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8904EN - Anti-Harassment:
Petition for Order of
Protection
August 2014
Forms and Instructions
8904EN – Rev. 08/2014
Table of Contents:
Section 1: Introduction ................................................................................................................1
A.
What is an anti-harassment petition? ...........................................................................1
B.
Do I need an anti-harassment petition? .......................................................................1
C.
Where do I file an anti-harassment petition? ................................................................2
D.
Should I use this packet? .............................................................................................2
E.
What forms are in this packet? ....................................................................................2
F.
Words You May Need to Know ....................................................................................3
Section 2: General Instructions for Filling out Forms ...................................................................6
Section 3: Instructions for each Form ..........................................................................................8
A.
Worksheet for the Harassment and/or Stalking Petition ............................................... 8
B.
Motion for Waiver of Fees (WPF UH-02.0100).............................................................8
C.
Financial Statement (WPF UH-02.0110) ......................................................................9
D.
Order to Proceed without Payment of Fees (WPF UH-02.0120) ................................ 10
E.
Law Enforcement Information Sheet – WPF all cases 01.0400.................................. 10
F.
Confidential Information Form (WPF UH-01.0600) ....................................................11
G.
Notice of Hearing (WPF UH-02.0400)........................................................................12
H.
Petition for an Order of Protection (WPF UH-02.0200) .............................................. 12
I.
Temporary Protection Order and Notice of Hearing (WPF UH-03.0200) .................... 14
J.
Order for Protection from Unlawful Civil Harassment (ORAH) WPF UH-04.0500 ....... 15
K.
Petition for an Order for Protection – Respondent under Age 18 – Harassment
(PTAH18) - WPF UHST-05.0100 ..............................................................................16
L.
Temporary Protection Order and Notice of Hearing – Respondent under Age 18 –
Harassment (TORAH18) UH-05.0300 .......................................................................18
M.
Order for Protection – Respondent under Age 18 – Harassment (ORAH) WPF UH05.0500 .....................................................................................................................19
N.
Return of Service – Harassment (WPF UH-04.0110) .................................................20
Section 4: Arranging for service ................................................................................................22
Section 5: Getting Ready for and Going to Your Hearing ..........................................................23
A.
Going to the Hearing..................................................................................................23
This publication provides general information concerning your rights and responsibilities. It is not intended
as a substitute for specific legal advice.
This information is current as of August 2014.
© 2014 Northwest Justice Project — 1-888-201-1014
(Permission for copying and distribution granted to the Alliance for Equal Justice and to individuals for noncommercial purposes only.)
8904EN – Rev. 08/2014
Section 1:
A.
Introduction
What is an anti-harassment petition?
It asks the court to grant you a ”stay-away” order against someone who has been acting
towards you in a way that unreasonably interferes with your privacy or creates an
intimidating, hostile, or offensive living environment for you. If that person’s behavior
has seriously alarmed, annoyed, or harassed you, you might want an anti-harassment
order.
This procedure is generally for people who:
•
are not married to their harasser AND
•
have not lived with the harasser AND
•
have no children in common with the harasser
You must prove the other person's conduct:
•
would cause any reasonable person to suffer serious emotional distress AND
•
was intentional or willful AND
•
served no legitimate or legal purpose
This is different from the definition of domestic violence. The penalties for violations
may be different.
 The law on anti-harassment orders and penalties is online at
http://apps.leg.wa.gov/rcw/default.aspx?cite=10.14, or check with
your local library or local law library.
If the judge awards you an anti-harassment protection order, and the person you got
the order against violates the order, that person can be
•
found in contempt of court
•
ordered to do jail time
•
ordered to pay you or the court a penalty
•
found guilty of a gross misdemeanor
B.
Do I need an anti-harassment petition?
Use the courts’ Worksheet for the Harassment and Stalking Petition. It will help you
figure out what to ask for. A copy of the Worksheet is in this packet.
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C.
Where do I file an anti-harassment petition?
Check with your local clerk of court. You typically file a petition for an Anti-Harassment
Order in district court, but Municipal or superior court may handle these matters in your
county.
D.
Should I use this packet?
This packet is for simple anti-harassment cases only. This packet will not help if:
•
you are under the age of 18
•
you want to file a petition for a child under the age of 18
In those cases, get advice from a lawyer.
 Anti-harassment practice varies by county. Some
judges/commissioners prefer to fill out parts of the forms
themselves. Others want you to do it. For specific information on
how to fill out forms in your county, contact the following: the
court clerk; the court facilitator; your local Domestic Violence
advocacy program; your local volunteer attorney program; an
experienced local family law attorney.
E.
What forms are in this packet?
This packet has the following forms and instructions for each form:
a) Worksheet for the Harassment and/or Stalking Petition - UHST 2.0250
b) Motion for Waiver of Fees - WPF UH-02.0100
c) Financial Statement – WPF UH 02.0110
d) Order to Proceed without Payment of Fees - WPF UH-02.0120
e) Law Enforcement Information Sheet - WPF all cases 01.0400
f) Confidential Information Form
g) Notice of Hearing - WPF UH-02.0400
h) Petition for an Order of Protection - WPF UH-02.0200
i) Temporary Protection Order and Notice of Hearing - WPF UH-03.0200
j) Order for Protection from Unlawful Civil Harassment (ORAH) - WPF UH-04.0500
k) Petition for an Order for Protection – Respondent Under Age 18 – Harassment
(PTAH18) - WPF UHST-05.0100
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l) Temporary Protection Order and Notice of Hearing – Respondent Under Age 18
– Harassment (TORAH18) - WPF UH-05.0300
m) Order for Protection - Respondent Under Age 18 – Harassment (ORAH18) WPF
UH-05.0500
n) Return of Service – WPF DRPSCU 01.0250
F.
Words You May Need to Know
Bailiff: A member of the judge’s staff who is in charge of courtroom procedure and
security. The bailiff and the clerk may sometimes be the same person.
Caption: The heading of each legal document. It has the name of the court, the names
of the parties, the case number, the name of the document itself, and, sometimes, the
type of case.
Clerk of the Court: An officer of the court who handles clerical matters like keeping
records, entering judgments into the record and providing certified copies. Every
courthouse has a Superior Court Clerk’s Office. Someone from the clerk’s office staff is
also usually in the courtroom during hearings.
Commissioner/Court Commissioner: This person is like a judge, but only makes decisions
relating to a specific subject matter. Many counties have family law commissioners who
decide family law cases 1.
Confirm a Hearing or Trial: Notifying the court that you intend to have the hearing or
trial scheduled in your case. The way to confirm your hearing or trial differs by county.
Not all counties require it. Often you need to call the court a few days before the
hearing or trial. Local rules explain each county’s requirements. If yours requires you to
give confirmation notice and you do not, the court may cancel the hearing or trial.
Conformed Copy: A copy of any court document you have filed with the clerk. You must
have it stamped with the date filed. If the document is an order, it must also have the
name of the judge who signed it written or stamped on it.
Contested Case: Opposing parties take part and disagree about the case’s outcome.
Continuance: Delaying your court hearing to a later date. In some counties, you must
ask the judge for a continuance.
Custodian (also Custodial Parent): The person the children live with most of the time.
Declaration: A written statement made to the court under oath.
In many counties, court commissioners make decisions in family law cases instead of judges. To make
this packet simpler, we mostly just use “judge.”
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Default Order: An order the Petitioner can request if
•
the respondent fails to file a Response before the deadline OR
•
s/he has appeared in the case but then fails to file a Response after being served
with a Motion for Default
Docket: the court’s schedule of cases it will hear on a specific day.
Ex Parte: Going before the court without notifying the other party. Sometimes also
refers to the courtroom where you see a judge without notifying the other party.
Ex Parte Restraining Order: An order the judge signs if emergency circumstances require
protection before the court can hold a temporary hearing.
Exhibit: Documents, records, and photographs introduced into evidence at trial or
hearing. Attachments to legal forms are sometimes exhibits. If they are, they should
follow the format rules for court forms. (This packet has basic information about the
format rules in the General Instructions section.)
