DISTRICT COURT OF WASHINGTON FOR KITSAP COUNTY NO. Petitioner PETITION FOR AN ORDER FOR PROTECTION HARASSMENT (PTORAH) vs. Respondent 1. I am petitioning for an Order for Protection against Unlawful Harassment. I am the victim of unlawful harassment committed by respondent, as described in the statement 2. below. I am the parent or guardian of child(ren) under age 18 and seek to restrain a person age 18 years or over from contact with my child(ren) because contact is detrimental, as described in the statement below. The harassment took place in this judicial district. Respondent lives in this judicial district. 3. 4. Identification of Minors: Name (First, Middle Initial, Last) Age Race Sex How Related to Petitioner Respondent Resides with 5. Other court cases or any other protection, restraining or no-contact orders involving me, the minors and the respondent: CASE NAME AND NUMBER COURT/COUNTY PT FOR AN ORD FOR PROTECTION (HARASSMENT) (PTORAH) – Page 1 of 3 UH-02.0200 (6/2002) - RCW 10.14.040, .(Ch. 117 L 2002 § 2) American LegalNet, Inc. www.FormsWorkFlow.com REQUEST FOR TEMPORARY ORDER: AN EMERGENCY EXISTS as described in the statement below. I need a temporary restraining order issued immediately without notice to the respondent until a hearing to avoid great or irreparable harm. I request a Temporary Order for Protection that will: I REQUEST AN ORDER FOR PROTECTION following a hearing THAT WILL: RESTRAIN respondent from making any attempts to keep under surveillance, me the minors named in paragraph 4 above. RESTRAIN respondent from making any attempts to contact, except for mailing of court me the minors named in paragraph 4 above. documents, EXCLUDE respondent from any place I may reside. RESTRAIN respondent from entering or being within __________________(distance) residence workplace other: of my OTHER: REMAIN EFFECTIVE longer than one year because respondent is likely to resume acts of unlawful harassment against me if the order expires in a year. REQUIRE the respondent to pay the fees and costs of this action. Unlawful harassment means a knowing and willful course of conduct directed at a specific person which seriously alarms, annoys, or harasses, or is detrimental to such person and which serves no legitimate or lawful purpose. The course of conduct shall be such as would cause a reasonable person to suffer substantial emotional distress and shall actually cause substantial emotional distress to the petitioner or when the course of conduct would cause a reasonable parent to fear for the well-being of their child. Course of conduct means a pattern of conduct composed of a series of acts over a period of time, however short, evidencing a continuity of purpose. “Course of conduct” includes, in addition to any other form of communication, contact, or conduct, the sending of an electronic communication. Constitutionally protected activities are not included within the meaning of “course of conduct.” STATEMENT: The respondent has committed acts of unlawful harassment as follows. (Describe specific acts of harassment and their approximate dates, beginning with the most recent act. You may want to include police responses.) ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ PT FOR AN ORD FOR PROTECTION (HARASSMENT) (PTORAH) – Page 2 of 3 UH-02.0200 (6/2002) - RCW 10.14.040, .(Ch. 117 L 2002 § 2) American LegalNet, Inc. www.FormsWorkFlow.com ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ If you requested a fee waiver, describe the incident(s) involving stalking, a sex offense, or domestic violence: ____________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ (Continue on separate page if necessary) I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. DATED at Washington. Petitioner PT FOR AN ORD FOR PROTECTION (HARASSMENT) (PTORAH) – Page 3 of 3 UH-02.0200 (6/2002) - RCW 10.14.040, .(Ch. 117 L 2002 § 2) American LegalNet, Inc. www.FormsWorkFlow.com