Fillable CIRCUIT COURT DISTRICT COURT OF MARYLAND FOR REQUEST (Maryland Courts)

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CIRCUIT COURT DISTRICT COURT OF MARYLAND FOR REQUEST (Maryland Courts)

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City/County
Court Address
vs.
Petitioner
Name
Date
Date
Signature
Name
☐ CIRCUIT COURT ☐ DISTRICT COURT OF MARYLAND FOR
Located at C
ase No.
REQUEST TO SHIELD DENIED OR DISMISSED PROTECTIVE ORDER RECORDS
(Family Law § 4-512(b)(1))
NOTE: Use this form to ask the court to shield from public inspection information in a protective order case in
which the court denied or dismissed the case. Do NOT use this form for peace order cases or in cases in which the
court granted a final protective order. The court will schedule a hearing and notify you and the other party.
On , the court denied or dismissed a Petition for Protection from
Domestic Violence at the
☐ interim ☐ temporary ☐ final protective order stage.
Check one:
☐ At least three (3) years have passed since the date of the denial or dismissal; OR
☐ I have attached a General Waiver and Release form (CC-DC-077) of all related tort claims.
A
ll of the following statements are true:
The court has not previously issued a protective or peace order against this respondent in any
proceeding between this petitioner and this respondent.
The respondent has not been found guilty of a crime arising from abuse against this petitioner.
At the time of the hearing there are no interim or temporary protective or peace orders pending against this
respondent in a proceeding between this petitioner and this respondent.
At the time of the hearing there are no criminal charges pending against this respondent arising from alleged
ab
use against this petitioner.
I request that the court order the shielding of all court records relating to the above-r
eferenced proceeding.
CERTIFICATE OF SERVICE
I certify that I served a copy of this petition upon the following party or parties by ☐ mailing first class
mail, postage prepaid
☐ hand delivery, on to:
OR
☐ I have filed the attached Motion for Service by Clerk form (CC-DC-DV-025).
CC-DC-DV-021A (Rev. 02/2020)
Respondent
Date
Date
Petitioner / Respondent Signature
Address
City, State, Zip
Telephone
Address
City, State, Zip
Address
Signature or Party Serving
Date
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CIRCUIT COURT DISTRICT COURT OF MARYLAND FOR REQUEST (Maryland Courts)

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Completed 23 February 2022

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