COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : : Plaintiff(s) -against- Calendar No. JUDICIAL SUBPOENA : : : Defendant(s) : ...................................................... IN THE DISTRICT COURT OF THE PEOPLE OF THE STATE OF NEW YORK SPOKANE COUNTY WASHINGTON TO _____________________________ Petitioner GREETINGS: ____________ DOB vs. NO. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the PETITION AND CERTIFICATE Court _____________________________ ____________ FOR ORDER FOR PROTECTION located at County of Respondent DOB (No Children) in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the PETITION & CERTIFICATION: REQUEST FOR TEMPORARY ORDER: AN EMERGENCY EXISTS as described in the statement below. Your failure to comply with thisorder issued immediately without notice to the and will make you liable to I need a temporary restraining subpoena is punishable as a contempt of court respondent until a hearing on avoid irreparable injury. I requestissued for a maximum penalty of $50 and all damages sustained as a to whose behalf this subpoena was a Temporary Order for Protection that will: the party I REQUEST comply. result of your failure toAN ORDER FOR PROTECTION: following a hearing THAT WILL: RESTRAIN respondent from causing me any physical harm, bodily injury, assault, including sexual assault, and from molesting, harassing, threatening, or stalking me. Witness, Honorable , one of the Justices of the RESTRAIN respondent from coming near me and from having any contact whatsoever Court in , 20 withCounty,persondaythrough others, by phone, mail, or any means, directly or indirectly, me, in or of except for mailing of court documents. EXCLUDE respondent from • any place I may reside. This address at present is • confidential • the following: (Attorney must sign above and type name below) Attorney(s) for RESTRAIN respondent from entering or being within ________________ (distance) of my • residence • workplace • school • other: OTHER: REMAIN EFFECTIVE longer than one year Office and P.O. Address because respondent is likely to resume acts of domestic violence against me if the order expires in a year. PETITION FOR ORDER FOR PROTECTION RCW 26.50.030 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: PAGE 1 OF 3 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : 5. Identification of Petitioner: -againstName Date of Birth Index No. Calendar No. : JUDICIAL SUBPOENA Plaintiff(s) 6. Identification of Respondent: : Name Date of Birth : : Other court cases or any other protection order or no-contact order involving me and the respondent are: CASE NAME Defendant(s) : . .CASE .NUMBER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... ........ COURT/COUNTY THE PEOPLEvictim of domestic violence committed by 1. I am the OF THE STATE OF NEW YORK 3. My age is the respondent as described in the statement below. • Under 16 • 16 or 17 • 18 or over _________________________________________ TO Respondent’s age is: 2. • I am a resident of this county. • Under 16 • 16 or 17 • 18 or over • I have left my residence because of abuse and this is the county of my new or former residence. GREETINGS: 4. My relationship with the respondent is: • Parent or child • Presently reside together • Presently dating • Related by marriage (in-law) • Spouse WE COMMAND YOU, and excuses being laid aside, you and each of you attend before • Resided together in past that all business• Dated in past • Related by blood , the Honorable spouse at the Court • Former located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed orThe respondent hastestify and give evidence as aviolence in this action(Describe specific acts of domestic adjourned date, to committed acts of domestic witness as follows. on the part of the violence and their approximate dates, beginning with the most recent act. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Domestic Violence includes physical harms, bodily injury, assault, stalking, OR the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a inflicting fear of imminent physical harm, bodily injury or assault between family or result of your failure to comply. household members. Witness, recent incident or threat of violence and date:_________________________________ , one of the Justices of the Describe the mostHonorable If you that the Court inare requestingCounty, protectionof day order last longer than one year, describe the reasons why: , 20 _____________________________________________________________________________________ _____________________________________________________________________________________ (Attorney must sign above and type name below) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Attorney(s) for _____________________________________________________________________________________ (Continue on separate page) Office and P.O. Address PETITION FOR ORDER FOR PROTECTION RCW 26.50.030 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: PAGE 2 OF 3 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. PETITION & CERTIFICATE: (Continued) : JUDICIAL SUBPOENA Plaintiff(s) _____________________________________________________________________________________ -against: _____________________________________________________________________________________ _____________________________________________________________________________________ : _____________________________________________________________________________________ : _____________________________________________________________________________________ Defendant(s) : . ._____________________________________________________________________________________ .................................................... _____________________________________________________________________________________ _____________________________________________________________________________________ THE PEOPLE OF THE STATE OF NEW YORK _____________________________________________________________________________________ TO _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ GREETINGS: _____________________________________________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend _____________________________________________________________________________________ before , the Honorable at the Court _____________________________________________________________________________________ located at County of in_____________________________________________________________________________________ room , on the day of , 20 , at o'clock in the noon, and at any recessed or_____________________________________________________________________________________ adjourned date, to testify and give evidence as a witness in this action on the part of the _____________________________________________________________________________________ _____________________________________________________________________________________ liable to Your failure to comply with this subpoena is punishable as a contempt of court and will make you the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a _____________________________________________________________________________________ result of your failure to comply. _____________________________________________________________________________________ _____________________________________________________________________________________ Witness, Honorable , one of the Justices of the Court in County, day of , 20 _____________________________________________________________________________________ I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. (Attorney must sign above and type name below) DATED ______________20_____ at Spokane, Washington. Attorney(s) for ________________________________________ Signature of Petitioner District Court complies with Americans with Disabilities Act Office and P.O. with disabilities that would (ADA).Persons Address require accommodation should call the Court (509) 477-3661, TDD available. PETITION FOR ORDER FOR PROTECTION RCW 26.50.030 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: PAGE 3 OF 3 American LegalNet, Inc. www.USCourtForms.com