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Pt for Or for Prot - Resp Under 18 - Harassment/ Stalking (PTSTK18) – Page 1 of 7 UHST -05.0100 ( 07/201 9) – RCW 10.14.040, .800, RCW 7.92.030 Court of Washington For _______ _______________________________ Minor to be protected , ___________________________ ___________ Petitioner , vs. ______________________________________ Minor Respondent . No. Petition for an Order for Protect ion Respondent Under Age 18 [ ] Harassment (PTAH18) and/or [ ] Stalking (PTSTK18)  Information about appointment of a guardian ad litem for respondent : Harassment:  If the minor respondent is not an emancipated minor, a guardian ad litem must be appo inted to represent him or her in this action under RCW 4.08.050.  The court may order the petitioner to pay guardian ad litem fees. Stalking:  If the respondent is 16 or 17 years of age, appointment of a guardian ad litem is not required. However, the court may still appoint one in certain circumstances.  If the respondent is 15 years of age or younger and is not an emancipated minor, a guardian ad litem must be appointed to represent him or her in this action under RCW 4.08.050.  The court will not order the petitioner to pay guardian ad litem fees.  This is a Petition for an Order for Protection against Harassment and/or Stalking as checked in the caption. I believe: [ ] I am a victim of stalking. [ ] _________________________ (name) is a victim of stalk ing and he/she is a minor . The respondent has been  stalking the victim either in person or cyber stalking, and  repeatedly contacting, or attempting to contact or monitor the victim for no lawful purpose and his/her actions caused the victim to feel inti midated, frightened , or threatened. Pt for Or for Prot - Resp Under 18 - Harassment/ Stalking (PTSTK18) – Page 2 of 7 UHST -05.0100 ( 07/201 9) – RCW 10.14.040, .800, RCW 7.92.030 [ ] ____________________ ________ _ (name) is a victim of unlawful harassment and he/she is a minor . The respondent’s actions toward the victim have seriously alarmed , annoyed, or harassed the victim or are detrimental to the victim and they serve no legitimate or lawful purpose. The respondent’s actions have cause d the victim substantial emotional distress or cause d me to fear for the well -being of the victim . How do the victim and respondent know each other? ________ _____________________ I have given a detailed explanation below. 1. Who is the petitioner [ ] My name is (please print) _________________________________. I am the petitioner. [ ] I am age 16 or 17 years of age and I am petitioning on my own behalf . [ ] I am a parent or guardian of a minor and I am petitioning on behalf of that minor. [ ] I am not the parent or guardian, but I am petitioning on behalf of a minor who lives with me and the respondent is not a parent of that minor. 2. Information abou t the respondent The respondent’s name is listed in the caption. The respondent is [ ] 16 or 17 years of age [ ] 15 or under [ ] Under 18; but I do not know the exact age. You only need to complete the following if you are requesting a harassment p rotection order: [ ] Respondent has been adjudicated of the following offense against my child: Offense: Case Name: ______________________________ Case Number: Court/County: [ ] Respondent is under investigation or has been investigated for the following alleged offense against my child: Alleged offense: Investigating agency: 3. Where do the parties live? Petitioner live s in ____________________________________ County . Did the petitioner leave their residence because of stalking conduct a nd that is the county of their new residence? [ ] Yes [ ] No The minor named in the caption lives in County. Respondent live s in ___________________________________ County . Pt for Or for Prot - Resp Under 18 - Harassment/ Stalking (PTSTK18) – Page 3 of 7 UHST -05.0100 ( 07/201 9) – RCW 10.14.040, .800, RCW 7.92.030 4. Where did the Conduct take place? The conduct took place in __________ __________ County . 5. School Do the minor to be protected and the minor respondent attend the same school? [ ] Yes [ ] No If yes, please complete: Name of school: ____________________________________ _____________________ Address of school: ______ ____________________________ _____________________  Statement describing the victim/s need for protection from the respondent  W rite clearly. If you need more space below, attach additional page/s. Do not write on the back. 6. Describe what the Respondent did or said that you think is harassment or stalking.  You must describe what the respondent actually said .  You must describe what the respondent actually did. The respondent has committed acts of harassment or stalking as follows: A. Describe the most rece nt act of harassment or stalking. Date and time (on or around): __________________________________________________ Location: __________________________________________________________________ What did the respondent do or say that you believe to be haras sing or stalking behavior? Pt for Or for Prot - Resp Under 18 - Harassment/ Stalking (PTSTK18) – Page 4 of 7 UHST -05.0100 ( 07/201 9) – RCW 10.14.040, .800, RCW 7.92.030 . How did the respondent make these statements? [ ] in person [ ] mail/written notes [ ] e-mail [ ] text [ ] phone [ ] social media (such as Facebook and Twitter ) [ ] other (describe): __________________________________________________________. B. Describe other incidents of harassment or stalking. For each incident, include the date, time (on or about), location, what was said, how statements were made, and w hat was done to the victim: . 