Fill and Sign the Dv 127 Confidential Law Enforcement Information Sheet 5 10 Edited Domestic Violence Forms

CONFIDENTIAL LAW ENFORCEMENT INFORMATION SHEET Notice to Petitioner : You must supply the respondent's name and birt h date, if known. Give as much information as possible. This information will NOT be given to the respondent. Notice to Law Enforcement : This information is confidential and supplie d to assist you in serving the protective order. After serving (or failing to serve) the order, notif y petitioner and complete the return of service section on the DV-125. A. PETITIONER INFORMATION Full name: Date of birth: Petitioner is a child. Petitioner’s residence address: Is this the address respondent is to stay away from? Yes No Do you want to be notified when respondent is served? Yes No Contact phone(s): home work cell msg B. RESPONDENT INFORMATION Full name: Nicknames: Respondent is a child. Residence Address: Is this the address respondent is to stay away from? Yes No Last four digits of SSN Other Addresses: Contact phone(s): home work cell msg Where is respondent now (what street addr ess)? Other information about respondent: Sex Race *Da te of Birth* HT WT Hair Eyes State ID / Driver’s Lic. # ST Other Identifiers (facial hair, piercings, sc ars, tattoos, marks, etc.) Friends / relatives / phone numbers / hangouts: Hazards at respondent’s home (dogs, traps, guns): Describe respondent’s house: log frame apartment single family duplex 1 story 2 story 3+ story main color trim color Garage: separate attached none 4x4 needed to access address? Y N Respondent’s employer Employer address Work phone Work hours Respondent’s position Supervisor Respondent’s vehicle information Make Model Plate No. State Year van pickup canopy camper toolbox car 2 door 4 door SUV other Other vehicles respondent is known to drive: C. OFFICER SAFETY INFORMATION Previous contact with police by respondent? No Yes Explain: Any threats by respondent toward petitioner, family, police? Describe: Weapons accessible to respondent (pistol, rifle, knife, other): Expected mental state or history of re spondent (include alcohol or drug use): Is a divorce or other legal action pending that involv es the respondent (child custody, eviction, bankruptcy, repossession of property)? Draw a map on the back of this form if it will help law enforcement. DV-127 (5/10)(cs) Civil Rule 65.1 CONFIDENTIAL LAW ENFORCEMENT INFORMATION SHEET (DOMESTIC VIOLENCE OR STALKING)