Free DOMESTIC ABUSE - Minnesota

Petitioner's Information Sheet
The following information will assist the Court in completing the processing of your case. Please complete and bring this document to the court administration office at the time you bring your Petition and other documents. Check off all sections that apply to you: I want my address to remain secret and not be part of the public file. My address is: The respondent lives in the same building as I do. The respondent and I work for the same employer. If yes, answer following: Yes No

1. Do you have the same supervisor as the respondent does? Yes, and our supervisor's name is No 2. Do you work in the same building or department as the respondent does? Yes, and the name of the building is Yes, and the name of the department is No . 3. The respondent and I work the same hours: The respondent and I attend the same school: I want my phone number to remain secret and not be part of the public file. My phone number is: When the order has been signed: Please call me at the above number and I will return to pick up my copy of the order. I will pick up my copy of the Order at a Women's Shelter or advocacy program. I will pick up my copy of the Order at the sheriff's department. . Please FAX my copy to me at: Please mail my copy to me at: . I will wait at the Courthouse until the order is ready. I understand that it may be several hours before a decision is made and either I receive my copy of the OFP or my petition is denied. If more information is needed or the order is not approved, please call me at the number shown above. DATED:
Signature of Petitioner
OFP104 State ENG Rev 2/03 www.courts.state.mn.us/forms Page 1 of 1

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