TRANSMITTAL FORM FOR DOCUMENTS PROTECTION FROM DOMESTIC ABUSE CASES Page _____ of _____ Pages The following documents pertaining to civil domestic abuse proceedings in ________________________ County were transmitted to the Clerk of Court of said county on the _____ day of _________________________, 20____. ________________________________________ Name & Title of Transmitting Officer Papers Transmitted Name of Case Date of Filing With Magistrate Service Date Served By Date of Hearing Summons & Petition Motion & Order for Emergency Hearing Order of Protection 1 2 3 4 5 6 7 8 9 10 Receipt of the document(s) is/are hereby acknowledged, this day of , . Clerk of Court By: Name Title American LegalNet, Inc. www.FormsWorkFlow.com SCCA 424 (12/2009)