5
Request for Civil Stalking Injunction Case Number: County: ^ Judge: District: State: Utah 1 Petitioner (person needing protection): 3 ,5 O A ftraf Middle L^st Address and phone # (to l<eep private, leave blanl<): Street City State Zip Phone #: To keep contact infomiatlon private, check here and ask for" Law Enforcement Service" form. Fill it out, and attach it. Name and phone number of Petitioner's attorney (if any): ^ 2 Respondent (person you need to be protected from): First Middle Other names used: Last Address; LS^^^^ (JL£LQLJ^ Street -6 City iidr state Zip A judge can grant a stalking injunction only if the Respondent did these 3 things: (1) The Respondent stalked you specifically, two or more times. "Stalked" means the Respondent stayed physically or visually close to you, made verbal or written threats to you, or did something that was threatening. (2) The Respondent knew or should have knovra that the stalking would cause you to fear that you or a family member could be physically hurt or emotionally distressed, or that a reasonable person would be afraid of being physically hurt or emotionally distressed, and (3) The Respondent's stalking actually made you or an immediate family member emotionally distressed or fearful that you would be hurt. An "immediate family member" means your spouse, child, sibling, or any other person who lives with you now, or who lived with you within the past 6 months. Note! In addition to your own statements in this Request, you must provide some other evidence of stalking, like police reports, sworn statements from witnesses, audiotapes, photos, letters, etc. For a complete definition of stalking, see Utah Code §§ 76-5-106.5 and 77- 3a-101-103. 3 Provide as much information as you can about the Respondent. If you don't know, write "unktiown." Respondent's Employer (Name and address): ^ gvYX'V ^ ^ \ ^C~>\ Request for Civil Stalldng Injunction 1 of 5 Approved by Board of District Court Judges, June 2006 Revised: January 2007

Sherri's Injunction Request

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Page 1: Sherri's Injunction Request

Request for Civil Stalking Injunction

Case Number: County: ^ Judge:

District: State: Utah

1 Petitioner (person needing protection):

3 ,5 O A ftraf Middle L^st

Address and phone # (to l<eep private, leave blanl<):

Street City State Zip

Phone #:

To keep contact infomiatlon private, check here and ask for" Law Enforcement Service" form. Fill it out, and attach it.

Name and phone number o f Petitioner's attorney (if any): ^

2 Respondent (person you need to be protected from):

First Middle

Other names used: Last

Address; LS^^^^ (JL£LQLJ^ Street

-6 City

i i d r state Zip

A judge can grant a stalking injunction only i f the Respondent did these 3 things: (1) The Respondent stalked you specifically, two or more times. "Stalked" means the Respondent stayed physically or

visually close to you, made verbal or written threats to you, or did something that was threatening. (2) The Respondent knew or should have knovra that the stalking would cause you to fear that you or a family member

could be physically hurt or emotionally distressed, or that a reasonable person would be afraid o f being physically hurt or emotionally distressed, and

(3) The Respondent's stalking actually made you or an immediate family member emotionally distressed or fearful that you would be hurt. A n "immediate family member" means your spouse, child, sibling, or any other person who lives with you now, or who lived with you within the past 6 months.

Note! In addition to your own statements in this Request, you must provide some other evidence o f stalking, like police reports, sworn statements from witnesses, audiotapes, photos, letters, etc.

For a complete definition of stalking, see Utah Code §§ 76-5-106.5 and 77-3a-101-103.

3 Provide as much information as you can about the Respondent. If you don't know, write "unktiown." Respondent's Employer (Name and address): ^ gvYX'V ^ ^ \ ^C~>\

Request for Civil Stalldng Injunction 1 of 5 Approved by Board of District Court Judges, June 2006 Revised: January 2007

Page 2: Sherri's Injunction Request

7 Best place and time to find the Respondent: (Place): ( , A 3 C ) I ^ K / H O K V i (Time):

Other addresses (hangouts): ^ j

Describe the Respondent's vehicle: Make : t>^ Year: C? g ' Color: j i ( L i c e n s e Plates: ^

I f more than one vehicle, describe here: Make: Year: ^ < Color: Q /odi. License Plates: <

Has the Respondent used weapons or been violent in the pasfrSB Yes • >}o • Don't know

Is the Respondent a law enforcement officer, government investk^oi; " V 10 i • € , 1 ^ U) < L , ^ c i v \^ K^,>\ or licensed private investigator? Yes • No • Don't know

4 Describe the stall(ing below:

a. When and where did the stalking events happen? (Attach additional pages if necessary.)

1 ̂ Stalking event: i

When: V^gyl ( j j T V x o a . - V t X v " T K J \0 5 C^l^(kf ^ £ ^ d ^ d ^ / 6 « 3 i o -e-elvx 2. <-'J^ ^ . 0 Where: A g ^ ' ^ ' ^ f Oe^tAcVvP^- •s^f-M-pjr <P .̂̂ >-v^ > i_)-V

2"** stalking event:

Where: ( t ^ ^ ( S f , t A j ' ^ Y ^ 6 T I T H - ^ :T ( ^ • < , t ^ o t ' > ^ i _ <?c>v^^,^-

b. Who did you report the stalking ^-C-v oiVJo o r 5 j f-v

c. List names o f all people who

king to ( i f anyone)? ( A C X c O T K r p T . k v ^ Q ^ r T T O t ^ j " ^ ^ I A W J U * J ' ' < ^ < i s / ( v ; ^O^^^ C o o a - t i ^ 5 ^ r ; - H - V / ' ^ o V v O ^ ^ lo witnessed the stalking: i _ _ g"',re,.rv^ J ~ C^t> ' c i-^yy

>OtA.

d. List any evidence you have o f the stalking, like transcripts, audiotape, police reports, photos, sworn statements from witnesses (affidavits), etc. You must attach at least one o f these to this form.

