Fillable PMC Petition-Fillable 30-362.3D OP Petition pg 3 & Plaintiff Guide Sheet R 1-17_OP Petition Pg2 & Plaintiff Guide Sheet 30-3622D 9-07.qxd

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PMC Petition-Fillable 30-362.3D OP Petition pg 3 & Plaintiff Guide Sheet R 1-17_OP Petition Pg2 & Plaintiff Guide Sheet 30-3622D 9-07.qxd

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BROWSE CITY OF PHOENIX (AZ) FORMS

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IMPORTANT: Please read the Plaintiff’s Guide Sheet on the back of Page 2.

1. Defendant/Plaintiff Relationship:

■

Married now or in the past;

■

Live together now or lived together in the past;

■

Child in common;

■

■ One of us pregnant by the other;

■

Related (Parent, In-law, Brother, Sister or Grandparent);

■

Romantic or sexual relationship (current or

previous);

■

Dating but not a romantic or sexual relationship;

■

Other _____________________________________________________

■

If checked, there is a pending action involving maternity, paternity, annulment, legal separation, dissolution, custody, parenting time or support

in ____________________________ County Superior Court, Case No. _____________________________.

3. Have you or the Defendant been charged or arrested for domestic violence OR requested a Protective Order?

■

Yes

■

Not sure

If yes or not sure, explain ________________________________________________________________________________________

4. I need a Court Order because: (PRINT date(s) and briefly what happened):

Date(s) Describe what happened (Additional space on next page, or attach statement as needed) A copy of this petition

is provided to the defendant when the order is served.

___________ _______________________________________________________________________________________________

_____________________________________

Plaintiff / Plaintiff Employer (workplace Injunction only)

Birth Date _____________________________

_____________________________________

Agent’s Name (workplace Injunction only)

PHOENIX MUNICIPAL COURT 300 W. Washington St. Phoenix, AZ 85003-2103 602-262-7120 TTY: Use 7-1-1

DISTRIBUTION: WHITE - COURT YELLOW - PLAINTIFF PINK - DEFENDANT 30-362.1D Rev. 7/15

_____________________________________

Defendant

_____________________________________

Address

_____________________________________

City, State, Zip

_____________________________________

Phone

Case No.___________________

PETITION for

■

■ Order of Protection

■

■ Injunction Against Harassment

■

Workplace Injunction

NCIC # AZ007101J / Court# 0741

This is not a Court Order

Clear Fields

Print Form

Defendant’s Guide Sheet for Protective Orders - Please Read Carefully

The following information is provided to further explain the protective order that has been served upon you and your responsibilities

as the Defendant.

1. You have been served with one of the following protective orders as indicated on the front of this document:

ORDER OF PROTECTION: An Order of Protection is used for a “family” relationship between you and the Plaintiff. This can include

one of the following: 1) married now or in the past, 2) live together now or lived together in the past, 3) parent of a child in

common, 4) one of you is pregnant by the other, 5) you are a relative (parent, in-law, brother, sister,or grandparent), or 6)

current or previous romantic relationship. The Plaintiff has alleged that you have committed or may commit an act of domestic

violence.

INJUNCTION AGAINST HARASSMENT: The Plaintiff has alleged that you have committed a series of acts (more than one) of

harassment against the Plaintiff within the last year.

INJUNCTION AGAINST WORKPLACE HARASSMENT: This Injunction, alleging a single act or series of acts of harassment, has been

filed against you by an employer or owner of a business or operation for the benefit of an employee or the business.

2. OTHER PROTECTED PERSONS: It is possible that you will be referred to Superior Court if your children are listed as protected

persons in this order. Only a Superior Court Judge can decide child custody or parenting time in a separate action.

3. SERVICE AND EFFECT: This protective order is valid for one year from the date it was served on you and is enforceable by law

enforcement in any state or tribal nation in the United States.

