3.21.19 Dismissal of Order of Protection Petition Petitioner is under 18 In the Court of County, TN Case # (the clerk fills this in) : Petitioner (person needing protection) an unema ncipated person (someone under 18 years of age) pursuant to TCA 24736 - 3 - 6 02. This Request is being made by who is parent or legal guardian or a caseworker. first middle last Name Age Relationship to Respondent Name Age Relationship to Respondent 1. 3 . 2 . 4. (person you want to be protected from): first middle last date of birth (MM/DD/YYYY ) street address city state zip Describe Respondent: Sex Race Hair Eyes Height Weight SSN Other Male Female White Asian Black Hispanic Other: Black Grey Blond Bald Brown Other: Brown Hazel Blue Green Gre y Other: Height Weight Social Sec. # (If known) Scars/Special Features Phone Number The Court Hereby Finds: The court finds that the Petition is dismissed for one of the following reasons: That the Petitioner has dismissed the petition. That the Petitioner did not show up for court. That the Petitioner did not prove the evidence in the petition by a preponderance of the evidence. The Court Further Finds, Regarding Costs: By clear and convincing evidence, the Petitioner is not a domestic abuse victim, stalking victim or sexual assault victim and that such determination is not based on the fact that the petitioner requested that the petition be dismissed, failed to attend the hearing or incorrectly filled out the petition; AND the Petitioner American LegalNet, Inc. www.FormsWorkFlow.com 3.21.19 knew that the allegation of domestic abuse, stalking, or sexual assault was false at the time the petition was filed. The Court orders: That the Petition for the Order of Protection is dismissed (check one) without prejudice with prejudice. That the costs and litigation tax of this cause are not taxed to the Petitioner. That the costs and litigation tax of this cause are taxed to the Respondent, for which execution shall issue, if necessary. That the costs and litigation tax of this cause are taxed to the Petitioner, for which execution shall issue, if necessary. Date: Signature of Judge or Chancellor American LegalNet, Inc. www.FormsWorkFlow.com