Fillable FORM 10.03-D: PETITION FOR CIVIL STALKING PROTECTION ORDER (State of Ohio)

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FORM 10.03-D: PETITION FOR CIVIL STALKING PROTECTION ORDER (State of Ohio)

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FORM 10.03-D: PETITION FOR CIVIL STALKING PROTECTION ORDER OR CIVIL SEXUALLY ORIENTED OFFENSE PROTECTION ORDER
FORM 10.03-D: PETITION FOR CIVIL STALKING PROTECTION ORDER OR CIVIL SEXUALLY ORIENTED OFFENSE PROTECTION ORDER
Amended: April 15, 2021
Discard all previous versions of this form
IN THE COURT OF COMMON PLEAS
COUNTY, OHIO
Petitioner
:
Case No.
:
Address (Safe mailing address)
:
Judge/Magistrate
City, State, Zip Code
:
Date of Birth:
/
/
:
v.
:
PETITION FOR CIVIL STALKING PROTECTION
ORDER (R.C. 2903.214)
:
Respondent
PETITION FOR CIVIL SEXUALLY ORIENTED
OFFENSE PROTECTION ORDER (R.C. 2903.214)
:
Address (If home address unknown, may be
work address)
:
City, State, Zip Code
:
Date of Birth:
/
/
Respondent is 18 years old or older
IF YOU ARE ASKING YOUR ADDRESS TO BE KEPT CONFIDENTIAL, PLEASE PUT A MAILING ADDRESS
WHERE YOU CAN SAFELY RECEIVE MAIL. IF YOU ARE A PARTICIPANT IN THE SECRETARY OF
STATE’S ADDRESS CONFIDENTIALITY PROGRAM, PLEASE USE THE P.O. BOX ADDRESS GIVEN TO
YOU. THIS FORM IS A PUBLIC RECORD.
1.
I need or a witness needs a foreign language interpreter in
or an American Sign Language interpreter per Sup.R. 88.
2.
I want do not want an ex parte (emergency) protection order per R.C. 2903.214(D).
Petitioner further requests a full hearing trial be scheduled, even if the ex-parte protection order is
granted, denied, or not requested.
3.
Who needs protection?
Me
My minor children
A family or household member who is not a minor child
Other
4.
I have listed below all family or household members who need protection, other than me or the person
for whom I am filing the Petition. (Leave blank if you are not including other family or household
members.)
[Page 2 of 5 Form 10.03-D]
Case No._____________________
FORM 10.03-D: PETITION FOR CIVIL STALKING PROTECTION ORDER OR CIVIL SEXUALLY ORIENTED OFFENSE PROTECTION ORDER
Amended: April 15, 2021
Discard all previous versions of this form
NAME
DATE OF BIRTH
RELATIONSHIP TO
PETITIONER
LIVES WITH
PETITIONER
/
/
YES NO
/
/
YES NO
/
/
YES NO
/
/
YES NO
/
/
YES NO
5.
Petitioner requests a Civil Stalking Protection Order.
You must describe two or more incidents closely related in time that made you believe that Respondent
will cause you physical harm or cause (or has caused) you mental distress. When did they happen (if
you do not know exact dates, give approximate dates)?
If you need more space, attach an additional page.
6.
Petitioner requests a Civil Sexually Oriented Offense Protection Order.
You must describe what Respondent did to you or the persons named in this Petition as fully as
possible. You do not need to prove a pattern of conduct. One act may be enough.
If you need more space, attach an additional page.
7.
Petitioner further requests the Court grant relief under R.C. 2903.214 for Petitioner and the family or
persons named in this Petition by granting a Civil Stalking Protection Order or Civil Sexually Oriented
Offense Protection Order that:
(a)
Directs Respondent to not abuse Petitioner and persons named in this Petition by harming,
attempting to harm, threatening, following, stalking, harassing, contacting, forcing sexual
relations upon them, or by committing sexually oriented offenses against them.
(b)
Directs Respondent to not enter the residence, school, business, place of employment, child
care providers, or day care centers of Petitioner and persons named in this Petition, including
the buildings, grounds, and parking lots at those locations.
(c)
Directs Respondent not to interfere with Petitioner's right to occupy the residence including, but
not limited to canceling any utilities or insurance or interrupting phone service, mail delivery, or
the delivery of any other documents or items.
[Page 3 of 5 Form 10.03-D]
Case No._____________________
FORM 10.03-D: PETITION FOR CIVIL STALKING PROTECTION ORDER OR CIVIL SEXUALLY ORIENTED OFFENSE PROTECTION ORDER
