out the Petition as completely and accurately as possible. If you have any questions about completing the Petition, ask the clerk of court's office for assistance or contact your local domestic violence program or the Ohio Domestic Violence Network at 800-934-9840. Under Federal and State Law no fees may be charged to obtain a protection order. FILLING OUT THE PETITION: Mark each instruction below after you read and complete it On the front page, leave the “Case No.” line and “Judge” lines blank. The clerk of court's office will fill in this information. On the top left-hand side of the front page, fill in the requested information about yourself. If you do not want your present address to be known, write “confidential” in the space for your address, but list someone else’s address where you can receive notices from the court. Also on the top left-hand side of the front page, fill in the requested information about Respondent as best you can. You may use Respondent’s work address if you do not know Respondent’s home address. If you do not know Respondent’s date of birth, leave that line blank. Do not attempt to obtain this information unless it is safe to do so. Paragraph 1: If you are filing the Petition on behalf of yourself, mark the first box. Paragraph 2: If you are filing the Petition on behalf of a family or household member, mark the box and fill in their name(s) and the other information requested in the chart. You may attach additional pages if you need more room. Paragraph 3: State the date(s) of the incident(s) that brought you to file the Petition. If you are requesting a stalking protection order provide a brief description of the pattern of conduct (two or more instances) that caused you to believe that the Respondent will cause physical harm or cause mental distress to you or another family member. If you are requesting a sexually oriented offense protection order, you do not have to provide a description of a pattern of conduct, only a brief description of what happened that caused you to request the sexually oriented offense protection order. (NOTE: Petitioner and or Respondent need not be related in any way for Petitioner to obtain either type of protection order.) If you are aware of any prior convictions of the Respondent for menacing by stalking or similar offenses, or prior convictions of Respondent for any sexually oriented offenses, list what information you know about those convictions. You may attach additional pages if you need more room to complete your description. Paragraph 4: Indicate the action you want the court to take by marking the boxes next to the numbered paragraphs that apply to your situation. Paragraph 4 (f): Write any special court orders you believe would help protect you and your family or household members. Paragraph 5: Be sure to mark the box next to Paragraph 5 if you need an emergency (“ex parte”) protection order. Paragraph 9: List ALL present or past court cases or investigations that involve Respondent. This includes all criminal, divorce, custody, visitation, and any other case that may have a bearing on the safety of you or your family or household members. Write the case name, the court, the case number, and the outcome of the case, if known. You may attach additional pages if you need more room. SIGNING THE PETITION: Try to fill out the Petition before you go to the courthouse. AFTER YOU HAVE FILLED OUT THE PETITION, TAKE IT TO A NOTARY PUBLIC TO HAVE YOUR SIGNATURE NOTARIZED. DO NOT SIGN THE PETITION UNLESS YOU ARE IN FRONT OF A NOTARY PUBLIC. An employee of the Clerk of Courts office may be available to take your oath. FILING THE PETITION: After you have your signature notarized, file your Petition at the clerk of court's office. The Clerk of Court’s office will tell you when and where your ex parte hearing will take place. There is no filing fee for a Petition for a CSPO. FEES Under Federal and State Law, you cannot be charged any costs or fees for obtaining a protection order. FORM 10.03-G INSTRUCTIONS FOR OBTAINING A CIVIL STALKING OR SEXUALLY ORIENTED OFFENSE REVISED May 1, 2007 PROTECTION ORDER (SSOOPO) Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkflow.com CASE NUMBER(S) _________________________ _________________________ ACKNOWLEDGMENTS INITIAL HERE X ____ I hereby acknowledge and understand that all information which I provide on my petition(s) for Civil Stalking or Sexually Oriented Offense Protection Order will be accessible to the public. I understand that the respondent(s) will be served with a complete and unedited copy of the petition(s). INITIAL HERE X ____ I hereby acknowledge and understand that if I do not provide (1) the first and last name of each Respondent and (2) each Respondent’s date of birth or social security number to the Montgomery County Common Pleas Court or the Montgomery County Sheriff’s Office, any Civil Stalking or Sexually Oriented Offense Protection Order(s) granted in my case(s) will not be registered in law enforcement computers until this information is obtained. SIGN HERE X ___________________________ Petitioner ___________________________ Witness American LegalNet, Inc. www.FormsWorkflow.com IN THE COURT OF COMMON PLEAS COUNTY, OHIO Petitioner : Case No. Address : Judge City, State, Zip Code : PETITION FOR CIVIL STALKING OR SEXUALLY ORIENTED OFFENSE PROTECTION ORDER (SSOOPO) (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). Sexually oriented offenses are defined in Revised Code Section 2950.01. FORM 10.03-D PETITION FOR CIVIL STALKING OR SEXUALLY ORIENTED OFFENSE PROTECTION ORDER (SSOOPO) REVISED May 1, 2007 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkflow.com [Side 2 of 10.03-D] 3. Petitioner states that Respondent has engaged in the following act(s) which create an immediate and present danger. For either (a) or (b) below attach additional paper if you need more room: (a) For a civil stalking protection order, describe the nature and extent of the pattern of conduct that causes you to believe that Respondent will cause you physical harm or causes (or has caused) mental distress. Also describe any previous convictions of Respondent for the crime of Menacing by Stalking if known. (b) 4. For a sexually oriented offense protection order, describe the acts of Respondent as fully as possible. You do not need to include any pattern of conduct information for a sexually oriented offense protection order. 