Petition For Restraining Order Form - Kansas District printable pdf download

IN THE TRIBAL DISTRICT COURT

OF THE PRAIRIE BAND POTAWATOMI NATION

11444 158

ROAD, MAYETTA, KS, 66509

___________________________________, Plaintiff

Case No. _____________________

vs.

___________________________________, Defendant

PETITION FOR RESTRAINING ORDER

To file this petition, you must be able to tell the Court that the

STATEMENT TO THE COURT UNDER OATH

following statements are true. If the statements are not true, you cannot file this petition in this court until the

statements are true. Check the box in front of each statement if the statement is true:

he incident(s) causing the filing of this petition occurred within the Prairie Band Potawatomi

[ ] TRUE T

Nation’s reservation boundaries.

[ ] TRUE This court has jurisdiction to hear this matter

Check all boxes that apply.

PERSONS TO BE PROTECTED (List names and ages of all persons including yourself, if applicable, to be protected by

this order and their relationship to the party seeking the orders; all named parties over18 years of age must sign this

petition):Name:____________________________________ Age:_______Date of Birth:_____________________________

Name:____________________________________ Age:_______Date of Birth:_____________________________

a. Defendant (name): __________________________________________________________________________________

[ ]

Sex:

Male

Female Ht: _______Wt:______ Hair color: _______Race:_________Age:_________Date of birth:______________

Defendant’s residence address (if known):

_____________________________________________________________________________________________

Defendant’s work address and name of business (if known):

_____________________________________________________________________________________________

Defendant’s home and cell number (if known):

_____________________________________________________________________________________________

This action is filed in this court because:

a) [ ] defendant resides on the Prairie Band Potawatomi Reservation.

b) [ ] defendant has caused physical or emotional injury to plaintiff in this jurisdiction.

c) [ ] other (specify): _______________________________________________________________________

How is that you know defendant (i.e., landlord/tenant, neighbor, etc.)? (Specify): _________________________________

____________________________________________________________________________________________________

Defendant has:

a. [ ] threatened to commit acts of violence against plaintiff(s). (Specify in item 13)

b. [ ] committed acts of violence against plaintiff(s). (Specify in item 13)

c. [ ] not threatened to commit and has not committed any acts of violence.

Petition For Restraining Order Form - Kansas District