4. PROTECTIVE ORDER HEARING: If you disagree with this protective order, you have the right to request a hearing which will be

held within 5 to 10 business days after your written request has been filed in the court that issued this order. If a hearing is held

and the Order remains in effect or is modified, and you and the Plaintiff 1) are married now or in the past, 2) live together now

or lived together in the past, or 3) are parents of a child in common, you may be prohibited from possessing a firearm. This

firearms prohibition may apply even if you fail to appear for the hearing. If you have questions as to whether your request for

a hearing can result in this firearms prohibition, you should contact an attorney. The Court cannot give you legal advice.

5. MODIFYING OR QUASHING (DISMISSING) THIS PROTECTIVE ORDER: Only a judge can modify or quash (dismiss) this protective

order. If you file an action for maternity, paternity, annulment, legal separation, or dissolution against the Plaintiff, you need to

advise this court at once. Nothing the Plaintiff does can stop, change, or undo this protective order without the

Court's written approval.

6. PLAINTIFF CONTACT: Even if the Plaintiff initiates contact, you could be arrested for violating this protective order. You have

the right to request a protective order against the Plaintiff if you do not want the Plaintiff to contact you. However, orders are

not automatically granted upon request. Legal requirements must be met.

7. LAW ENFORCEMENT STANDBY: If standby has been ordered by the judge on this protective order, you may return to the

residence once with a law enforcement officer to obtain necessary personal belongings. Neither law enforcement nor this

protective order can resolve conflicts over property, title, furniture, finances, real estate, or other ownership issues.

8. FIREARMS: If the judge has ordered under state law that you shall not possess, receive, or purchase firearms or ammunition,

you must surrender them within 24 hours after service to the law enforcement agency named on this protective order and

should request them to issue proof of that surrendering. You may also be required to provide documentation to the court that

firearms were transferred to the appropriate law enforcement agency.

PHOENIX MUNICIPAL COURT 300 W. Washington St. Phoenix, AZ 85003-2103 602-262-7120 TTY: Use 7-1-1

To request this document in an alternative format, please call 602-262-1625 or TTY: Use 7-1-1.

DISTRIBUTION: WHITE - COURT YELLOW - PLAINTIFF PINK - DEFENDANT 30-362.2D Rev. 7/15

Date(s) Describe what happened (continued) Case No. ____________________

___________ _______________________________________________________________________________________________

5. The following persons should also be on this Order. As stated in number 4, the Defendant is a danger to them:

Name ______________________________ Birth Date __________ Name ______________________________ Birth Date ___________

6. Defendant should be ordered to stay away from these locations, at all times, even when I am not present:

■

■ Home ___________________________________________________________________________________________________

■

■ Work ____________________________________________________________________________________________________

■

■ School/Others ______________________________________________________________________________________________

■

If checked, because of the risk of harm, order the defendant NOT to possess firearms or ammunition.

■

■ If checked, order the Defendant to participate in domestic violence counseling or other counseling. This can be ordered only after a hearing of

which Defendant had notice and an opportunity to participate.

9. Pets or other __________________________________________________________________________________________________

Under penalty of perjury, I swear or affirm the above statements are true to the best of my knowledge, and I request an Order / Injunction granting

relief as allowed by law.

Plaintiff_________________________________________ Judicial Officer/Attest_____________________________ Date________________

(Additional space available on last page.)

Plaintiff’s Guide Sheet for Protective Orders - Please Read Carefully

It is important to remember that a protective order does not guarantee your personal safety. The Plaintiff should carry a copy of the

court issued protective order at all times and give copies to others (e.g. employer, apartment manager, school, etc.). The Plaintiff

should immediately report any protective order violations to law enforcement.

1. You can request one of the following types of protective orders:

ORDER OF PROTECTION (OOP): This order is used for a “family” relationship between you and the Defendant. This can include one

of the following: 1) married now or in the past, 2) live together now or in the past, 3) parent of a child in common, 4) one of

you is pregnant by the other, 5) you are a relative (parent, in-law, brother, sister, or grandparent), or 6) current or previous

romantic or sexual relationship. Also, you must state how an act of domestic violence was threatened or committed against

you within the last year.

INJUNCTION AGAINST HARASSMENT (IAH): The Defendant, who is not a “family” member, has committed a series of acts (more

than one) of harassment against you in the last year. There is no fee for service of process if the petition arises out of a dating

relationship.