Filing: Giving court papers to the Court Clerk to place in the case file.
Hearing: Going before a judge to request a court order or to defend against another
party’s request. Hearings usually take place before the trial date and concern specific
issues. (Example: temporary relief.) Hearings on important issues (example: motions to
dismiss) may end the case. In many counties, the court does not allow live witness
testimony at hearings. The parties must file and serve materials in advance in writing.
Jurisdiction: The court’s authority to make decisions regarding certain people and
issues. If a court does not have jurisdiction, it has no authority to make orders over the
person or subject affected.
LEIS: Law Enforcement Information Sheet.
Moving Party: the person who files the petition.
Nonmoving party: the party who did not file the petition.
Order: A court document a judge signs that requires someone to do (or not do)
something. If you disobey a court order, the judge may hold you in contempt of court.
Note: An order is not in effect until a judge has signed it.
Other party: The person you are filing the petition against.
Party: A Petitioner or a Respondent.
Petition: The document that starts a case and asks the court for a final order.
Petitioner: The person who first files a legal case. The petitioner in the caption of a
form does not change, even when the other party files motions later.
Pro Se: Acting without a lawyer; representing yourself in court.
Proposed Order: An order one party will be asking the judge to sign. It will not yet have
the judge’s signature on it. Many counties require the parties to file and serve proposed
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orders with motions or responses to motions, to show how that party wants the court
to decide the motion. A proposed order becomes an order if the judge signs it.
Respondent: The person against whom you have filed your petition.
Response: A formal written answer to the Petition, filed with the court.
Ruling: The judge’s decision.
Service: Giving court papers to the other party. The law defines how to properly have
someone served. When you start a case, you must arrange for the Summons and
Petition and other papers that start the case to be properly hand-delivered or, in some
cases, and with advance court permission, sent by certified mail or published in a
newspaper. After you have had the Summons and Petition served, you can serve many
later papers by first class mail, with enough advance notice.
Summons: A written notice that the petitioner has filed a court case.
Temporary Order: An order the court enters after you have filed a case and before it is
finished. It is only in effect while the case is going on. Some temporary orders may end
at a fixed time, even before the case ends.
Time to Respond (or deadline to respond): The length of time a party has to respond to
something filed by another party.
Trial: The hearing where the judge listens to live testimony from parties and witnesses,
considers evidence properly introduced, hears argument, and decides the case’s
outcome.
Venue: The county where you should file the case.
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Section 2:
General Instructions for Filling out Forms
Case number. When you file the papers to start the case and pay the filing fee (or have
the fee waived), the court clerk will assign a case number. Write the case number near
the top on the right hand section of the first page of every form after "No."
(abbreviation for “number”). When you file your case, you may be able to use a special
stamp at the court clerk’s counter to stamp the case number on each paper. You can
write or stamp the case number.
 You must write or stamp the case number on the first page of every
copy of every paper you file with the court and the copies for other
parties. If you do not, your papers may be lost, or the clerk may
return them to you. Some courts will also fine you for filing
incorrect forms.
Title. Each form has a title. The title is on the right-hand side of the form under the
case number.
 Format: Pleadings (legal forms) you file with the court and
attachments to pleadings must follow the court rules about size and
margins (GR 14(a)). Use regular size (8 ½ x 11”) white paper. Write
on only one side. The first page of each paper you file must have a
three-inch margin (three inches of space) at the top. The other
margins (left, right and bottom, and the top from the second page
on) must be at least one inch wide. If your forms do not follow
these rules, the court clerk may refuse to file them or may make
you pay a fine.
The contents. Fill out each form according to the instructions for that form. In most
counties, you may print or type the information, but it must be readable and you must
use BLACK OR DARK BLUE INK.
 A few counties require that you type all documents. Check with the
clerk of the court where you are filing.
After filling out each form, re-read it. Make sure you have correctly filled in all the
blanks you need to. Any corrections must be neat and readable. Do not write in the
margins of any page. The clerk may reject your form.
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Dates. On the last page of most forms (not orders), there is a space for you to write the
date you signed the form.
Your Signatures. After you fill out a form, look for the place(s) where you sign.
Identifying Information. Court rules try to protect privacy but also allow for public
access to certain information in court files. Exception: The Law Enforcement
Information Sheet (LEIS) does not go in the public court file. It is safe to put information
in that form.
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Section 3:
A.
Instructions for each Form
Worksheet for the Harassment and/or Stalking Petition
Keep this nearby to help you fill out the other forms.
B.
Motion for Waiver of Fees (WPF UH-02.0100)
Waiver fees are only for very low-income people who otherwise cannot
afford to pay the filing fees involved in starting a case.
Fill in the caption.
You will fill the caption in the same way on each form. See example:
DISTRICT COURT OF WASHINGTON
FOR KING COUNTY
NO.
JANE ANNE DOE
MOTION FOR WAIVER OF FEES
(HARASSMENT)(MT)
Petitioner
vs.
KELLY JANE SMITH
Respondent
I. Motion
Read this paragraph.
II. Basis for Motion
2.1 Check this box if you are low-income.
2.2. Check the first box if:
•
Someone has stalked you. (Check the second box too.)
•
The other party is a sex offender or kidnapper. (Check the third box too.)
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•
The other party engaged in acts of domestic violence against you AND you both
are family or household members. (See RCW 26.50.010.) (Check the fourth box
too.)
II. Declaration
3.1 Check the first box if you are low-income. Check the second box if you have
information you think the court should know that does not go in the financial
statement.
3.2 Check the first box if
•
Someone has stalked you. (Check the second box too.)
•
The other party is a sex offender or kidnapper. (Check the third box too.)
•
The other party engaged in acts of domestic violence against you AND you both
are family or household members. (See RCW 26.50.010.) (Check the fourth box
too.)
If you filed this motion by mail, check the box next to “(Check if applies).”
Date and write in the name of the town/city where you are filling in this form. Sign
below that.
 Attach a financial statement to this form. See below.
C.
Financial Statement (WPF UH-02.0110)
Case name: Write in “your name” versus “respondent’s name” here.
Case number: Fill this in when you get a case number from the clerk.
1 - Print your name.
2 - Check this box if you have dependents living with you. Next to “How many?” write in
the number of dependents. Next to “ages,” put how old they are.
3 - My Monthly Income - Check the box to show whether you are working. If you are,
write in your employer’s name. Next to “Gross pay per month,” write how much you
make before taxes and other deductions. Write what you take home under that.
4 - Other Sources of Income- If you get a regular check for anything else (examples:
TANF, unemployment, workers comp), list it here. Check the box if you get food stamps.
Add up any income from box 3 plus what you listed here.
5 - My Household Assets - Fill in the boxes as appropriate. Add everything up.
Sections 6, 7 and 8 - Be as complete as you can. Add up the sub-totals from these
sections.
Date and sign at the bottom.
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D.
Order to Proceed without Payment of Fees (WPF UH02.0120)
Fill in the caption.
I. BASIS
II. FINDINGS
2.1 Check the first box if you are low-income. Check the box underneath that describes
your proof that you are low-income.
2.2 Check the first box if:
•
Someone has stalked you. (Check the second box too.)
•
The other party is a sex offender or kidnapper. (Check the third box too.)
•
The other party engaged in acts of domestic violence against you AND you both
are family or household members. (See RCW 26.50.010.) (Check the fourth box
too.)
II. ORDER
3.1 Check the first box. Check the next two boxes under that.
DO NOT SIGN THE ORDER. THE JUDGE DOES THAT.
Print your name and the date under “Presented by.”
E.
Law Enforcement Information Sheet – WPF all cases
01.0400
This form goes to your local law enforcement agency so they can enter your order into
the police computer. Do not give this form to any other party in your case. Do not put
it in with the papers that you have served.
Write your case number in the top right-hand blank. Under that, check the second box.
Write the name of the court and your case number in the first blanks. Under that, check
the second box (“dissolution… paternity”).
Restrained Person’s Information. In each blank, write information about the restrained
party (his/her name, driver’s license number, nickname, sex, and so on). Fill out as
much of this form as you can. You do not need to know all the answers.
