Petition For Protective Order Page 2
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5v.
Case No.
4. The respondent is (or appears to be)
a minor: Age
an adult
5. a. Respondent has stalked or sexually assaulted me as described below and this
conduct has placed me in fear of:
death or physical injury to me
further sexual assault
the death or physical injury of the following family member of mine:
Name of family member:
Relationship to me:
b. I am afraid of physical injury or death, or further sexual assault, because
6. Description of respondent’s conduct. (Explain what respondent is doing or did,
including when, where and how often the stalking or sexual assault occurred. Be
specific. Include dates and places.)
This is Not a Court Order
Page 2 of 5
CIV-752 (10/13)(cs)
AS 18.65.850-.870
PETITION FOR STALKING OR SEXUAL ASSAULT PROTECTIVE ORDER
Civil Rule 65.1
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