Legal Non-Molestation Application

Legal Non-Molestation Application

Applicant Name:   Applicant Address:

Respondent Name:   Respondent Address:

Court or File Number:   Date of Application:

RECITALS

WHEREAS, the Applicant alleges that the Respondent has engaged in conduct constituting molestation, harassment, stalking or threats that create a reasonable fear for the Applicant's personal safety or the safety of household members or minor children; and

WHEREAS, the specific incidents giving rise to this application are set forth in the Facts in Support of Application below, including dates, locations, witnesses, and any civil or criminal reports filed; and

WHEREAS, the Applicant seeks a Non-Molestation Order to prevent further molestation, harassment, or contact by the Respondent, to preserve the peace and safety of the Applicant and any protected persons.

NOW, THEREFORE, the Applicant applies to the Court for relief as requested in this application and declares under penalty of perjury that the statements made herein are true and correct to the best of the Applicant's knowledge.

1. DEFINITIONS

For purposes of this application: "Molestation" includes any conduct intended to alarm, annoy, intimidate, threaten, or place another person in fear of imminent physical harm, including but not limited to repeated unwanted communication, stalking, physical assault, threats of violence, damaging property, or coercive conduct. "Protected Persons" includes the Applicant, the Applicant's minor children, and other household members identified in this application.

2. FACTS IN SUPPORT OF APPLICATION

Describe each incident of molestation, harassment, threats, or intimidation, identifying approximate date, time, place, and the conduct engaged in by Respondent:

Police Report Filed:   Report Number:   Agency:

3. RELIEF REQUESTED

The Applicant requests the Court issue the following orders to protect the Applicant and other Protected Persons. Check all that apply and describe any specific conditions.

Non-Molestation Order prohibiting Respondent from molesteing, harassing, threatening, or contacting the Applicant and Protected Persons.

No Contact Order: prohibit direct or indirect communication by telephone, electronic means, third parties, or in person.

Exclusion from Residence: order excluding Respondent from the residence located at

Child Contact Restrictions or Supervised Visitation as set forth in:

Order for Return or Protection of Personal Property (describe):

Restriction on Possession of Firearms by Respondent

Other relief requested (specify):

4. URGENT / TEMPORARY RELIEF

Applicant requests immediate temporary relief ex parte where applicable to prevent imminent harm. State reasons why temporary protection is necessary without prior notice to Respondent:

5. SERVICE AND NOTICE

Proposed method of service upon Respondent (select and provide details):

Personal Service by Process Server or Law Enforcement

Certified Mail / Return Receipt

Alternative or Constructive Service (describe basis for request)

6. UNDERTAKINGS, CERTIFICATION, AND PENALTIES

The Applicant certifies under penalty of perjury that the information contained in this application is true and correct. Applicant acknowledges that knowingly making a false statement in this application may subject the Applicant to civil and criminal penalties under applicable law. Applicant further agrees to notify the Court promptly of any material change in circumstances affecting the need for or scope of relief sought.

Applicant affirms that to the best of Applicant's knowledge no prior effective non-molestation orders are outstanding between the parties except as disclosed below:

7. NOTICES

All notices, pleadings, and communications concerning this application shall be delivered to the contact information provided below unless otherwise directed by Court order.

8. MISCELLANEOUS CLAUSES

Governing Law: This application and any resulting order shall be governed by and construed in accordance with the substantive law of the jurisdiction in which the Court sits. Venue lies in the appropriate court as required by local rules.

Entire Agreement: This application, together with any orders issued by the Court, constitutes the entire understanding between the parties with respect to the matters addressed herein and supersedes all prior agreements and understandings, whether written or oral.

Severability: If any provision of this application or any resulting order is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

Amendments and Waiver: No amendment or waiver of any provision of this application shall be effective unless in writing and signed by the party against whom enforcement is sought. The failure to enforce any provision shall not constitute a waiver of that provision.

Counterparts: This application may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one instrument.

9. DECLARATION

I, the undersigned Applicant, declare under penalty of perjury under the laws of this jurisdiction that the facts set forth in this application are true and correct to the best of my knowledge and belief. I understand that willful misrepresentation may subject me to penalties.

Applicant Printed Name:   Date Signed:

Sign Now