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Petition For Renewal Of Sexual Assault Protection Order And Notice Of Hearing Form. This is a Washington form and can be use in Sexual Assault Statewide.
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Tags: Petition For Renewal Of Sexual Assault Protection Order And Notice Of Hearing, SA-5.030, Washington Statewide, Sexual Assault
Court of Washington
For
No.
__________________________________ _________
Petitioner (Protected Person)
DOB
vs.
__________________________________ _________
Respondent (Restrained Person)
DOB
Petition for Renewal of Sexual
Assault Protection Order and Notice
of Hearing
(PT/NTHG)
Clerk's Action Required
1. The Sexual Assault Protection Order dated _______________________________ will expire on
________________________________________[date].
2. Petitioner requests renewal of the Sexual Assault Protection Order because:
.
3. Petitioner requests the following relief in the order:
1. Restrain respondent from having any contact with petitioner, including but not limited to
telephone calls, mail, e-mail, fax and written notes, directly, indirectly, or through third parties
regardless of whether those third parties know of the order.
2. Exclude respondent from the following places:
Petitioner’s residence
Petitioner’s workplace
Petitioner’s school
Petitioner’s day care
Other:
Pt for Renew of Sexual Assault Pro. Ord/Nt of Hrg (PT/NTHG) – Page 1 of 2
WPF SA-5.030 (8/2006) – Laws of 2006, ch. 138
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3. Prohibit respondent from knowingly coming within, or knowingly remaining within
__________________ [distance] of:
Petitioner’s residence
Petitioner’s workplace
Petitioner’s school
Petitioner’s day care
Other:
4. Restrain respondent from attending _________________________________ school at
_________________________________________________ [address] attended by the petitioner
and Order respondent to transfer to a different school. (If this relief is granted, respondent or
respondent’s parents or legal guardians will be responsible for transportation and all other costs
associated with change of school.)
5. Other:
4. There has been no material change in relevant circumstances since entry of the Sexual Assault
Protection Order.
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and
correct.
at
Dated:
_______________________________________
Signature of Petitioner
________________________________________
Signature of Person Filing on Behalf of Petitioner
, Washington.
_______________________________________
Print or Type Name
_______________________________________
Print or Type Name
Notice of Hearing: To the Respondent:
A hearing will be held on ______________________________, at ______________ a.m./p.m. at
_____________________________________________________________ [location] to determine whether
the requested renewal of the Sexual Assault Protection Order should be granted.
If You do not Appear, the Court May Enter an Order Granting the Requested Renewal.
County Clerk
Dated: __________________________
By:_________________________, Deputy Clerk
This document must be served on the other party, and
a Return of Service must be filed with the court clerk at or before the hearing.
Pt for Renew of Sexual Assault Pro. Ord/Nt of Hrg (PT/NTHG) – Page 2 of 2
WPF SA-5.030 (8/2006) – Laws of 2006, ch. 138
American LegalNet, Inc.
www.FormsWorkflow.com