WPCg  
      e    ϕԺȼA"!#2m1"US*
:O6KcƘq,9[; >iOk'GrLT
|v˲Gډg~"hDiW`u_M%5KT8W3>+h!־;o<TJIpP%sg^F|'<CY)fQ~oH?QRC>bf}Ka}3jPGQcFw1iاY>V
^hlsȔ5-9ii޴s
2b䕮BNZH_qi΄&
wYa*#JղQYU.	]^4cbߒ2>.?E >^\EW)~%*KAxz0YuA=|#$`.             U  >   @       ~  0        0        0        0        0        0        0        0        0        0        0        0        0        0        0      v  0      [  0      @   0      "!  0      "  0      "  0      #  0      $  0      %  0      &  0      w'  0      [(  0      <)  0      *  0      *  0      +  0      ^,  0      ,  0   Y  -   U   *   .  0   _  /  0      y0  0      @1  0      2  0   h   2  0   B   B3  0      3  0      #4  0   B   4  0      5  0      5  0      {6  0      7  0   B   7  0   F   7  0      A8  0      8  0      9  0      T:  0   0    ;  0   0   0;  0   0   `;  0      ;  0      I<  0      =  0   F   =  0      >  0      >  0      ?  0   F   n@  0   F   @  0   F   @  0      @A  0      A  0      B  0   !  AC  0   	  bD  0      kE  0     dF  0f     G  0      H  0   ;  I  0     J  0   *  K   U   0   M  0   >  GM  0   D   N  0   A  N  0     
P  0      Q  0   L   rR  0   {   R  0     9S  0      FT  0      T  0   P   tU     k  U  0      /W   	      W   	      W   	      X   	       X   	      4X   	      HX   	      \X  	1   e   nX  	7      X   	      X   	      X   	      Y   	      Y   	      )Y   	      ;Y   	      MY   	      _Y   	      qY   	      Y   	      Y  w      Y   U   @   Y   U   @   Y   	      +Z   	      =Z   	      OZ   	      aZ   	      sZ   	      Z   	      Z   	      Z   	      Z   	      Z   	      Z   U   0   Z   U   0   +[   	      [[   U   0   k[   U   0   [   	      [   U   0   [   U   0   \   	      ;\   U   0   K\   U   0   {\   	      \   U   0   \   U   0   \   	      ]   	      +]   	      ;]   	      K]   	      []   	      m]   	      ]   	      ]   	      ]   	      ]   	      ]   	      ]   	      ]   	      ^   	      ^   	      )^   	      =^   	      Q^   	      c^   	      u^   	      ^   	      ^   	      ^   	      ^   	      ^   	      ^   	      ^   	      _   	      _   	      3_   	      G_   	      [_   	      o_   	      _   	      _   	      _   	      _   	      _   	      _   	      _   	      `   	      `   	      1`   	      C`   	      W`   	      i`   	      }`   	      `   	      `   	      `   	      `   	      `   	      `   	      `   	      a   	      #a   	      5a   	      Ga   	      Ya   	      ka   	      }a   	      a   	      a     "   a        a  0      a  #     b   U   N   He  	%      e  M      e     (   e  N      e  	1   u   e  	7   2   ?f  4      qf        f   b      f  	m      f     :   f   b      f  ^      g   \	  	   `  & T i m e s   N e w   R o m a n          '                                 I N   T H E   D I S T R I C T   C O U R T   O F   J O H N S O N   C O U N T Y ,   K A N S A S                                                                                                                                                                                                                                                                                                                                                                                                                                   
       *     R o n a l d   W .   N e l s o n    0    n a t a l i e   
 .      
       
       
           2   S   +       P   0 _ l e v e l 1            , ;  1     `	   h   p    x  (#; 2      3
   
       . .          8  .    `	   h   p    x  (#8         2   P   +       P   0 _ l e v e l 2            X 8  .    `	   h   p    x  (#8 2     3
   
       . .          8  .    `	   h   p    x  (#8         2   P   +       P   0 _ l e v e l 3             8  . 4 4 4 `	   h   p    x  (#8 2     3
   
       . .          8  .    `	   h   p    x  (#8         2   M   +       P   0 _ l e v e l 4             5  + `	 `	 `	   h   p    x  (#5 2     3
   
       . .          8  .    `	   h   p    x  (#8         2   M   +       P   0 _ l e v e l 5             5  + 
 
 
   h   p    x  (#5 2     3
   
       . .          8  .    `	   h   p    x  (#8         2   J   +       P   0 _ l e v e l 6             2  (     h   p    x  (#2 2     3
   
       . .          8  .    `	   h   p    x  (#8         2   J   +       P   0 _ l e v e l 7            4 2  (     h   p    x  (#2 2     3
   
       . .          8  .    `	   h   p    x  (#8         2   G   +       P   0 _ l e v e l 8            `	 /  %    h   p    x  (#/ 2     3
   
       . .          8  .    `	   h   p    x  (#8         2   G   +       P   0 _ l e v e l 9            
 /  % < < < h   p    x  (#/ 2     3
   
       . .          8  .    `	   h   p    x  (#8         2   S          P   0 _ l e v s l 1            , ;  1     `	   h   p    x  (#; 2      3
   
 Ԁ      8  .    `	   h   p    x  (#8         2   P          P   0 _ l e v s l 2            X 8  .    `	   h   p    x  (#8 2     3
   
 Ԁ      8  .    `	   h   p    x  (#8         2   P          P   0 _ l e v s l 3             8  . 4 4 4 `	   h   p    x  (#8 2     3
   
 Ԁ      8  .    `	   h   p    x  (#8         2   M          P   0 _ l e v s l 4             5  + `	 `	 `	   h   p    x  (#5 2     3
   
 Ԁ      8  .    `	   h   p    x  (#8         2   M          P   0 _ l e v s l 5             5  + 
 
 
   h   p    x  (#5 2     3
   
 Ԁ      8  .    `	   h   p    x  (#8         2   J          P   0 _ l e v s l 6             2  (     h   p    x  (#2 2     3
   
 Ԁ      8  .    `	   h   p    x  (#8         2   J          P   0 _ l e v s l 7            4 2  (     h   p    x  (#2 2     3
   
 Ԁ      8  .    `	   h   p    x  (#8         2   G          P   0 _ l e v s l 8            `	 /  %    h   p    x  (#/ 2     3
   