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 or Sexually Oriented Offense 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, following, stalking, harassing, contacting, forcing sexual relations upon them, or by committing sexually oriented offenses against 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. FORM 10.03-D PETITION FOR CIVIL STALKING OR SEXUALLY ORIENTED OFFENSE PROTECTION ORDER (SSOOPO) REVISED May 1, 2007 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkflow.com [Side 3 of 10.03-D] 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. 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 OR SEXUALLY ORIENTED OFFENSE PROTECTION ORDER (SSOOPO) REVISED May 1, 2007 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkflow.com FORM 10-A: PROTECTION NOTICE TO NCIC New Form Modification of Previous Form (Required fields appear in bold print) SUBJECT NAME (LAST) (FIRST) (M.I.) ADDRESS PHYSICAL DESCRIPTION: (STREET) HGT (CITY) WGT HAIR (STATE) EYES (ZIP) SEX RACE NUMERICAL IDENTIFIER (NOTE: Only ONE of the 4 numerical identifiers is needed.) 1. SSN / / 2. DOB / 3.* DRIVERS LIC. NO. STATE EXPIRATION YR. 4.* VEHICLE LIC. NO. STATE EXPIRATION YR. (* If #3 or #4 is used as a numerical identifier, entire line MUST be completed.) / LIC. TYPE BRADY HANDGUN DISQUALIFIERS: (18 U.S.C. § 922( d)(8) requires all “yes” to disqualify subject from purchasing a handgun) Does order protect an intimate partner or child(ren)? Did subject have opportunity to participate in hearing regarding order? Does order find subject a credible threat or explicitly prohibit physical force? IS THE SUBJECT BRADY DISQUALIFIED? CASE / ORDER NO. YES YES YES YES NO NO NO NO (15 DIGIT MAXIMUM) COURT ORIGINATING AGENCY IDENTIFIER R.C. 2903.213 R.C. 2919.26 R.C. 2903.214 R.C. 3113.31 DATE OF ORDER / / (9 DIGIT ORI ASSIGNED BY NCIC) NAME OF JUDGE EXPIRATION OF ORDER / / (IN R.C. 2919.26 CASES, NONEXP MAY BE USED) TERMS AND CONDITIONS OF ORDER (Mark all that are applicable) : 01 The subject is restrained from assaulting, threatening, abusing, harassing, following, interfering, or stalking the protected person and/or the child(ren) of the protected person. 02 The subject shall not threaten a member of the protected person’s family or household. 03 The protected person is granted exclusive possession of the residence or household. 04 The subject is required to stay away from the residence, property, school, or place of employment of the protected person or other family or household member. 05 The subject is restrained from making any communication with the protected person, including but not limited to, personal, written, or telephone contact, or their employer, employees, or fellow workers, or others with whom the communication would be likely to cause annoyance or alarm the victim. 06 The subject has visitation or custody rights of the children named in this order. 07 The subject is prohibited from possessing and/or purchasing a firearm or other weapon. 08 See the Miscellaneous Field for comments regarding the specific terms and conditions of the order. Miscellaneous comments: OHP DATA ONLY 09 The protected person is awarded temporary exclusive custody of the children named. LIST ALL PROTECTED PERSONS (Total of 9 allowed, may attach additional forms; SSN is NOT necessary if DOB is given): #EPO PROTECTED PERSON (LAST) DOB / (FIRST) / SSN / SSN / SSN / / (M.I.) RACE SEX PROTECTED PERSON (LAST) DOB MIS/ / (FIRST) / / (M.I.) RACE SEX PROTECTED PERSON (LAST) DOB / Authorized by (signature): (circle one) Form 10-A May be reproduced locally (FIRST) / / (M.I.) RACE SEX Date Judge/Magistrate REVISED May 1, 2007 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkflow.com * Case Number DO NOT SERVE OR SHOW THIS SHEET TO RESPONDENT FOR USE BY LAW ENFORCEMENT ONLY LAW ENFORCEMENT INFORMATION This completed form is required by law enforcement to enforce your order. Fill in the following information as completely as possible. Type or print only. Addresses, birthdates and Social Security numbers of both parties are necessary to serve and enforce your order. * Name of Respondent (First, Middle, Last) RESPONDENT INFORMATION * Social Security Number or ID Number (specify) Height Weight Eye Color Nickname Skin Tone Build Relation to Petitioner Home Phone Hair Color * Sex Interpret Required? Language Current Address Employer Employer’s Address Vehicle License Number * Race Vehicle Make and Model * Birthdate WORK Hours: Phone: Vehicle Color Vehicle Year * Name of Petitioner (First, Middle, Last) PETITIONER INFORMATION Current Address *Birthdate/Age PHONE Home: Work: Contact Name Contact Address Contact Phone * (MUST LIST NAME AND DATE OF BIRTH) PERSONS PROTECTED BY THIS ORDER Name / Birthdate / Social Security Number Name / Birthdate / Social Security Number 1. (Petitioner) 4. (Child) 2. (Child) 5. (Other) 3. (Child) 6. (Other) HAZARD INFORMATION Weapons Guns/Rifles Knives Explosives Other Location of Weapons: Vehicle ! On Person ! Residence ! Itemize/Explain: CURRENT STATUS Respondent’s History Includes: Are you and the respondent living together right now? Does the respondent know you are trying to get this order? Does the respondent know he/she may be moved out of home? Is the respondent likely to react violently when served? Yes Yes Yes Yes No No No No ! Mental Health Problems (Commitment, Treatment, Suicide Attempt, Other) ! Assault ! Assault with Weapons ! Alcohol / Drug Abuse ! Active Warrant for Arrest _________________________________________ (Give name of Court, if known) * These information items must be provided for the Protection Order to be entered into the NCIC law enforcement data system. ! See Reverse For Additional Information Prepared by: Date: DR-82 (8/10/00) Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkflow.com