Free PETITIONER'S VERIFIED REQUEST FOR DISMISSAL - Indiana

PO-0108

Approved 07-01-02 Revised 07-01-08

STATE OF INDIANA

) ) SS: COUNTY OF ___________ )

IN THE ________________COURT ____ (_____________ DIVISION, ROOM ____) CASE NO._________________________

_______________________, ) Petitioner ) vs. ) _______________________, ) Respondent )

PETITIONER'S VERIFIED REQUEST FOR DISMISSAL

On ______________________________, I, the Petitioner, filed a Petition for an Order for Protection and Request for a Hearing. Check appropriate paragraph: ____ At this time, I am requesting this Verified Request for Dismissal pursuant to Indiana Code § 34-26-5-12. I respectfully request that the Court grant this Request without delay or any conditions, and dismiss the case without prejudice. ____ At this time, I am filing this Verified Request for Dismissal for an Order of Protection to terminate an Order of Protection issued on ________________________. I affirm, under the penalties for perjury, that the foregoing representations are true.

DATE: ________

Petitioner's Signature __________________________ Printed _________________________

Petitioner's Address ___________________________ ___________________________ Respondent's Address __________________________ ___________________________