 Ԁ      8  .    `	   h   p    x  (#8         2   G          P   0 _ l e v s l 9            
 /  % < < < h   p    x  (#/ 2     3
   
 Ԁ      8  .    `	   h   p    x  (#8         2   S          P   0 _ l e v n l 1            , ;  1     `	   h   p    x  (#; 2      3
   
       8  .    `	   h   p    x  (#8         2   P          P   0 _ l e v n l 2            X 8  .    `	   h   p    x  (#8 2     3
   
       8  .    `	   h   p    x  (#8         2   P          P   0 _ l e v n l 3             8  . 4 4 4 `	   h   p    x  (#8 2     3
   
       8  .    `	   h   p    x  (#8         2   M          P   0 _ l e v n l 4             5  + `	 `	 `	   h   p    x  (#5 2     3
   
       8  .    `	   h   p    x  (#8         2   M          P   0 _ l e v n l 5             5  + 
 
 
   h   p    x  (#5 2     3
   
       8  .    `	   h   p    x  (#8         2   J          P   0 _ l e v n l 6             2  (     h   p    x  (#2 2     3
   
       8  .    `	   h   p    x  (#8         2   J          P   0 _ l e v n l 7            4 2  (     h   p    x  (#2 2     3
   
       8  .    `	   h   p    x  (#8         2   G          P   0 _ l e v n l 8            `	 /  %    h   p    x  (#/ 2     3
   
       8  .    `	   h   p    x  (#8         2   G          P   0 _ l e v n l 9            
 /  % < < < h   p    x  (#/ 2     3
   
       8  .    `	   h   p    x  (#8         T   6           )   : H e a d i n g   B a s e   H e a d i n g   B a s e         
   UU d                 X      XX 
   UU d      H   F          ,   4 H e a d i n g   1   H e a d i n g   1         
     d      X      XX 
            
     d      X      XX     H   F          ,   4 H e a d i n g   2   H e a d i n g   2         
     d      X      XX 
          
     d      X      XX     H   3             4 H e a d i n g   3   H e a d i n g   3       d  
   {T B  
          
   {T B      H   0             4 H e a d i n g   4   H e a d i n g   4       d  
   {T B  
          
   {T B      H                4 H e a d i n g   5   H e a d i n g   5       d  
   {T B             ? $          % 2  A   `   A r i a l         ? 
              X      XX S            \	  	   `  & T i m e s   N e w   R o m a n         S 
   {T B  % 2  A   `   A r i a l             H                4 H e a d i n g   6   H e a d i n g   6       d  
   {T B             ? $          % 2  A   `   A r i a l         ? 
              X      XX S            \	  	   `  & T i m e s   N e w   R o m a n         S 
   {T B      H   F          ,   4 H e a d i n g   7   H e a d i n g   7       B  
   M 2             
              X      XX 
   M 2      H   I          /   4 H e a d i n g   8   H e a d i n g   8       B  
   M 2             
              X      XX 
   M 2      H   I          /   4 H e a d i n g   9   H e a d i n g   9       B  
   M 2             
              X      XX 
   M 2      h                    : D e f a u l t   P a r a   D e f a u l t   P a r a g r a p h   F o n t       ,                 & c 1   c 1                ,   ;           8   & p 2   p 2   ;  1   Z  `	   h   p    x  (#; 8  .    `	   h   p    x  (#8     ,   ;           8   & p 3   p 3   ;  1   Z  `	   h   p    x  (#; 8  .    `	   h   p    x  (#8     ,                 & c 4   c 4                ,   G           D   & p 5   p 5      S ;  1     `	   h   p    x  (#; 8  .    `	   h   p    x  (#8    S     ,   G           M   & p 6   p 6      S ;  1    >	 `	   h   p    x  (#; A  7        X   `	   h   p    x  (#A    S     ,   ;           8   & p 7   p 7   ;  1   Z  `	   h   p    x  (#; 8  .    `	   h   p    x  (#8     ,   ;           8   & p 8   p 8   ;  1   Z  `	   h   p    x  (#; 8  .    `	   h   p    x  (#8     ,                 & c 9   c 9                0                 ( c 1 0   c 1 0                0   8           D   ( p 1 1   p 1 1       ,  " :
 :    p    x  (#,       8  .    `	   h   p    x  (#8     0   8           D   ( p 1 2   p 1 2       ,  " H
 H    p    x  (#,       8  .    `	   h   p    x  (#8     0   G           D   ( p 1 3   p 1 3      S ;  1     `	   h   p    x  (#; 8  .    `	   h   p    x  (#8    S     0   8           D   ( p 1 4   p 1 4      +	 ,  " 
     p    x  (#,       8  .    `	   h   p    x  (#8     0                   ( t 1 5   t 1 5       0                   ( t 1 6   t 1 6       0                   ( t 1 7   t 1 7       0   F           C   ( p 1 8   p 1 8       ;  1   Z  `	   h   p    x  (#;      8  .    `	   h   p    x  (#8     0   F           C   ( p 1 9   p 1 9       ;  1   Z  `	   h   p    x  (#;      8  .    `	   h   p    x  (#8     0   R           O   ( p 2 0   p 2 0      S     ;  1     `	   h   p    x  (#;      8  .    `	   h   p    x  (#8    S     0                 ( c 2 1   c 2 1                0   C           O   ( p 2 2   p 2 2           ,  " :
 :    p    x  (#,            8  .    `	   h   p    x  (#8     0   C           O   ( p 2 3   p 2 3           ,  " 1
 1    p    x  (#,            8  .    `	   h   p    x  (#8     0   R           O   ( p 2 4   p 2 4      N     ;  1     `	   h   p    x  (#;      8  .    `	   h   p    x  (#8    N     0                 ( c 2 5   c 2 5                0                 ( c 2 6   c 2 6                0                 ( c 2 7   c 2 7                0   G           D   ( p 2 8   p 2 8      N ;  1     `	   h   p    x  (#; 8  .    `	   h   p    x  (#8    N     0   ;           8   ( p 2 9   p 2 9   ;  1   Z  `	   h   p    x  (#; 8  .    `	   h   p    x  (#8     H   4           '   4 B o d y   T e x t   B o d y   T e x t       d  
     d     X          
     d     X     X   k           ^   : A t t e n t i o n   L i   A t t e n t i o n   L i n e            X    X     8  .    `	   h   p    x  (#8            8  .    `	   h   p    x  (#8    X     X   Q           `   : M e s s a g e   H e a d   M e s s a g e   H e a d e r   
     d         `	 )   `		  `	   h   p)             8  .    `	   h   p    x  (#8 
     d      ,   m           `   & C C   C C       d  
   =          X 8  .    `	   h   p    x  (#8       8  .    `	   h   p    x  (#8 
   =           V                 : D o u b l e   I n d e n   D o u b l e   I n d e n t       d  
     d      X      XX    X    X     5  +    `	   h   p    x 5                        8  .    `	   h   p    x  (#8        
     d      X      XX     V   <           <   : D o u b l e   S p a c e   D o u b l e   S p a c e d      X     X      XX                         X     X      XX     h   =   +       #   : D o u b l e   S p a c 1   D o u b l e   S p a c e d - N u m b e r e d      X                         2      3
   
