PETITION FOR EMERGENCY TEMPORARY PROTECTIVE ORDER (Note: This form is for use when the Court is NOT open for business) Petitioner ____________________________________ First Middle Last and/or on behalf of minor family member(s) District Court of ___________ County State of Oklahoma Court Phone Number (___)_____________ Additional Petitioner Information Name(s) and age(s) of minor family member(s) __________________________________________ __________________________________________ __________________________________________ Defendant Identifiers -VSDefendant __________________________________ First Middle Last Relationship to Petitioner: __________________ Defendant's Address (Street address, City, State, Zip Code) SEX RACE DOB HT WT EYES HAIR DISTINGUISHING FEATURES DRIVERS LICENSE # STATE EXPIRES Other (Clerk's File Stamp Below) Petitioner, being sworn, states: 1. Petitioner's Relationship to the Defendant INSTRUCTION: Check all boxes that apply to the relationship between Petitioner and Defendant Married Parent & Child Persons Related by Marriage Persons Living Same Household Biological Parents of Same Child Victim of Rape Divorced Persons Related by Blood Present Spouse of an Ex-Spouse Formerly Living in Same Household Persons in a Previous Dating Relationship American LegalNet, Inc. www.FormsWorkFlow.com 2. Statement of Jurisdiction INSTRUCTION: Check all that apply Petitioner is a resident of the county wherein this Petition is filed. Defendant is a resident of the county wherein this Petition is filed. The domestic abuse occurred in the county wherein this Petition is filed. 3. Actions of the Defendant INSTRUCTION: Check and complete one or more of the following. Fill in the blank lines of checked items. The Defendant has caused or attempted to cause physical _____________________________________________________. (Name(s)) harm to: The Defendant has threatened* imminent physical harm to: ____________________ ____________________________________________________(Name(s)) * According to 22 O.S. §60.1(1), "Threat" means a threat of imminent physical harm which is committed by an adult, emancipated minor, or minor child thirteen (13) years of age or older against another adult, emancipated minor, or minor child who are family or household members or who are or were in a dating relationship. 4. Description of Incident(s) Describe what happened, when and where the event(s) occurred. ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ _____________________________________________ ATTACH ADDITIONAL PAGES IF NECESSARY Petition for Emergency Temporary Protective Order and Statement of Peace Officer - AOC Form ­ November 1, 2010 Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com 5. Request for Order of Protection INSTRUCTION: If granted, the EMERGENCY TEMPORARY EX PARTE ORDER shall be effective only until the close of business on the next day the Court is open for business. You must come to the courthouse on that day to ask the Court for further Protective Order relief. If the Court does NOT grant an Emergency Temporary Ex Parte Order, you may still file a Petition when the Court opens for business. The Court is not open for business, and the Petitioner requests an EMERGENCY TEMPORARY EX PARTE ORDER because it is necessary to protect the Petitioner(s) from immediate and present danger of domestic abuse (22 O.S. §60.2(A)(2), §60.3(C), and §40.3). Petitioner requests the Court to authorize a law enforcement officer to complete the written statement attached to this Petition, and to impose all terms and conditions in the Emergency Temporary Ex Parte Order which are necessary to protect the Petitioner(s) from the immediate and present danger of domestic abuse. 6. WARNINGS TO PETITONER: A. 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 21 O.S. §§500 and 504, the penalty for perjury, or subornation of perjury, is a felony punishable by imprisonment for not more than five (5) years. B. If the court makes specific findings that a petition for a protective order has been filed frivolously and no victim exists, the court may assess attorney fees and court costs against the plaintiff pursuant to 22 O.S. §60.2 (C)(2). C. It is against the law to file a petition for a protective order against a spouse or former spouse for the purposes of harassment, undue advantage, intimidation or limitation of child visitation rights in any divorce proceeding or separation action without justifiable cause. Violators may be subject to criminal penalties pursuant to 22 O.S. §60.4(H). 7. Sworn Statement/Affirmation of Truth I have read the above and foregoing document, understand the meaning thereof, and declare, under penalty of perjury, that the facts and statements contained herein are true to the best of my knowledge and belief. _____________________________________ PETITIONER DATE Petition for Emergency Temporary Protective Order and Statement of Peace Officer - AOC Form ­ November 1, 2010 Page 3 of 5 American LegalNet, Inc. www.FormsWorkFlow.com STATEMENT OF PEACE OFFICER ATTESTING TO EMERGENCY TEMPORARY ORDER OF PROTECTION INSTRUCTION: This section should be completed when the Emergency Temporary Order is Granted Name of Attesting Officer Law Enforcement Agency Office Address Telephone Number(s) Date and Time of Judge's Authorization Approval of Order was granted on this ______ day of ____________, 20___ at ____:_____o'clock ___.m Pursuant to 22 O.S. §60.3(C) and §40.3, I hereby state and attest to the following facts: 1. The following individual, __________________________________ (name of Petitioner), has requested an Emergency Temporary Order of Protection, and has completed the attached Petition for such Order. 2. The Court is not open for business at the time of this request. 3. I have notified Judge _____________________________ of the District Court of _____________________ county of the request for an Emergency Temporary Order of Pr