Civil Petition for Stalking or SA Protective Order

PETITION FOR STALKING OR SEXUAL ASSAULT PROTECTIVE ORDER

This is Not a Court Order

IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT

CASE NO.

I swear or affirm under penalty of perjury that all the information I provide in this petition is true to the best of my knowledge and belief.

I am requesting the following protective order(s). NOTE: If there is any chance you might need protection for more than 20 days, you should request both a long-term order (6 months) and an ex parte order (20-day). To do this, check both boxes.

1. an ex parte protective order (20 day order)

I certify that I have not tried to notify the respondent that I am filing this petition.

notified or tried to notify the respondent as follows:

a long-term protective order (6 month order)

2. The respondent is a (check all that apply):

(former) friend neighbor classmate co-worker

client or former client correctional facility employee

legal guardian of petitioner other

I do not know and have never been acquainted with the respondent

3. I (petitioner) am a minor Age adult

4. The respondent is (or appears to be) a minor Age an adult

5.a. Respondent has stalked or sexually assaulted me as described below and this conduct has placed me in fear of:

death or physical injury to me further sexual assault

the death or physical injury of the following family member of mine:

Name of family member:

Relationship to me:

5.b. I am afraid of physical injury or death, or further sexual assault, because

6. Description of respondent’s conduct. (Explain what respondent is doing or did, including when, where and how often the stalking or sexual assault occurred. Be specific. Include dates and places.)

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

respondent not to follow, approach, confront, watch or stalk me in any other way or threaten to do so.

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:

respondent to stay away from my residence.

Is this also respondent's current residence? yes no

Respondent’s residence is unknown to me within my apartment complex approximately from my residence

Describe:

respondent to stay away from my school.

Name and location of school:

Is this also respondent’s school? yes no

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 no

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

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

respondent not to have sexual contact with me.

8. Other cases. The following are all the pending civil cases or criminal cases, in this or another state, involving either me or respondent (that I know of):

The following are other court cases (civil or criminal) involving the respondent that I want the court to know about:

9. Information about respondent (if known).

Respondent’s full legal name and any nicknames or other names used:

Respondent's mailing address:

Respondent's home phone: Work phone:

10. Petitioner information. [The court needs your mailing address to send court papers, including notices of hearing, to you. If you believe it is not safe for the respondent to know where you live, write a "message" address where you can be sure you will receive court papers. If you do not have an address and telephone number that can safely be revealed to the respondent, ask the court clerk how you can provide this information so that it will be kept confidential and not revealed to the respondent. Civil Rule 65.1]

My mailing/message address

Street or Box No. City State Zip

My message phone:

My full legal name:

Any nicknames or other names:

Print Name

Subscribed and sworn to or affirmed before me at , Alaska on