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Get and Sign Petitioner Verified Form
For Dismissal pursuant to
Indiana Code § 34-26-5-12. I respectfully request that the Court grant this Request
without delay or any conditions, and dismiss the case without prejudice.
____ At this time, I am filing this Verified Request for Dismissal for an Order of
Protection to terminate an Order of Protection issued on ________________________.
I affirm, under the penalties for perjury, that the foregoing representations are true.
DATE: ________
Petitioner’s Signature...
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