       . .                   X     H              l   4 E n c l o s u r e   E n c l o s u r e       d  
   =          X 8  .    `	   h   p    x  (#8                      8  .    `	   h   p    x  (#8        
   =           \   T           ]   : E n v e l o p e   A d d   E n v e l o p e   A d d r e s s       &      &&    `	 /  %    h   p    x  (#/       8  .    `	   h   p    x  (#8     X      XX     Z   a           o   : E n v e l o p e   R e t   E n v e l o p e   R e t u r n              E Q          * jp     `   P a l a m i n o         E     X      XX S            \	  	   `  & T i m e s   N e w   R o m a n         S * jp     `   P a l a m i n o             `       o       o    : F o o t n o t e   R e f   F o o t n o t e   R e f e r e n c e       &      && S            \	  	   `  & T i m e s   N e w   R o m a n         S     X      XX S            \	  	   `  & T i m e s   N e w   R o m a n         S     (                 #$           0
   
     V   w           t   : F o o t n o t e   T e x   F o o t n o t e   T e x t       -                  , ;  1     `	   h   p    x  (#;       8  .    `	   h   p    x  (#8 -         X      XX         (   ;  c           2$             
   <    .  .                    Xx  X  X X      Xx  X  X Xx      -        ,   E  1     `	   h   p    x  (#   XE    &F %  X Xx    &F % % &F     0
   
 -         % &F            X   %           %   : I n s i d e   A d d r e   I n s i d e   A d d r e s s       X      XX               X      XX     L                   6 S a l u t a t i o n   S a l u t a t i o n       V                 : P l e a d i n g   H e a   P l e a d i n g   H e a d                `   ]           P   : R e f e r e n c e   I n   R e f e r e n c e   I n i t i a l s                , 8  .    `	   h   p    x  (#8       8  .    `	   h   p    x  (#8         <              A   . H e a d e r   H e a d e r        (# A  7        X   `	   h   p    x  (#A     <              A   . F o o t e r   F o o t e r        (# A  7        X   `	   h   p    x  (#A     P                    8 P a g e   N u m b e r   P a g e   N u m b e r    
   a  
 ^   )    .  .                    Xx  X  X X      Xx  X  X Xx     _         [   $     (#   X$         ,    [              ʬ   X Xx 05/27/09   Xx  X  ʬ @    VV) V     (                  2 $       
   <!    .  .                    Xx  X  X X      Xx  X  X Xx      C h e c k 3 6    C h e c k 3 1    C h e c k 3 2    C h e c k 3 3    C h e c k 3 4    C h e c k 3 5    T e x t 7 8          	 
     3 5 ; A G M S Y _ 1     1 .   a .   i .   1 .   a .   i .   1 .   a .    f   i .    T e x t 4 5    T e x t 4 6    T e x t 4 7    T e x t 4 8    T e x t 4 9    T e x t 5 0    T e x t 5 1    T e x t 5 2    T e x t 5 3    T e x t 5 5    T e x t 5 6       Z 2  A $ `   ( A r i a l   U n i c o d e   M S         Z 2  A $ `  ( A r i a l   U n i c o d e   M S          T e x t 5 7    T e x t 6 0    T e x t 6 1    T e x t 6 2    T e x t 6 3    C h e c k 3 7    C h e c k 3 8    C h e c k 3 9    C h e c k 4 0    C h e c k 4 1    T e x t 1 1   2   	   `    C G   T i m e s         2   	   `    C G   T i m e s          T e x t 2   2   	   `    C G   T i m e s         2   	   `    C G   T i m e s          T e x t 3   2   	   `    C G   T i m e s         2   	   `    C G   T i m e s          T e x t 4   2   	   `    C G   T i m e s         2   	   `    C G   T i m e s          T e x t 5   2   	   `    C G   T i m e s         2   	   `    C G   T i m e s          T e x t 6    T e x t 7    T e x t 8    T e x t 9    T e x t 1 0    T e x t 6 4    T e x t 6 6    T e x t 8 6    T e x t 7 3    C h e c k 4 9    C h e c k 5 0    C h e c k 5 1    C h e c k 5 2    T e x t 7 4    T e x t 7 5    C h e c k 5 4    C h e c k 7 1    T e x t 7 6    T e x t 7 7    C h e c k 6 9    C h e c k 7 0    C h e c k 2 9    C h e c k 3 0    T e x t 8 0    T e x t 6 9    T e x t 8 1    T e x t 8 2    T e x t 8 3    C h e c k 5 5    C h e c k 5 6    C h e c k 5 7    C h e c k 5 8    C h e c k 5 9    C h e c k 6 0    C h e c k 6 1    C h e c k 6 2    T e x t 2 2    C h e c k 6 3    T e x t 2 3    C h e c k 7 2    T e x t 8 7    C h e c k 6 4    T e x t 2 4    C h e c k 6 5    T e x t 2 5    C h e c k 6 6    T e x t 2 6    C h e c k 6 7    T e x t 2 7    C h e c k 6 8    T e x t 2 8    T e x t 3 4    T e x t 3 5    T e x t 3 6    T e x t 3 7    T e x t 8 4    T e x t 3 9    T e x t 4 0    T e x t 4 1    T e x t 4 2    T e x t 4 3    T e x t 4 4    T e x t 8 5    
              X #| x            (   r               <$          .  .                    Xx  X  X X      Xx  X  X Xx  \ \ K J C D C 0 1 \ S A V I N   4 0 6 0   P C L   6                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          0                                                                                                                                                                 ( 9  	   Z  6 T i m e s   N e w   R o m a n   R e g u l a r           X                                                             3#   3 7 = C I Q Y a g       1 .   a .   i .   ( 1 )   ( a )   ( i )   1 )   a )                i )                                       S:    :i +00 P a g e      o f     &              U   
   0   #   x          d  #      P a g e      o f     &  8:Z     
   <!    .  .                    Xx  X  X X      Xx  X  X Xx     _                
     
