Las Vegas Justice Court

Electronically Filed
12/23/2019 10:16 AM
Suzan Baucum
CLERK OF THE COURT

1
19PO2029
Case No.
Dept. No. Department #: LVJC 10

3 IN THE JUSTICE COURT OF Las Veoas TOWNSHIP

4 COUNTY OF Clark , STATE, OF NEVADA

,7
e shurmur )

Applicant(s),) APPLICATION FOR ORDER FOR

I vs.
PROTECTION AGAINST STALKING,
whitlock AGGRAVATED STALKING,
9
oR HARASSMI,NT (NRS 200.s91)
)
10 )
)
11 Adverse Party(s).)

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STALKING - A person commits the crime ofstalking when, without lawful aulhority, that person wllfully or maliciously engages in
a course ofconduct that would cause a reasonable person 10 feel tenorized, liightened, intimidated or harassed, and that actually
causes
thc victim to feel terrorizcd, frightened, inlimidated or harassed (NRS200575(l))

t4 ACGRAVATED STALKING - A person commits the crime of aggravated statking when that person commits the crime ofstalking
-a, in conjrn"t;on tt,e,ewith, threatens the person with the intent io cause him to be placed in reasonable fear ofdeath or substantial
bodily harm. (NRS 200.575 (2))
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HARASSMf,NT - A person commiE the crime ofharassmenr when (a) that p€rson, without la*,ful authority, knowingly threatens: (l )
L6 to cause bodily injury in the future to the person threatened or to any other person; (2) to cause physical damage to the prop€rty of- .
another persoq (j) to subject the pelson threatened or any other pirson to physical confinementor restraint;or (4) to do any act which
is intendid to zuLstantially harm ihe person threatened or any other person with respect to his physical or mental health or safety;-and
7'7 (b) the person by words o; conduct piaces the person receiving the lhreat in reasonable lear that the threat will be carried out. (NRS
200.57t)

18

L9 PLEASE TYPE OR PRINT CLEARLY'

20 COMPLETE THE APPLICATION TO THE BEST OF YOUR KNOWLEDGE.

2t I am applying for protection (check all that apply):
22
E For Myself I on b.hulf of unother person(s)

24

Form A3-Application for Order for Protection Againsl Stalking, @200? Ncvada Supr€me Cout
Aggravated Statkin& or Harassment (NRS 200 591) June 30,2007

PaBe I of7

Case Number: 19PO2029

 Applicant states the following facts under penalty of perjury:

I reasonably believe that the Adverse Party has committed and/or is committing the

crime ol stalking, aggravated stalking or harassment as defined above' The acts occurred as

follows:

(NOTE: BE SPECIFIC AS TO WHO COMMITTED WHAT ACT OR ACTS, AGAINST

IYHOM, WHEN, WHERE,IYHETHER COMMITTED OR THREATENED; INDICATE
APPROXIMATE DATE(S) AND LOCATION(S).)

THIS FORM IS A PUBLIC RECORD

on mar.20 2019 my father died. mrs whittlock then tried to evict me using a power of attny. she had no
of atlny cause my dad was a stroke victim unable to respond. she has called police maybe
hundreds of times this year. she walks around and on my property stalking me and my friends . she
false reports to metro. she says lies to people concerning me
10

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74

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7'7

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1,9

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2l NOTE: PLEASE DO NOTWNTE ON THE BACKS OFANY PAGES;

CHECK BOX IF YOU ARE USING ADDITIONAL PAGES.

Z Check yyou use a continuotion page (to be incorporated by reference)

24 This matter does not have to be reported to law enforcement; however, has a report ever been

25 filed? E Yes E No I dont know

Form A3-Applicarion for Order for Proteclion ASainst Stalkin& 02007 Ncvada Supreme Court
Aggravatcd St6lkin8, or Hatassmenl ( N RS 200.59 I ) June 30, 2007

Pagc 2 of7
 If yes, approximate date(s):

N/A

Name of Iaw enforcement agency:

N/A

Case/Event number if known:

(NOTE: IT IS NOT NECESSARY TO FILE A LAW ENFORCEMENT REPORT'

iur m you HAvE oNE AvAILABLE, PLEASE ATTACH A coPY oR BRrNG IT
TO THE COURT HEARING.)

For purposes of this form, a "TPO Action" is defined to include the following Justice Court
actions:
--"--'-
(t) en Order for Protection Against Stalking and Harassment (NRS 200'591);
(2) An Order for Protection of Children (NRS 33.400);
10 (NRS33'270)'
i3j nn Orde, for Protection Against Harassment in the Workplace .A
.,TpO Aciion" is also defined to include the following Justice/Tamily/District Court action:
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(a) An Order for Protection Against Domestic Violence (NRS 33'020)

Please Check the Appropriate Box Below:

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I In the last 2 years, Applicant or any party seeking protection has not filed a TPO
14 action against the Adverse Party anywhere in the State ofNevada, and the Adverse
Party ha-s not filed a TPO action against Applicant or any party seeking protection
15 anywhere in the State ofNevada.

