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STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY
Court address

PETITION FOR PERSONAL PROTECTION ORDER AGAINST STALKING (NONDOMESTIC)

CASE NO.

Court telephone no.

A

Petitioner name

Age

Respondent name, address, and telephone no.

Age

Address and telephone no. where court can reach petitioner

v

B C

1. The petitioner and respondent have never been husband and wife, resided in the same household together, had a child in common, or had a dating relationship with one another. 2. The respondent is required to carry a firearm in the course of his/her employment. Unknown. 3. a. There are are not other pending actions in this or any other court regarding the parties.
Name of court and county Name of judge

Case number

b. There

are

are not

orders/judgments entered by this or any other court regarding the parties.
Name of court and county Name of judge

Case number

D

4. I need a personal protection order because: Explain what has happened (attach additional sheets).

E

F

5. I make this petition under the authority of MCL 600.2950a and ask the court to grant a personal protection order prohibiting the respondent from stalking me as defined by MCL 750.411h and MCL 750.411i, which includes but is not limited to: following me or appearing within my sight. appearing at my workplace or residence. approaching or confronting me in a public place or on private property. entering onto or remaining on property owned, leased, or occupied by me. sending mail or other communications to me. contacting me by telephone. placing an object on or delivering an object to property owned, leased, or occupied by me. threatening to kill or physically injure me. purchasing or possessing a firearm. other: 6. I ask the court to grant a personal protection order against stalking. I request an ex parte order because immediate and irreparable injury, loss, or damage will occur between now and a hearing or because notice itself will cause irreparable injury, loss, or damage before the order can be entered. 7. I have a next friend petitioning for me. I certify that the next friend is not disqualified by statute and is an adult.

G

H
Date CC 377 (3/09) Petitioner's signature MCL 600.2950a, MCR 3.703

PETITION FOR PERSONAL PROTECTION ORDER AGAINST STALKING (NONDOMESTIC)

PROOF OF SERVICE

Petition for Personal Protection Order Against Stalking Case No.

TO PROCESS SERVER: You must serve the copies of the petition for personal protection order and file proof of service with the court clerk. If you are unable to complete service, you must return this original and all copies to the court clerk.

CERTIFICATE / AFFIDAVIT OF SERVICE / NONSERVICE OR OFFICER CERTIFICATE I certify that I am a sheriff, deputy sheriff, bailiff, appointed court officer, or attorney for a party [MCR 2.104(A)(2)], and that: (notarization not required) AFFIDAVIT OF PROCESS SERVER Being first duly sworn, I state that I am a legally competent adult who is not a party or an officer of a corporate party, and that: (notarization required)

I served a copy of the petition for personal protection order against stalking by: personal service registered mail, delivery restricted to the respondent (return receipt attached) on:
Respondent name Complete address of service Day, date, time

I have personally attempted to serve a copy of the petition for personal protection order against stalking on the following respondent and have been unable to complete service.
Respondent name Complete address of service

I declare that the statements above are true to the best of my information, knowledge, and belief.
Service fee Miles traveled Fee Signature TOTAL FEE Name (type or print) Title

$ $

$ $ $

Incorrect address fee Miles traveled Fee

Subscribed and sworn to before me on
Date

, Signature:
Deputy court clerk/Notary public

County, Michigan.

My commission expires:
Date

Notary public, State of Michigan, County of

ACKNOWLEDGMENT OF SERVICE I acknowledge that I have received a copy of the petition for personal protection order against stalking on
Day, date, time

.

Signature of respondent

MCR 2.105(A)

Form CC 377 PETITION FOR PERSONAL PROTECTION ORDER AGAINST STALKING (NONDOMESTIC RELATIONSHIP)
Use this form if you want an order to restrain another person over the age of 18 from stalking you and you do not have a domestic relationship to this person.

INSTRUCTIONS FOR COMPLETING "PETITION FOR PERSONAL PROTECTION ORDER AGAINST STALKING"

Please print neatly. Press firmly because you are printing on five copies. By filling in this form, you are asking for a personal protection order that tells the respondent not to do certain things you don't want him or her to do. If you are in immediate danger, you should ask the judge for an "ex parte" order, which will be issued without waiting for a hearing. Items A through H must be completed before your petition can be filed with the court. Please read the instruction for each item. Then fill in the correct information for that item on the form. A Write your name, address, and telephone number in the "Petitioner" box. If you are under 18 years of age, write in your age. Write the name, address, and telephone number of the person you want restrained in the "Respondent" box; if he or she is under 18 years of age, write in his/her age. If you want your address and telephone number to be kept from the respondent, do not write your address here. Put in the address of a relative or friend or a post office box where the court can contact you. Check the box if the respondent is required to carry a firearm while at work. If you aren't sure, check the box "unknown." Check whether there is a pending action between you and the respondent. If there is, fill in the case number, the name of the court and county where the action was filed, and the name of the judge. Check whether there are any court orders or judgments between you and the respondent. If there are, fill in the case number, the name of the court and county where the order or judgment was entered, and the name of the judge that signed the order. D Explain in as much detail as possible why you are asking for a personal protection order. Describe what has happened or what has been threatened so the judge has enough facts to decide if a personal protection order should be signed. You must detail two or more separate instances of harassment (unconsented contact) that caused you to feel terrorized, frightened, intimidated, threatened, harassed, or molested. Include dates and places. Write on a separate sheet of paper and attach it to this form. Check only those boxes you need because you must be able to convince the judge you need all the protection you are requesting. An "ex parte order" means you do not have to let the other party know in advance that you are asking the court for an order and you do not have to wait for a court hearing to get the order. Check the box for an "ex parte order" if you believe the other party might hurt you or threaten you if he or she found out you were getting an ex parte personal protection order. If you do not check the box for an ex parte order, you must have a court hearing. Fill out form CC 381. G If you are under 18 years old, you may need an adult (called a "next friend") to petition for you. Check this box if you have a next friend helping you file this form. Write in today's date and sign the form. Hand the form to the county clerk. The clerk will fill in the rest of the information and will give you your copies.

B C

E F

H

You must read the booklet "Instructions for Personal Protection Orders" for directions on the legal process.