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0916-FC03935
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ADDRESS
PETITION FOR ORDER OF PROTECTION
STALKING ONLYfUNRELATED PARTIES
1. I am the petitioner and (check one)
I reside __County,
o Under 18 years of age, but emancipated.
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3. Respondent may be served (fill in the app priate blank or blanks)
0entx;.\\ :\tI 08 )u VVl6, iat.__--,--___,..---
(home address) (work address) \0 ylZS
(other address)
4. Respondent is ( check one)
At least 18 years of age. 0 Under 18 years of age, but emancipated.
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5. An act of abuse/stalking, as stated below, happened '
. , in_-1fkiloVl County, Missouri
6. Respondent is stalking me.
Explain relationship (e.g. co-workers, neighbors, etc.)
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An immediat and present danger of abuse .exist because respondent me 01). or abou the 0 lowi
date(s): \ 00 - ']' ') I
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