INJUNCTION AGAINST WORKPLACE HARASSMENT (IAWH): This Injunction may be filed by an employer or owner of a business or

operation for the benefit of an employee or the business against a single act or series of acts of harassment.

2. ANIMALS and ORDERS OF PROTECTION: You may also ask the court to grant you the custody, care, and control of any animal

owned by you, the defendant, or a minor child living in your household (A.R.S. § 13-3602(G)(7)). If you are asking the court to

include animals on an Order of Protection, please write your request on Line 9 of the Petition.

3. OTHER PROTECTED PERSONS: It is possible that you will be referred to Superior Court if your children are listed as protected

persons in this order. Only a Superior Court Judge can decide child custody or parenting time in a separate action.

4. ONE DEFENDANT: A separate petition must be filed for each defendant. A copy of your petition and the order will be given

to the Defendant and may be used in future judicial proceedings.

5. SERVICE AND EFFECT: This protective order is valid for one year from the date it is served on the Defendant and is enforceable

by law enforcement in any state or tribal nation in the United States. There is no fee for law enforcement service of an OOP

or IAH involving a dating relationship. There is a fee to serve an IAH not involving a dating relationship or an IAWH. The court

will instruct you on how service can be made. The cost to serve injunctions depends on mileage and attempts. If you cannot

afford to hire a process server, you can ask the judge to defer or waive the fee.

6. PROTECTIVE ORDER HEARING: If the Defendant disagrees with this protective order, he/she has the right to request a hearing

which will be held within 5 to 10 business days after a written request has been filed in the court that issued this order. If you

do not appear at the hearing, your Order may be quashed (dismissed); therefore, you must notify the court of any change in

your contact information to assure you are notified of any hearings.

7. MODIFYING OR QUASHING (DISMISSING) THIS PROTECTIVE ORDER: Only a judge can modify or quash (dismiss) this protective

order. If you file an action for maternity, paternity, annulment, legal separation, or dissolution against the Defendant, advise

this court at once. Nothing you do can stop, change, or undo this protective order without the Court's written approval.

8. PLAINTIFF CONTACT: Even if you initiate contact, the Defendant could be arrested for violating this protective order. If the

Defendant does not want contact with you they have the right to request a protective order against you. However, orders are

not automatically granted upon request. Legal requirements must be met.

9. LAW ENFORCEMENT STANDBY: If you or the Defendant needs to get personal belongings from the other, you may request

standby from the judge. Standby allows you or the Defendant to return once with a law enforcement officer to obtain

necessary personal belongings from the residence. Neither law enforcement nor this protective order can resolve conflicts over

property, title, furniture, finances, real estate, or other ownership issues.

10. FIREARMS: You may request the judge order the Defendant not to possess, receive, or purchase firearms or ammunition.

11. COUNSELING: If requested, counseling for the Defendant can only be ordered at a hearing of which the Defendant had an

opportunity to participate.

12. PUBLIC ACCESS: To comply with federal law no identifying information about you will be published on the Judicial Branch

Website (www.azcourts.gov).

PROTECTION ORDER WORKSHEET / CONFIDENTIAL Case No._________________________

NOTICE: INFORMATION PROVIDED ON THIS FORM WILL NEVER BE GIVEN TO THE DEFENDANT AND WILL ONLY BE USED TO SERVE YOUR ORDER. PROVIDING COMPLETE AND ACCURATE

INFORMATION WILL HELP YOUR ORDER BE SERVED IN A SAFE AND TIMELY MANNER. INACCURATE INFORMATION WILL DELAY SERVICE, OR RESULT IN YOUR ORDER NOT BEING SERVED.

Your Name____________________________________________________ Date of Birth _____________________

■

Male

■

Female

Home Address_________________________________________________ Apt______ City______________ St_____ Zip____________

Home Phone______________________ Work_______________________ Cell______________________ Other_____________________

Safest phone number to reach you

■

■ Home

■

■ Work

■

■ Cell

■

■ Other ______________________________________________________

Other Address_________________________________________________ Apt_______ City______________ St_____ Zip____________

Does defendant know where you live?