Does the Restrained Person Have a Disability, etc.? If you check “yes,” write a
description that will help law enforcement in serving the order.
Hazard Information. If the restrained person has a history of mental health problems,
assault(s), or drug/alcohol abuse, check the boxes that apply.
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Circle any type of weapon you think the restrained person might use. Check the box
showing where they usually keep the weapon. Write details at the end of the item.
Current Status. Read each question. Circle the appropriate answer “Y” for yes, “N” for
no, or “N/A” for does not apply.
Protected Person’s Information. In each blank, write your name, sex, race, birth date,
and the other requested information. If the other party already knows your address,
write your address in the blank under “If your information is not confidential.” If you do
not want the other party to know your address, write under “If your information is
confidential” the name, address and phone number of a “contact” where you can safely
and reliably get mail. Examples: a friend, family member, or post office box.
Minor’s Information. If you have children, write each child’s information in the blanks.
At the end of the form, next to “Filled out by,” write your name and the date. If you
have written on the back of the form, check the box next to “see reverse for additional
information.”
Victim’s Household Members or Adult Children Protected: fill in the information for
any of these who the order protects.
F.
Confidential Information Form (WPF UH-01.0600)
1. Write the county where you are filing the case, and the case number. If you have no
case number yet, write it in when the clerk gives it to you.
2. Check the first box (divorce/separation… nonparental
custody/paternity/modification…).
3. If restraining orders or protection orders are in place, check the related boxes on the
form. Show who the order protects.
4. If you believe the safety of an adult or child would be in danger by giving out address
information, even if you do not have a restraining order or a protection order, check
the box “[t]he health, safety, or liberty…” Explain the risk of harm.
5. The law requires a residential address on page 2 of the Confidential Information
Form. If you are afraid to give your home address, try to give a different address. See
if the court clerk will accept it. An alternative address could be a post office box, a
private mailbox, a friend or relative’s address. If the court clerk will not accept your
Confidential Information Form, talk with a lawyer, your local domestic violence
program, or call CLEAR at 1-888-201-1014.
Write in the information requested on the form concerning the petitioner and
respondents and the child/ren. Fill in the information about yourself.
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G.
Notice of Hearing (WPF UH-02.0400)
Fill in the caption.
After “TO:” fill in the respondent’s name.
If the clerk does not fill the rest of this form in for you:
In the blank directly underneath “TO,” write your name. In the next sentence, write the
name of your petition.
In the next paragraph, write the date, time, and place of your hearing.
The clerk fills in the rest.
H.
Petition for an Order of Protection (WPF UH-02.0200)
Fill in the caption. Check “Harassment.”
Under “I believe:” check the box next to “I am, or the minor I am petitioning for is, a
victim of unlawful harassment…” Check the box next to “The respondent and I” and the
boxes under that apply.
1 - Who is the petitioner?
Print your name in the blank next to “My name is.”
At the top of the second page, check the box that describes you. If you checked the third
or fourth box, list the names and ages of any children you want the court order to cover.
 If you need to check the fifth box, use the instructions in our packet
called Stalking Protection Order: Forms and Instructions instead.
2 –Who is the respondent? Read this. If it is not true of your case, STOP. DO NOT USE
THIS PACKET. Talk to a lawyer.
3 – Where do the parties live? In the first sentence, print the name of the county you
live in.
Check “no” in answer to the second sentence.
In the third sentence, print the county where any children you want the order to cover
live.
In the fourth sentence, print the county where the Respondent lives.
4 – Where did the Conduct take place? Print where the harassment happened to you.
5 – Describe what the Respondent did or said that you think is harassment or stalking.
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A – Print when the respondent most recently harassed you. Print where it happened.
Use as much space as you need to explain what the respondent did or said to harass
you. Check the all boxes that apply at the bottom of page 3.
B – Use this section to describe other times the respondent harassed you. Put when and
where it happened. Include what the respondent did/said to you and how they said it.
6 - How did the incidents you describe make you, the minor, or the vulnerable adult
feel? Use the legal definition of “unlawful harassment” in the box in the worksheet for
help answering this question.
7 –Has the respondent used, displayed, or threatened to use a firearm or other
dangerous weapon in a felony? If you know the respondent has used (or threatened to
use) a gun or other weapon in the commission of a felony crime, explain here what you
know and how you know it.
8 – Has the respondent previously committed an offense that makes him or her
ineligible to possess a firearm under the provisions of RCW 9.41.040? Say “yes” and
explain what you know if you know the respondent
•
Has committed a felony
•
Was found guilty of assault in the fourth degree, coercion, stalking, reckless
endangerment, criminal trespass in the first degree, or violation of a protection
order or no-contact order restraining the respondent or excluding them from a
home
•
Is free on bond or personal recognizance pending trial, appeal, or sentencing for
a serious offense
•
Was the respondent in a previous harassment/stalking case where the court
prohibited the use, attempted use, or threatened use of force against the
respondent’s intimate partner or child
•
Lost his/her right to own a weapon after involuntary commitment for mental
health treatment
9 – Does possession of a firearm or other dangerous weapon by the respondent
present a resinous and imminent threat to public health or safety, or to the health or
safety of a victim? If you think it would put public health/safety, your safety or a child’s
safety at risk, explain why here.
10 – Do you have any evidence of the harassment or stalking conduct other than
testimony? If you are going only on your own testimony, check “no.” Skip to Paragraph
Eleven.
If you check “yes,” make sure you will be able to share with the court the evidence you
are listing. Check all the boxes next to the evidence you can attach to your petition.
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11 – Has/have the victim/s or the respondent ever requested or obtained protection
from the other person in a restraining order, civil protection order, or criminal nocontact order? If either you or the respondent has gotten this type of order before,
print:
•
The type of order
•
The name of the court that heard the case
•
The date the court held a hearing in the matter
•
Whether the court agreed to enter the order
12 – Is there any other litigation between the victim/s and the respondent? Fill this out
as completely as you can.
13 –
Decide what you need the court to do. Check the boxes showing what you need.
 “Surveillance” in the second box means constantly following and
watching you, in-person OR using technology.
Emergency temporary protection: If you need an order right away, check the
appropriate box. Explain as completely as you can what will happen if you do not get an
order right away. Example: The person harassing you has also followed you home and
threatened to kill you. You know the person has a gun.
Print the date and place you signed this petition. Sign and then print your name.
Confidential address: If you do not want to list your address, check the last box on the
last page. Print an address where you can reliably get mail. Otherwise, print your home
address in the blank under “My address for the purpose of receiving service of legal
documents is.”
I.
Temporary Protection Order and Notice of Hearing (WPF
UH-03.0200)
 Check with the court clerk, the facilitator, or your local domestic
violence advocate before you start filling out this form. The judge
in the county where you are filing may not want you to submit a
proposed order. Fill this Order out only if you first make sure it is
okay to do so.
Page 1:
Fill in the caption.
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Next Hearing Date and Time: If neither the clerk nor judge fills this part in, you can. To
the right of the caption, under “Next Hearing Date and Time,” fill in the information the
clerk gives you.
Minors addressed in this order: If you want the order to cover your children, list them
in the blank chart.
…it is therefore ordered that: Check all the boxes showing what you want the judge to
order. If you check the Stay-Away box, a reasonable distance other people use is 1,000
feet, roughly the length of a swimming pool.
Surrender of Weapons: Check this box if you want the court to order the Respondent to
surrender his/her weapons.
WACIC Data Entry box: If you live outside city limits, print the name of the county
where you live. Then check the box for the sheriff’s office. If you live inside city limits,
check the Box next to “Police Department.”
Service: Check the box showing whether the clerk or you are sending the paperwork to
law enforcement. Check the correct box to show whether it is the Sheriff or the cops. If
you are using a private server, check the box next to the first “Or.”
 Check the second “Or” only if you are filling this form in after a
hearing and the Respondent appeared at the hearing.
DO NOT SIGN AND DATE THE ORDER. THE JUDGE DOES THAT.
Print your name and the date under “Presented by.”
J.
