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Pt for an Or for Protection – Harassment/Stalking (PTORAH, PTORSTK) – Page 1 of 7 W PF UHST -02.0200 ( 07/201 9) – RCW 10.14.040, .800, RCW 7.92.030 Court of Washington For Petitioner , vs. Respondent . No. Petition for an Order for Protection - [ ] Harassment (PTORAH) and/or [ ] Stalking (PTORSTK )  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 the victim of stalking and he/she is a minor or vulnerable adult . The respondent has been  stalking the victim either in person or cyber stalking, and  repeatedly contacting the victim or attempting to contact or monitor the victim for no lawful purpose and his/her actions caused the victim to feel intimidated, frightened , or threatened. [ ] I am a victim of unlawful harassment . [ ] _____________________________ (name) is a victim of unlawful harassment and he/she is a minor. The respondent’s actions t oward the victim have seriously alarmed, annoyed , or harassed the victim , or are detrimental to the victim and serve no legitimate or lawful purpose. The respondent’s actions have cause d substantial emotional distress to the victim or cause d me to fear for the well -being of my child. How do the victim and respondent know each other? _________________________ I have given a detail ed explanation below. Pt for an Or for Protection – Harassment/Stalking (PTORAH, PTORSTK) – Page 2 of 7 W PF UHST -02.0200 ( 07/201 9) – RCW 10.14.040, .800, RCW 7.92.030 1. Who is the petitioner? My name is (please print) _________________________________. I am the petitioner. [ ] I am 18 or o lder and I am petitioning on my own behalf. [ ] I am 16 or 17 and I am petitioning on my own behalf. [ ] I am the parent or guardian of child/ren under age 1 8 and I am petitioning on their behalf : Children’s Name /s (First, Middle Initial, Last) Age [ ] I am not the parent or guardian, but the child/ren live/s with me and I am petitioning on their behalf and the respondent is not a parent . Children’s Name /s (First, Middle Initial, Last) Age [ ] I am filing this petition on behalf of petitioner, (name) _______________________ _, a vulnerable adult as defined in RCW 74.34.020 , who is a victim of stalking . I am an interested person as defined in RCW 74.34.020(10). My relationship to th is petitioner is _____________________ . 2. Is the respondent 18 years of age or older? [ ] Yes [ ] No (If no, use the Petition for Order for Protection Harassment/Stalking Respondent Under Age 18 , instead of this petition. ) 3. Where do the parties live? Petitioner live s in _________________________ __________ _ County . Did the petitioner leave their residence because of stalking conduct and that is the county of their new residence? [ ] Yes [ ] No Children named above live in County. Respondent live s in ___________________________________ County . 4. Where did the Conduct take p lace? The conduct took place in County . Pt for an Or for Protection – Harassment/Stalking (PTORAH, PTORSTK) – Page 3 of 7 W PF UHST -02.0200 ( 07/201 9) – RCW 10.14.040, .800, RCW 7.92.030 Statement describing the victim/s need for protection from the respondent  Write clearly. If you need more space below, attach additional page/s. Do not write on the back. 5. Describe what the Respondent did or said that you think is harassment or stalking .  You mus t describe what the respondent actually said .  You must describe what the respondent actually did. The r espondent has committed acts of harassment or stalking as follows: A. Describe the most recent incident of harassment or stalking . Date and time (on or a round): _________________________________________________ _ Location: __________________________________________________________________ What did the respondent do or say that you believe to be harassing or stalking behavior? . Pt for an Or for Protection – Harassment/Stalking (PTORAH, PTORSTK) – Page 4 of 7 W PF UHST -02.0200 ( 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 what was done to a victim. . 6. How did the incidents you describe above make you, the minor, or the vulnerable adult feel? . Pt for an Or for Protection – Harassment/Stalking (PTORAH, PTORSTK) – Page 5 of 7 W PF UHST -02.0200 ( 07/201 9) – RCW 10.14.040, .800, RCW 7.92.030 7. Has the respondent used, displayed, or threatened to use a firearm or other dangerous weapon in a felony ? Please d escribe : . 8. Is the respondent ineligible to possess a firearm under the provisions of RCW 9.41.040 ? Please describe: . 9. Does possession of a firearm or other dangerous weapon by the respondent present a serious and imminent threat to public hea lth or safety, or to the health or safety of a victim ? Please describe : . 10 . Do you have any evidence of the harassment or stalking conduct other than testimony? [ ] No [ ] Yes. I have attached the following evidence : [ ] Copy of mail or w ritten notes [ ] Copy of text messages [ ] Copy of email messages [ ] Copy of social media messages [ ] Police report [ ] Declaration or Affidavit from the following witness : ___________________ [ ] Other (describe): ___________________ _______ ___________________ 11 . Has/have the victim/s or the respondent ever requested or obtained protection from the other person in a restraining order, civil protection order, or criminal no -contact order? If yes, l ist the type of order, the name of the cour t and the approximate date, and whether the request was granted: Pt for an Or for Protection – Harassment/Stalking (PTORAH, PTORSTK) – Page 6 of 7 W PF UHST -02.0200 ( 07/201 9) – RCW 10.14.040, .800, RCW 7.92.030 12. Is there any other litigation between the victim/s and the respondent? This includes all matters - pending or past - such as parenting plans, landlord -tenant disputes, employme nt disputes, or property disputes. If yes, p rovide case number/s if known, type of case, and name of court: .  Request s 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 or having any contact, including nonphysical contact, with the person/s to be protected, directly, indirectly, or through third parties regardless of whether those th ird parties know of the order , except for mailing of court documents . [ ] Surveillance : Prohibit or restrain the respondent from making any attempt to keep or from keeping the person/s to be protected under surveillance, including electronic surveillanc e. [ ] Exclude from places : Exclude the respondent from the [ ] residence [ ] workplace [ ] school [ ] day care of the person/s to be protected. [ ] Stay Away : Prohibit or restrain the respondent from entering or being within, or from knowingl y coming within, or knowingly remaining within ________ (distance) of the [ ] residence [ ] workplace [ ] school [ ] day care of the person/s to be protected. [ ] other locations : _______________________________________________. [ ] 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 pis tol license s, and prohibit the respondent from accessing, obtaining or possessing firearm s, or other dangerous weapon s, or concealed pistol license s. [ ] Duration : Remain effective longer than one year because respondent is likely to resume acts of unla wful harassment or stalking conduct against the persons to be protected if the order expires in a year. Pt for an Or for Protection – Harassment/Stalking (PTORAH, PTORSTK) – Page 7 of 7 W PF UHST -02.0200 ( 07/201 9) – RCW 10.14.040, .800, RCW 7.92.030 Emergency temporary protection (up to 14 days) until the court hearing : [ ] An emergency exists as described below . I request that a Temporary Prote ction Order granting the relief I requested above for a no -contact, surveillance, exclude from places, or stay away order be issued immediately, without prior notice to the respondent, be effective until the hearing. [ ] I also request a temporary surrend er of a ll firearm s, other dangerous weapon s, and concealed pistol license s without notice 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 i mmediately without prior notice to the respondent? ______________________________________________________________________ ____ __________________________________________________________________________ ______________________________________________________ ___________________ __________________________________________________________________________ __________________________________________________________________________ I declare under penalty of perjury under the laws of the state of Washington that th e foregoing is true and correct. Dated : at Washington. Petitioner Print or type name I agree to receiv e legal documents at this address : _______________________________________________________________________. [ ] This ad dress 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 .