Request To Modify Protective Order

Request to Modify Protective Order 1 Petitioner (protected person): Case Number: ________________ District:_____ County: _______________________ State: Utah Judge: _________________________________ Commissioner: ___________________________ This is a private record. First Middle Last Address and phone # (to keep private, leave blank): Street Other people who need protection (relatives or people who live with you): Name (Initials only if Relationship to Age Petitioner under 18) City State Zip Phone #: Name and phone number of Petitioner's attorney (if any): __________________ __________________ __________________ __________________ __________________ ____ ____ ____ ____ ____ ______________ ______________ ______________ ______________ ______________ 2 Respondent (person you need to be protected from): Describe Respondent: Sex Race Date of Birth Hair Ht. Wt. First Middle Last Other names used: Relationship to Petitioner: Address (street): ___________________________________________________________________________________________ Eyes Social Security # (only the last 4 numbers) Distinguishing features (like scars, tattoos, limp. etc.): State Zip City Driver's license issued by (State): Expires: Respondent's Employer (Name and address): _________________________________________________________________________________________________ Other places to find Respondent (other work locations, relatives, friend, hangouts, etc. ­ include city/state/zip on each address, if possible) Location type (work, relative, friend, etc.) Best times to find at this address Phone number Describe Respondent's vehicle(s): Make Model Color License Plates Request to Modify Protective Order Approved Board of District Court Judges May 21, 2008 Revised June 20, 2014 Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Has the Respondent used weapons or been violent in the past? Yes No If yes, describe here: ___________________________________________________________________________________________________ _______________________________________________________________________________________________ Is the Respondent on probation or parole? Yes No If yes, list the name of the probation/parole agency, the officer, and the telephone number here: ______________________________________________________________ 3 What kind of protective order do you have now? (Check one, and attach a copy of your protective order to this form.) Temporary Protective Order, signed by this court on (date): Protective Order, signed by this court on (date): 4 Why do you want this order changed? Check here if you need more space and attach a separate sheet of paper to this form. Please, Judge, I am asking you to: Order the Respondent to go to a court hearing Issue a new (modified) order to replace the current order. Please make the modified order the same as the current order except for the change(s) below. 5 Please change Number _____ in the current order to: ___________________________________________________________________________________________ 6 Please change Number _____ in the current order to: ___________________________________________________________________________________________ 7 Please change Number _____ in the current order to: Request to Modify Protective Order Approved Board of District Court Judges May 21, 2008 Revised June 20, 2014 Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com ___________________________________________________________________________________________ The Petitioner must read and sign below: I swear that: I am the Petitioner and I have read this Request to Modify Protective Order. I understand it is a serious crime to lie to get a Protective Order. If I lie, I can be charged with a felony, punishable by up to 5 years in prison. The statements in this Request are true and correct to the best of my knowledge. I believe I have the right to the protective orders I have asked for in this Request. I am not using this Request to harass the Respondent or to abuse the judicial process. I have not included any non-public information in this document. Date: ____________________________ Petitioner's signature: Clerk or Notary Public fills out below: Subscribed and sworn to before me on (date): in County, Utah , Clerk / Notary Public Clerk or Notary's Signature: __________________________________________________ Request to Modify Protective Order Approved Board of District Court Judges May 21, 2008 Revised June 20, 2014 Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com