Free Microsoft Word - PA-006, Rev. 12-05 (Word5) - Maine

STATE OF MAINE DISTRICT COURT Location Docket No. Plaintiff: on behalf of: v. Defendant: on behalf of: COMPLAINT FOR PROTECTION FROM HARASSMENT
(5 M.R.S.A. §§ 4651 et seq.)

1. Plaintiff information: Full name: Gender: Female Male Date of birth: Present street address, city and telephone number: (list only your name if address is to be kept confidential AND COMPLETE FORM PA-015, AFFIDAVIT FOR CONFIDENTIAL ADDRESS WHICH CAN BE OBTAINED FROM THE CLERK). ___________________________ _____________________________________________________________________________ If different, mailing address:___________________________________________________ 2. Defendant information: Full name: Gender: Female Male Date of birth: Race: White Black Asian or Pacific Islander American Indian or Alaskan Native Present street address, city and telephone number: ____________________________________ _____________________________________________________________________________ If different, mailing address:___________________________________________________

Unknown

3. I base my claim for protection from harassment on the following facts: Describe the harassment and include who committed it, when and where it occurred. (If additional space is needed attach another sheet.) ______________________________________________________

This claim involves an allegation of stalking domestic violence sexual assault. 4. I have have not contacted law enforcement officials about the harassment. I ASK THE COURT TO: (a) Order the defendant to stop harassing me. (b) Order the defendant to have no contact with me, directly or indirectly. (c) Order the defendant not to enter my residence. (d) Order the defendant to refrain from repeatedly, and without reasonable cause, following me or being at, or in the vicinity of, my home, school, business or place of employment. (e) Order the defendant to refrain from interfering with my property. (f) Order the defendant to pay monetary compensation for losses that I have incurred as the result of the harassment. (g) Order the defendant to pay my attorney's fees and court costs and to order any other necessary and proper relief. Date:
PA-006, Rev. 12/05

Signature of plaintiff

MOTION FOR TEMPORARY ORDER I am in immediate and present danger of physical abuse or extreme emotional distress from the defendant's conduct or my business property is in immediate and present danger of suffering substantial damage as a result of the defendant's actions because:

I have made the following efforts to notify the defendant of my request for a temporary order:

I therefore request that a temporary order for protection from harassment be issued. Date: Signature of plaintiff Personally appeared the above named Plaintiff and signed and made oath to the truth of the statements in the above complaint, before me, Date: Clerk / Notary Public / Attorney at Law