Order for Protection from Unlawful Civil Harassment
(ORAH) WPF UH-04.0500
 Check with the court clerk, the court facilitator, or your local
domestic violence advocate first before you start to fill out this
form. Local practice varies by county. The judge in the county
where you are filing may not want you to submit a proposed order.
Fill this Order out only if you first confirm that it is okay to do so.
Page 1:
Fill in the caption.
1. Read this.
2. Check the box to show how you had the respondent served. Use “other” if
service was by mail or publication.
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3. If you want the order to cover your children, list them in the blank chart, one
child per line.
Page 2:
First Section: Check all the boxers showing what you want the court to order. In the
Stay-Away box, check the boxes of the places you want the court to order the
respondent away from. Write in the minimum number of feet you want the respondent
to stay away. (Example: a distance commonly used is 1,000 feet, roughly the length of
a swimming pool.) If you want the respondent to reimburse you for the cost of filing this
case, check the box next to Pay Fees and Costs. Print the amount of costs in the second
box. Get and fill out a form WPF UH 04.0700 from the courts website:
http://www.courts.wa.gov/forms/?fa=forms.static&staticID=14.
Surrender of Weapons: Check the second box in this section if you asked the court to
order the Respondent to surrender his/her weapons.
WACIC Data Entry: If you live outside city limits, check and put the name of your county
in the blank next to “County Sheriff’s office.” If you live inside city limits, check and fill
in the name of your city or town next to “Police Department.” Fill out the rest of this
section after the judge has ruled in your case.
This Antiharassment protection order expires on: Leave this blank. The judge will fill it
in.
DO NOT DATE AND SIGN THE ORDER. THE JUDGE DOES THAT.
Print your name and the date under “Presented by.”
K.
Petition for an Order for Protection – Respondent under
Age 18 – Harassment (PTAH18) - WPF UHST-05.0100
Fill out the caption.
Information about appointment of a guardian ad litem for respondent: read this.
Skip to page 2. Check the first box. Then check the boxes directly underneath that apply.
1 –Who is the petitioner? Print your name. Check either the second or the third box in
this section, whichever applies.
2 – Information about the respondent: Check whichever of the first three boxes applies
to the respondent. Check whichever of the next two applies to the respondent. Print the
information requested.
3 –Where do the parties live?
In the first sentence, print the name of the county you live in.
Check “no” at the bottom of the page.
Print the name of the county the child you are filing for lives in.
Print the name of the county the respondent lives in.
16
8904EN – Rev. 08/2014
4 –Where did the conduct take place? Print the name of the county where the
harassment happened.
5 –School: If the child you are filing for and the respondent do NOT go to the same
school, check “no.” Skip the rest of this paragraph. If the child you are filing for and the
respondent DO go to the same school, list the school’s name and address.
6 –Describe what the respondent did or said that you think is harassing or stalking:
A – Print when the respondent most recently harassed you. Print where it happened.
Use as much space as you need to explain what the respondent did or said to harass
you. Check the all boxes that apply at the bottom of page 3.
B – Use this section to describe other times the respondent harassed you. Put when and
where it happened. Include what the respondent did/said to you and how they said it.
7 – You should refer to the legal definition of “unlawful harassment” in the box in the
worksheet for help answering this question.
8 – If you know the respondent has used or threatened to use a weapon in a felony
crime, fill this out as completely as you can.
9 – Say “yes” and explain what you know if you know the respondent
•
•
•
•
•
Has committed a felony
Was found guilty of assault in the fourth degree, coercion, stalking, reckless
endangerment, criminal trespass in the first degree, or violation of a protection
order or no-contact order restraining the respondent or excluding them from a
home
Is free on bond or personal recognizance pending trial, appeal, or sentencing for
a serious offense
Was the respondent in a previous harassment/stalking case where the court
prohibited the use, attempted use, or threatened use of force against the
respondent’s intimate partner or child
Lost his/her right to own a weapon after involuntary commitment for mental
health treatment
10 - Fill this out as completely as you can. Be as specific as possible.
11 – If you are going only on your own testimony, check “no.” Skip to Paragraph Eleven.
If you check “yes,” make sure you will be able to share with the court the evidence you
are listing. Check all the boxes next to the evidence you can attach to your petition.
12 - Fill this out as completely as you can.
– I ask the Court for an order…
Check the boxes showing what you need the court to do.
 “Surveillance” in the second box on page 6 means constantly
following and watching you, in-person OR using technology.
17
8904EN – Rev. 08/2014
Emergency temporary protection (page 7): If you need an order right away, check the
appropriate box. Explain as completely as you can what will happen if you do not get an
order right away. Example: The person stalking you has threatened to follow you home
and kill you. You know the person has a gun.
B – Stalking: Check the boxes showing what you need the court to do.
Fill in the date and place you signed the petition. Sign and print your name.
Confidential address: If you do not want to list your address, check the last box on page
seven. Write in an address where you can reliably get mail.
L.
Temporary Protection Order and Notice of Hearing –
Respondent under Age 18 – Harassment (TORAH18) UH05.0300
 Check with the court clerk, the facilitator, or your local domestic
violence advocate before you start filling out this form. The judge
in the county where you are filing may not want you to submit a
proposed order. Fill this Order out only if it is okay to do so.
Page 1:
Fill in the caption.
Next Hearing Date and Time: If neither the clerk nor judge fills this part in, you can. To
the right of the caption, under “Next Hearing Date and Time,” put the information the
clerk gives you.
If you think the respondent needs a guardian ad litem, check the box under “Warning to
the Respondent.” The judge will fill in the name of the guardian ad litem.
If it is okay for you to fill out the proposed order, check all the boxes showing what you
want the judge to order. If you check #3, a reasonable distance other people use is
1,000 feet, roughly the length of a swimming pool. If you check #4, write the name of
the school the court will order the respondent to leave.
Surrender of Weapons: Check this box if you asked the Court to order the respondent
to surrender weapons.
Page 2, third box: If you live outside city limits, print the name of the county where you
live. Then check the box for the sheriff’s office. If you live inside city limits, check the box
next to “Police Department.”
18
8904EN – Rev. 08/2014
Check the box showing whether the clerk or you are sending the paperwork to law
enforcement. Check the correct box to show whether it is the Sheriff or the cops. If you
are using a private server, check the box next to the first “Or.”
DO NOT SIGN AND DATE THE ORDER. THE JUDGE DOES THAT.
Print your name and the date under “Presented by.”
M.
Order for Protection – Respondent under Age 18 –
Harassment (ORAH) WPF UH-05.0500
 Check with the court clerk, the court facilitator, or your local
domestic violence advocate first before you start filling out this
form. Local practice varies by county. The judge in the county
where you are filing may not want you to submit a proposed order.
Fill this Order out only if it is okay to do so.
Page 1:
Fill in the caption.
1 - Read this. Check the box if you believe the court has jurisdiction. If you do not
believe the court has jurisdiction, STOP. See a lawyer.
2 - Check the box that shows how you had the respondent served. Use “other” only if
service was by mail or publication.
3 –If you asked the court to order a guardian ad litem for the respondent, check this
box. Wait until after the hearing to fill the rest of it out.
Section that starts at bottom of page 1:
Check all the boxes showing what you want the court to order. If you check the Stay
Away box, check the boxes of the places you want the court to order the respondent
away from. Write in the minimum number of feet you want the respondent to stay
away from those places. (Example: A distance commonly used is 1,000 feet, roughly
the length of a swimming pool.) Use the Pay Fees and Costs box if you want the
respondent to pay you back for any costs of filing this case.
Surrender of Weapons: Check the second box in this section if you want the court to
order the Respondent to surrender his/her weapons. Otherwise, check the first box.
WACIC Data Entry: If you live outside city limits, check and fill in the name of your
county in the blank next to “County Sheriff’s office.” If you live inside city limits, check
19
8904EN – Rev. 08/2014
and fill in the name of your city or town next to “Police Department.” Fill out the rest of
this section after the judge has ruled in your case.
Page 3: This Antiharassment Protection Order expires on: Leave this for the judge to fill
in.
DO NOT DATE AND SIGN THE ORDER. THE JUDGE DOES THAT.
