Free PA-005, Protection Order Service Inf., Rev. 01/01 - Maine

PROTECTION ORDER SERVICE INFORMATION DEFENDANT Defendant's Name: Home Address: Apartment No. and / or floor: Color of house or other description: If living with another person, other person's name: Day / Work Telephone: Evening / Home Telephone: Hours defendant will most likely be at home: Name of Employer: Work Address: Work Schedule: S M T W Th F S Hours Worked: AM/PM to (Circle Work Days) PHYSICAL DESCRIPTION (If known) VEHICLE (If known) Birth Date: Make and Year: Height: Type/Model: Weight: Color: Hair Color: Registration No. and State: Eye Color: Gender: Race: White Black Asian or Pacific Islander Amer. Indian/Alaskan Native

AM/PM

Unknown

If you are unable to provide the above information, please list below the name, address and telephone number of anyone who can help the serving officer locate the defendant:

ADDITIONAL INFORMATION Does the defendant own a firearm or other weapon? If so, where is the weapon usually kept? Does the defendant have a history of violence? Is there anything else the serving officer should know about the defendant?

PLAINTIFF Plaintiff's Name: Address (unless confidential): Day / Work Telephone:
PA-005, Rev. 01/01

Evening / Home Telephone: