State of Minnesota
County
Select County
District Court
Judicial District: Court File Number: Case Type: Harassment
Petitioner(s)
vs.
Petitioner's Request & Order for Dismissal of Harassment Restraining Order
Respondent(s)
Petitioner(s) request dismissal of the Harassment Restraining Order issued on because:
(Each Petitioner must sign this request in order for the matter to be dismissed by the court. Attach additional pages if more than two petitioners exist.)
Petitioner, by signing here, requests dismissal
Petitioner, by signing here, requests dismissal
Sworn/affirmed before me Date:
Sworn/affirmed before me Date:
Notary Public/Deputy Court Administrator
Notary Public/Deputy Court Administrator
ORDER Based on the Petitioner's request, the Court orders that the Harassment Restraining Order issued on against the above named Respondent(s) is dismissed.
Date
Dated: Judge of District Court
Distribution Certified copy or original Return to Court Administrator with Affidavit of 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:
HAR401
State
ENG
Rev 2/01
www.courts.state.mn.us/forms
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