Free DOMESTIC ABUSE - Minnesota

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State: Minnesota
Category: Court Forms - State
Author: MSC
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Page Size: Letter (8 1/2" x 11")

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State of Minnesota
Select County
In the Matter of:

District Court
Judicial District: Court File Number: Case Type: Domestic Abuse


Application for Extension of Order for Protection (Minn. Stat. 518B.01, subd. 6a)


I am the petitioner in the above named matter. Being sworn/affirmed on oath, I state: 1. 2. 3. An Order for Protection was issued on

. .

The Order for Protection will expire on I am requesting an extension of the Order for Protection because: The respondent violated the Order for Protection. I am reasonably in fear of physical harm from the respondent. The respondent engaged in acts of harassment or stalking. The respondent is/was incarcerated and has been or is about to be released.


Describe in detail the acts of the respondent that explain why you are asking for the extension. Give approximate dates and list the most recent incidents first. (Attach additional sheets if needed.)

Dated: Signature (Sign only in front of notary public or court administrator.) Name: Sworn/affirmed before me this day of , . Address: City/State/Zip: Telephone: Notary Public \ Deputy Court Administrator

Notice of Hearing
To the Above Named Respondent: The application of the petitioner for an extension of the Order for Protection at .m. at will be heard on
(Date) (Time) (Address)

Date: Deputy/Court Administrator FAILURE TO APPEAR AT THE HEARING WILL NOT BE A DEFENSE TO PROSECUTION FOR VIOLATION OF THE COURT'S ORDER. Distribution _______ Certified copy or original - Return to Court Administrator with Affidavit of Personal Service attached Copy for Petitioner(s) Copy for Respondent(s) Copy for file until original returned Copy for local police department Copy for Sheriff Other: _______ Dissolution File
OFP701 State ENG Rev 6/04 Page 1 of 1