Michigan > Local County > Kent > 17th Circuit
Personal Protection Order (PPO) - Michigan
| Personal Protection Order (PPO) Form. This is a Michigan form and can be used in 17th Circuit Kent Local County . |
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Personal Protection Order (PPO) Petition Instructions Please fill out the entire form following these instructions. Every section is numbered. You are the Petitioner! Step 1--Mark the Domestic or Stalking box describing the situation that pertains to your relationship (The Petitioner) with other person (The Respondent). Step 2--You are the Petitioner. Fill in your name and full address. (If you are in hiding, do not put your address on the form.) Step 3--The person you are filing against is the Respondent. Fill in the entire box including Respondent's name, full address and description. Step 4--Mark all the boxes that apply to your relationship with the Respondent. Step 5--Indicate any other Court orders, judgments or pending cases between you and the Respondent. Please attach copies of these documents if issued in a County other than Kent or a State other than Michigan. (Police Reports are acceptable.) Step 6--Indicate acts already committed against you. For Domestic cases, mark all situations that apply for A through O. For Stalking cases, mark all situations that apply for E through O. Step 7--Do Not Sign Step 8--Do Not Sign American LegalNet, Inc. www.FormsWorkflow.com Kent County-17th Judicial Circuit/FAMILY DIVISION 180 Ottawa Avenue NW Suite 3500 Grand Rapids MI 49503 616-632-5067 STATE OF MICHIGAN For Court Use Only Judge Petition for Personal Protection Order Step 1--Type of PPO Case Domestic Relationship (See #4 for definition.) Stalking - The petitioner and respondent are not husband and wife, have not resided in the same household together, Step 2--Petitioner What is your age? Case Number: have no children in common, and have had no intimate dating relationship with one another. (No relationship whatsoever.) Step 3--Respondent Name: ___________________________________________________ Address: _________________________________________________ City, State, ZIP: ____________________________________________ Phone #: (______)__________________________________________ Respondent's Height: _______ Weight: _______ Race: ____________ Birthdate: __________ Hair color: __________ Eye color: __________ Parent's Name if resp. is under 18: ____________________________ Is the respondent employed by any law enforcement agency that requires firearm possession? NO YES If yes, answer: Name of Supervisor: ________________________________________ Name: ___________________________________________________ Address: _________________________________________________ City, State, ZIP: ____________________________________________ Phone #: (______)__________________________________________ Step 4--The petitioner and respondent (mark all that apply): Were husband & wife, now divorced. Are husband & wife. Years married: ______ Have a child(ren) in common. # of children: ______ Reside or resided in the same household. From ______ to ______ Have or have had an intimate dating relationship. Address: _________________________________________________ Other, please describe: __________________________________ Phone #: (______)__________________________________________ Step 5--Do you have a case in another county or state with this person? Have you filed any police reports within the last three months? NO NO YES YES I need a personal protection order because of events occurred or threatened. Please see attached affidavit. Step 6--I ask the court to grant a personal protection order prohibiting the respondent from: STALKING SECTION ONLY (May not mark A--D): Entering onto the property wherever I live. I own rent my current E-Interfering with the petitioner's efforts to remove his/her child(ren) or residence. Other: _____________________________________________ personal property from the premises solely owned or leased by the other The respondent(s'): party. (Are your personal possessions being held hostage from you at other residence?) Lives at the residence owned or leased in the petitioner's name. F-Following petitioner. Address is not the petitioner's address. G-Attempting to locate petitioner's address and/or phone number. Has been jailed on domestic violence allegations and is restricted H-Approaching or confronting petitioner in a public place or on private under a no-contact order. property. (May be in same public place, just may not harass.) DOMESTIC SECTION ONLY: I-Entering onto or remaining on property owned, leased or occupied by A-Entering onto the property located at: (Day Care, schools, vacation property, etc.) petitioner. (Provides protection when at friends, neighbors, relatives, etc.) _____________________________________________________________ J-Sending mail, fax, email, pager, voice mail, answering machine, etc. B-Assaulting, attacking, beating, molesting or wounding: (Names) Other ______________________________________________________ _____________________________________________________________ K-Contacting Petitioner by phone. (Child(ren) issues, child(ren) speak w/ respondent.) C-Removing minor child(ren) from the petitioner who has court-ordered L-Placing an object or delivering an object to property owned, leased, or custody, except as allowed by a custody or parenting time order as long as occupied by petitioner. (Notes on vehicles, etc.) removal of the child(ren) does not violate other conditions of personal proM-Threatening to kill or physically injure: (Names) ___________________________ tection order. (Not intended to keep a parent away from their child. We cannot change visitation issues with a PPO). D-Having access to information in records concerning minor child(ren) of petitioner and respondent that will reveal petitioner's address, telephone number, or employment address or that will reveal the child(ren)'s address or telephone number. (Only if you have child(ren) w/ respondent and are in hiding; interfering with finances, Dr. appts, etc.) _______________________________________________________________________________ N-Interfering with the petitioner at his/her place of employment or engaging in conduct that impairs his/her employment or environment. (School, volunteer work, etc.) Also may include E through O. O-Other: Engaging others to further harm/harass/intimidate petitioner/ ___________________________________________________________ I ask the Court to grant an ex-parte order because immediate and irreparable injury, loss, or damage will occur between now and a hearing or because notice will cause irreparable injury, loss or damage before the order can be enter
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