Request for Civil Stalking Injunction

Case Number: County: Judge: ^

District: State: Utah

Petitioner

(person needing

protection):

ftraf

,5 O A
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):

Respondent

(person you need to be protected

from):

First

Middle

Last

Other names used: Address; LS^^^^

Street

(JLLQLJ^

-6 City

iidr
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! I n addition to your own statements i n 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 3a-101-103. and 77-

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

Best place and time to find the Respondent: (Place): Other addresses (hangouts): Describe the Respondent's vehicle: M a k e : t > ^ I f more than one vehicle, describe here: Make:

( , A 3 C ) I ^ K

HOKVi j

(Time):

7
^

^ Year: C? g '

Color: j i ( L i c e n s e Plates:

Year: ^ < Color: Q /odi. License Plates: < >}o Don't know c i v \^ K^,>\

Has the Respondent used weapons or been violent i n the pasfrSB Yes

Is the Respondent a law enforcement officer, government investk^oi; " V 1 0 i , 1 ^ U) < L, ^ 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: When: V^gyl ^ d^d^ Where: A g ^ ' ^ ' ^ f 2"** stalking event: (jj T V x o a . - V t X v " T K J \0 5 C^l^(kf / 6 3 i o -e-elvx 2. <-'J^ ^ . Oe^tAcVvP^- s ^f -M -pjr <P^.^>-v^ > i_)-V ^ 0 i

Where: ( t ^ b. c.

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Who did you report the stalking king to ( i f anyone)? ( A CX c O T K r p T . k v ^ Q ^ r T T O t ^ j " ^ ^ I A W J U * J' ( v ; ^O^^^ Cooa-ti^ 5 ^ r ; - H - V / '^oVvO^ ^ ^-C-v oiVJo o r 5 j f-v ' < ^ < i s / List names o f all people who 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. Y o u 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

e.

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

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Check here if you need more space. Ask the clerkfor the "Describe Stalking"form. Fill it out and attach it to this form. Other facts: V V y ^ v-g^

n-^.^.J.
Other Court Cases
a. b.

'f^ro'f'-^d'/

o tA Of.
Yes
K I N O

Are there other Court orders to the Respondent about stalking? (If Yes,fillout below and attach a copy of the court order.) B D Yes 'Ho (Ifyes, list ALL court cases below):
County and State Court Case # (NOT the police report #)

Have you or the Respondent ever been involved i n any other court case involving either o f you?
i Did the judge make an order?

Type of Case

Person involved N /1 Y o u " ^ Respondent

Yes

No-0/'5n^i:f5e,

/0(U Covv<Coo4

0 0 0 7 ^ -^fflWg

Respondent Yes Yes DNo No

You Respondent You Respondent

Request for Civil Stalking Injunction

3ofS

Approved by Board of District Court Judges, June 2006

Revised: January 2007

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Please, Judge, I am asking you to:

Make the orders I have checked below,

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Personal Conduct
Order the Respondent not to stalk me.

No Contact
Order the Respondent not to contact, phone, mail, email, or communicate with me i n any way, either directly or indirectly, or any person listed below: Other people the Respondent must not contact:
Name Relationship to Petitioner reiiiioner Address

Jr^
S o

C o cj^4 stay Away

O * ^

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'^' Cej^vTt^ frrr^tjgX (-77 f yVjQ I Uv* Work address: School address: Describe vehicle: q b. Other ~7~L{.i| Lu^v^ ^ D k P / < : <^ G M C ^ ^ 6 ^ 5 /V/ j ^

6t C 5 "

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J protect you and other protected people Other Assistance Needed fXjs? below any other orders needed to protecfyou and othei listed on page 1 of this form): ^
txw^ i / \^

A'l^,

TS~CA-QL4|^

!Ac2_

Request for Civil Stalking Injunction

4of5

Approved by Board of District Court Judges, June 2006

Revised: January 2007

The Petitioner must read and sign below:

I swear Date: 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 i n this county, or the stalking took place in this county. 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 i n this county. Parent or guardian's signature:^ Print Parent or guardian's name:

Date:

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