Fill and Sign the Request to Dismiss Petition for Order of Missouri Form

OSCA (02-16 ) AA42 (AFRP) 1 of 1 455.030.3, 455.067 RSMo IN THE _______ JUDICIAL CIRCUIT , _________ _________________________, MISSOURI Judge or Division: Case Number: (Date File Stamp) Court ORI Number: Petitioner: MSHP Number: Responsible Law Enforcement ORI: vs. Related Cases: Respondent: Alias/Nicknames: Respondent’s Home Address: Home Phone Number: Respondent’s DOB: Age: SSN (last four digits) : Respondent’s Work Address: Work Phone Number: Work Hours: Race: Sex: F M Hair Color: Height: Eye Color: Weight: Other Locations Where Respondent May Be Served: (Identifying Information for use by Law Enforcement) Visible Identifying Marks (e.g. tattoos, birthmarks, braces, mustache, beard, pierced ear, glasses): Petitioner’s Relationship to Respondent pursuant to 18 U.S.C. §§ 921(a)(32) and 922(g)(8) determination: Spouse Child(ren) in common Former spouse Intimate residing/resided together Are/were in a continuing social relationship of a romantic/intimate nature Related by blood. Define relationship: Related by marriage. Define relationship: Residing/resided together; no intimacy Stalking /Sexual Assault . Define relationship: Affidavit of Foreign Order of Protection - Adult I am filing my foreign order of protection as permitted by section 455.067 , RSMo. A certified copy of the foreign or der of protection is attached. The order is a true and accurate copy and has not been altered. Subsequent orders affecting foreign order of protection (if any): (Describe below; e.g. divorce order, extension of original protection order, etc.) _____________________________________________________________ ___________________________________ Date of Order _____________________________________________________________ ___________________________________ Date of Order _____________________________________________________________ ___________________________________ Date of Order I swear/affirm under penalty of perjury that these facts are true according to my best knowledge and belief. _________________________________________ Date NOTICE: Section 455.030.3 , RSMo , provides that a Petitioner seeking protection under the Domestic Violence Act is not required to reveal any current address or place of residence on this motion. Do not provide this information if doing so will endanger you. ______________________________________________ Petitioner’s Signature ____________________ __________________________ Address (Optional) ______________________________________________ City, State and Zip ______________________________________ ________ Telephone