Nevada > Statewide > Stalking And Harassment
Application For Order For Protection Against Stalking Aggravated Stalking Or Harassment A-3 - Nevada
| Application For Order For Protection Against Stalking Aggravated Stalking Or Harassment Form. This is a Nevada form and can be used in Stalking And Harassment Statewide . |
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Case No. ___________________ Dept. No. ___________________ IN THE JUSTICE COURT OF _____________ TOWNSHIP COUNTY OF __________________, STATE OF NEVADA _____________________________________ ) Applicant(s),) APPLICATION FOR ORDER FOR ) PROTECTION AGAINST STALKING, vs. ) AGGRAVATED STALKING, _____________________________________ ) OR HARASSMENT (NRS 200.591) Adverse Party(s).) ) ) STALKING - A person commits the crime of stalking when, without lawful authority, that person willfully or maliciously engages in a course of conduct that would cause a reasonable person to feel terrorized, frightened, intimidated or harassed, and that actually causes the victim to feel terrorized, frightened, intimidated or harassed. (NRS 200.575 (1)) AGGRAVATED STALKING - A person commits the crime of aggravated stalking when that person commits the crime of stalking and, in conjunction therewith, threatens the person with the intent to cause him to be placed in reasonable fear of death or substantial bodily harm. (NRS 200.575 (2)) HARASSMENT - A person commits the crime of harassment when (a) that person, without lawful authority, knowingly threatens: (1) to cause bodily injury in the future to the person threatened or to any other person; (2) to cause physical damage to the property of another person; (3) to subject the person threatened or any other person to physical confinement or restraint; or (4) to do any act which is intended to substantially harm the person threatened or any other person with respect to his physical or mental health or safety; and (b) the person by words or conduct places the person receiving the threat in reasonable fear that the threat will be carried out. (NRS 200.571) PLEASE TYPE OR PRINT CLEARLY. COMPLETE THE APPLICATION TO THE BEST OF YOUR KNOWLEDGE. I am applying for protection (check all that apply): For Myself On behalf of another person(s) Form A3-Application for Order for Protection Against Stalking, Aggravated Stalking, or Harassment (NRS 200.591) Page 1 of 7 ©2007 Nevada Supreme Court June 30, 2007 1 2 3 4 5 6 7 8 9 Applicant states the following facts under penalty of perjury: I reasonably believe that the Adverse Party has committed and/or is committing the crime of stalking, aggravated stalking or harassment as defined above. The acts occurred as follows: (NOTE: BE SPECIFIC AS TO WHO COMMITTED WHAT ACT OR ACTS, AGAINST WHOM, WHEN, WHERE, WHETHER COMMITTED OR THREATENED; INDICATE APPROXIMATE DATE(S) AND LOCATION(S).) THIS FORM IS A PUBLIC RECORD __________________________________________________________________________________________ __________________________________________________________________________________________ 10 __________________________________________________________________________________________ 11 __________________________________________________________________________________________ 12 __________________________________________________________________________________________ 13 __________________________________________________________________________________________ 14 __________________________________________________________________________________________ 15 16 17 18 19 20 21 22 23 24 25 __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ NOTE: PLEASE DO NOT WRITE ON THE BACKS OF ANY PAGES; CHECK BOX IF YOU ARE USING ADDITIONAL PAGES. Check if you use a continuation page (to be incorporated by reference) This matter does not have to be reported to law enforcement; however, has a report ever been filed? Yes No ©2007 Nevada Supreme Court June 30, 2007 Page 2 of 7 Form A3-Application for Order for Protection Against Stalking, Aggravated Stalking, or Harassment (NRS 200.591) 1 2 3 4 5 6 7 8 9 10 11 12 If yes, approximate date(s): _____________________________________________________________________ Name of law enforcement agency: _____________________________________________________________________ Case/Event number if known: _____________________________________________________________________ (NOTE: IT IS NOT NECESSARY TO FILE A LAW ENFORCEMENT REPORT, BUT IF YOU HAVE ONE AVAILABLE, PLEASE ATTACH A COPY OR BRING IT TO THE COURT HEARING.) For purposes of this form, a "TPO Action" is defined to include the following Justice Court actions: (1) An Order for Protection Against Stalking and Harassment (NRS 200.591); (2) An Order for Protection of Children (NRS 33.400); (3) An Order for Protection Against Harassment in the Workplace (NRS 33.270). A "TPO Action" is also defined to include the following Justice/Family/District Court action: (a) An Order for Protection Against Domestic Violence (NRS 33.020) Please Check the Appropriate Box Below: 13 14 15 16 17 18 19 20 21 22 23 24 25 In the last 2 years, Applicant or any party seeking protection has not filed a TPO action against the Adverse Party anywhere in the State of Nevada, and the Adverse Party has not filed a TPO action against Applicant or any party seeking protection anywhere in the State of Nevada. In the last 2 years, the following TPO action(s) in the State of Nevada have been filed involving Applicant and the Adverse Party: Case # Court Place of Approx. Outcome (TPO (if known) (Justice/Family) Filing Date Filed granted, denied, rescinded, etc.) Applicant must be at least 18 years of age. If not 18 years of age, consult with the Clerk. 1. a) Applicant's Name Age _______ ____________________________________________ (Last) (First) (Middle) Form A3-Application for Order for Protection Against Stalking, Aggravated Stalking, or Harassment (NRS 200.591) Page 3 of 7 ©2007 Nevada Supreme Court June 30, 2007 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 b) Applicant's relationship to Adverse Party: ________________________________ c) Provide names below of those for whom you are seeking protection, including yourself, minors or household members that need this protection. Indicate the relationships of all persons listed to yourself and to the Adverse Party (e.g., spouse, intimate partner, friend, roommate
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