Court of Washington For ______________________________________ Minor to be protected, ______________________________________ Petitioner, vs. ______________________________________ Minor Respondent. Information about appointment of a guardian ad litem for respondent: Harassment: If the minor respondent is not an emancipated minor, a guardian ad litem must be appointed to represent him or her in this action under RCW 4.08.050. The court may order the petitioner to pay guardian ad litem fees. If the respondent is 16 or 17 years of age, appointment of a guardian ad litem is not required. However, the court may still appoint one in certain circumstances. If the respondent is 15 years of age or younger and is not an emancipated minor, a guardian ad litem must be appointed to represent him or her in this action under RCW 4.08.050. The court will not order the petitioner to pay guardian ad litem fees. No. Petition for an Order for Protection Respondent Under Age 18 Harassment (PTAH18) and/or Stalking (PTSTK18) Stalking: This is a Petition for an Order for Protection against Harassment and/or Stalking as checked in the caption. I believe: I am a victim of stalking. _________________________ (name) is a victim of stalking and he/she is a minor. The respondent has been - stalking the victim either in person or cyber stalking, and - repeatedly contacting, or attempting to contact or monitor the victim for no lawful purpose and his/her actions caused the victim to feel intimidated, frightened or threatened. Pt for Or for Prot - Resp Under 18- Harassment/Stalking (PTSTK18) ­ Page 1 of 7 UHST-05.0100 (07/2015) ­ RCW 10.14.040, .800, RCW 7.92.030 American LegalNet, Inc. www.FormsWorkFlow.com _____________________________ (name) is a victim of unlawful harassment and he/she is a minor. The respondent's actions toward the victim have seriously alarmed, annoyed, or harassed the victim or are detrimental to the victim and they serve no legitimate or lawful purpose. The respondent's actions have caused the victim substantial emotional distress or caused me to fear for the well-being of the victim. How does the victim and respondent know each other? _____________________________ I have given a detailed explanation below. 1. Who is the petitioner My name is (please print) _________________________________. I am the petitioner. I am age 16 or 17 years of age and I am petitioning on my own behalf. I am a parent or guardian of a minor and I am petitioning on behalf of that minor. I am not the parent or guardian, but I am petitioning on behalf of a minor who lives with me; and the respondent is not a parent of that minor. 2. Information about the respondent The respondent's name is listed in the caption. The respondent is 16 or 17 years of age 15 or under Under 18; but I do not know the exact age. You only need to complete the following if you are requesting a harassment protection order: Respondent has been adjudicated of the following offense against my child: Offense: Case Name: ______________________________ Case Number: Court/County: Respondent is under investigation or has been investigated for the following alleged offense against my child: Alleged offense: Investigating agency: 3. Where do the parties live? Petitioner lives in ____________________________________ county. Did the petitioner leave their residence because of stalking conduct and that is the county of their new residence? Yes No The minor named in the caption lives in __________________________ county. Respondent lives in ___________________________________ county. 4. Where did the Conduct take place? Pt for Or for Prot - Resp Under 18- Harassment/Stalking (PTSTK18) ­ Page 2 of 7 UHST-05.0100 (07/2015) ­ RCW 10.14.040, .800, RCW 7.92.030 American LegalNet, Inc. www.FormsWorkFlow.com The conduct took place in ____________________ county. 5. School Do the minor to be protected and the minor respondent attend the same school? Yes No If yes, please complete: Name of school: _________________________________________________________ Address of school: _______________________________________________________ Statement describing the victim/s need for protection from the respondent Write clearly. If you need more space below, attach additional page/s. Do not write on the back. 6. Describe what the Respondent did or said that you think is harassment or stalking. You must describe what the respondent actually said. You must describe what the respondent actually did. The respondent has committed acts of harassment or stalking as follows: A. Describe the most recent act of harassment or stalking. Date and time (on or around): __________________________________________________ Location: __________________________________________________________________ What did the respondent do or say that you believe to be harassing or stalking behavior? Pt for Or for Prot - Resp Under 18- Harassment/Stalking (PTSTK18) ­ Page 3 of 7 UHST-05.0100 (07/2015) ­ RCW 10.14.040, .800, RCW 7.92.030 American LegalNet, Inc. www.FormsWorkFlow.com . How did the respondent make these statements? in person mail/written notes e-mail text phone social media (such as Facebook and Twitter) other (describe): __________________________________________________________. B. Describe other incidents of harassment or stalking. For each incident, include the date, time (on or about), location, what was said, how statements were made, and what was done to the victim: . 7. How did the incidents you describe above make you or the minor feel? . Pt for Or for Prot - Resp Under 18- Harassment/Stalking (PTSTK18) ­ Page 4 of 7 UHST-05.0100 (07/2015) ­ RCW 10.14.040, .800, RCW 7.92.030 American LegalNet, Inc. www.FormsWorkFlow.com 8. Has the respondent used, displayed, or threatened to use a firearm or other dangerous weapon in a felony? Please describe: . 9. Has the respondent previously committed an offense that makes him or her ineligible to possess a firearm under the provisions of RCW 9.41.040? Please describe: . 10. Does possession of a firearm or other dangerous weapon by the respondent present a serious and imminent threat to public health or safety, or to the health or safety of the victim? Please describe: . 11. Do you have any evidence of the harassment or stalking conduct other than testimony? No Yes. I have attached the following evidence: Copy of letter(s) Copy of text messages Copy of emailed messages Copy of social media messages Police report Declaration or Affidavit from the