South Dakota > Statewide > Protection Orders > Stalking
Petition And Affidavit For A Protection Order (Stalking Or Physical Injury As A Result Of An Assault Or A Crime Of Violence) UJS-121A - South Dakota
| Petition And Affidavit For A Protection Order (Stalking Or Physical Injury As A Result Of An Assault Or A Crime Of Violence) Form. This is a South Dakota form and can be used in Stalking Protection Orders Statewide . |
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STATE OF SOUTH DAKOTA COUNTY OF ) ) ) IN CIRCUIT COURT ________________ JUDICIAL CIRCUIT ______________________________ ______________________________, Petitioner(s), -vs, Respondent TPO NO._____________________ PETITION AND AFFIDAVIT FOR A PROTECTION ORDER (STALKING, OR PHYSICAL INJURY AS A RESULT OF AN ASSAULT, OR A CRIME OF VIOLENCE) I, the above named Petitioner, or the Parent/Legal Guardian of Petitioner child listed above in this legal action, being duly sworn upon oath, state and affirm the following: I am a resident of County, South Dakota. The Respondent is a resident of County, South Dakota. I AM ASKING THE COURT FOR A PROTECTION ORDER BASED UPON THE FACTS BELOW: On or about (month) (day) (year) at approximately o'clock (am/pm), the person against whom I seek this Protection Order committed the following acts of stalking: Willfully, maliciously, and repeatedly followed me. Harassed me by pursuing a willful and knowing course of conduct which seriously alarms, annoys or harasses me with no legitimate purpose and that the pattern of conduct is a series of acts over a period of time showing a continuing pattern of harassment. Threatened me in a manner that makes me afraid of great bodily injury or death. I, as the Petitioner, have suffered physical injury as a result of an assault. I, as the Petitioner, have been the victim of a crime of violence. Provide a detailed description of what happened on the above date: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Yes Yes Yes Yes No No No No Don't Know Don't Know Don't Know Don't Know Was law enforcement called for this incident? Was the person against whom you seek protection arrested for this incident? Is the person in jail? Has the person been found guilty of violating previous protection orders? If so, against whom________________________________________ Give the date of the conviction_______________ and the county and state of the conviction Does the person own guns or weapons? Was a weapon used in this incident? Has the person threatened anyone with a weapon? 1 Form UJS-121A (Stalking Petition) Rev. 11/07 American LegalNet, Inc. www.FormsWorkflow.com Yes Yes Yes No No No Don't Know Don't Know Don't Know Provide a detailed description of other similar incidents or actions (please include dates and times, if possible): _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ REQUEST FOR HEARING AND PROTECTION ORDER Based upon this Petition and Affidavit in which I truthfully set forth the details of the stalking, I respectfully ask the court to set a date to hear this matter and after hearing the evidence, to grant me a Protection Order: 1) To Restrain the Respondent from: a) following or harassing, or making any credible threat with the intent to place petitioner(s) in reasonable fear of death or great bodily injury, SDCL 22-19A-1; b) from committing an assault or a crime of violence, SDCL 22-1-2(9). 2) To Grant the Protection Order for a period of time (no longer than 5 years). 3) To Restrain the Respondent from coming within a distance of of me personally or the children above as additional petitioners and of: my residence (street,apt/box) (city) (state) (zip) my work (street,apt/box) (state) (zip) (city) other places (street,apt/box) (city) (state) (zip) (street,apt/box) (state) (zip) (city) (street,apt/box) (city) (state) (zip) 4) That the Respondent be restrained from contact with the Petitioner(s) by any direct or indirect means except as authorized by a court order. 5) To Order other relief which I believe is necessary for my protection: 2 Form UJS-121A (Stalking Petition) Rev. 11/07 American LegalNet, Inc. www.FormsWorkflow.com (If you are requesting an immediate temporary protection order without notice to the person you want restrained and without an opportunity for the person to appear; you must state why you believe you will suffer immediate and irreparable injury or damage if you have to wait until the hearing.) REQUEST FOR IMMEDIATE PROTECTION ORDER WITHOUT NOTICE TO THE OTHER PARTY In addition to what I have requested in sections 1-5 above, I further request that the Court grant me an immediate Temporary Protection Order Restraining Respondent from Stalking based upon the following sworn statements and beliefs: The reasons I need this order immediately and cannot wait until the scheduled hearing are: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ I believe that I will suffer immediate and irreparable injury, loss or damage if I am not granted a Temporary Order of Protection immediately without notifying the Respondent and his/her attorney or giving the other party an opportunity to be heard. The immediate and irreparable injury, loss or damage which I believe I will suffer is: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ On this _____ day of _____________, ________, I swear or affirm under oath that the information I have provided in this Petition and Affidavit are true and correct to the best of my knowledge. I believe I am entitled to the protection I have requested. I am asking for this prot
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