Illinois > Local County > Champaign > Domestic Violence
Verified Petition For Civil No Contact Order - Illinois
| Verified Petition For Civil No Contact Order Form. This is a Illinois form and can be used in Domestic Violence Champaign Local County . |
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CIRCUIT COURT OF ILLINOIS Sixth Judicial Circuit Champaign County _____________________________________ Petitioner's Name (person completing form) Name(s) of other protected parties _____________________________________ _____________________________________ Check if filing on behalf of: a minor child, or an adult who because of age, disability, health, or inaccessibility cannot file the petition (list name(s) below) _____________________________________ vs. _____________________________________ Respondent's Name (person you want protection If the Respondent is under age 18 and if remedy #4 is requested the name(s) of minor parent(s) or legal guardian(s) Independent Criminal Juvenile (file stamp) Case No: _ (to be completed by Court) from) ______________________________________ Notice to School Board(s) if remedy #4 is requested VERIFIED PETITION FOR CIVIL NO CONTACT ORDER (Sexual Conduct and/or Penetration) PETITIONER INFORMATION Petitioner's Address: _________________________________________________________________________________ (Street/P.O. Box) (City) (State) (Zip Code) Disclosure of Petitioner's and/or protected party'(s) address would risk further abuse. The address listed above is Petitioner's and/or protected party'(s) alternative address for service of notice. Other protected persons (persons to be included in the Civil No Contact Order) in addition to the Petitioner are: Name: Address: _________________________________________________________________________________ (Street/P.O. Box) (City) (State) (Zip Code) Name: Address: (Street/P.O. Box) (City) Page 1 of 5 - Verified Petition for Civil No Contact Order (State) (Zip Code) 12/12 Katie M. Blakeman Clerk of the Sixth Judicial Circuit Court 101 E. Main Street Urbana, Illinois 61801 American LegalNet, Inc. www.FormsWorkFlow.com RESPONDENT INFORMATION (if known) CIRCUIT COURT OF ILLINOIS Name: Sex: Male Female DOB: Sixth Judicial Circuit Champaign County Height: _________ Weight: Race: Social Security #: XXX-XXLicense Plate #: (last 4 numbers) Hair Color: Driver's License #: Other Numeric Identifier: Home Address: Name of Workplace: Work Address: Eye Color: (number - optional) (Street/P.O. Box) Description: (e.g. passport #, military serial # or other) (City) (State) (Zip) Work Hours: (Street/P.O. Box) (City) (State) (Zip) Distinguishing Physical Features: (tattoos, scars, etc.) Respondent is incarcerated at: _______________________________________________________________ Respondent's address is unknown. Service by publication is requested (Section 2-206 (a) of the Code of Civil Procedure). {Reasonable efforts to accomplish actual service must be shown by evidence or affidavit. 740 ILCS 22/208(c)} Respondent may be: considered armed and/or dangerous suicidal considered armed, dangerous and suicidal I am requesting a Civil No Contact Order because on or about _______________________________________ at (date) (location) , the following occurred: (Be specific as to dates, events and locations) __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ (additional pages may be added) Page 2 of 5 - Verified Petition for Civil No Contact Order Katie M. Blakeman Clerk of the Sixth Judicial Circuit Court 101 E. Main Street Urbana, Illinois 61801 American LegalNet, Inc. www.FormsWorkFlow.com CIRCUIT COURT OF ILLINOIS Venue is appropriate in this county because: the Petitioner resides here; the Respondent resides here; the alleged non-consensual sexual conduct or non-consensual sexual penetration occurred here (check all that apply). Sixth Judicial Circuit Champaign County REMEDIES SECTION (740 ILCS 22/213) Pursuant to the Civil No Contact Order Act, the Petitioner seeks the following remedies: 1. feet away from the Petitioner and/or That the Respondent be ordered to stay at least other protected persons. That Respondent be prohibited from entering or remaining at the Petitioner's and/or other protected persons': place of residence, located at _____________________________________________________ place(s) of employment, located at ________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ school(s) and/or daycare, located at ________________________________________________ ___________________________________________________________________________________ and any of the following specified places, when Petitioner and/or other protected persons are present: ___________________________________________________________________________________ 2. That the Respondent refrain from contact with Petitioner and/or other protected persons in any way, directly, indirectly or through third parties, including, but not limited to, phone, written notes, mail, email, or fax. 3. That Respondent stay away from and be prohibited from taking, transferring, encumbering, concealing, damaging, or otherwise disposing of the Petitioner's and/or other protected persons' real and/or personal property or animal(s). 4. That the Respondent be restrained from attending_______________________________ school at __________________________________________(address) attended by the Petitioner. {740 ILCS 22/213(b-6)} 5. Other injunctive relief as follows: WHEREFORE, Petitioner asks the Court to grant the relief requested in this Petition. Page 3 of 5 - Verified Petition for Civil No Contact Order Page 3 of 5 Petition for Civil No Contact Order American LegalNet, Inc. www.FormsWorkFlow.com Katie M. Blakeman Clerk of the Sixth Judicial Circuit Court 101 E. Main Street Urbana, Illinois 61801 VERIFICATION CIRCUIT COURT OF ILLINOIS UNDER THE PENALTIES OF PERJURY AS PROVIDED BY LAW PURSUANT TO SECTION 1-109 OF THE CODE OF CIVIL PROCEDURE, THESixth Judicial Circuit UNDERSIGNED CERTIFIES THAT THE STATEMENTS SET Champaign County FORTH IN THIS INSTRUMENT ARE TRUE AND CORRECT, EXCEPT AS TO MATTERS HEREIN STATED TO BE ON INFORMATION AND BELIEF AND AS TO SUCH MATTERS THE UNDERSIGNED CERTIFIES AS AFORESAID THAT THE UNDERSIGNED VERILY BELIEVES THE SAME TO BE TRUE. Signature of Petitioner Petitioner's Attorney or Petitioner if not represented by an attorney Name Telephone Number Address City/State/Zip Page 4 of 5
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