Fill and Sign the Restraining Order Form

- 1 - IN THE ______________ COURT OF ______________ COUNTY STATE OF ________________ ) ) ) Petitioner/Plaintiff, ) ) ) NO. Vs. ) ) ) Respondent/Defendant ) ) PETITION FOR TEMPORARY RESTRAININGORDER AND PERTINENT INJUNCTION COME NOW, Plaintiffs, ________________________ and ______________________, and file this their Petition for a Temporary Restraining Order and Permanent Injuncti on and in support thereof, would show the following: 1. a. _____________ is an adult resident citizen of _____________ County, _____________ , whose address is __________________________. b. _____________ is an adult resident citizen of _____________ County, _____________ , whose address is __________________________. c. _____________ is an adult resident citizen of _____________ County, _____________ , whose address is __________________________. 2. During _____________ , 20____, _____________ ended a relationship with _____________ . Subsequent to that time, _____________ became engaged to be married to _____________ . 3. Since the time that _____________ and _____________ have become engaged to be married, _____________ has knowingly and willfully engaged in a pattern of conduct of threatening and harassing _____________ and _____________ . Specifically, _____________ had conversations with and made telephone calls to _____________ and _____________ 's employer, during which she used abusive and profane language and made threats regarding the safety of _____________. Likewise, _____________ has made remarks to individuals who know _____________ and _____________ indicating that she - 2 - intended to cause bodily harm to _____________. _____________ has further made threatening statements to _____________ in person. 4. As the proximate and foreseeable result of _____________'s irrational, hostile, abusive and threatening conduct, and her intent and apparent ability to carry out the threats made by her to _____________and _____________ , _____________ and _____________ are in fear for their safety. WHEREFORE, Plaintiffs _____________ and _____________ request that this Court enter a Temporary Restraining Order against _____________ prohibiting her from contacting both _____________ , _____________ , _____________ 's daughter, _____________ , and _____________ 's employer, _____________ or any employee thereof, by telephone, letter, or by any other means or method of communication and prohibiting her from coming to _____________ and _____________ 's home and place of business or otherwise coming within five hundred (500)feet of _____________, _____________ , _____________ 's daughter, _____________ , _____________ 's employer, _____________ , or any employee thereof. MOTION FOR PERMANENT INJUNCTION 5. _____________ and _____________ incorporate herein by reference the allegations contained in Paragraphs 1 through 4 above. 6._____________ and _____________ request that the Temporary Restraining Order remain in effect until such time as a hearing can be had on t he merits of this cause, at which time _____________ and _____________ request that a Permanent Injunction be issued prohibiting any contact between the parties on a permanent basis. WHEREFORE, PREMISES CONSIDERED, _____________ and _____________ pray for the following relief: A. A Temporary Restraining Order prohibiting _____________ from contacting _____________ and _____________ and either of their employers; and B. A Permanent Injunction prohibiting any contact between the parties on a permane nt basis; and C. Other such relief as the Court deems just and equitable. DATED this the _____ day of _____________, 20___. Respectfully submitted, __________________________ STATE OF _____________ - 3 - COUNTY OF __________Personally appeared before me, the undersigned authority in and for the said county and state, on this ____ day of _____________ 20___, within my jurisdiction, the within named __________________________ , duly identified before me, who acknowledged that he executed the above and foregoing instrument. _____________________________ NOTARY PUBLIC My Commission Expires:_______________________ STATE OF _____________ COUNTY OF ___________ Personally appeared before me, the undersigned authority in and for the said county and state, on this _____ day of _____________ 20___, within my jurisdiction, the within named __________________________ , duly identified before me, who acknowledged that she executed the above and foregoing instrument. ____________________________ NOTARY PUBLIC My Commission Expires:_______________________ OF COUNSEL: - 4 - CERTIFICATE OF SERVICE I, ________________, do hereby certify that I have this day caused to be mailed, via United States Mail postage prepaid, a true and correct copy of the foregoing document to: DATED this the _____ day of _____________, 20___.