CONFIDENTIAL LAW ENFORCEMENT INFORMATION SHEET
Notice to Petitioner
: You must supply the respondent's name and birth date, if known. Give as much information
as possible. This information will NOT
be given to the respondent.
Notice to Law Enforcement
: This information is confidential and supplied to assist you in serving the protective
order. After serving (or failing to serve) the order, notify petitioner and complete the return of service section on
the DV-125.
A. PETITIONER INFORMATION
Full name:
Date of birth: Petitioner is a child.
Petitioner’s residence address:
Is this the address respondent is to stay away from?
Yes No
Do you want to be notified when respondent is served?
Yes No
Contact phone(s): home
work cell msg
B. RESPONDENT INFORMATION
Full name:
Nicknames: Respondent is a child.
Residence Address:
Is this the address respondent is to stay away from?
Yes No Last four digits of SSN
Other Addresses:
Contact phone(s): home
work cell msg
Where is respondent now (what street address)? Other information about respondent:
Sex Race
*Da
te of Birth*
HT WT
Hair Eyes State ID / Driver’s Lic. # ST
Other Identifiers
(facial hair, piercings, scars, tattoos, marks, etc.)
Friends / relatives / phone numbers / hangouts:
Hazards at respondent’s home (dogs, traps, guns):
Describe respondent’s house:
log frame apartment single family duplex
1 story 2 story 3+ story main color trim color
Garage:
separate attached none 4x4 needed to access address? Y N
Respondent’s employer
Employer address
Work phone
Work hours
Respondent’s position
Supervisor
Respondent’s vehicle information
Make
Model
Plate No.
State
Year
van pickup canopy camper
toolbox car 2 door 4 door
SUV other
Other vehicles respondent is known to drive:
C. OFFICER SAFETY INFORMATION
Previous contact with police by respondent?
No Yes Explain:
Any threats by respondent toward petitioner, family, police? Describe:
Weapons accessible to respondent (pistol, rifle, knife, other):
Expected mental state or history of respondent (include alcohol or drug use):
Is a divorce or other legal action pending that involves the respondent (child custody, eviction, bankruptcy,
repossession of property)?
Draw a map on the back of this form if it will help law enforcement.
DV-127 (5/10)(cs) Civil Rule 65.1
CONFIDENTIAL LAW ENFORCEMENT INFORMATION SHEET (DOMESTIC VIOLENCE OR STALKING)
