IN THE CIRCUIT COURT OF THE STATE OF OREGON COUNTY OF Petitioner (Former Protected Child) (your full name) and Respondent (full name of person to be restrained) )))))))))))))) CONFIDENTIAL INFORMATION FORM (CIF) FOR PETITIONER (FORMER PROTECTED CHILD) IN FAMILY ABUSE PREVENTION ACT (FAPA) CASES Case No. Original Petitioner (full name of person who obtained original restraining order but is not a party to this renewal request.) This document is not accessible to the public or other parties. See UTCR 2.130 The information below is about: Petitioner (Former Protected Child) N ame (Last, First, Middle): The names of the parties and are NOT confidential. Date of Birth of Petitioner (Former Protected Child): ATTENTION COURT STAFF : THIS IS A RESTRICTED-ACCESS DOCUMENT. This Confidential Information Form is not available to the opposing party or his/her attorney , or to the public; except for the state and law enforcement. See UTCR 2.130 CONFIDENTIAL INFORMATION FORM FOR PETITIONER RE: RENEWAL OF RESTRAINING ORDER (FORMER PROTECTED CHILD) 226 Page 1 of 2 (FAPA 12/11) American LegalNet, Inc. www.FormsWorkFlow.com I hereby declare that the above statements are true to the best of my knowledge and belief and that I understand they are made for use as evidence in court and are subject to penalty for perjury. Date: Signature: Type or Print Name: COMPLETED AND SUBMITTED BY: Petitioner (Former Protected Child) NOTICE TO PETITIONER: The Sheriff is required by law to provide you with a true copy of the proof of service which shows when the Restraining Order has been served. If you would like to also receive an email message and/or cell phone text message advising you of when the Restraining Order has been served on the Respondent and another message 30 days before the Order expires, please provide the information requested below. This information will be given to the sheriff222s office in the county where the Restraining Order was obtained. This is voluntary227you are not required to provide this information. Your cell phone number: Your cell phone carrier (ATT, Verizon, etc.): Your email address: Note: If this information changes, you must notify the Sheriff222s office of the new information in order to receive the notice by email or cell phone text message. CONFIDENTIAL INFORMATION FORM FOR PETITIONER RE: RENEWAL OF RESTRAINING ORDER (FORMER PROTECTED CHILD) 226 Page 2 of 2 (FAPA 12/11) American LegalNet, Inc. www.FormsWorkFlow.com