Free DOMESTIC VIOLENCE PROTECTION ORDER INFORMATION SHEET - Nevada

*CONFIDENTIAL * ORDER FOR PROTECTION OF CHILDREN INFORMATION (TO BE FILLED OUT BY APPLICANT)
Instructions: Please provide all information known to you and please print legibly. All requested information is helpful for service, even if the information is only partially known. APPLICANT DATA Name:
________________________________________________________________________________________________________________________________________ (Last) (First) (Middle)

Phone: Home: ___________________Work: _________________________ Cell:_________________
Name of Minor:

__________________________________________________________________________________________
(Last) (Last) (First) (First) (Middle) (Middle)

Other Name Used By Minor: _________________________________________________________________________ Additional Contact Person: ________________________ Phone: ____________Address: _________________________ Full Name:
(Last) (First)

ADVERSE PARTY DATA Other Name Used:
(Middle) (Last) (First) (Middle)

Relationship To Minor (if any): Last Known Home Address:
(Street Address)

Date of Birth
(Bldg/Apt #)

/

/

and/or Social Security No.:
(Y) (City) (State) (Zip Code)

(M) (D)

Is this address difficult to find? Mailing Address:



No



Yes If yes, please explain ______________________________

___________________________________________________________________________________________
(If different from above)________________________________________________________________________________________
(Street Address) (Bldg/Apt #) (Bldg/Apt #) (City) (City) (State) (State) (Zip Code) (Zip Code)

Other Likely Address:
(Street Address)

Home Phone: ______________________________________________ Cell Phone: ______________________________ Occupation: Employer: Work Days: __________ Work Hours: _______

Work Phone: ____________ Work Address:
(Street Address) (City) (State) (Zip Code)

Hair Color:

Eye Color:

Height:

Weight:

Sex

Race:

Scars/Marks/Tattoos (Description and Location): Does the Adverse Party speak English?
(Yes or No)

If not, what language?

Vehicle Make: ________ Model: ________ Year: ________License Plate Number/State: ___________________________

(Circle one)
Are the Minor and the Adverse Party living together now? Yes or No Are the Minor and the Adverse Party employed by the same employer? Yes or No Is the Adverse Party likely to react violently when served? Yes or No Is the Adverse Party likely to avoid service? Yes or No Does the Adverse Party have a Carrying Concealed Weapon (CCW) Permit? Yes or No Does the Adverse Party have access to weapons? Yes or No If yes, please describe type and location of weapon(s): Does the Adverse Party's history include (please circle): assaults, assaults w/weapon, batteries, mental health problems, drug/alcohol abuse, outstanding/prior arrest warrants, safety issues? Explain: Do not write in this space. For court purposes only. Issuing Court ORI: NV______________ Court Case Number: _______________
Law Enforcement: Do not serve this sheet with documents to be delivered.

*CONFIDENTIAL*