Fill and Sign the On Behalf of Names of Minor Children Form

HAR102 State ENG Rev 7 /17 www.mncourts.gov/forms Page 1 of 5 State o f Minnesota District Court County Judicial District: Court File Number: Case Type: Harassment Petitioner’s Affidavit and Petition for Harassment Restraining Order (Minn. Stat. § 609.748) Petitioner Respondent Name: (Person harassin g you or your minor child ): Address: Name: Address: Date of Birth: On behalf of: (name s of minor children who are victims of harassment and their dates of birth) vs. Name: DOB: Name: DOB: Date of Birth: Name: DOB: (if known, or approximate age) I understand that I must tell the truth. I state that: 1. I am the Petitioner in this case. The victim of the harassment is  me  a minor child for whom I am the parent, legal guardian or stepparent. (If you are the guardian, a ttach a copy of the order appointing y ou.) The name of each victim, other than me, is: How does each victim know the Respondent and what is their relationship? If you are filing on behalf of another person, what is your relationship to each victim? 2. a) How many restraining orders have been in effect, ordering Respondent to stay away from the victims you included at #1 above?  none  one  two or more. For each restraining order provide: HAR102 State ENG Rev 7 /17 www.mncourts.gov/forms Page 2 of 5 Court File Number, if known County and State where the court is located b) Does Respondent have a current Harassment R estraining Order or Order for Protection against you?  Yes, Case File Number (if known)  No, I am not aware of any. 3. The following court c ases involve me and the Respondent in issues of child custody or parenting time: Court File Number County and State where the court is located 4. Respondent has harassed the victim(s) as follows: • Check all boxes that apply and give the date and de tails of each incident. • To get a Restraining order, you must describe actions that meet the legal definition of harassment in Minnesota. See the Instructions for the definition of harassment. • If you need more space, attach a full sheet of paper and continue your description there. Do not write on the back.  Respondent physically or sexually assaulted the victim as follows:  Respondent has followed, pursued or stalked the victim as follows:  Respondent made uninvited visits to the victim as follows: HAR102 State ENG Rev 7 /17 www.mncourts.gov/forms Page 3 of 5  Respondent made harassing phone calls to the victim as follows:  Respondent made threats to the victim as follows:  Respondent frightened the victim with threatening behavior as follows:  Respondent broke into and entered the victim’s residence as follows:  Respondent damaged the victim ’s property as follows:  Respondent stole property from the victim as follows:  Respondent took pictures of the victim without permission as follows:  Responde nt shared private sexual images of the victim without permission as follows:  Respondent used the victim’s personal information, without consent, to invite, encourage, or solicit a third party to engage in a sexual act with the victim as follows: HAR102 State ENG Rev 7 /17 www.mncourts.gov/forms Page 4 of 5  More than once, Respondent has done acts that meet the legal definition of “t argeted residential picketing” by:  I told Respondent not to come to certain public events that I or the children a ttend because: After that, Respondent attended public events I/we attended: (List dates, places and name of events) These acts by Respondent show a pattern of attending public events while knowing that attending is harassing to me/children .  Other: 5. Describe the effect the harassment has upon the victim’s safety, security or privacy: 6. Do you believe the harassment will continue? Why? 7. I ask the Court to issue a Restraining Order as follows: C heck all boxes (a through e ) that apply.  a. Respondent shall not harass  me  minor child (ren) for whom I am the parent, legal guardian, or stepparent. List the full names of the minor children included in this Petition:  b. Respondent shall have no contact with  me  the minor child(ren) listed above .  c. Respondent shall stay away from where I/we live (address)  d. Respondent shall stay away from my/the victim’s job site located at  e. Other: HAR102 State ENG Rev 7 /17 www.mncourts.gov/forms Page 5 of 5 8. Court Hearing Petitioner: Read these Notices about a Hearing • You have a right to request a court hearing. • If the Judge dismisses your case because it has no merit, no hearing will be held. • The Judge can issue a Restraining Order without a court hearing if the Judge finds there is immediate and present danger of harassment. • If the Judge issues a Restraining Order without a hearing, the Respondent can re quest a hearing within 20 days of the date the P etition is served. If Respondent requests a hearing, the court will notify you by mail at least five days before the hearing date. • If there is a hearing, you must attend the hearing and prove that t he statements in your Petition & Affidavit are true, and that Respondent’s actions are harassment, as defined by Minnesota law. Choose a. or b.  a. I am not requesting a court hearing at this time. But i f the court denies my request for a rest raining order because the court finds there is no immediate and present danger of harassment, then (check one)  I want  I don’t want a court hearing. OR  b. I am requesting a court hearing. 9. I request a Restraining Order for a length o f:  2 years  Until the following date:________________________________, which is less than 2 years from today.  Up to 50 years because:  I have two or more prior restra ining orders against Respondent (listed at #2 above.)  Respondent has violated a prior or existing restraining order between us on two or more occasions . I understand the court will likely schedule a court hearing for any request o ver 2 years. I declare under penalty of perjury that everything I have st ated in this document is true and correct. Minn. Stat. § 358.116. Dated : ____________________________ Signature Name County and state where signed Address City/State/Zip Telephone ( ) E-mail addr ess: Notice: If your address or telephone changes, you must give Court A dministration your new i nformation right away, in writing.