7. How did the incidents you describe above make you or the minor feel? Pt for Or for Prot - Resp Under 18 - Harassment/ Stalking (PTSTK18) – Page 5 of 7 UHST -05.0100 ( 07/201 9) – RCW 10.14.040, .800, RCW 7.92.030 . 8. Has the respondent used, displayed, or threatened to use a firearm or other dangerous weapon in a fel ony? Please describe: . 9. Is the respondent ineligible to possess a firearm under the provisions of RCW 9.41.040? Please describe: . 10. Does possession of a firearm or other dangerous weapon by the respondent present a serious and immine nt threat to public health or safety , or to the health or safety of the victim ? Please describe : . 11. Do you have any evidence of the harassment or stalking conduct other than testimony? [ ] No [ ] Yes. I have attached the following evidenc e: [ ] Copy of letter(s) [ ] Copy of text messages [ ] Copy of email messages [ ] Copy of social media messages [ ] Police report [ ] Declaration or Affidavit from the following witness (es ): _______________ _ [ ] Other (describe): __________ ___________________________________ 12. Are there o ther court cases, civil protection orders, or criminal no -contact orders involving the minor to be protected and the minor respondent: Case Number Court Name (Superior/District/Municipal) Case Title or Parties a) _________________ ________________________________ ______________________ b) _________________ ________________________________ ______________________ c) _________________ ________________________________ ______________________ Pt for Or for Prot - Resp Under 18 - Harassment/ Stalking (PTSTK18) – Page 6 of 7 UHST -05.0100 ( 07/201 9) – RCW 10.14.040, .800, RCW 7.92.030  Requests 13. I ask the Court for an order approving the following requests for protection : I Request an Order for Protection - following a hearing that will : [ ] No -Contact : Restrain the respondent from making any attempts to contact or having any contact, incl uding nonphysical contact, with the minor to be protected directly, indirectly, or through third parties regardless of whether those third parties know of the order , except for mailing of court documents . [ ] Surveillance : Prohibit or restrain the resp ondent from making any attempt to keep, or from keeping the minor to be protected under surveillance, including electronic surveillance. [ ] Exclude from places : Exclude the respondent from the [ ] residence [ ] workplace [ ] school [ ] day care of the minor to be protected. [ ] Stay Away : Prohibit or restrain the respondent from entering or being within, or from knowingly coming within, or knowingly remaining within __________________ (distance) of the [ ] residence [ ] workplace [ ] sc hool [ ] day care of the minor to be protected. [ ] other:_______________________________________________________________. [ ] School Attendance : Restrain respondent from attending ________________________ school at ________________________ _________ ______________________ (address) attended by the minor to be protected and order respondent to transfer to a different school. [ ] Other : [ ] Evaluation : Order the respondent to have a [ ] mental health [ ] chemical dependency evaluation [ ] other: _______________________________________________________________. [ ] Pay Fees and Costs : Require the respondent to pay fees and costs of this action, which may include administrative court costs and service fees and petitioner’s costs , including attorneys’ fees. [ ] Surrender Firearms : Require the respondent to immediately surrender all firearm s, other dangerous weapon s, and any concealed pistol license s and prohibit the respondent from accessing, obtaining or possessing a firearm , other danger ous weapon, or concealed pistol license s. [ ] Duration : Remain effective longer than one year because respondent is likely to resume acts of unlawful harassment or stalking conduct against the minor to be protected if the order expires in a year. Pt for Or for Prot - Resp Under 18 - Harassment/ Stalking (PTSTK18) – Page 7 of 7 UHST -05.0100 ( 07/201 9) – RCW 10.14.040, .800, RCW 7.92.030 Eme rgency Temporary Protection (up to 14 days) Until the Court Hearing : [ ] An emergency exists as described below . I request that a Temporary Protection Order granting the relief I requested above for a no -contact, surveillance, exclude from places, stay a way , or school attendance order be issued immediately, without prior notice to the respondent, to be effective until the hearing. [ ] I also request a temporary surrender of a ll firearm s, other dangerous weapon s, and concealed pistol license s without noti ce to the other party because irreparable injury could result if an order is not issued until the hearing. What irreparable harm would result if an order is not issued immediately without prior notice to the respondent? ___________________________________ ___________________________________ ____ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________ ________ __________________________________________________________________________ . I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Dated : at , Washington. ______________________ _____________ ____ Petitioner or person filing on behalf of petitioner _______________________________________ Print or type name I agree to receiv e legal documents at this address : ___________________________________________________________________ ____. [ ] This address is not my home address because my family, household or I would be at risk of abuse by respondent if I disclosed my home address.