COURTOFCOMMONPLEASBUTLERCOUNTY,OHIO Petitioner:CaseNo. Address:Judge City,State,ZipCode:PETITIONFORSTALKINGCIVILPROTECTION:ORDER(SCPO)(R.C.2903.214)v.: Respondent:NoticetoPetitioner: Throughoutthisform,markevery G G thatapplies.Address: City,State,ZipCode:SS#DOB9 1. PetitionerseeksreliefonPetitionersownbehalf. 9 2. Petitionerseeksreliefonbehalfofthefollowingfamilyorhouseholdmembers:N MEAGE/DOBHOWRELATEDTOPETITIONER3.OhiolawdefinesMENACINGBYSTALKINGasfollows:No person by engaging in a pattern of conduct shall knowingly cause another to believe that the offender will cause physical harm to the other person or cause mental distress to the other person. (OhioRevisedCodeSection2903.211(A).)ItisNOTrequiredthatRespondentberelatedtoPetitionerinanyway.PetitionerstatesthatRespondenthasengagedinthefollowingact(s)ofMENACINGBYSTALKING(describethenatureand extentoftheact(s),anddescribeanypreviousconvictionsofrespondentformenacingbystalking): 4. PetitionerrequeststhattheCourtgrantreliefunderR.C.2903.214forthesafetyandprotectionofthePetitionerandthefamily orhouseholdmembersnamedinthisPetitionbygrantingastalkingcivilprotectionorderthat:2001 © American LegalNet, Inc.:(a) DirectsRespondentnottoabusePetitionerandthefamilyorhouseholdmembersnamedinthisPetitionbyharming, attemptingtoharm,threatening,molesting,following,stalking,bothering,harassing,annoying,contacting,orforcing sexualrelationsuponthem.9(b) RequiresRespondenttorefrainfromentering,approaching,orcontacting(includingcontactbyanymedia,writings, e-mail, fax, telephone, voice mail, and delivery service in person or by any intermediary) the residence, school, business,andplaceofemploymentofPetitionerandthefamilyorhouseholdmembersnamedinthisPetition.9(c) RequiresRespondentnottodamageanyofthepropertyofPetitionerandPetitionersfamily.9(d) RequiresRespondentnottopossessanyfirearmorotherdeadlyweapon.9(e) Requires Respondent to complete batterer counseling, substance abuse counseling, or other counseling as determinednecessarybytheCourt.9(f) RequiresRespondenttopayallcostsofthisaction.9(g) Includesthefollowingadditionalprovisions: 9 5. PetitionerfurtherrequeststhattheCourtissueanexparte(emergency)protectionorderinaccordancewithR.C. 2903.211(C)(2)andthisPetition.: 6. PetitionerfurtherrequeststhattheCourtissuenomutualprotectionordersorotherordersagainstPetitionerunlessall oftheconditionsofR.C.2903.211(E)(3)aremet.: 7. PetitionerfurtherrequeststhatifPetitionerhasavictimadvocate,thecourtwillpermitthevictimadvocatetoaccompany PetitioneratallstagesoftheseproceedingsasrequiredbyR.C.2903.211(L).: 8. PetitionerfurtherrequeststhattheCourtgrantsuchotherreliefastheCourtconsidersequitableandfair.9 9.ThefollowingisalistofallpresentandpastcourtcasesinvolvingRespondent,thatPetitionerhasknowledgeof:CASENAME CASENUMBER COURT/COUNTY OUTCOMEOFCASE2001 © American LegalNet, Inc.Iherebyswearoraffirmthatthe answersabovearetrue,completeandaccurate. Iunderstandthatfalsificationofthisdocumentmayresultinacontemptofcourtfindingagainstmewhichcouldresultinajail sentence and fine, andthatfalsificationofthisdocumentmayalsosubjectmetocriminalpenaltiesforperjuryunderR.C.2921.11.Sworntoandsubscribedbeforemeonthisdayof,. SIGNATUREOFPETITIONERNO TARYPUBLIC SIGNATUREOFATTORNEYFORPETITIONER,IFANY PRINTATTORNEYNAMEANDREGISTRATIONNUMBER ADDRESS CITY,STATE,ZIP TELEPHONENUMBER2001 © American LegalNet, Inc.
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