Petition For Personal Protection Order Against A Minor (Non Domestic) {CC 377M}

Approved, SCAO Original - Court 1st copy - Judge/Assignment clerk (green) 2nd copy - Respondent (blue) 3rd copy - Petitioner (pink) 4th copy - Return (yellow) STATE OF MICHIGAN 6th JUDICIAL CIRCUIT Oakland COUNTY Court address PETITION FOR PERSONAL PROTECTION ORDER AGAINST A MINOR (NONDOMESTIC) CASE NO. 1200 N Telegraph Rd, Pontiac, MI 48341-1043 DOB (248) 975-9511 Respondent name, address, and telephone no. Court telephone no. DOB or age A Petitioner name Address and telephone no. where court can reach petitioner v 1. The petitioner and respondent have never been husband and wife, resided in the same household together, had a child in common, or had a dating relationship with one another. The respondent is not the unemancipated minor child of the petitioner. The petitioner is not the unemancipated minor child of the respondent. The respondent is between 10 and 17 years of age. B 2. a. There are are not other pending actions in this or any other court regarding the parties. Name of judge Case number Name of court and county b. There are are not orders/judgments entered by this or any other court regarding the parties. Name of judge Case number Name of court and county C 3. I need a personal protection order because: Explain what has happened (attach additional sheets). D 4. I make this petition under the authority of MCL 600.2950a(1) and ask the court to grant a personal protection order prohibiting the respondent from a. stalking me as defined by MCL 750.411h and MCL 750.411i, which includes but is not limited to following me or appearing within my sight. appearing at my workplace or residence. approaching or confronting me in a public place or on private property. entering onto or remaining on property owned, leased, or occupied by me. sending mail or other communications to me. contacting me by telephone. placing an object on or delivering an object to property owned, leased, or occupied by me. threatening to kill or physically injure me. purchasing or possessing a firearm. other: b. posting a message through the use of any medium of communication, including the Internet or a computer or any electronic medium, pursuant to MCL 750.411s. 5. I request an ex parte order because immediate and irreparable injury, loss, or damage will occur between now and a hearing or because notice itself will cause irreparable injury, loss, or damage before the order can be entered. 6. I have a next friend petitioning for me. I certify that the next friend is not disqualified by statute and is an adult. E F G Date Petitioner's signature MCL 600.2950a, MCL 712A.2(h), MCR 3.703 CC 377M (3/11) PETITION FOR PERSONAL PROTECTION ORDER AGAINST A MINOR (NONDOMESTIC) American LegalNet, Inc. www.FormsWorkFlow.com Petition for Personal Protection Order Against a Minor (Nondomestic) Case No. PROOF OF SERVICE TO PROCESS SERVER: You must serve the copies of the petition for personal protection order against a minor and file proof of service with the court clerk. If you are unable to complete service, you must return this original and all copies to the court clerk. CERTIFICATE / AFFIDAVIT OF SERVICE / NONSERVICE OR OFFICER CERTIFICATE I certify that I am a sheriff, deputy sheriff, bailiff, appointed court officer, or attorney for a party [MCR 2.104(A)(2)], and that: (notarization not required) AFFIDAVIT OF PROCESS SERVER Being first duly sworn, I state that I am a legally competent adult who is not a party or an officer of a corporate party, and that: (notarization required) I served a copy of the petition for personal protection order against a minor by: personal service registered mail, delivery restricted to the respondent and the parent(s), guardian(s), or custodian(s) of the respondent (return receipt attached) on: Name of respondent Complete address of service Day, date, time Name of parent/guardian/custodian Complete address of service Day, date, time Name of parent/guardian/custodian Complete address of service Day, date, time I have personally attempted to serve a copy of the petition for personal protection order against a minor on the following respondent and have been unable to complete service. Respondent name Complete address of service I declare that the statements above are true to the best of my information, knowledge, and belief. Service fee Miles traveled Fee Signature TOTAL FEE Name (type or print) Title $ Incorrect address fee $ Miles traveled Fee $ $ $ Subscribed and sworn to before me on My commission expires: Date Date , Signature: Deputy court clerk/Notary public County, Michigan. Notary public, State of Michigan, County of ACKNOWLEDGMENT OF SERVICE I acknowledge that I have received a copy of the petition for personal protection order against a minor on Signature of respondent Signature of respondent's parent/guardian/custodian Signature of respondent's parent/guardian/custodian MCR 2.105(A) American LegalNet, Inc. www.FormsWorkFlow.com Day, date, time .