Free PA-015, Affidavit Confidential Address, Rev. 09/01 - Maine


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STATE OF MAINE DISTRICT COURT Location Docket No.

Plaintiff v. AFFIDAVIT FOR CONFIDENTIAL ADDRESS
(19-A M.R.S.A. § 4008) (5 M.R.S.A. § 4656)

Defendant For the protection of the plaintiff, the plaintiff requests the court to keep his/her address confidential. The plaintiff's address is:

The undersigned plaintiff states under oath that the health, safety or liberty of myself and/or my child(ren) would be jeopardized by disclosure of this information for the following reasons:

Date: Signature

Personally appeared the above named and made oath to the truth of the statements in the above affidavit, before me,

and signed

Date: Clerk / Notary Public / Attorney at Law

PA-015, Rev. 09/01