■

Yes

■

No Does defendant know where you work?

■

Yes

■

Is defendant currently living with you?

■

Yes

■

No Do you require an interpreter?

■

Yes

■

No Language__________________

Is there a pending / existing order against you related to the defendant named on this petition?

■

Yes

■

Do you, the defendant, or anyone else involved in this matter work for this Court?

■

Yes

■

No (If Yes, stop here and see staff.)

DEFENDANT INFORMATION (person you want served) Does defendant require an interpreter?

■

Yes

■

No Language___________________

Name______________________________________________________________________

■

Male

■

Female

Date of Birth_____________________________ Are you positive this is the correct date of birth?

■

Yes

■

Race__________ Height__________ Weight__________ Eyes__________ Hair__________ Relationship ___________________________

Home Address_________________________________________________ Apt______ City______________ St_____ Zip____________

Apartment / Complex Name _______________________________________________________ Best Time at Home ____________________

Home Phone______________________ Work_______________________ Cell______________________ Other_____________________

Employer________________________ Address__________________________________ Work Hours____________ Days Off____________

Type of Work_____________________ Job Site Address___________________________________ Best Time at Work _________________

Does defendant work in one location?

■

Yes

■

No If No, list other location___________________________________________________

List all names the defendant may answer to_______________________________________________________________________________

Defendant’s Vehicle Year________ Make______________ Style___________ Color__________ License Plate________________ State_____

Friends or Relatives the defendant may be staying with or who may know their whereabouts.

_______________________________________________________________________________________________________________

Name Address (Area Code) Phone Relationship

_______________________________________________________________________________________________________________

Name Address (Area Code) Phone Relationship

The Defendant

■

is violent toward police

■

is a drug user

■

is a heavy drinker

■

is mentally ill

■

is on probation / parole

Does Defendant

■

carry a gun or knife

■

have a gun or knife

Other information that may help serve your order (places defendant goes; days or times most likely to be there ) _____________________________

_______________________________________________________________________________________________________________

Law Enforcement will serve an Order of Protection free, however they will charge a service fee for an Injunction Against Harassment. Refer to the Protective

Order Service Information handout to learn more about service fees.

DISTRIBUTION: WHITE - COURT YELLOW - JUDICIAL PROCESS DETAIL 30-152D Rev. 2/16

PHOENIX MUNICIPAL COURT 300 W. Washington St. Phoenix, AZ 85003-2103 602-262-7120 TTY: Use 7-1-1

To request this document in an alternative format, please call 602-262-1625 or TTY: Use 7-1-1.

INVOICE WORKSHEET

Date Received ______________________________________________ Det./PA Assigned _____________________________________________

Miles Address Checked & Phone Number Called Date/Time Result/Comments

FISCAL MANAGEMENT USE ONLY

■

Order Served Cost Calculation

Service Fee

Notary/Handling Fee

_________ miles x $2.40

(minimum charge $16.00)

Total Service Fee

■

Service Fees Waived

■

Order Served & Affidavit of Service Returned to Court

■

Order Not Served Due To

■

Bad Address

■

Moved

■

No Information

■

Avoiding

■

Other _________________________

■

Not in City Limits, lives in _______________________________________________

■

File Stop Card completed for Defendant

■

Court Notified of Non-Service and Reason(s)

Total Miles Traveled

16.00

8.00

___________

■

Order Not Served Cost Calculation

Service Fee

Notary/Handling Fee

_________ miles x $2.40

(minimum charge $16.00)

Total Service Fee

8.00

___________

PHOENIX MUNICIPAL COURT 300 W. Washington St. Phoenix, AZ 85003-2103 602-262-7120 TTY: Use 7-1-1

To request this document in an alternative format, please call 602-262-1625 or TTY: Use 7-1-1.

DISTRIBUTION: WHITE - COURT YELLOW - PLAINTIFF PINK - DEFENDANT 30-362.3D Rev. 1/17

Date(s) Describe what happened (continued) Case No.____________________

___________ _______________________________________________________________________________________________

Petition Page _______ of _______

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Completed 12 July 2020

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