DO NOT GIVE TO DEFENDANT - FOR LAW ENFORCEMENT PURPOSES ONLY DO NOT GIVE TO DEFENDANT - FOR LAW ENFORCEMENT PURPOSES ONLY DPS#132DEPARTMENT OF PUBLIC SAFETY PROTECTION ORDER SERVICE INFORMATION In order to help us serve your order quickly and safely, please fill out this form as completely as possible. Use a pen and print clearly. Note - The information contained on this form is for law enforcement purposes only and should not be released to the defendant. Today222s Date PLAINTIFF INFORMATION Your Name Last First Middle Your date of birth: Do you wish to be notified after the order is served? Yes No Telephone number for notification of service: (This may be different than your home #) Relationship Information - Check all that apply. I am the spouse/former spouse of the defendant. I currently or have in the past lived with the defendant while having a sexual relationship with him/her. The defendant and I have a child or children in common. I am the defendant222s child or step-child or I am filing on behalf of that child or step-child. I am the child of a person who currently or has in the past lived with the defendant while having a sexual relationship with him/her or I am filing on behalf of that child. DEFENDANT INFORMATION (So we can quickly identify the defendant.) Defendant222s Name Last First Middle Suffix - Jr. Sr. 1st 2nd 3rd Defendant222s date of birth If you don222t know, what is defendant222s approximate age? List other names that the defendant uses: Sex Male Female Race White African American Native American Asian Other Skin Color/Tone Light Medium Dark Other Height Feet Inches Weight Pounds Eye Color Brown Blue Gray Green Hazel Other Corrective Lenses Glasses Contact Lenses Hair Color Brown Blond Black Red Gray/White Bald Other Hair Length Short Medium Long Bald Facial Hair Beard Mustache Tattoos - Describe location and design Scars or marks - Describe location Body piercing - Describe location Other identifying marks Identifying Marks Please complete the second page of this form to ensure that your order is served as soon as possible. American LegalNet, Inc. www.FormsWorkFlow.com DO NOT GIVE TO DEFENDANT - FOR LAW ENFORCEMENT PURPOSES ONLY DO NOT GIVE TO DEFENDANT - FOR LAW ENFORCEMENT PURPOSES ONLY DPS#132PROTECTION ORDER SERVICE INFORMATION - Page 2 SERVICE INFORMATION (So we can quickly locate the defendant.) Defendant222s Telephone Numbers Home Cell Phone Work Other Defendant222s Address House # Street or Town Road # City/Town State Map must be drawn if street number is not available. Physical description of Defendant222s residence: Best days and times to contact defendant at residence? Defendant222s employer? Name Address What is the defendant222s work schedule? - Enter defendant222s schedule for each day below. Monday Tuesday Wednesday Thursday Friday Saturday Sunday Where may the defendant be if not at home or work? (List the address and telephone number for other locations the defendant might be in the space provided below.) House # Street/Town Road # City/Town State Telephone # House # Street/Town Road # City/Town State Telephone # Defendant222s Vehicle Plate # Year Make Model Color SERVICE ISSUES (So we can serve your order safely.) Will the defendant try to avoid being served this order? Yes No Does the defendant have guard/vicious dogs? Yes No Is the defendant likely to be under the influence of drugs or alcohol? Yes No Will the officer who serves this order be in any danger? Yes No If you answered yes, why will the officer be in danger? American LegalNet, Inc. www.FormsWorkFlow.com