IN THE DISTRICT COURT IN AND FOR COUNTY, STATE OF OKLAHOMA ) Plaintiff, ) ) -vs- Case No. ) ) ) Defendant. ) PETITION FOR PROTECTIVE ORDER Plaintiff, being sworn, states: 1. (Check one or more) The defendant caused or attempted to cause serious physical harm to The defendant threatened with imminent serious physical harm. __ The defendant has stalked or harassed________________________________ 2. The incident causing the filing of this petition occurred on or about (Describe what happened:) . (date) 3. The victim and the defendant are related as follows: (check one) married divorced parent and child persons related by blood persons related by marriage _____ present spouse of an ex-spouse persons living in the same household persons formerly living in the same household _____ biological parents of the same child _____ not related 4. (Answer this question only if the plaintiff is filing on behalf of someone else, minor or incompetent) The plaintiff and the victim are related as follows: married divorced parent and child persons related by blood persons related by marriage _____ present spouse of an ex-spouse persons living in the same household persons formerly living in the same household _____ biological parents of the same child 5. (A) (Check A or B) the victim is in immediate and present danger of abuse from the defendant and an emergency ex parte order is necessary to protect the victim from serious harm. The plaintiff requests the following relief in the emergency ex parte order: (check one or more) ______ ______ ______ order the defendant not to abuse or injure the victim. order the defendant not to visit, assault, molest or otherwise interfere with the victim. order the defendant not to threaten the victim. order the defendant to cease stalking the victim. order the defendant to cease harassment of the victim. order the defendant to leave the residence located at on or before order the defendant who is a minor child to leave the residence located at ____________________ by immediately placing the defendant in any type of care authorized for children taken into custody pursuant to subsection A of Section 7303-1.1 of Title 10 of the Oklahoma Statutes. Circle age of defendant: Thirteen (13), fourteen (14), fifteen (15), sixteen (16), or seventeen (17). ______ (B) 6. ___________________________________________________________________________________ __________ (describe other relief that plaintiff requests) the plaintiff does not request an emergency ex parte order. Plaintiff requests the following order to be made by the court following notice to the defendant and a hearing: (check one or more) order the defendant not to abuse or injure the victim. order the defendant not to visit, assault, molest or otherwise interfere with the victim. order the defendant not to threaten the victim. ______ order the defendant cease stalking the victim. ______ order the defendant to cease harassment of the victim. order the defendant to leave the residence located at on or before ______ order the defendant who is a minor child to leave the residence located at ____________________ by immediately placing the defendant in any type of care authorized for children taken into custody pursuant to subsection A of Section 7303-1.1 of Title 10 of the Oklahoma Statutes. Circle age of defendant: Thirteen (13), fourteen (14), fifteen (15), sixteen (16), 2000 © American LegalNet, Inc. or seventeen (17). ______ (Describe other relief that plaintiff requests) order the defendant to pay attorney fees of the plaintiff in the sum of $ order the defendant to pay the court costs of this action in the sum of $ on or before . on or before . 7. ______ ______ Victim is a resident of the county wherein this petition is filed. Defendant is a resident of the county wherein this petition is filed. 8. WARNING: Whoever makes a statement or allegation in this Petition for Protective Order but does not believe that the statement or allegation is true, or knows that it is not true, or intends thereby to avoid or obstruct the ascertainment of the truth, may be found guilty of perjury. Pursuant to Sections 500 and 504 of Title 21 of the Oklahoma Statutes, the penalty for perjury, or subornation of perjury, is imprisonment for not more than five (5) years. 9. Plaintiff being first duly sworn on oath states: That I have read the above and foregoing document, understand the meaning thereof, and declares, under penalty of perjury, that the facts and statements contained herein are believed to the best of my knowledge to be the truth, and nothing but the truth. Plaintiff Witness my hand and seal, affixed on the day of , 19 Court Clerk, Deputy Court Clerk or Notary Public AOCFORM.47 2000 © American LegalNet, Inc.