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IN THE DISTRICT COURT OF ______________ COUNTY, KANSAS

____________________, Plaintiff vs. ____________________, Defendant Case No. _______________

PROTECTION FROM STALKING CONFIDENTIAL FORM

NOTE:

THIS FORM WILL BE SHOWN ONLY TO AUTHORIZED COURT OR LAW ENFORCEMENT PERSONNEL. THIS FORM WILL NOT BE DISCLOSED TO THE PUBLIC OR TO THE DEFENDANT. IT IS THE PLAINTIFF'S RESPONSIBILITY TO NOTIFY THE COURT OF ANY CHANGE IN ADDRESS OR TELEPHONE NUMBER.

Name of Plaintiff _______________________________________________________________

Confidential Address: Street _______________________________________________________________________ City _________________________ State ________________ Zip Code ___________________ Phone Number ______________________

07/10/04