Request for Civil Stalking Injunction 2 of 5 Approved by Board of District Court Judges, June 2006 Revised: January 2007

Page 3: Sherri's Injunction Request

e. Describe what the stalker did and why i t made you or your family member feel emotionally distressed or afraid of being physically harmed, and why it would have made a reasonable person feel emotionally distressed or afraid o f ^ / being physically harmed: c i c A ^ r w ^ C W K T ^ ^ J ^ S oo<i^x^ d i r O i f P c d - CUJ^ (f>lcK-(.

5'CUX '^'e .c- .Wxrrajs'cL, o.̂ ^ t!̂ >.^Viv>\i c!-«.V<: ^ - • C_Wgv L iso/vj^ \ S ^ - ' V C S J K U \ V I C-o^wt oxc^r" 1,

^ , 1 |_J 1 f

3 1 < X » ^

fs 4 o ^ r 0>J

• Check here if you need more space. Ask the clerk for the "Describe Stalking" form. Fill it out and attach it to this form.

f Other facts: V V y ^ v-g^

n-^.^.J. 'f^ro'f'-^d'/ o tA

Of. Other Court Cases a. Are there other Court orders to the Respondent about stalking? • Yes K I N O f

(If Yes, fill out below and attach a copy of the court order.)

b. Have you or the Respondent ever been involved in any other court case involving either o f you? BD Yes • 'Ho (Ifyes, list ALL court cases below):

Type of Case

C o v v < C o o 4

County and State Court Case # (NOT the police report #)

/0(U 0 0 0 7 ^ -^fflWg Respondent

Person involved

N/1 Y o u " ^ Respondent

i Did the judge make an order?

• You • Respondent

• You • Respondent

Yes • N o - 0 / ' 5 n ^ i : f 5 e ,

• Yes D N o

• Yes • No

Request for Civil Stalking Injunction 3ofS Approved by Board of District Court Judges, June 2006 Revised: January 2007

Page 4: Sherri's Injunction Request

L//^ e ^ - ' ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ 4 - i . ^ ^ ^ S ^ / / . - T T ^ ^ , v / ^

-̂v-4o t U /-Vtlo^^w ' t r / / ^ ) >^ ^1^1 ^ ^ 5 5 1 ^ y v t ^ ^ ( ^ ^ y ^

Please, Judge, I am asking you to: Make the orders I have checked below,

6 ^ Personal Conduct Order the Respondent not to stalk me.

No Contact Order the Respondent not to contact, phone, mail, email, or communicate with me in any way, either directly or indirectly, or any person listed below: Other people the Respondent must not contact:

Name

8

Jr^

Co cj^4 O * ^

Relationship to Petitioner

S o A

Address

reiiiioner #

stay Away Order the Respondent to stay away from:

a. M y current or ftlture^fil V e h i c l e ^ Job 13 School Ml Home, premises and property (My current addresses are listed below): , \ ' I Home address: isS'^' C e j ^ v T t ^ f r r r ^ t j g X (-77 f yVjQ I U v * 6 t C 5 "

Work address: /V/ j ^ School address:

Describe vehicle: q ^ D k <^ G M C ^ ^ 6 ^ 5

• b. Other ^ ^ ^ ^ P / < : ^ ^ ^ ^ ^ ^ ^ r ^ ^

~ 7 ~ L { . i | Lu^v^ Y >^<?0^6'^ J g . . ^ 6 ' ^

\fl Other Assistance Needed fXjs? below any other orders needed to protecfyou and othei J protect you and other protected people

listed on page 1 of this form): ^ t x w ^ i / \^ A ' l ^ , T S ~ C A - Q L 4 | ^ !Ac2_

Request for Civil Stalking Injunction 4of5 Approved by Board of District Court Judges, June 2006 Revised: January 2007

Page 5: Sherri's Injunction Request

The Petitioner must read and sign below: I swear that:

• I am the Petitioner and I have read this Request for Civil Stalldng Injunction, • I am a victun o f stalking and believe the Respondent is the stalker, and • I live in this county or the Respondent lives in this county, or the stalking took place in this county.

Date: Petitioner's signature:^

I f the Petitioner is a minor, then parent or guardian must sign below.

I swear that: • I am Petitioner's parent or guardian and I have read this Request for Civil Stalking Injunction, • Petitioner is a victim o f stalking and I believe the Respondent is the stalker, and • The petitioner lives in this county or the Respondent lives in this county, or the stalking took place in this

county.

Date: Parent or guardian's signature:^

Print Parent or guardian's name:

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 for Civil Stalking Injunction 5 of 5 Approved by Board of District Court Judges, June 2006 Revised: January 2007