Print your name and the date under “Presented by.”
N.
Return of Service – Harassment (WPF UH-04.0110)
Your server must complete a separate Return of Service for each party s/he serves. After
your server has completed service and signed the Return of Service form(s), follow the
instructions in this packet for filing it with the court.
 The court does not serve the Respondent. You must arrange for
service and make sure your server delivers the papers properly.
You cannot serve the papers on the Respondent yourself.
Carefully follow the rules for service (see the section called “Arranging
for Service,” below). If you do not do service properly, any court
orders you get could be set aside.
Caption. Fill out the caption.
Paragraph 2.
Write in the blank the name of the party you are having served. Read the list of forms.
Check the box to the left of each form served on that party. Sometimes you must fill in
a blank to describe a form. (Example: if you check the box after “declaration,” put the
name of the person who wrote the declaration). If you had the other party served with
any forms not listed, check the box marked “other.” Write in the names of those other
forms. You MUST list all the forms that you had served on the other party. If you leave a
form off your list, you will have no proof that the other party got it.
Paragraph 3.
The server should fill in the date, time (show a.m. or p.m.) and address where they
served the papers.
Paragraph 4.
20
8904EN – Rev. 08/2014
If the server gave the papers directly to the other party, check the first box. If the server
did abode service 2, check the second box. Put the name of the person to whom the
server gave the papers.
Paragraph 5.
If your server included the Notice re: Dependent of a Member of a Person in Military
Service form in the packet of papers served (we recommend that you have it served
whenever the forms to be served include a summons), check the first box in this
paragraph and the first box in the middle of the sentence. Put the date at the end of the
paragraph. 3 If you did not have this form served, skip this paragraph.
Paragraph 6.
In the “Other” section, your server may write other information. Examples: Your server
tries several times to serve the other party, but s/he is never home or cannot be found.
The server should write the dates and times and descriptions of each time the server
tried to serve the other party. If the server gave the papers to an adult living with the
other party who would not give his/her name, the server should write what the person
who received the papers looks like.
Signature.
The server should write the city and state where s/he signed the form, write the date,
and sign where it says “Signature” and then print or type his/her name where it says
“Print or Type Name.”
Usually, only professional servers will use the box for fees and mileage.
Staple a copy of the summons to the Return of Service.
After your server fills out this form, s/he should give it to you for filing with the court.
2
We explain “abode service” in the “instructions for personal service” section.
The law allows for service of this notice later by mail. We do not have instructions for later service or for
proving that you had the notice mailed.
3
21
8904EN – Rev. 08/2014
Section 4:
Arranging for service
Do not serve the documents on the other parties yourself. Get someone over age 18
to serve the papers for you.
Consider hiring a professional process server. If you can afford it, you should hire a
professional process server or the sheriff to serve the papers for you. It usually costs
$30-$80. Using a professional process server may be best. The sheriff may not be willing
to try more than once to serve the Respondent if they are not at home when the sheriff
tries to serve him/her. Process servers are in the yellow pages of the phone book.
Ask an adult friend to be your process server. If you cannot afford a process server or
the sheriff, any adult over age 18, who is not a party in the case and who has no mental
disability making that person incompetent, may serve the papers for you. That person
must understand how important it is to serve the papers and fill out the return of
service form correctly.
Give your server the envelope of papers you prepared for service on the other party,
and:
•
the other party’s home and work address
•
a physical description of the other party
•
any other information that will help the server locate the other party for service
Give your server a Return of Service form to fill out and return to you once service is
complete. (Some process servers have their own Return of Service form that they will fill
out and give you instead.)
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8904EN – Rev. 08/2014
Section 5:
Getting Ready for and Going to Your Hearing
The Respondent must respond in writing to your motion before the hearing. Check with
the court clerk. Find out when the Respondent’s response is due.
If the Respondent sends no response:
•
If the Respondent does not show up after not sending a response either, ask
the judge to sign your proposed orders. See the section called Going to the
Hearing, below and the checklists at the end of this publication.
•
If the Respondent comes to the hearing despite sending no response, the judge
will probably go forward with the hearing anyway. Be ready.
If the Respondent sends a response, read it carefully. Be ready to tell the judge what
you disagree with in the response.
The respondent may not give you his/her response until the day of the hearing. If this
happens, tell the judge. Ask the judge for more time to read the response and to
prepare your own reply. You can ask for more time in one of two ways:
•
You can ask for a brief recess (break) to review the response, if you feel you can
simply reply orally to what is in the respondent’s papers OR
•
You can ask for a continuance. This means you are asking the court to
reschedule the hearing. Do this if you need time to get evidence to bring to the
court to rebut (argue against) the respondent’s response.
If you ask for a continuance, but the court will not allow it: ask the court to “strike”
(disregard) the respondent’s response, because you did not have proper notice to reply
to it.
A.
Going to the Hearing
 If the Other Party Gets a Lawyer. If at any time before the hearing another
party’s lawyer contacts you or shows up at a hearing, you may decide to get a
lawyer yourself. If so, tell the lawyer and the court that you need to postpone
(continue) the hearing. Do not panic. The lawyer may ask you to sign some
documents. Do not sign anything you do not understand. If the judge
reschedules your hearing, ask him/her to sign a temporary order effective until
the new hearing date.
 Prepare for the Hearing. Try to go to court before the day of your hearing and
watch how the court generally does hearings. Try to make some notes to
yourself about the main points you want to make when you have a chance to
talk during the hearing.
 Get to Your Hearing Early. Dress neatly. Bring a pad of paper and black pen for
writing notes. Bring your set of the papers and your copies of any papers the
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8904EN – Rev. 08/2014
other parties gave you in response. Do not bring your children. The judge
usually will not let them sit in the courtroom. If you are not there on time, the
court will cancel the hearing (or the respondent may win).
 When You Get to the Courtroom. Tell the person in charge in the courtroom
(the clerk or bailiff) your name and your case name and number. Take a seat.
Stand up when the judge walks in the room. When they call your case name, tell
the court you are there. Remain in court until they call your case for hearing.
Move forward when they tell you to. If your court allows you to submit proposed
orders, now is the time to give the court the originals of your orders.
 Getting an Order. If the respondent does not appear, show the judge your
Return of Service or Certificate of Mailing or Personal Delivery. Ask the judge to
sign your orders. Tell the clerk or bailiff you need a copy of the orders.
 Presenting Your Case. If the other party shows up at the hearing, each of you
will have a chance to tell your side of the case. Stand while speaking. Tell the
judge briefly what you want and why. Try to keep your argument short. Only
outline your main points. You may have only five minutes to speak. In most
cases, the judge will have read your papers before the hearing. Do not repeat
everything in your papers. Try to make notes to use at the hearing.
 DO NOT INTERRUPT THE JUDGE.
 Hearing the Judge’s Decision. After the judge has heard both sides, s/he will
decide on your requests. Listen carefully. Make notes. The judge may make
changes to any orders you may have prepared. Usually the judge signs your
court orders the day of your hearing. Some counties require the judge to sign
them before the parties leave the courthouse. Find out beforehand what the
local practice is in the county where you have filed.
 DO NOT LEAVE THE COURTHOUSE WITH, CHANGE OR DESTROYCOURT ORDERS
THE JUDGE HAS SIGNED. If the clerk in the courtroom gives you the original
orders the judge has signed, file them with the court clerk’s office.
 Getting Copies of the Orders. You will need copies of the orders as signed by
the judge. You need certified copies of any order with a safety restraint. (Get one
certified copy for yourself, and one for each restrained party you need to serve.)
Get conformed copies of other orders.
 Ask the clerk how to get the conformed and certified copies you need. Follow
those instructions.
o For certified copies, the clerk will need to make them and s/he may
charge you a fee. (Example: $5 for the first page, $1 for every extra
page.)
o For conformed copies,
24
8904EN – Rev. 08/2014

The clerk may allow you to take the original orders and make
copies in the library or at the clerk’s office.

If the copies of proposed orders you brought to court are exactly
the same as the orders the judge signed, the clerk may tell you to
stamp those copies with the date filed stamp and the judge’s
signature stamp.
