Fill and Sign the Temporary Sexual Assault Protection Order and Notice of Form

Pt for Renew of Sexual Assault Pro. Ord/Nt of Hrg (PT/NTHG) – Page 1 of 2WPF SA-5.030 (8/2006) – Laws of 2006, ch. 138 Court of WashingtonFor No.__________________________________ _________Petitioner (Protected Person) DOB vs.__________________________________ _________Respondent (Restrained Person)DOBPetition for Renewal of Sexual Assault Protection Order and Notice of Hearing(PT/NTHG) Clerk's Action Required 1.The Sexual Assault Protection Order dated _______________________________ will expire on ________________________________________[date].2.Petitioner requests renewal of the Sexual Assault Protection Order because: . 3. Petitioner requests the following relief in the order: 1. Restrain respondent from having any contact with petitioner, including but not limited to telephone calls, mail, e-mail, fax and written notes, 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: Pt for Renew of Sexual Assault Pro. Ord/Nt of Hrg (PT/NTHG) – Page 2 of 2WPF SA-5.030 (8/2006) – Laws of 2006, ch. 138 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 . 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.) 5 . Other :4. There has been no material change in relevant circumstances since entry of the Sexual Assault Protection Order.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 PetitionerPrint or Type Name_______________________________________________________________________________Signature of Person Filing on Behalf of Petitioner Print or Type NameNotice of Hearing: To the Respondent:A hearing will be held on ______________________________, at ______________ a.m./p.m. at_____________________________________________________________ [location] to determine whether the requested renewal of the Sexual Assault Protection Order should be granted.If You do not Appear, the Court May Enter an Order Granting the Requested Renewal. County Clerk Dated: __________________________ By:_________________________, Deputy Clerk This document must be served on the other party, and a Return of Service must be filed with the court clerk at or before the hearing.