Fill and Sign the Sa 1015 Washington State Courts Form

Petition for Sexual Assault Protection Order (PTORSXP) - Page 1 of 5 WPF SA-1.015 Mandatory (03/2018) – RCW 7.90.020, .030, .040, RCW 9.41.800 Court of Washington For Petitioner (Person to be protected) vs. Respondent (Person to be restrained) No . Petition for Sexual Assault Protection Order (PTORSXP) 1. Petitioner is a victim of nonconsensual sexual conduct or nonconsensual sexual penetration committed by the respondent as described in the statement below. I am filing on behalf of myself and I am 16 years or older. I am filing on behalf of a minor, age _________________. My relationship to the minor is _____________________. My name is ____________________________________. I am filing on behalf of a vulnerable adult as defined in RCW 74.34.020 or 74.34.021; or other adult who, because of age, disability, health or inaccessibility, cannot file the petition. My relationship to the vulnerable adult or other adult is ________________________________________. My name is ______________________________. 2. Petitioner lives in this city this county. 3. Respondent’s age is: Under 16 16 or 17 18 or over (Complete this if known.) If the respondent is under age 18, the name(s) of the minor’s parent(s) or legal guardian(s) is/are: ______________________________ ______________________________ 4. Is r espondent a service member, or a dependent of a service member? yes no unknown 5. Petitioner’s relationship to respondent is: ______________________________ ______________________________ 6. Petitioner may be served with legal documents at: __________ _________________________ _____________________________________________. (If d isclosure of petitioner’s address would risk abuse or harassment of the petitioner or the petiti oner’s family or household members, petitioner must list an alternative address.) Petition for Sexual Assault Protection Order (PTORSXP) - Page 2 of 5 WPF SA-1.015 Mandatory (03/2018) – RCW 7.90.020, .030, .040, RCW 9.41.800 7. Other court cases or other restraining, protection or no-contact orders involving the petitioner and the respondent: Case Name Case Number Court/County/State Petitioner Requests a Sexual Assault Protection Order, following a hearing, that will grant the relief requested below: 1. Restrain respondent from having any contact with petitioner, including but not limited to telephone calls, mail, written notes, email, texting, and social media (such as Facebook, and Twitter), directly, indirectly, or through third parties regardless of whether those third parties know of the order. 2 . Exclude respondent from the following places: Petitioner’s residence Petitioner’s workplace Petitioner’s school Petitioner’s day care Other: 3. Prohibit respondent from knowingly coming within, or knowingly remaining within __________________ (distance) of: Petitioner’s residence Petitioner’s workplace Petitioner’s school Petitioner’s day care Other: 4. Other : 5. Restrain respondent from attending _________________________________ school at _________________________________________________ (address) attended by the petitioner and order respondent to transfer to a different school. (If this relief is granted, respondent or respondent’s parents or legal guardians will be responsible for transportation and all other costs associated with change of school.) 6. Require the respondent to surrender any firearm or other dangerous weapon, or any concealed pistol license, and prohibit the respondent from obtaining or possessing a firearm or other dangerous weapon, or a concealed pistol license. Petition for Sexual Assault Protection Order (PTORSXP) - Page 3 of 5 WPF SA-1.015 Mandatory (03/2018) – RCW 7.90.020, .030, .040, RCW 9.41.800 Emergency temporary protection (up to 14 days) until the court hearing: An emergency exists as described below. I request that a Temporary Sexual Assault Protection Order granting the relief requested above in1) through 4) be issued immediately, without prior notice to the respondent, to be effective until the hearing. Describe the harm the temporary order is intended to prevent that would be likely to occur if respondent were given prior notice. . I also request a temporary surrender of a firearm or other dangerous weapon without notice to the other party because irreparable injury could result if an order is not issued until the hearing. What irreparable injury could result if an order is not issued immediately without prior notice to the respondent? __________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ A Sexual Assault Protection Order is available to protect a victim of nonconsensual sexual conduct or nonconsensual sexual penetration, including a single incident of nonconsensual sexual conduct or nonconsensual sexual penetration, from future interactions with the assailant. Nonconsensual means a lack of freely given agreement. Sexual conduct means any of the following: (a) any intentional or knowing touching or fondling of the genitals, anus, or breasts, directly or indirectly, including through clothing; (b) any intentional or knowing display of the genitals, anus, or breasts for the purposes of arousal or sexual gratification of the respondent; (c) any intentional or knowing touching or fondling of the genitals, anus, or breasts, directly or indirectly, including through clothing, that the petitioner is forced to perform by another person or the respondent; (d) any forced display of the petitioner’s genitals, anus, or breasts for the purposes of arousal or sexual gratification of the respondent or others; (e) any intentional or knowing touching of the clothed or unclothed body of a child under the age of 13, if done for the purpose of sexual gratification or arousal of the respondent or others; and (f) any coerced or forced touching or fondling by a child under the age of thirteen, directly or indirectly, including through clothing, of the genitals, anus, or breasts of the respondent or others. Sexual Penetration means any contact, however slight, between the sex organ or anus of one person by an object, the sex organ, mouth or anus of another person, or any intrusion, however slight, of any part of the body of one person or of any animal or object into the sex organ or anus of another person, including but not limited to cunnilingus, fellatio, or anal penetration. Evidence of emission of semen is not required to prove sexual penetration. Petition for Sexual Assault Protection Order (PTORSXP) - Page 4 of 5 WPF SA-1.015 Mandatory (03/2018) – RCW 7.90.020, .030, .040, RCW 9.41.800 Statement: Statement about sexual assault and fear of future dangerous acts: ( complete both sections) A. Describe any nonconsensual sexual conduct or nonconsensual sexual penetration, and the approximate date(s) : . B. Describe statements or actions of the respondent at the time of the sexual assault(s) or later that cause the petitioner reasonable fear of future dangerous acts : . Petition for Sexual Assault Protection Order (PTORSXP) - Page 5 of 5 WPF SA-1.015 Mandatory (03/2018) – RCW 7.90.020, .030, .040, RCW 9.41.800 Complete the statements below that apply: (Complete this section if the petitioner and the respondent are minors who attend the same school and petitioner requests the court to order the respondent not to attend the same school attended by the petitioner.) Describe any continuing physical danger or emotional distress to the petitioner caused by the respondent’s attendance at the same school as the petitioner: . Has the respondent used, displayed, or threatened to use a firearm or other dangerous weapon in a felony? Please describe: . Has the respondent previously committed an offense that makes him or her ineligible to possess a firearm under the provisions of RCW 9.41.040? Please describe: . Does possession of a firearm or other dangerous weapon by the respondent present a serious and imminent threat to public health or safety, or to the health or safety of the petitioner? Please describe: . Other: . (C ontinue on separate page if necessary. ) I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Dated: at __________ Washington. Signature of Petitioner Print Name Signature of Person Filing on Behalf of Petitioner Print Name