Fill and Sign the Anti Harassment Information King County

TEMP PROTECTION ORD/NT OF HRG (HARASSMENT) (TMORAH) - 1 of 2 UH-03.0200 (7/2001) CR 65(b), - RCW 10.14.080 (1), (2) COURT OF WASHINGTON FOR Petitioner vs. Respondent NO. TEMPORARY PROTECTION ORDER AND NOTICE OF HEARING (HARASSMENT) (TMORAH) (Clerk’s action required) Next Hearing Date and Time: _________________________________ At: ______________________________ WARNING TO THE RESPONDENT: Violation of the provisions of this order with actual notice of its terms is a criminal offense under chapter 10.14 RCW and will subject a violator to arrest. Willful disobedience of the terms of this order may also be contempt of court and subject you to penalties under chapter 7.21 RCW. Minors addressed in this order: Name (First, Middle Initial, Last) Age Race Sex Based upon the petition, testimony, and case record, the court finds that the respondent committed unlawful harassment as defined in RCW 10.14.080, and IT IS THEREFORE ORDERED THAT: Respondent is RESTRAINED from making any attempts to keep under surveillance petitioner and any minors named in the table on page one. Respondent is RESTRAINED from making any attempts to contact petitioner and any minors named in the table on page one. TEMP PROTECTION ORD/NT OF HRG (HARASSMENT) (TMORAH) - 2 of 2 UH-03.0200 (7/2001) CR 65(b), - RCW 10.14.080 (1), (2) Respondent is RESTRAINED from entering or being within _______________ (distance) of petitioner’s residence place of employment other: The address is confidential Petitioner waives confidentiality of the address which is: Other: _____________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ It is further ordered that the clerk of court shall forward a copy of this order on or before the next judicial day to: County Sheriff’s Office __________________________________________________ Police Department WHERE PETITIONER LIVES which shall enter it in a computer-based criminal intelligence system available in this state used by law enforcement to list outstanding warrants. The clerk of court petitioner shall forward a copy of this order on or before the next judicial day to: County Sheriff’s Office ____________________________________________________Police Department WHERE RESPONDENT LIVES which shall personally serve the respondent with a copy of this order and shall promptly complete and return to this court proof of service. OR Petitioner has made private arrangements for service of this order. OR Respondent appeared; further service is not required. The respondent is directed to appear and show cause why the court should not enter an order for protection effective for one year or more and order the relief requested by the petitioner or other relief the court deems proper, which may include payment of costs. FAILURE TO APPEAR AT THE HEARING OR TO OTHERWISE RESPOND WILL RESULT IN THE COURT ISSUING AN ORDER FOR PROTECTION PURSUANT TO CHAPTER 10.14 RCW EFFECTIVE FOR A MINIMUM OF ONE YEAR FROM THE DATE OF THE HEARING. THE NEXT HEARING DATE AND TIME IS SHOWN BELOW THE CAPTION ON PAGE ONE. A copy of this Temporary Protection Order and Notice of Hearing has been filed with the clerk of the court. This Temporary Order for Protection is effective until the next hearing date and time shown below the caption on page one. DATED at _______a.m./p.m. JUDGE/COURT COMMISSIONER I acknowledge receipt of a copy of this Order: I acknowledge receipt of a copy of this Order: ______________________________________ Petitioner Date Respondent Date