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E In the last 2 years, the following TPO action(s) in the State ofNevada have been filed
L'7 involving Applicant and the Adverse Party:
1B

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20

2L

22 Appticanl musl be at least I8lears ofoge. If nol 18 years ofage, consult with the Clerk'

l. a) Applicant's Name Age

24 shurmur. iefferv e 5't

(Last) (First) (Middle)

Form A3-Application fior Order for Prolection Against Slalkin& 02007 Nevada Suprcne Coun
June 10. 2007
Aggravatcd StalkinS, or Harassment (NRS 200.591)

Page 3 of7
1 b) Applicant's relationship to Adverse Party: neibor

2 c) Provide names below ofthose for whom you are seeking protection, including

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yourself, minors or household members that need this protection. Indicate the relationships of
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all persons listed to yourselfand to the Adverse Party (e.g., spouse, intimate partner, friend,
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roommate, neighbor, relative, acquaintance, co-worker, stranger):
6

'l NAME AGE RELATIONSHIP RELATIONSHIP

TO APPLICANT TO ADVERSE
I PARTY
jefiery shurmur Self (if applicable)
9 51 neibor

10

11

\2

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Explain why protection is needed for the individuals listed above:
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L't

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19 (NOTE: YOUR APPLICATION WILL NOT BE DENIED BASED UPON A

PARTICULAR RELATIONSHIP, HOWEVER, DEPENDING UPON YOUR
20 RELATIONSHIP, YOU MAY ALSO BE ELIGIBLE TO APPLY FOR AN ORDER OF
PROTECTION AGAINST DOMESTIC VIOLENCE PURSUANT TO NRS CHAPTER
2L 33.)

2. Has the Adverse Party ever lived with any Party listed above? I Yes I No

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If so, for how long?

24 J. Is anyone listed above living with the Adverse Party now? rl Yes I No

If so, who? trUA

Form AJ-App,ication for Order for Protection Against SlalkinS, @2007 Nevada Supreme Court
AgSmvated Stalking, or Harassmenl (NRS 200.591) June 10. 2007

Page 4 of 7
1 4. Date of separation (ifapplicable): run

2
5. Are there children involved? [ Yes tsNo If so, how are they involved?
3

5 6. Has the Adverse Party ever been involved in any other relevant court actions (e.g.,

6 eviction, divorce, custody, criminal, etc.)?

I don't know
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! v.r I No If yes, please explain:

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11 7. Residence(s) where protection is needed:

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tr CONptOgNfl AL (If confitlential, check and move to the nef, queslion) or,
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I Ifnot confidential, list address, city, state and zip code:
6 w.washington las vegas NV 89107
t4

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15 8. Place(s) ofemployment where protection is needed:

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E CONptOgNf lAL (If conJidenlial, check and move to the next question) ot,
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E Ifnot confidential, list name, address, city, state and zip code:
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2t 9. Location ofschool(s) where protection is needed:

)) I CONfIOSNTIAL (If coniidential, check and move to the next question) or,
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! Ifnot confidential, list name, address, city, state and zip code:
Not applicable
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@2007 Nevada Supreme Coun

Form A3-Application for Order for Protection Against Stalkin&
Jun€ 30, 2007
Aggravated StalkinS, or Harassmenl (NRS 200.591)

Page 5 of7
1 10. Other specific locations frequented where protection is needed (i.e., spo(s, extra-

2 curricular activities, church, employment, after-school activities, etc.):

3
! CONFIOENTIAL (If conlidential, check and move to the nett question) or,
4
E lfnot confidential, list name, address, city, state and zip code:
5

7 I L Ifthere are persons other than those listed on page 4 that the Adverse Party should be
I directed not to contact, please name the individuals and explain why these precautions

9 are needed:

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11 12. If there are any other safety concems that the court should know (e.g., firearms, etc.),
L2 please briefly explain:

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16 RELIEF REOUESTED
L7 THEREFORE, I REQUEST that a Temporary Order be issued against the Adverse
18 Party requiring the Adverse Party to refrain from contacting, intimidating, threatening or

r9 otherwise interfering with me and/or other persons identified in this application, either

directly or through an agent.

)1 that the Court require the Adverse Party to stay away from
I FURTHER REQUEST

the places listed above.

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Form A!-Applicrtion for Order for Protcction Against Stalkin& @2007 Nevada Supreme Coun
Aggravatcd Stalkin& or Harassment (N RS 200.591 ) June 30,200?

Page 6 of7
1 I FURTHER REQUEST the following other conditions:
N/A
2

5 I FURTHER REQUEST that this court set a hearing date for an Extended order as

soon as possible,
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Ev., X No

(NOTf,:IFGRANTEDANDSERVED,ATEMPORARYORDERMAYBEENFORCEI)
rbn up ro so DAys, ExcEP.I THAT IF AN EXTENDED ORDER IS REQUESTED, THE
TEMPORARY ORDER REMAINS IN EFFECT UNTIL THE HEARING ON THE
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EXTENDED ORDER IS HELD BY THf, COURT. IF GRANTED AND SERVED' AN
EXTENDED ORDER MAY BE ENFORCED FOR UP TO ONE YEAR.)
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I ACKNOWLEDGE that an Extended order may only be granted after notice of the petition for the
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Order and of the Hearing thereon is served upon the Adverse Party pursuant to the Rules of Civil
Procedure, and a hearing is held on the petition'

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14 DECLARATION
(NRS 53.04s)
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I DECLARE UNDER PENALTY OF PERIURY UNDER THE LAW OF THE STATE OF

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l7 NEVADA THAT: (I) I AM THE APPLICANT HEREIN, (2) I HAVE READ THE STATEMENTS

18 CONTAINED HEREIN OR HAVE HAD THEM READ TO ME, (3) I BELIEVE THESE

19 STATEMENTS TO BE TRUE, AND (4) THE REQUESTED ORDER IS NEEDED.

ox"a, i2 23 ?d9
2L
ieffery e shurmur
PRINTNAME

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Form A3-Application for Order for Protcction Against Stalkin& @2007 Nevada Supreme Coun
June 30, 200?
Ag8ravarcd Slalkin& or Harassmenl (NRS 200.591)

Page 7 of7