* Case NumberDO NOT SERVE OR SHOW THIS SHEET TO RESPONDENTFOR USE BY LAW ENFORCEMENT ONLYLAW ENFORCEMENT INFORMATION This completed form is required by law enforcement to enforce your order. Fill in the following information as completely as possible.Type or print only. Addresses, birthdates and Social Security numbers of both parties are necessary to serve and enforce your order.* Name of Respondent (First, Middle, Last)RESPONDENT INFORMATION* Social Security Number or ID Number (specify)Nickname* Sex* Race* BirthdateRelation to PetitionerHeightWeightEye ColorHair ColorSkin ToneBuildCurrent AddressHome PhoneInterpret Required? LanguageEmployerEmployer's AddressWORKHours:Phone:Vehicle License NumberVehicle Make and ModelVehicle ColorVehicle Year* Name of Petitioner (First, Middle, Last)PETITIONER INFORMATIONCurrent Address*Birthdate/AgePHONEHome:Work:Contact NameContact AddressContact Phone* (MUST LIST NAME AND DATE OF BIRTH)PERSONS PROTECTED BY THIS ORDERName / Birthdate / Social Security NumberName / Birthdate / Social Security Number1. (Petitioner)4. (Child)2. (Child)5. (Other)3. (Child)6. (Other)HAZARD INFORMATIONLocation of Weapons:WeaponsOtherExplosivesKnivesGuns/RiflesItemize/Explain:Vehicle On Person Residence CURRENT STATUS(Circle)Respondent's History Includes:Yes Mental Health Problems (Commitment, Treatment, Suicide Attempt, Other) AssaultAre you and the respondent living together right now? Does the respondent know you are trying to get this order? Does the respondent know he/she may be moved out of home? Is the respondent likely to react violently when served?No Yes Assault with Weapons Alcohol / Drug AbuseNo Yes Active Warrant for ArrestNoNo Yes (Give name of Court, if known)* These information items must be provided for the Protection Order to be entered into the NCIC law enforcement data system. See Reverse For Additional InformationDate:Prepared by:DR-82 (8/10/00)Discard all previous versions of this form2001 © American LegalNet, Inc.
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