Application For Order For Protection Against Sexual Assault - Nevada Justice Court - 2009 Page 6
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_____________________________________________________________________
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_____________________________________________________________________
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10.
Other specific locations frequented where protection is needed (i.e., sports, extra-
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curricular activities, church, employment, after-school activities, etc.):
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CONFIDENTIAL (If confidential, check and move to the next question) or,
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If not confidential, list name, address, city, state and zip code:
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_____________________________________________________________________
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_____________________________________________________________________
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If there are persons other than those listed on page 4 that the Adverse Party should be
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directed not to contact, please name the individuals and explain why these precautions
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are needed: ___________________________________________________________
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_____________________________________________________________________
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12.
If there are any other safety concerns that the Court should know (e.g., firearms, etc.),
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please briefly explain:
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____________________________________________________________________________
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____________________________________________________________________________
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RELIEF REQUESTED
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THEREFORE, I REQUEST that a Temporary Order be issued against the Adverse
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Party requiring the Adverse Party to refrain from contacting, intimidating, threatening or
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otherwise interfering with me and/or other persons identified in this application, either
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directly or through an agent.
I FURTHER REQUEST that the Court require the Adverse Party to stay away from
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the places listed above.
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Application for Order for Protection Against Sexual Assault
May 2009
6 of 7
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