Free Petition For Peace Order - Maryland

DISTRICT COURT OF MARYLAND FOR
Located at
Court Address Petitioner Street Address, Apt. No. City, State, Zip Code Home: Work: Telephone Number(s)

City/County

Case No.
vs.
Respondent Street Address, Apt. No. City, State, Zip Code Home: Work: Telephone Number(s)

PETITION FOR PEACE ORDER
(NOTE: Fill in the following, checking the appropriate boxes. If you need additional paper, ask the clerk.) 1. I want protection from
Respondent

The Respondent committed the following acts against within the past 30 days on the dates stated below. (check all that apply) shooting harassment rape or other sexual offense (or attempt) stalking detaining against will kicking

Victim

, choking shoving slapping

punching stabbing

hitting with object trespass

threats of violence other

malicious destruction of property

The details of what happened are: (Describe injuries. State the date(s) and place(s) where these acts occurred. Be as specific as you can.):

2. I know of the following court cases involving the Respondent and me: Court Kind of Case Year Filed Results or Status (if you know)

3. Describe all other harm the Respondent has caused you and give date(s), if known

4. I want the Respondent to be ordered: NOT to commit or threaten to commit any of the acts listed in paragraph 1 against NOT to contact, attempt to contact, or harass NOT to go to the residence(s) at NOT to go to the school(s) at NOT to go to the work place(s) at To go to counseling. To go to mediation. Other specific relief:
Name

Name Address Name of school and address

To pay the filing fees and court costs.

I solemnly affirm under the penalties of perjury that the contents of this Petition are true to the best of my knowledge, information, and belief.
Date Petitioner

NOTICE TO PETITIONER Any individual who knowingly provides false information in a Petition for Peace Order is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000 or imprisonment not exceeding 90 days or both.
DC/PO 1 (Rev. 2/2003)