IN THE CIRCUIT COURT OF THE STATE OF OREGON COUNTY OF MOTION AND AFFIDAVIT I, (your name) the petitioner (former protected child), being first duly sworn, move this court for an order allowing the voluntary withdrawal and dismissal of the Order Renewing Restraining Order Re: Former Protected Child for the following reasons: STATEMENT OF POINTS AND AUTHORITIES ORS 107.720(2) authorizes the court to terminate a restraining order upon the request of the petitioner. Signature of Petitioner (Former Protected Child) Print or type name of Petitioner (Former Protected Child) STATE OF OREGON ) ) County of ) This instrument was acknowledged before me this day of , 20by (Print Name of Petitioner) NOTARY PUBLIC FOR OREGON/COURT CLERK My commission expires: See CIF Petitioner (Former Protected Child) (date of birth) (your full name) and See CIF Respondent (date of birth) (full name of person to be restrained) ) ) ) ) ) ) ) ) ) ) ) ) ) ) PETITIONER222S (FORMER PROTECTED CHILD) MOTION AND AFFIDAVIT FOR DISMISSAL OF RESTRAINING ORDER RE: FORMER PROTECTED CHILD (FAMILY ABUSE PROTECTION ACT) Case No. See CIF Original Petitioner (date of birth) ) (full name of person who obtained original restraining order but is not a party to this renewal request) PETITIONER222S (FORMER PROTECTED CHILD) MOTION AND AFFIDAVIT FOR DISMISSAL - Page 1 of 2 (FAPA 1/2016) American LegalNet, Inc. www.FormsWorkFlow.com Certificate of Document Preparation. You are required to truthfully complete this certificate regarding the document you are filing with the court. Check all boxes and complete all blanks that apply: I selected this document for myself and I completed it without paid assistance. I paid or will pay money to for assistance in preparing this form. Submitted by: Print Name, Petitioner Attorney for Petitioner OSB No. (if applicable) Address or Contact Address City, State, Zip Telephone or Contact Telephone Number Use a Safe Contact address Use a Safe Contact number PETITIONER222S (FORMER PROTECTED CHILD) MOTION AND AFFIDAVIT FOR DISMISSAL - Page 2 of 2 (FAPA 1/2016) American LegalNet, Inc. www.FormsWorkFlow.com