  ]                  X      X 8   ʬ         d                  d  8  *                          *  8        INTHEDISTRICTCOURTOF_______________COUNTY,KANSAS *  8     ݌   	       Ќ     	      ,   E  1   Z  `	   h   p    x  (#   XE       ,           ,    {   ݌̌'  
    X  Z X(#' 	      ,   E  1   Z  `	   h   p    x  (#   XE       ,          ________________________________ ,    F   ݌   	 b   Ќ'  
    X  Z X(#' 	      ,   E  1   Z  `	   h   p    x  (#   XE      9     Z p    x  (#  Z X(#9  ,          Plaintiff    p CaseNo.____________________ ,    ~   ݌   	 H   Ќ'  
    X  Z pX(#' 	      ,   E  1   Z  `	   h   p    x  (#   XE      9     Z p    x  (#  Z X(#9  ,  /         ,  /     ݌̌'  
    X  Z pX(#' 	      ,   E  1   Z  `	   h   p    x  (#   XE      9     Z p    x  (#  Z X(#9  ,  3        vs. ,  3     ݌   	 
d   Ќ'  
    X  Z pX(#' 	      ,   E  1   Z  `	   h   p    x  (#   XE      9     Z p    x  (#  Z X(#9  ,  O         ,  O     ݌̌'  
    X  Z pX(#' 	      ,   E  1   Z  `	   h   p    x  (#   XE      9     Z p    x  (#  Z X(#9  ,  S        ________________________________    p  ,  S     ݌   	 0   Ќ'  
    X  Z pX(#' 	      ,   E  1   Z  `	   h   p    x  (#   XE       ,  	        Defendant ,  	  	   ݌   	 	   Ќ'  
    X  Z X(#' 	      ,   E  1   Z  `	   h   p    x  (#   XE       ,  
         ,  
  
   ݌̌'  
    X  Z X(#' 	     E  1   Z  `	   h   p    x  (#   XE  -              -          PETITIONFORPROTECTIONFROMABUSEORDER -       ݌   	 x
   Ќ     	      -              -  O        (K.S.A.603101etseq.) -  O  v   ݌   	 ^   Ќ     	      L      X      Xx  X  X Xx                          L           L    h   ݌   	 D   Ќ                      X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X    X   K  .   4 `	   h   p    x  (#  Z X(#K           L          1.    4     `	 Plaintiffseeksanorderforprotectionfromabuse: L       ݌   	 $   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X      K  .    `	   h   p    x  (# , X(#K           L           L       ݌̌                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X           L  >            `	 a.% _    &% _      ԀForPlaintiffOnly,or L  >     ݌   	    Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                       X    X E  + `	 `	 `	   h   p    x  (#  X(#E           L              `	 (Kansaslawrequiresaformerorcurrentrelationshipwhichmaybeestablished   	    byanyoneofthefollowingoptions.)               L       ݌   	 l   Ќ                           Xx  X  X Xx 	               L      X      Xx  X  X Xx                         X    X      H  .    `	   h   p    x  (#`	 `	 `	X(#H           L           L       ݌̌                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                       X E  + `	 `	 `	   h   p    x  (#  X(#E           L  V        _        i_        .PlaintiffandDefendant: L  V     ݌   	 8   Ќ                       X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X    X      H  .    `	   h   p    x  (#`	 `	 `	X(#H           L              `	           % `    &% `   #   Ԁareinadatingrelationship L       ݌   	 n   Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L              `	           % a    &% a      Ԁwereformerlyinadatingrelationship L    t   ݌   	 T   Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L              `	           % b    &% b   U   Ԁresidetogetherinthesameresidence L       ݌   	 :   Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  !            `	           % c    &% c      Ԁformerlyresidedtogetherinthesameresidence L  !     ݌   	     Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L              `	           % d    &% d      Ԁhaveachildincommon L    V   ݌   	    Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  V          L  V       ݌̌                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                              L  s!        b.&ForPlaintiffandPlaintiffsminorchild(_        ren_        ),or L  s!  !   ݌   	    Ќ                       X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X    X E  + `	 `	 `	   h   p    x  (#  X(#E           L  "        (Kansaslawrequiresaformerorcurrentrelationshipwhichmaybeestablished   	 h   byanyoneofthefollowingoptions.) L  "  #   ݌   	 N    Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X    X      H  .    `	   h   p    x  (#`	 `	 `	X(#H           L  $         L  $  %   ݌̌                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                       X E  + `	 `	 `	   h   p    x  (#  X(#E           L  Z&        _        i_        .PlaintiffandDefendant: L  Z&  !'   ݌   	 "j    Ќ                       X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X    X      H  .    `	   h   p    x  (#`	 `	 `	X(#H           L  '            `	           &areinadatingrelationship L  '  (   ݌   	  #P!   Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  )            `	           &wereformerlyinadatingrelationship L  )  Y*   ݌   	 #6"   Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  K+            `	           &residetogetherinthesameresidence L  K+  +   ݌   	 $ #   Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  ,            `	           &formerlyresidedtogetherinthesameresidence L  ,  X-   ݌   	 %!$   Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  S.            `	           &haveachildincommon L  S.  .   ݌   	 &!%   Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  /         L  /  Q0   ݌̌                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X           L  0            `	      ii.Plaintiffsminorchild(_        ren_        )andDefendant: L  0  b1   ݌   	 d(#'   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  o2            `	           &residetogetherinthesameresidence L  o2  2   ݌   	 J)$(   Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  3            `	           &formerlyresidedtogetherinthesameresidence L  3  |4   ݌   	 0*%)   Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  w5            `	            L  w5  6   ݌̌                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  6         L  6  F7   ݌̌                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  7         L  7  c8   ݌̌                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  8         L  8  9   ݌   	 -)-   Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X    X E  + `	 `	 `	   h   p    x  (#  X(#E           L  #:        c.&OnlyonbehalfofPlaintiffsminorchild(_        ren_        )orminorchild(_        ren_        )residing   	       withPlaintiff(Kansaslawrequiresaformerorcurrentrelationshipwhichmaybe   	     establishedbyanyoneofthefollowingoptions.) L  #:  :   ݌   	 |   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X    X      H  .    `	   h   p    x  (#`	 `	 `	X(#H           L  <         L  <  =   ݌̌                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X           L  Q>            `	      _        i_        .Minorchild(_        ren_        )andDefendant: L  Q>  >   ݌   	 H   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  ?            `	           &areinadatingrelationship L  ?  ~@   ݌   	 .	~   Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  fA            `	           &wereformerlyinadatingrelationship L  fA  A   ݌   	 
d   Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  B            `	           &residetogetherinthesameresidence L  B  tC   ݌   	 
J   Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  eD            `	           &formerlyresidedtogetherinthesameresidence L  eD  D   ݌   	 0   Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  E            `	           &haveachildincommon L  E  |F   ݌   	 	   Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L  ^G         L  ^G  G   ݌   	 
   Ќ                        X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X       K  1 `	  `	 `	 
   h   p    x  (#  X(#K           L  H        Theminorchild(_        ren_        )forwhomPlaintiffseeksprotectionare:(givefullnames   	 	   andyearofbirth) L  H  jI   ݌   	 x
   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X      T  1 `	  `	 `	 
   h   p    x  (#`	  `	 `	, X(#T           L  J        NAME          YOB     MOTHERSNAME      FATHERSNAME L  J  K   ݌   	 ^   Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                                         L  L            `	 % e    -     Ԁ-     % e   FM    L  L  M   ݌   	 D   Ќ                        X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                                   L  N            `	 -     Ԁ-      L  N  O   ݌   	 *z   Ќ                        X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                                   L  NP            `	 -     Ԁ-      L  NP  P   ݌   	 `   Ќ                        X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                                   L  R            `	 -     Ԁ-      L  R  R   ݌   	 F   Ќ                        X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                                   L  S            `	 -     Ԁ-      L  S  fT   ݌   	 ,   Ќ                        X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                                   L  U         L  U  2V   ݌   	    Ќ                        X    Xx  X  X Xx 	      
f       	 
  (    0                              3                                                /                   	                  / "                     "          ,   T  1     `	   h   p    x  (#`	  `	 `	, X(#T              X,      K  .    `	   h   p    x  (#   X(#K     W   2        2
   
