Petition For Protective Order - Oklahoma District Court, Aoc Form 67 - Order Of Protection Page 2

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RELIEF REQUESTED
Order Defendant to have no contact with Petitioner, either in person or by telephone, at any time or place.
Order Defendant to not abuse, threaten, injure, assault, molest, stalk, harass, or otherwise interfere with
Petitioner.
Assume emergency jurisdiction under UCCJEA, and Order suspension of child visitation orders due to
physical violence or threat of abuse by Defendant or a threat to violate a custody order by Defendant.
Order Defendant to not stalk the Petitioner.
Order Defendant to leave the residence located at _________________________________ on or before
____________________, and take no action to change utilities or telephone service.
Order Law Enforcement Officers to accompany Defendant to the residence to remove necessary clothing
and personal effects, and remain in attendance until Defendant leaves the premises.
Order Defendant who is a minor, to leave the residence located at ________________________ by
immediately placing Defendant in any type of care authorized for children taken into custody pursuant to
10 O.S. §7303-1.1a
Circle Age of Minor Defendant: 13
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Describe other relief Petitioner requests: ______________________________________________
6.
Petitioner is a resident of the county wherein this Petition is filed.
Defendant is a resident of the county wherein this Petition is filed
The domestic abuse occurred in the county wherein this Petition is filed, but neither Petitioner nor
Defendant are residents of this county.
7. Petitioner requests that Defendant be ordered to pay all court costs, costs of service, photo evidence fees
and attorneys’ fees, if applicable.
8. WARNING: Whoever makes a statement or allegation in this Petition for Protective Order but does not
believe that the statement or allegation is true, or knows that it is not true, or intends thereby to avoid or
obstruct the ascertainment of the truth, may be found guilty of perjury. Pursuant to Sections 500 and 504 of
Title 21 of the Oklahoma Statutes, the penalty for perjury, or subornation of perjury, is a felony punishable
by imprisonment for not more than five (5) years.
9. Petitioner, being first duly sworn on oath states: I have read the above and foregoing document, understand
the meaning thereof, and declare, under penalty of perjury, that the facts and statements contained herein
are believed to the best of my knowledge to be the truth and nothing but the truth. I understand that I am
required by Court Order to appear at the Hearing on my Petition.
PETITIONER
Subscribed and sworn to before me this ____ day of ___________, 20____.
Deputy Court Clerk, Judge or Notary
Defendant’s Address(es) for Service
Petitioner requests following law enforcement agencies
receive copy of any protective Order entered herein:
If address is tribal land, which tribe?
th
Official AOC Form (complies with Session Law Ch. 407, 49
Legislative Session effective 11/1/03)
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