Free PO6.vp - Maryland

DISTRICT COURT OF MARYLAND FOR ................................................................................................ City/County
Located at ......................................................................................Case No ................................................................
Court Address

...........................................................................................
Name of Petitioner on Original Court Order Street Address, Apt. No.

...........................................................................................

...........................................................................................
Home: Work: ........................................................................................... City, State, Zip Code Telephone

vs.

Name of Respondent on Original Court Order

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Street Address, Apt. No. Home: Telephone Work: ........................................................................................... City, State, Zip Code

PETITION TO MODIFY/RESCIND PEACE ORDER
I am the Respondent, Petitioner, in this case. I ask this Court to: modify the Peace Order in this case dated .............................................as follows: ................................................. .................................................................................................................................................................................................... .................................................................................................................................................................................................... rescind the Peace Order in this case dated................................................................................................................ My reasons are: ............................................................................................................................................................. .................................................................................................................................................................................................... .................................................................................................................................................................................................... .................................................................................................................................................................................................... ...........................................................................................
Date

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Signature

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Street Address (unless confidential) City, State, Zip Code

........................................................................................... ...........................................................................................
Home Telephone Work Telephone

CERTIFICATE OF SERVICE
I hereby certify that on ................................................................................., I mailed a copy of this Petition to:
Date

....................................................................................................................................................................................................
Name and Address

....................................................................................................................................................................................................
Name and Address

...........................................................................................
Date

...........................................................................................
Signature

ORDER OF COURT
It is this..................day of ....................................................., ...................., ORDERED that:
Month Year

this matter be scheduled for a hearing. the Petition is DENIED because............................................................................................................................... ....................................................................................................................................................................................... ...........................................................................................
Judge

DC/PO 6 (Rev. 2/2003)