 .3
   
     `	      Defendantcanbeservedat:(pleaseprovideallavailableaddresses)   W  X   ݌   	    Ќ     X 3   `	  `	 `	, X(#  X(#3         	      L      X      Xx  X  X Xx                                  L  Y         L  Y  ;Z   ݌   	    Ќ                       X    Xx  X  X Xx 	          9      `	  N(#`	  `	 `	, X(#9          `	 HOME:    N street% h    -     Ԁ-     % h   X[   city% i    -     Ԁ-     % i   [      	 t            `	      state% j    -     Ԁ-     % j   q\   Ԁzipcode% k    -     Ԁ-     % k   \   Ԁphonenumber% l    -     Ԁ-     % l   ]      	 Z            r   6   " "  N z  * (# X N(#6     "          N timeswhendefendantisusuallythere% m    -     Ԁ-     % m   &^      	 @              r 6      z  * (#" "  zX(#6 ?  " 
  `	  N z  *  (#   zX(#?     `	 WORK:    N street% n    -     Ԁ-     % n   __   Ԁcity% o    -     Ԁ-     % o   _      	 \   Q  +   `	  N z  *   Q  (#  `	  N zX (#Q     `	          N state% p    -     Ԁ-     % p   `   Ԁzipcode-     Ԁ-     phonenumber% q    -     Ԁ-     % q   Ra      	 B       `	          N timeswhendefendantisusuallythere% r    -     Ԁ-     % r   b      	 (   N  " 
  `	  N z  *  (#
  `	  N zX K  (#N     `	 OTHER:    N street-      t  XvG
 X  X Xx Ԁ   Xx  X
 Xt XvG Ԁ u  XvG
 X  X Xx Ԁ-        Xx  X
 Xu XvG city% v    -     Ԁ-     % v   c      	        `	          N state% w    -     Ԁ-     % w   id   Ԁzipcode% x    -     Ԁ-     % x   d   Ԁphonenumber% y    -     Ԁ-     % y   e      	          `	          N timeswhendefendantisusuallythere% z    -     Ԁ-     % z   e      	 !     L      X      Xx  X  X Xx                         X    X        T  .    `	   h   p    x  (#  `	  N zX (#T           L  If            `	            L  If  9g   ݌̌                              Xx  X  X Xx 	     "                     "          ,X K  1     `	   h   p    x  (#  X(#K            ,      E  ( `	 `	   h   p    x  (#   X(#E     g   2        3
   
