Petition For Protection From Abuse Page 3
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Past incidents: _________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
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Paragraph 9
Because of the immediate and present danger of abuse, petitioner requests that an ex parte Temporary Restraining
Order be issued immediately without bond:
a.
____ prohibiting defendant from abusing, harassing, stalking, following, or threatening the protected
person(s) in any manner whatsoever. This prohibition includes the use, attempted use, or threatened
use of force or physical violence that would reasonably be expected to cause bodily injury.
b.
____ prohibiting the defendant from contacting the protected person(s) personally, electronically, by phone,
in writing, or through a third party, without the express written permission of this court.
c.
____ prohibiting defendant from going within one hundred (100) yards of the residence, apartment complex,
or multiple family dwelling of the protected person(s) located at:
_______________________________________________________________________________
No. & Street
Apt. No.
City
State
Zip Code
d.
____ ordering the defendant to stay away from the protected person(s)’ place of employment/school and not to
interfere in any manner with such employment/school located at:
_______________________________________________________________________________
Employment/School
Address
City
State
Zip Code
_______________________________________________________________________________
Employment/School
Address
City
State
Zip Code
LPOR B
v.7
Page 3 of 7
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