Petition For Injunction

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NO. _________________________
PETITIONER
IN THE DISTRICT COURT
JUDICIAL DISTRICT
DEFENDANT
{COUNTY, STATE}
PETITION FOR INJUNCTION
Petitioner’s Name:
Address:
Phone Number:
SSN:
DOB:
Driver’s License No.
Defendant’s Name:
Address:
Phone Number:
SSN:
DOB:
Driver’s License No.
I, the Petitioner, hereby swear and attest that the Defendant has plans to do me and/or my personal
property great damage. I confirm that this damage outweighs any monetary reparations that could be
offered at a later date. I further confirm that any damage caused to the Defendant by this petition is
outweighed by the planned harm.
The Defendant plans the following harm against my person/property:
This plan is an imminent and urgent threat because:
q The Defendant has threatened me q The Defendant has harmed me in the past q Other:
I swear and affirm that the information listed above is true and correct to the best of my knowledge. Due
to the imminent and urgent threat against me, I request an injunction against the Defendant to protect me
from harm.
Petitioner Signature
Date

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