Amended: April 15, 2021
Discard all previous versions of this form
(d)
Directs Respondent not to remove, damage, hide, or dispose of any property, companion
animals, or pets owned or possessed by Petitioner and persons named in this Petition.
(e)
Grants Petitioner permission to take Petitioner’s companion animals or pets, as described
below, away from the possession of Respondent.
(f)
Directs Respondent not to possess, use, carry, or obtain any deadly weapon, firearms, and
ammunition.
(g)
Directs Respondent to be electronically monitored, because Respondent’s conduct, as
explained below, puts the health, welfare, or safety of Petitioner and the persons named in this
Petition at risk. Also, as explained below, Respondent continues to present a danger to
Petitioner and the persons named in this Petition. If you need more space, attach an
additional page.
(h)
Includes the following additional provisions:
8.
Petitioner further requests that the Court not issue any mutual protection orders or other orders against
Petitioner unless all of the conditions of R.C. 2903.214(E)(3) are met.
9.
Petitioner further requests that if Petitioner has a victim advocate, the Court permit the victim advocate
to accompany Petitioner at all stages of these proceedings as required by R.C. 2903.214(L).
10.
Petitioner further requests that the Court grant such other relief designed to ensure the safety and
protection of Petitioner and persons named in this Petition.
11.
Petitioner has listed court cases (including divorce, custody, visitation, children service case; pending
criminal case or conviction for felonious assault, aggravated assault, assault, aggravated menacing,
menacing by stalking, menacing, aggravated trespass; animal cruelty; sexually oriented offenses; no
contact order; stay away order, and other protection order) and other legal matters involving
Respondent, that may relate to this case: (If you need more space, attach an additional page.)
CASE NAME
CASE NUMBER
COURT/COUNTY
RESULT OF CASE
I swear or affirm that the answers above are true, complete, and accurate to the best of my knowledge. I
understand that making false statements in this document may result in a contempt of court finding
against me which could result in a jail sentence and fine, and may also subject me to criminal penalties
for perjury under R.C. 2921.11.
SIGNATURE OF PETITIONER
DATE
click to sign
signature
click to edit
[Page 4 of 5 Form 10.03-D]
Case No._____________________
FORM 10.03-D: PETITION FOR CIVIL STALKING PROTECTION ORDER OR CIVIL SEXUALLY ORIENTED OFFENSE PROTECTION ORDER
Amended: April 15, 2021
Discard all previous versions of this form
IF YOU DO NOT HAVE A LAWYER, PLEASE LEAVE THE INFORMATION BELOW BLANK.
Signature of Petitioner’s Attorney
Attorney’s Registration Number
Name of Attorney
Attorney’s Telephone
Attorney’s Address
Attorney’s Fax
City, State, Zip Code
Attorney’s Email
[Page 5 of 5 Form 10.03-D]
Case No._____________________
FORM 10.03-D: PETITION FOR CIVIL STALKING PROTECTION ORDER OR CIVIL SEXUALLY ORIENTED OFFENSE PROTECTION ORDER
Amended: April 15, 2021
Discard all previous versions of this form
THE COURT OF COMMON PLEAS
COUNTY, OHIO
Petitioner
:
Case No.
v.
:
Judge/Magistrate
Respondent
:
REQUEST FOR SERVICE
TO THE CLERK OF COURT:
Pursuant to Civ.R. 65.1(C)(2), please serve Respondent a copy of the Petition, ex parte protection order, if granted,
and any other accompanying documents to the address below and as follows:
Personal service
Certified Mail, Return Receipt Requested
Other (specify)
Other (address):
Personal Service
Certified Mail, Return Receipt Requested
Other (specify)
SPECIAL INSTRUCTIONS TO SHERIFF:
SIGNATURE OF ATTORNEY OR PETITIONER
RETURN OF SERVICE
Respondent was served on
.
Officer and Badge Number
Law Enforcement Agency
Date
CLERK’S CERTIFICATE OF MAILING
Service of Process was sent by
this
day of
.
Attest:
Deputy Clerk
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FORM 10.03-D: PETITION FOR CIVIL STALKING PROTECTION ORDER (State of Ohio)

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Completed 8 February 2022

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