Sexual Assault Protection Order Information - 2009
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1*CONFIDENTIAL*
SEXUAL ASSAULT PROTECTION ORDER INFORMATION
(TO BE FILLED OUT BY APPLICANT)
Instructions: Please provide all information known to you and print legibly. All requested information is helpful for service, even if the
information is only partially known. Please note that if you do not provide an address for the Adverse Party, or if the sheriff/constable
cannot effectuate service at the address you give, Applicant has the ultimate responsibility for having the Adverse Party served by private
process server or other means.
APPLICANT DATA
Name:
_____________________________________________________ ________________________________________________________________________
(Last)
(First)
(Middle)
Address
Mailing Address:
(If different from above)________________________________________________________________________________________
(Street Address)
(Bldg/Apt #)
(City)
(State)
(Zip Code)
Phone Number:________________________________________________
Phone: Home:
Work:
Cell:
Other Name Used: __________________________________________________________________________________
(Last)
(First)
(Middle)
Additional Contact Person: ________________________ Phone: ____________ Address: _________________________
ADVERSE PARTY DATA
Full Name:
Other Name Used:
(Last)
(First)
(Middle)
(Last)
(First)
(Middle)
Relationship To You (if any):
Date of Birth
/
/
and/or Social Security No.:
(M) (D) (Y)
Last Known Home Address:
(Str
eet Address)
(Bldg/Apt #)
(City)
(State)
(Zip Code)
No
Yes If yes, please explain
______________________________
Is this address difficult to find?
__________________________________________________________________________________________
Mailing Address:
(If different from above)________________________________________________________________________________________
(Street Address)
(Bldg/Apt #)
(City)
(State)
(Zip Code)
Other Likely Address:
(Street Address)
(Bldg/Apt #)
(City)
(State)
(Zip Code)
Home Phone: ______________________________________________ Cell Phone: ______________________________
Occupation:
Employer:
Work Days: __________ Work Hours: _______
Work Phone: ____________ Work Address:
(Street Address)
(City)
(State)
(Zip Code)
Hair Color:
Eye Color:
Height:
Weight:
Sex
Race:
Scars/Marks/Tattoos (Description and Location):
__________________________________________________________________________________________
Does the Adverse Party speak English?
If not, what language?
(Yes or No)
Vehicle Make: ________ Model: ________ Year: ________License Plate Number/State: ___________________________
(Circle one)
Yes or No
Are the Applicant and the Adverse Party living together now?
Yes or No
Are the Applicant and the Adverse Party employed by the same employer?
Yes or No
Is the Adverse Party likely to react violently when served?
Yes or No
Is the Adverse Party likely to avoid service?
Yes or No
Does the Adverse Party have a Carrying Concealed Weapon (CCW) Permit?
Yes or No
Does the Adverse Party have access to weapons?
If yes, please describe type and location of weapon(s):
Does the Adverse Party's history include (please circle): assault, assaults w/weapon, battery, mental health problems, drug/alcohol abuse,
outstanding/prior arrest warrants, safety issues? Explain:
Do not write in this space. For court purposes only.
Issuing Court ORI: NV______________
Court Case Number: _______________
Law Enforcement: Do not serve this sheet with documents to be delivered.
*CONFIDENTIAL*
Sexual Assault Protection Order Information (applicant)
May 2009
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