 If the judge signed the orders you presented, make sure all parties get copies of
the orders showing the judge’s signature as follows:
o If your orders have no safety restraints, or if the respondent or his/her
lawyer appeared and/or signed the orders, mail conformed (not
certified) copies of the orders the judge signed to the other party/ies. Use
the Certificate of Mailing or Personal Delivery procedure explained in our
Filing a Motion for a Temporary Order packets.
o Have the respondent personally served if all the following are true:

the order includes safety restraints and you are the protected
party

neither the restrained party nor lawyer appeared for the hearing

neither the restrained party nor lawyer signed the order
You must serve a certified copy of the order if it has safety restraints. Conformed copies
of any other orders will do. File a new Return of Service with the court showing service
of these orders. Deliver a copy of the Return of Service to the law enforcement agency
named in the order.
25
Worksheet for the Harassment and/or Stalking Petition
There are several different kinds of protection orders. This worksheet is designed to help
you complete a petition for Harassment Orders and/or Stalking Protection Orders.
If you qualify for a Domestic Violence Protection order, this is not the correct form
to complete.
To help you figure out which order you may be able to get, read the 2 options in the table
below. Each option generally describes harassment or stalking conduct. More than one
option may apply:
Option 1 (Harassment protection
order)
Harassment is a pattern of
conduct that makes you feel
annoyed, alarmed or distressed.
Option 2 (stalking protection order)
Stalking is conduct like harassment, following, or
monitoring, that makes you feel intimidated,
frightened, or threatened and occurs more than
once. It may also involve cyberstalking which is
transmitting threats or obscene words or pictures to
or about you one or more times.
You can find a complete definition of Harassment or Stalking at the end of this
worksheet.
You may be eligible for one or both of these orders. The court will determine which
order best fits your situation.
Your next step is to fill out the petition. In the petition, you will let the court know what
protections you want and explain what the other party has done.
If you think the conduct is harassment, then file your petition in this county if the
harassment took place here OR if the person who committed the acts lives in this
county.
If you think the conduct is stalking, then file your petition in the county where you
reside or where you fled to avoid the stalking contact.
 You can start your petition in District Court.
• The District Court will transfer your case to Superior Court, or
• You can start your petition in Superior Court instead of District Court
If:
1. this case involves title or possession of real property, and the respondent claims
an interest in that property such as ownership or right to occupy.
2. the order put limits on the respondent’s care, custody, or control of his or her
minor children.
3. you and the respondent are parties in a superior court case.
4a. you are alleging harassment by a respondent who is under the age of 18.
4b. you are alleging stalking and the petitioner, victim, or respondent is under the
age of 18.
Worksheet for Harassment/Stalking Petition Page 1 of 2
UHST 2.0250 (06/2014) RCW 10.14.800
 Definitions
Unlawful harassment means:
• a knowing and willful course of conduct directed at a specific person which seriously
alarms, annoys, or harasses, or is detrimental to such person and which serves no
legitimate or lawful purpose.
o The course of conduct shall be such as would cause a reasonable person to
suffer substantial emotional distress and shall actually cause substantial
emotional distress to the petitioner, or when the course of conduct would cause a
reasonable parent to fear for the well-being of their child.
“Course of conduct:”
• means a pattern of conduct composed of a series of acts over a period of time,
however short, evidencing a continuity of purpose.
• includes, in addition to any other form of communication, contact, or conduct, the
sending of an electronic communication. Constitutionally protected activities,
including free speech, are not included within the meaning of “course of conduct.”
Stalking Conduct means:
a) any act of stalking as defined under RCW 9A.46.110: A person intentionally and
repeatedly harasses or repeatedly follows another person, and
• the person being harassed or followed is placed in fear that the stalker intends to
injure the person, another person, or property of the person or of another person.
The feeling of fear must be one that a reasonable person in the same situation would
experience under all the circumstances; and
• the stalker either: (i) intends to frighten, intimidate, or harass the person; or (ii) knows
or reasonably should know that the person is afraid, intimidated, or harassed even if
the stalker did not intend to place the person in fear or intimidate or harass the
person.
Or
b) any act of cyberstalking as defined under RCW 9.61.260: With intent to harass,
intimidate, torment, or embarrass any other person, and under circumstances not
constituting telephone harassment, the stalker makes an electronic communication to a
person or a third party:
• using any lewd, lascivious, indecent, or obscene words, images, or language, or
suggesting the commission of any lewd or lascivious act;
• anonymously or repeatedly whether or not conversation occurs; or
• threatening to inflict injury on the person or property of the person called or any
member of his or her family or household.
Or
c) any course of conduct involving repeated or continuing contacts, attempts to contact,
monitoring, tracking, keeping under observation, or following another [person] that:
• would cause a reasonable person to feel intimidated, frightened, or threatened and
that actually causes such a feeling;
• serves no lawful purpose; and
• the stalker knows or reasonably should know threatens, frightens, or intimidates the
person, even if the stalker did not intend to intimidate, frighten, or threaten the
person.
Worksheet for Harassment/Stalking Petition Page 2 of 2
UHST 2.0250 (06/2014) RCW 10.14.800
Court of Washington
For
No. ________________________
Petitioner,
vs.
Respondent.
Motion and Declaration For Waiver of
Filing Fees and Surcharges Harassment
(MTAF)
(RCW 10.14.060; RCW 10.14.055)
I. Motion
1.1
I am the petitioner in this action.
1.2
I am asking for a waiver of all filing fees and surcharges.
II. Basis for Motion
2.1.
[ ] GR 34 allows the court to waive “filing fees or surcharges the payment of
which is a condition precedent to a litigant's ability to secure access to judicial
relief” for a person who is indigent. RCW 10.14.060 provides that if the
petitioner’s request for fee waiver is granted, “then no fees for service may be
charged to the petitioner.” As outlined below, I am indigent.
2.2.
[ ] RCW 10.14.055 allows the court to waive “filing fees or surcharges the
payment of which is a condition precedent to a litigant's ability to secure access
to judicial relief” for a person who is seeking relief from a person:
[ ] who has stalked them as that term is defined in RCW 9A.46.110; or
[ ] who has engaged in conduct that would constitute a sex offense as
defined in RCW 9A.44.130; or
[ ] from a person who is a family or household member as defined in
RCW 26.50.010(2) who has engaged in conduct that would constitute
domestic violence as defined in RCW 26.50.010(1).
RCW 10.14.060 provides that if the petitioner’s request for fee waiver is granted,
Mt and Decl for Civil Fee Waiver - Harassment (MTAF) - Page 1 of 2
UH 02.0100 (07/2011) – GR 34, RCW 10.14.055, .060
“then no fees for service may be charged to the petitioner.”
Dated:
Signature of Requesting Party
Print or Type Name
III. Declaration
I declare that,
3.1
[ ]
I cannot afford to meet my necessary household living expenses and pay
the filing fees and surcharges imposed by the court. Please see the
attached Financial Statement, which I incorporate as part of this
declaration.
[ ]
In addition to the information in the financial statement I would like the
court to consider the following:
.
3.2.
[ ]
I am seeking protection from the respondent who:
[ ]
has stalked me, or the minor child(ren) listed in the petition;
[ ]
has engaged in conduct that would constitute a sex offense as
defined in RCW 9A.44.130; or
[ ]
is a family or household member as defined in RCW 26.50.010(2)
who has engaged in conduct that would constitute domestic
violence as defined in RCW 26.50.010(1);
as described in the Statement in the Petition for Order for Protection –
Harassment.
[ ]
(Check if applies.) I filed this motion by mail. I enclosed a self-addressed
stamped envelope with the motion so that I can receive a copy of the order once
it is signed.
I declare under penalty of perjury under the laws of the state of Washington that the
foregoing is true and correct.
Signed at (city) _________________, (state) ______ on (date) __________________.