 .3
   
     `	      PlaintiffseeksprotectionfromabusebecauseDefendant:(checkallthatapply)   g  h   ݌   	 b#"   Ќ   X '     X(#`	 `	X(#'       	      L      X      Xx  X  X Xx                        H  .    `	   h   p    x  (#  X(#H           L  j         L  j  j   ݌   	 H$#   Ќ                       X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                                  L  }k        % {    &% {   l   ԀcausedPlaintiffbodilyinjuryorattemptedtocausePlaintiffbodilyinjury L  }k  k   ݌   	 .%~ $   Ќ                       X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                                  L  m        % |    &% |   m   ԀplacedPlaintiffinfearofimminentbodilyinjurybythreateningPlaintiff L  m  m   ݌   	 &d!%   Ќ                       X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                                  L  n        % }    &% }   ?o   Ԁcausedtheminorchild(_        ren_        )bodilyinjuryorattemptedtocausetheminor L  n   o   ݌   	 &J"&   Ќ                       X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X    X      E  + `	 `	 `	   h   p    x  (#  X(#E           L  Pp        ݀child(_        ren_        )bodilyinjury L  Pp  1q   ݌   	 '0#'   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L  r        % ~    &% ~   r   Ԁplacedtheminorchild(_        ren_        )infearofimminentbodilyinjury L  r  r   ݌   	 ($(   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L  s        %     &%    pt   Ԁengagedinanyofthefollowingactswithaminorunder16yearsofagewho L  s  Qt   ݌   	 )$)   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X           L  du        ݀isnotthespouseofDefendant:sexualintercourseorlewdfondlingor L  du  u   ݌   	 *%*   Ќ                            Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L  v        ݀touchingonthepersonofeithertheminororDefendant. L  v  dw   ݌   	 x+&+   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                                        L  Ex         L  Ex  x   ݌   	 ^,',   Ќ                       X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                                  L  vy         L  vy  y   ݌   	 D-(-   Ќ                       X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                      X       E  + `	 `	 `	   h   p    x  (#`	 `	 `	X(#E           L  z        4.    `	 DescribewhyPlaintiffseeksaprotectionfromabuseorderandincludespecific   	       facts:%     -        Xx  X  X Xx Ԁ   Xx  X  X Xx Ԁ   Xx  X  X Xx Ԁ-        Xx  X  X Xx %    	|    L  z  n{   ݌   	     Ќ                          Xx  X  X Xx 	      L      X      Xx  X  X Xx                      X                L  }            `	 %     -        Xx  X  X Xx Ԁ   Xx  X  X Xx Ԁ   Xx  X  X Xx Ԁ-        Xx  X  X Xx %    s~    L  }  E~   ݌   	 |   Ќ                           Xx  X  X Xx 	      L      X      Xx  X  X Xx                      X                L  +            `	 %     -        Xx  X  X Xx Ԁ   Xx  X  X Xx Ԁ   Xx  X  X Xx Ԁ-        Xx  X  X Xx %        L  +     ݌   	 b   Ќ                           Xx  X  X Xx 	      L      X      Xx  X  X Xx                      X                L          ݀    `	 %     -        Xx  X  X Xx Ԁ   Xx  X  X Xx Ԁ   Xx  X  X Xx Ԁ-        Xx  X  X Xx %    \    L    -   ݌   	 H   Ќ                           Xx  X  X Xx 	      L      X      Xx  X  X Xx                      X                L              `	 %     -        Xx  X  X Xx Ԁ   Xx  X  X Xx Ԁ   Xx  X  X Xx Ԁ-        Xx  X  X Xx %    Ѕ    L       ݌   	 .	~   Ќ                           Xx  X  X Xx 	      L      X      Xx  X  X Xx                      X      H  .    `	   h   p    x  (#`	 `	 `	X(#H           L          %     -     Ԁ-     %    z    L    [   ݌   	 
d   Ќ                       X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                                  L          %     -     Ԁ-     %    R    L    3   ݌   	 
J   Ќ                       X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                                  L          %     -     Ԁ-     %    *    L       ݌   	 0   Ќ                       X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                                  L  c        %     -     Ԁ-     %        L  c     ݌   	 	   Ќ                       X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                                  L  ;        %     -     Ԁ-     %    ڏ    L  ;     ݌   	 
   Ќ                       X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                                  L          %     -     Ԁ-     %        L       ݌   	 	   Ќ                       X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                                  L          ݀(Attachadditionalpagesasneeded.) L    n   ݌   	 x
   Ќ                       X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L  6         L  6  Ĕ   ݌   	 ^   Ќ                       X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                      X       B  ( `	 `	   h   p    x  (#  X(#B           L  g        5.    `	 PlaintiffrequeststhatPlaintiffs&addressand/or&telephonenumberremain   	 D   confidentialforthefollowingreason(s):(completeifappropriate) L  g  9   ݌   	 *z   Ќ                          Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X    X      E  .   `	 
   h   p    x  (#`	 `	X(#E           L              `	 -     Ԁ-      L    z   ݌   	 `   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L  ř            `	 %     -     Ԁ-     %        L  ř  S   ݌   	 F   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X    X H  ( `	 `	   h   p    x  (#  `	, X(#H           L          (IfPlaintiffrequeststhatPlaintiffsaddressremainconfidential,Plaintiffmust   	 ,   completetheProtectionfromAbuseConfidentialAddressFormandincludeit   	    withthispetition.) L       ݌   	    Ќ                            Xx  X  X Xx 	      L      X      Xx  X  X Xx                              B  +   
   h   p    x  (#`	 `	X(#B           L           L       ݌   	    Ќ                       X    Xx  X  X Xx 	     /                   	                 / 0   `	 `	, X(#  
 X(#0 "                     "          ,   N  1     `	   h   p    x  (#`	 `	, X(#N     0   `	 `	, X(#   X(#0        ,        2        6
   
