PETITION FOR PROTECTIVE ORDER District Court of ___________ County State of Oklahoma Case No. PO-_____________ Court Phone Number (___)_____________ Petitioner ____________________________________ First Middle Last and/or on behalf of minor family member(s) 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 * If you do not meet one of the above relationship tests then a protective order is only available if you are a victim of Stalking. Under the Protection from Domestic Abuse Act, "Stalking" means the willful, malicious, and repeated American LegalNet, Inc. www.FormsWorkFlow.com following or harassment of a person by an adult, emancipated minor, or minor thirteen (13) years of age or older, in a manner that would cause a reasonable person to feel frightened, intimidated, threatened, harassed, or molested and actually causes the person being followed or harassed to feel terrorized, frightened, intimidated, threatened, harassed or molested. Stalking also means a course of conduct composed of a series of two or more separate acts over a period of time, however short, evidencing a continuity of purpose or unconsented contact with a person that is initiated or continued without the consent of the individual or in disregard of the expressed desire of the individual that the contact be avoided or discontinued. Unconsented contact or course of conduct includes, but is not limited to: (a.) following or appearing within the sight of that individual, (b.) approaching or confronting that individual in a public place or on private property,(c.) appearing at the workplace or residence of that individual, (d.) entering onto or remaining on property owned, leased, or occupied by that individual, (e.) contacting that individual by telephone, (f.) sending mail or electronic communications to that individual, or (g.) placing an object on, or delivering an object to, property owned, leased or occupied by that individual; 22 O.S. §60.1(2). If you are seeking a protective order as a victim of Stalking, and you do not meet one of the above relationship tests, you must have filed a complaint against the defendant with the proper law enforcement agency before filing this Petition (a copy of the complaint must be attached or provided at the hearing). Victim of Stalking 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. blank lines of checked items. Fill in the The Defendant has caused or attempted to cause physical harm _____________________________________________________. (Name(s)) to: Petition for Protective Order - AOC Form ­ November 1, 2010 Page 2 of 7 American LegalNet, Inc. www.FormsWorkFlow.com 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. The Defendant has harassed*___________________________________. (Name(s)) * According to 22 O.S. §60.1(3), "Harassment" means a knowing and willful course or pattern of conduct by a family or household member or an individual who is or has been involved in a dating relationship with the person, directed at a specific person which seriously alarms or annoys the person, and which serves no legitimate purpose. The course of conduct must be such as would cause a reasonable person to suffer substantial emotional distress, and must actually cause substantial distress to the person. "Harassment" shall include, but not be limited to, harassing or obscene telephone calls in violation of 21 O.S. §1172 and fear of death or bodily injury. The Defendant has stalked* ____________________________________. (Name(s)) *If the Petitioner is a victim of stalking, but is not a family or household member or an individual who is or has been in a dating relationship with the Defendant, you must file a complaint against the Defendant with the proper law enforcement agency before filing a petition for a protective order with the District Court. The Petitioner shall attach a copy of the complaint to the petition or present the complaint to the court at the time of the hearing. (See definition of "stalking" in section 1, above) Description of Incident(s) The incident(s) which caused the filing of the petition occurred on or about __________. (MM/DD/YEAR) Describe what happened, when and where the event(s) occurred. List all actions or behaviors you intend to present to the Court at the hearing. _____________________________________________________________________ _ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Petition for Protective Order - AOC Form ­ November 1, 2010 Page 3 of 7 American LegalNet, Inc. www.FormsWorkFlow.com ___________________________________________________