Signature
Print or Type Name
Mt and Decl for Civil Fee Waiver - Harassment (MTAF) - Page 2 of 2
UH 02.0100 (07/2011) – GR 34, RCW 10.14.055, .060
Case Name:_____________________________ Case Number:__________________
Financial Statement - Harassment (Attachment)
1. My name is:
2. [ ] I provide support to people who live with me: How many?
Age(s):
3. My Monthly Income:
6. My Monthly Household Expenses:
Employed [ ]
Rent/Mortgage:
$
Employer’s Name:
Food/Household Supplies:
$
Gross pay per month (salary or $
hourly pay):
Utilities:
$
Take home pay per month:
Transportation:
$
Unemployed [ ]
$
4. Other Sources of Income Per Month in my
Household:
Ordered Maintenance actually $
paid:
Source:
$
Ordered Child Support
actually paid:
$
Source:
$
Clothing:
$
Source:
$
Child Care:
$
Source:
$
Education Expenses:
$
Insurance (car, health):
$
Medical Expenses:
$
Sub-Total: $
[ ] I receive food stamps.
Total Income, lines 3 (take
$
home pay) and 4:
5. My Household Assets:
Sub-Total: $
7. My Other Monthly Household Expenses:
Cash on hand:
$
$
Checking Account Balance:
$
$
Savings Account Balance:
$
$
Auto #1 (Value less loan):
$
$
Auto #2 (Value less loan):
$
Sub-Total: $
Home (Value less mortgage):
$
Other:
$
$
/mo
Other:
$
$
/mo
Other:
$
$
/mo
Other:
$
$
/mo
Other:
$
Sub-Total: $
Total Household Assets: $
Total Household Expenses
$
and Debts, lines 6, 7, and 8:
Date:
8. My Other Debts with Monthly Payments:
Signature:
Financial Statement - Harassment (Attachment) - Page 1 of 1
UH 2.0110 (07/2011) GR 34, RCW 10.14.060
Court of Washington
For
No. ____________________________
Petitioner,
vs.
Respondent.
Order Re Waiver of Filing Fees and
Surcharges - Harassment
[ ] Granted (ORPRFP)
[ ] Denied (ORDYMT)
[X] Clerk’s Action Required 3.1
I. Basis
The court received the motion to waive filing fees and surcharges filed by or on behalf of
the
petitioner.
II. Findings
The Court reviewed the motion and supporting declaration(s). Based on the
declaration(s) and any relevant records and files, the Court finds:
2.1
[ ]
The petitioner is indigent based on the following: He or she:
[ ]
is represented by a qualified legal aid provider that screened and
found the applicant eligible for free civil legal aid services; and/or
[ ]
receives benefits from one or more needs-based, means-tested
assistance programs; and/or
[ ]
has household income at or below 125% of the federal poverty
guideline; and/or
[ ]
has household income above 125% of the federal poverty
guideline but cannot meet basic household living expenses and
pay the fees and/or surcharges; and/or
[ ]
other:
.
2.2
[ ]
The petitioner is seeking protection from a person who:
Order re Civil Fee Waiver _Harassment (ORPRFP, ORDYMT) - Page 1 of 2
UH 02.0120 (07/2011) – GR 34, RCW 10.14.055, .060
[ ] has stalked them as that term is defined in RCW 9A.46.110;
[ ] engaged in conduct that would constitute a sex offense as defined in
RCW 9A.44.130; or
[ ] is a family or household member as defined in RCW 26.50.010(2) who
has engaged in conduct that would constitute domestic violence as
defined in RCW 26.50.010(1).
2.3
[ ]
Other:
.
III. Order
Based on the findings the court orders:
3.1
[ ]
The motion is granted, and
[ ]
all filing fees and surcharges the payment of which is a condition
precedent to the petitioner’s ability to secure access to judicial
relief are waived.
[ ]
Law Enforcement shall serve all papers in this action without
charging a fee for service to the petitioner.
[ ]
other:
.
3.2
[ ]
The motion is denied.
3.3
If there is a material change in financial circumstances, the ruling can be revisited
by the court or the petitioner.
If the motion was granted and the court, upon review, later finds that either the
petitioner or another responsible party to this proceeding has sufficient resources
to pay the waived filing fees or surcharges, the Court may modify this order and
require the petitioner or another party to pay the filing fees and/or surcharges that
have been waived by this order.
Dated:
Judge/Commissioner
Presented by:
Signature of Petitioner or Lawyer/WSBA No.
Print or Type Name
Date
Order re Civil Fee Waiver _Harassment (ORPRFP, ORDYMT) - Page 2 of 2
UH 02.0120 (07/2011) – GR 34, RCW 10.14.055, .060
Court of Washington
For
No.
Petition for an Order for Protection -
Petitioner,
vs.
Harassment (PTORAH) and/or
Stalking (PTORSTK)
Respondent.
 This is a Petition for an Order for Protection against
Harassment and/or Stalking as checked in the caption.
I believe:
I am, or the minor or vulnerable adult I am petitioning for is, a victim of stalking
because
the respondent and I, or the minor or vulnerable adult I am petitioning for, are
not and never have been related by blood or marriage, lived together, or been in
a dating relationship, and
the respondent has been
- stalking me either in person or (cyber stalking), and
- repeatedly contacting me or attempting to contact or monitor me for no lawful
purpose and his/her actions caused me to feel intimidated, frightened or
threatened.
I am, or the minor I am petitioning for is, a victim of unlawful harassment because
the respondent’s actions toward me have seriously alarmed, annoyed or harassed
me, or are detrimental to me and they serve no legitimate or lawful purpose. The
Pt for an Or for Protection – Harassment/Stalking (PTORAH, PTORSTK*) – Page 1 of 9
WPF UHST-02.0200 (06/2014) – RCW 10.14.040, .800, RCW 7.92.030
respondent’s actions have caused me substantial emotional distress or caused
me to fear for the well-being of my child.
The respondent and I:
are or have been related by blood or marriage, lived together, or been in a
dating relationship
have not been and are not now related by blood or marriage, lived
together, or been in a dating relationship.
I have given a detailed explanation below.
1. Who is the petitioner?
My name is (please print) _________________________________. I am the
petitioner.
I am 18 or older and I am petitioning on my own behalf.
I am 16 or 17 and I am petitioning on my own behalf.
I am the parent or guardian of child/ren under age 18 and I am petitioning on
their behalf:
Children’s Name/s
(First, Middle Initial, Last)
Age
I am not the parent or guardian, but the child/ren live/s with me; and I am
petitioning on their behalf; and the respondent is not a parent.
Children’s Name/s (First, Middle Initial, Last)
Age
I am filing this petition on behalf of petitioner, (name)
________________________, a vulnerable adult as defined in RCW
74.34.020, who is a victim of stalking. I am an interested person as defined in
Pt for an Or for Protection – Harassment/Stalking (PTORAH, PTORSTK*) – Page 2 of 9
WPF UHST-02.0200 (06/2014) – RCW 10.14.040, .800, RCW 7.92.030
RCW 74.34.020(10). My relationship to this petitioner is
_____________________.
2. Who is the respondent?
The Respondent/s is/are 18 years of age or older.
3. Where do the parties live?
Petitioner lives in ____________________________________ county.
Did the petitioner leave their residence because of stalking conduct and that is the
county of their new residence?
Yes
No
Children named above live in __________________________ county.
Respondent lives in ___________________________________ county.
4. Where did the Conduct take place?
The conduct took place in ____________________ county.
 Statement describing the victim/s need for protection from
the respondent
 Write clearly. If you need more space below, attach additional page/s. Do not
write on the back.
5. Describe what the Respondent did or said that you think is harassment or
stalking.
• You must describe what the respondent actually said.
• You must describe what the respondent actually did.
The respondent has committed acts of harassment or stalking as follows:
A. Describe the most recent incident of harassment or stalking.
Date and time (on or around):
__________________________________________________
Location:
_______________________________________________________________
What did the respondent do or say that you believe to be harassing or stalking behavior?
Pt for an Or for Protection – Harassment/Stalking (PTORAH, PTORSTK*) – Page 3 of 9
WPF UHST-02.0200 (06/2014) – RCW 10.14.040, .800, RCW 7.92.030
.
