Petition Page 1 of 6 Revised July 31, 2018 Circuit Court of the Judicial District, County of , State of Wyoming Name: Petitioner, vs. FV Name: Respondent. PETITION FOR ORDER OF PROTECTION UNDER THE WYOMING DOMESTIC VIOLENCE PROTECTION ACT, THE PETITIONER AND THE RESPONDENT MUST BE 223HOUSEHOLD MEMBERS224 AS SET FORTH IN PARAGRAPH 6, BELOW. 1. PETITIONER'S LAST NAME, FIRST, MIDDLE INITIAL 206 (Print) Address (Optional) City & State (Optional) Telephone Number (Optional) OTHER NAMES USED BY PETITIONER DOB RACE GENDER HEIGHT WEIGHT EYE COLOR HAIR COLOR * NOTE: ALL BOXED AREAS ON PAGE 1 & 2 MUST BE FILLED IN. Check here if the Petitioner is requesting the court to order the address of the Petitioner and any children of the Petitioner and Respondent be kept confidential. American LegalNet, Inc. www.FormsWorkFlow.com Petition Page 2 of 6 Revised July 31, 2018 2. RESPONDENT222S LAST NAME, FIRST NAME, MIDDLE INITIAL (Print) Address Mailing Address (if different) City & State Telephone Number DOB RACE GENDER HEIGHT WEIGHT EYE COLOR HAIR COLOR EMPLOYER DRIVER222S LICENSE # STATE OF ISSUE VEHICLE LICENSE # STATE OF ISSUE MILITARY ID # IDENTIFICATION CARD # STATE OF BIRTH OTHER NAMES USED BY RESPONDENT HAS THE FOLLOWING DISTINGUISHING MARKS, SCARS, TATTOOS, LOCATED: 3. CASE(S) RELATED TO THIS ACTION, IF ANY Docket No. Judge Court (if different) Docket No. Judge Court (if different) 4. This Petition is filed pursuant to Wyoming222s Domestic Violence Protection Act, WYO. STAT. ANN. 247247 35-21-101 to 112. 5. I, the above-named Petitioner, am a resident of County, State of . The acts of domestic abuse set forth in paragraphs 8 & 9 below took place at the following location(s) (designate city, county, and state): American LegalNet, Inc. www.FormsWorkFlow.com Petition Page 3 of 6 Revised July 31, 2018 6. My relationship with the Respondent is as circled below: We are married to each other. We are living with each other as if we are married. We were formerly married to each other. We formerly lived with each other as if married. I am a parent of the Respondent. I am an adult sharing common living quarters with the Respondent. Respondent and I are parents of a child(ren) and are not living with each other. I am an adult child of the Respondent. We are in a dating relationship. We have been in a dating relationship. 7. Respondent and I are parents of the following minor children (state names and ages of each child, and where that child is presently living and with whom the child is presently living): Child222s Last, First, Middle Name Date of Birth Race Sex Living With 8. On or about (date) , , Respondent (specifically describe the facts upon which the alleged domestic abuse is based): American LegalNet, Inc. www.FormsWorkFlow.com Petition Page 4 of 6 Revised July 31, 2018 9. Respondent has committed acts of domestic abuse against me on prior occasions. Examples are described below: 10. List all firearms and ammunition currently possessed by the Respondent: Describe any weapons used in the incident described above: 11. I ask this Court to issue an Ex Parte Order of Protection, set the same for hearing, and after hearing this Petition, issue an initial Order of Protection not to exceed three years. I ask the Court to grant the following relief in the Ex Parte Order of Protection and the Order of Protection (check as appropriate): (A) Order Respondent that he/she shall not physically abuse me, threaten to physically abuse me or do any act which unreasonably restrains my personal liberty, directly or indirectly. (B) Order Respondent to stay away from me, from my place of residence, from my place of employment and stay away from any location where I may be. (C) Give me possession of the residence and order Respondent to vacate said residence if he/she is still in possession of said residence. (D) Order Respondent to provide me with suitable alternative housing. American LegalNet, Inc. www.FormsWorkFlow.com Petition Page 5 of 6 Revised July 31, 2018 (E) Grant me temporary legal custody of the following child(ren): Please check box if custody and/or visitation have been determined in another Court. (F) Prohibit the Respondent from abducting, removing or concealing the child(ren) from me. (G) Order Respondent to pay me the sum of $ per month as child support. Please check box if child support has been previously determined in another Court. (H) Decide whether or not Respondent should have visitation privileges with said child(ren). (I) Order Respondent to pay me temporary support in the sum of $ per month. (J) Order Respondent to pay medical costs incurred by me as a result of the abuse inflicted by the Respondent. (Bring medical bills if available.) (Attach sheet if necessary.) (K) Order Respondent not to transfer, conceal, encumber or otherwise dispose of my property or property accumulated by us jointly, while we were married and/or living together. (L) Appoint an attorney to assist and advise me under WYO. STAT. ANN. 247 35-21-103(e). (M) Order the Respondent to pay my attorney fees. (N) Order a commercial mobile services provider (as defined in 47 U.S.C. sec. 332 (d)) to transfer to the Petitioner the sole right to use and sole financial responsibility for a mobile telephone number(s) used by the Petitioner or a minor child in the Petitioner222s custody, and terminate in the provider222s system the Respondent222s ability to use and to access any data associated with the mobile telephone number(s). A provider may apply any customary requirements for establishing an account and transferring a mobile telephone number(s). The mobile number(s) to be transferred: Name of commercial mobile services provider: Current account holder (Respondent222s name): American LegalNet, Inc. www.FormsWorkFlow.com Petition Page 6 of 6 Revised July 31, 2018 Contact information for current account holder: Account to be transferred to (Petitioner222s name): Contact information for new account holder: (O) Order the following: I, the Petitioner, being first duly sworn upon my oath, state that I have read the above and foregoing information, and I believe the matters set forth are true and correct under penalty of perjury: Dated PETITIONER STATE OF WYOMING ) ) ss COUNTY OF ) SUBSCRIBED AND SWORN to before me this day of, 20. Witness my hand and official seal. (SEAL) CLERK OF COURT/NOTARIAL OFFICER My commission expires: American LegalNet, Inc. www.FormsWorkFlow.com