 .3
   
     `	      PlaintiffrequeststhattheCourtissueanExParteTemporaryOrderofProtection   	 t   andFinalOrderofProtectionrestrainingdefendantfrom:     ˠ   ݌   	 Z   Ќ      0   `	 `	, X(#`	 `	, X(#0       	      L      X      Xx  X  X Xx                                  L  I         L  I  ɢ   ݌   	 @   Ќ                       X    Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X       H  + `	 `	 
   h   p    x  (#`	 `	, X(#H           L  l        &    
 abusing,molestingorinterferingwiththeprivacyorrightsoftheprotected   	 &v   person(s) L  l  D   ݌   	 \   Ќ                            Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X           L  c        &    
 enteringorcomingonoraroundthepremisesortheresidenceoftheprotected   	 B   person(s)locatedat:%     -     Ԁ-     %       , L  c     ݌   	 (   Ќ                            Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L          andtheworkplacelocatedat:%     -     Ԁ-     %    x   . L    8   ݌   	    Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                      X           L              `	 (Giveaddressorotherdescriptionofresidenceandworkplacefromwhich   	    Defendantistobeexcluded.DONOTincludetheresidentialaddressifPlaintiff   	     isrequestingthatPlaintiffsresidentialaddressistoremainconfidential.) L       ݌   	 p!    Ќ                          Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X    X      K  .    
   h   p    x  (#`	 `	, X(#K           L  ɫ         L  ɫ     ݌̌                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                      |X    X      N  . 
  `	 
   h   p    x  (#   
 X(#N           L  ?        7.    `	 Plaintiffstatestheresidenceis: L  ?  )   ݌   	 <#"   Ќ                       |    Xx  X  X Xx 	      L      X      Xx  X  X Xx                      |X           L              `	     
 %     &%            jointlyowned,orrentedandjointlyoccupiedbyPlaintiffandDefendant L       ݌   	 "$r#   Ќ                      |    Xx  X  X Xx 	      L      X      Xx  X  X Xx                      |X                L              `	     
 %     &%    u        owned,orrentedbyPlaintiff L    >   ݌   	 %X $   Ќ                       |    Xx  X  X Xx 	      L      X      Xx  X  X Xx                      |X                L  D            `	     
 %     &%    	        owned,orrentedbyDefendantonly L  D  Ҳ   ݌   	 %>!%   Ќ                       |    Xx  X  X Xx 	      L      X      Xx  X  X Xx                      |X                L  ݳ            `	     
 %     &%            owned,orrentedbysomeoneelse(explain)%     -     Ԁ-     %        L  ݳ  k   ݌   	 &$"&   Ќ                       |    Xx  X  X Xx 	      L      X      Xx  X  X Xx                      |X                L              `	     
      %     -     Ԁ-     %        L    u   ݌   	 '
#'   Ќ                       |    Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X    X      N  .    
   h   p    x  (#
  `	, X(#N           L              
 %     &%             notapplicablebecausethePlaintiffandDefendantdonotlivetogether. L    ո   ݌   	 (#(   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L           L       ݌̌                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X    X Q  1 `	  `	 `	 
   h   p    x  (#   
 X(#Q           L          %     &%       ԀPlaintiffrequeststheCourtorderthattheDefendantimmediatelymovefrom   	 l*%*   andnotreturntotheresidence,andthatLawEnforcementofficersbedirectedto   	 R+&+   removeDefendantfromtheresidence,locatedat:%     -     Ԁ-     %    4    L       ݌   	 8,',   Ќ                            Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X    X      T  1    `	 
   h   p    x  (#`	  `	 `	, X(#T           L              `	 %     -     Ԁ-     %    =   . L       ݌   	 -n(-   Ќ                             Xx  X  X Xx 	     /                   	                 / 0   `	 X(#   `	, X(#0 "                     "          ,X H  1     `	   h   p    x  (#`	 X(#H     *   `	 X(#   X(#*        ,        2        8
   
 .3
   
     `	      PlaintiffrequeststhattheCourtissueanExParteorderoftemporarycustodyof   	       theminorchildrenandhasattachedacompletedformconcerningjurisdiction   	     (_        UCCJEA_        Ԁform).(Completeeitheroption(a.)ORoption(b.))        ݌   	 |   Ќ   X $   `	 X(#`	 X(#$       	        X        E  .    `	   h   p    x  (#`	 X(#E    	 b        X    X      E  + `	 `	 `	   h   p    x  (#  X(#E a.%     &%       ԀDefendantsparentageofthechild(_        ren_        )hasnotbeenestablishedand   	 H   Defendanthasnorighttocustodyorparentingtimewiththechild(_        ren_        ).   	 .	~             b.%     &%       ԀDefendantsparentageofthechild(_        ren_        )hasbeenestablishedandthePlaintiff   	 
J   requeststhefollowingcustodyandparentingtimeorders:   	 0            B  (     h   p    x  (#`	 `	 `	X(#B _        i_        .Temporarylegalcustodyandresidencyoftheminorchild(_        ren_        )be:%     Ԁ   	 	   B  (     h   p    x  (#  X(#B      &%       Ԁ     JointlegalcustodybetweenPlaintiffandDefendantuntilthisorder   	 
             expires;or,   	 	      4 E  (     h   p    x  (# , hX(#E %     &%       Ԁ     Solelegalcustodygrantedto&Plaintiff,&Defendantuntilthis   	 x
   orderexpires.   	 ^      X        4 E  (     h   p    x  (#   X(#E Ӏii.Rightsoftemporaryparentingtimeasfollows:   	 D        X Ӏ     &PlaintiffandDefendantshallhaveparentingtimeasdescribedin   	 *z        theattachedparentingplan;or   	 `   Ѐ     &Defendantshallhavenoparentingtime;or   	 F        &Defendantshallhavesupervisedparentingtimeasfollows:%     -     Ԁ-     %    +      	 ,   K  +   `	   h   p    x  (#   X(#K     `	      %     -     Ԁ-     %          	        `	      %     -     Ԁ-     %       .   	       X   K  (     h   p    x  (#  `	  X(#K      &PlaintiffandDefendantshallexchangetheminorchild(_        ren_        )for   	     L      X      Xx  X  X Xx                         X    X      N  . `	  `	 `	   h   p    x  (#   X(#N           L  X             parentingtimeat:%     -     Ԁ-     %        L  X  B   ݌   	 t   Ќ                              Xx  X  X Xx 	      L      X      Xx  X  X Xx                         X                L               %     -     Ԁ-     %    N   .          L       ݌   	 Z   Ќ                              Xx  X  X Xx 	               L      X      Xx  X  X Xx                         X            T  1    `	 
   h   p    x  (#`	  `	 `	  X(#T           L           L       ݌̌                              Xx  X  X Xx 	     -   `	 X(# X 
 X(#- "                     "          ,   H  1     `	   h   p    x  (#`	 X(#H     *   `	 X(#   X(#*        ,          P   2        9
   
 .3
   
     `	      Thecourtshouldgivecopiesoforderstotheappropriatelawenforcement   	 &v   agencies;setadate,timeandhearingonthismatter;andissuesummonsto   	 \   Defendant,notifyingDefendantofthisactionandthereliefrequested.   P  3   ݌   	 B   Ќ      $   `	 X(#`	 X(#$       	      L      X      Xx  X  X Xx                      |X            E  . 
  `	 
   h   p    x  (#`	 X(#E           L           L       ݌   	 (   Ќ                       |    Xx  X  X Xx 	     -   `	 X(#
  `	, X(#- "    	                 "          , H  1     `	   h   p    x  (#`	 X(#H     *   `	 X(#   X(#*        ,        2        10
   
