Case Number: ________________ District:_____ County: _______________________ State: Utah Judge: __________________________________ Commissioner:____________________________ Return of Service Petitioner (person who asked for the protective order): First Middle Last Respondent (person Petitioner asked to be protected from): First Middle Last Law Enforcement Officer fills out below, then signs and returns this form to the agency that requested service so data can be entered into Statewide Domestic Violence Network. The documents checked below were given to me on (date): , personally served the I, (officer’s name and title): Respondent Petitioner these documents at (time): _______ on (date):_______________at the following address: Street City Request for Protective Order Temporary Protective Order Amended Temp.Protective Order Protective Order Order Extending Temporary Protective Order Request for Civil Stalking Injunction Temp. Civil Stalking Injunction Civil Stalking Injunction State Request for Modified Protective Order Temporary Modified Protective Order Modified Protective Order Verified Petition for Child Protective Order Ex Parte Child Protective Order Amended Ex Parte Child Protective Order Child Protective Order Respondent’s Request to Dismiss Protective Order Zip Notice of Hearing to Respondent Notice of Hearing: Request to Dismiss or Vacate Protective Order Order Extending Ex Parte Child Protective Order Respondent’s Request to Vacate Temporary Protective Order Other (specify): __________________________________________________________________________ I certify that I am a law enforcement officer, at least 18 years old, not a party to this case, and that I served the documents checked above. I also wrote my official title and date of service on those documents. Date: ________________________________ Officer’s signature: Agency Representative fills out below: I certify that the information on this form has been entered into the Statewide Domestic Violence Network. Date: Return of Service – Protective Orders Agency Representative’s Signature: 1 of 1 Approved by Board of District Court Judges, January 2006 Revised: January 2007 American LegalNet, Inc. www.FormsWorkflow.com