Petition For Protective Order (Page 3 of 5) in pdf

Petition For Protective Order Page 3

Case No.

7. I request an order from the court directing (check all that apply)

a. respondent not to follow, approach, confront, watch or stalk me in any other

way or threaten to do so.

b. respondent not to contact me by telephone, e-mail or U.S. mail or otherwise

communicate directly or indirectly by any means with me or the following

members of my household:

c. respondent to stay away from my residence.

Is this also respondent's current residence?

yes

Respondent’s residence is

unknown to me

within my apartment complex

approximately

feet/miles from my residence

Describe:

d. respondent to stay away from my school.

Name and location of school: 

Is this also respondent’s school?

yes

e. respondent to stay away from my place of employment. Name and location

of place of employment:

Is this also respondent’s place of employment?

yes

If yes, list the hours respondent works (if known)

f. respondent to stay away from the following places I go to:

g. respondent not to have sexual contact with me.



You do not have to provide this information if you do not want the respondent to know the

location of your school or place of employment.

This is Not a Court Order

Page 3 of 5

CIV-752 (10/13)(cs)

AS 18.65.850-.870

PETITION FOR STALKING OR SEXUAL ASSAULT PROTECTIVE ORDER

Civil Rule 65.1

Petition For Protective Order Page 3