 .3
   
     `	      Afterahearing,thecourtshouldissueafinalorderofprotectionprohibiting   	    Defendantfromcommittinganyactsofabuseagainsttheprotectedperson(s),and   	    orderthefollowingadditionalrelief:        ݌   	     Ќ    $   `	 X(#`	 X(#$       	      L      X      Xx  X  X Xx                      X          H  1 `	  `	 `	 
   h   p    x  (#`	 X(#H           L  V         L  V  :   ݌   	 p!    Ќ                           Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L          %     &%       Ԁ    
 suitablealternatehousingforPlaintiffandminorchild(_        ren_        ) L    k   ݌   	 V"!   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L          %     &%    G       
 custodyoftheminorchild(_        ren_        )(_        UCCJEA_        Ԁformcompleted) L    (   ݌   	 <#"   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L  p        %     &%           
 childsupport L  p     ݌   	 "$r#   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L          %     &%           
 supportofspouse L    j   ݌   	 %X $   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L  L        %     &%           
 possessionofpersonalproperty,andtheassistanceoflawenforcement   	 %>!%   officersinsecuringthatproperty,ifnecessary L  L     ݌   	 &$"&   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L  6        %     &%           
 attorneysfees,ifrepresentedbycounsel,andcosts L  6     ݌   	 '
#'   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L          %     &%    z       
 counselingforDefendant L    [   ݌   	 (#(   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L  D        %     &%           
 other,pleasespecify:%     -     Ԁ-     %    9    L  D     ݌   	 )$)   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L  L        %     &%           
 %     -     Ԁ-     %    *    L  L     ݌   	 l*%*   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L  `        %     &%       Ԁ%     -     Ԁ-     %    4   Ԁ L  `     ݌   	 R+&+   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L  k        &-     Ԁ-     Ԁ L  k     ݌   	 8,',   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L  :        &-     Ԁ-     Ԁ L  :     ݌   	 -n(-        
       8   ʬ         d          d  8       
       
   
 ь                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                      X           L          11.    `	 ThefollowinglegalactionshavebeenfiledbetweenPlaintiffandDefendantor   	       involvingtheminorchild(_        ren_        ):(checkcasetype,givecountyfiledin,andgive   	     casenumberanddatefiled,ifknown) L    	   ݌   	 |   Ќ                          Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L          %     &%    u       
 divorce/custody%     -     Ԁ-     %        L    V   ݌   	 b   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L          %     &%    ~       
 paternity%     -     Ԁ-     %        L    _   ݌   	 H   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L          %     &%           
 childinneedofcare%     -     Ԁ-     %        L    m   ݌   	 .	~   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L          %     &%           
 actionseekingprotectiveorder%     -     Ԁ-     %        L    u   ݌   	 
d   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                L          %     &%           
 other%     -     Ԁ-     %        L    v   ݌   	 
J   Ќ                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                        X                      L           L       ݌̌                             Xx  X  X Xx 	      L      X      Xx  X  X Xx                                  L  #        L  #   ݌   	 	   Ќ                       X    Xx  X  X Xx 	                ?      p    x  (#`	  `	 `	, X(#?         	 
   __________________________________________   	 	         6   	    p    x  (# X(#6      Plaintiffssignature   	 x
        PlaintiffsName:%     -     Ԁ-     %         	 ^        Address1:%     -     Ԁ-     %    E     	 D        Address2:%     -     Ԁ-     %         	 *z        City,State,Zip:%     -     Ԁ-     %         	 `        TelephoneNumber:%     -     Ԁ-     %    7     	 F   <  " 
     p    x  (#  X(#<      (DONOTincludetheresidentialaddressifPlaintiffisrequestingthatPlaintiffs   	    residentialaddressistoremainconfidential.IfPlaintiffrequeststhatPlaintiffsaddress   	    remainconfidential,PlaintiffmustcompletetheProtectionfromAbuseConfidential   	 t   AddressFormandincludeitwiththispetition.)   	 Z        ?   	    p    x  (#  , pX(#? <  " 
     p    x  (#  X(#< %     -     Ԁ-     %    !	     	 &v   AttorneyrepresentingPlaintiff(ifany)   	 \   AttorneysName:%     -     Ԁ-     %    #
     	 B   Address1:%     -     Ԁ-     %    
     	 (   Address2:%     -     Ԁ-     %    k     	    City,State,Zip:%     -     Ԁ-     %         	    Telephone:%     -     Ԁ-     %         	     ?  " 
     p    x  (#   X(#?  7      +	   ?  " 
     p    x  (#   X(#?         +	 <   	    p    x  (#   X(#<  7         VERIFICATION 7   M  ݌   	 <#"   Ќ      -      X(#  X(#- 	     ?  " 
     p    x  (#   X(#?  1   N  1   Z  `	   h   p    x  (#   X(#N       1  /       STATEOF____________________    h ) 1  /   ݌   	 %X $   Ќ0      X(#  Z X(#0 	      1   N  1   Z  `	   h   p    x  (#   X(#N       1  P           Z          `	               h )ss: 1  P   ݌   	 %>!%   Ќ0      X(#  Z X(#0 	      8        E  (     h   p    x  (#   X(#E  8         COUNTYOF__________________    h ) 8     ݌   	 &$"&   Ќ	      6      S   N  1     `	   h   p    x  (#   X(#N         XS                 6         IswearoraffirmthatthestatementsmadeinthisPetitionaretrueandcorrecttothebest   	 (#(   ofmyknowledgeandbeliefandthatIamthepersonfilingthispetition. 6   )  ݌   	 l*%*   Ќ0      X(#   X(#0      X 	          <   	    p    x  (#   X(#<                __________________________________________   	 8,',        Plaintiffssignature   	 -n(-    .      S   K  1     `	   h   p    x  (#  X(#K            .  c       SUBSCRIBEDANDSWORNtobeforeme,aNotaryPublic,this______dayof   	       _______________________________20%     -     Ԁ-     %      . .  c   ݌   	     Ќ-     X(#   X(#-      S 	               __________________________________________   	 b        NotaryPublic *        	 H                  H  .    `	   h   p    x  (#  X(#H  *                       *   E  ݌̌      	          {  d      X    4 `	 " N  h   p    x   (# (# ' 0* , . 81 3 5 @8 : < H? A X(#{ MyAppointmentExpires:   	 0        c  1   Z  `	   h   p    x  (#   X  , " N X (# 'Xc ___________________   	 	   K  .    `	   h   p    x  (#  Z X(#K 