Pt for an Or for Protection – Harassment/Stalking (PTORAH, PTORSTK*) – Page 4 of 9
WPF UHST-02.0200 (06/2014) – RCW 10.14.040, .800, RCW 7.92.030
How did the respondent make these statements?
in person
mail/written notes
e-mail
text
phone
social media (such as facebook and twitter)
other (describe):
_________________________________________________________.
B. Describe other incidents of harassment or stalking. For each incident, include the
date, time (on or about), location, what was said, how statements were made, and
what was done to a victim.
Pt for an Or for Protection – Harassment/Stalking (PTORAH, PTORSTK*) – Page 5 of 9
WPF UHST-02.0200 (06/2014) – RCW 10.14.040, .800, RCW 7.92.030
.
6. How did the incidents you describe above make you, the minor, or the vulnerable
adult feel?
.
7. Has the respondent used, displayed, or threatened to use a firearm or other
dangerous weapon in a felony? Please describe:
.
8. Has the respondent previously committed an offense that makes him or her ineligible
to possess a firearm under the provisions of RCW 9.41.040? Please describe:
.
Pt for an Or for Protection – Harassment/Stalking (PTORAH, PTORSTK*) – Page 6 of 9
WPF UHST-02.0200 (06/2014) – RCW 10.14.040, .800, RCW 7.92.030
9. Does possession of a firearm or other dangerous weapon by the respondent present
a serious and imminent threat to public health or safety, or to the health or safety of a
victim? Please describe:
.
10. Do you have any evidence of the harassment or stalking conduct other than
testimony?
No
Yes. I have attached the following evidence:
Copy of mail or written notes
Copy of text messages
Copy of emailed messages
Copy of social media messages
Police report
Declaration or Affidavit from the following witness:
___________________
Other (describe):
_____________________________________________
11. Has/have the victim/s or the respondent ever requested or obtained protection
from the other person in a restraining order, civil protection order, or criminal nocontact order?
If yes, list the type of order, the name of the court and the approximate date, and
whether the request was granted:
.
12. Is there any other litigation between the victim/s and the respondent? This includes
all matters - pending or past - such as parenting plans, landlord-tenant disputes,
employment disputes, or property disputes. If yes, provide case number/s if known,
type of case, and name of court:
Pt for an Or for Protection – Harassment/Stalking (PTORAH, PTORSTK*) – Page 7 of 9
WPF UHST-02.0200 (06/2014) – RCW 10.14.040, .800, RCW 7.92.030
.
 Requests
13. I ask the Court for an order approving the following requests for
protection:
I Request an Order for Protection following a hearing that will:
No-Contact: restrain the respondent from making any attempts or having any contact,
including nonphysical contact, with the person/s to be protected, directly, indirectly, or
through third parties regardless of whether those third parties know of the order, except
for mailing of court documents.
Surveillance: prohibit or restrain the respondent from making any attempt to keep or
from keeping the person/s to be protected under surveillance, including electronic
surveillance.
Exclude from places: exclude the respondent from the
residence
workplace
school
day care of the person/s to be protected.
Stay Away: Prohibit or restrain the respondent from entering or being within, or from
knowingly coming within, or knowingly remaining within ________ (distance) of the
residence
workplace
school
day care of the person/s to be protected.
other locations:_______________________________________________.
Other:
Evaluation: Order the respondent to have a
mental health
chemical dependency
evaluation.
other: ______________________________________________________________.
Pay Fees and Costs: Require the respondent to pay fees and costs of this action, which
may include administrative court costs and service fees and petitioner’s costs including
attorneys’ fees.
Surrender Firearms: Require the respondent to surrender any firearm or other
dangerous weapon, or any concealed pistol license and prohibit the respondent from
obtaining or possessing a firearm or other dangerous weapon, or a concealed pistol
license.
Duration: Remain effective longer than one year because respondent is likely to resume
acts of unlawful harassment or stalking conduct against the persons to be protected if
the order expires in a year.
Pt for an Or for Protection – Harassment/Stalking (PTORAH, PTORSTK*) – Page 8 of 9
WPF UHST-02.0200 (06/2014) – RCW 10.14.040, .800, RCW 7.92.030
Emergency temporary protection (up to 14 days) until the court hearing:
An emergency exists as described below. I request that a Temporary Stalking
Protection Order granting the relief I requested above for a no-contact, surveillance,
exclude from places, or stay away order be issued immediately, without prior notice to
the respondent, to be effective until the hearing.
I also request a temporary surrender of a firearm or other dangerous weapon without
notice to the other party because irreparable injury could result if an order is not issued
until the hearing.
What irreparable harm would result if an order is not issued immediately without prior notice
to the respondent?
__________________________________________________________________________
__________________________________________________________________________
_________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
I certify under penalty of perjury under the laws of the state of Washington that the
foregoing is true and correct.
Dated:
Washington.
at
Petitioner
Print or type name
My address for the purpose of receiving service of legal documents is:
_______________________________________________________________________.
This is not my residence address. My family, household or I would be at risk of
abuse by respondent if I disclosed my residence address. I agree to receive service of
process at this address.
Pt for an Or for Protection – Harassment/Stalking (PTORAH, PTORSTK*) – Page 9 of 9
WPF UHST-02.0200 (06/2014) – RCW 10.14.040, .800, RCW 7.92.030
COURT OF WASHINGTON
FOR
NO.
Petitioner
NOTICE OF HEARING HARASSMENT
(NTHG)
(Optional Use)
(Clerk’s Action Required)
vs.
Respondent
TO:
_________________________ (Petitioner/Respondent) has filed a petition/motion for the following
relief: _________________________________________________________________________ .
[name of petition/motion]
A hearing will be held on ______________________________ [date], at ____________ a.m./p.m. at
____________________________________________________________ [location] to determine
whether the requested relief should be granted. IF YOU DO NOT APPEAR, THE COURT MAY
ENTER AN ORDER GRANTING THE RELIEF REQUESTED.
Dated:
COUNTY CLERK
By:
Deputy Clerk
This document must be served on the other party, and
proof of service must be in the court file prior to the hearing.
NOTICE OF HEARING (NTHG) - Page 1 of 1
WPF UH-02.0400 (6/2002) - RCW 10.14.070, .080
Court of Washington
For
NO.
Petitioner,
vs.
Temporary Protection Order and
Notice of Hearing – Harassment
(TMORAH)
(Clerk’s action required)
Respondent.
Next Hearing Date and Time:
_____________________________
At:
______________________________
Warning to the Respondent: Violation of the provisions of this order with actual notice of its
terms is a criminal offense under chapter 10.14 RCW and will subject a violator to arrest.
Willful disobedience of the terms of this order may also be contempt of court and subject you
to penalties under chapter 7.21 RCW.
Minors addressed in this order:
Name (First, Middle Initial, Last)
Age
Race
Sex
Based upon the petition, testimony, and case record, the court finds that the respondent
committed unlawful harassment as defined in RCW 10.14.080, and it is therefore ordered
that:
No-Contact: respondent is restrained from making any attempts to contact petitioner
and any minors named in the table on page one.
Surveillance: respondent is restrained from making any attempts to keep under
surveillance petitioner and any minors named in the table on page one.
Temp. Protection Order/Nt of Hearing – Harassment (TMORAH) - Page 1 of 2
UH-03.0200 (06/2014) CR 65(b), - RCW 10.14.080 (1), (2)
Stay-Away: respondent is restrained from entering or being within _______________
(distance) of petitioner’s
residence
place of employment
other:
The address is confidential
Petitioner waives confidentiality of the address which is:
Other: _______________________________________________________________
____________________________________________________________________
____________________________________________________________________ .
Surrender of Weapons
Respondent shall immediately surrender any firearms and other dangerous weapons to the
person or agency named in the Order to Surrender Weapons (Issued without Notice) signed
by the court on this date, under this cause number.
It is further ordered that the clerk of court shall forward a copy of this order on or before the
next judicial day to: ____________________________________
County Sheriff’s Office
Police Department where petitioner lives which shall enter it into the Washington Crime
Information Center.
The clerk of court
petitioner shall forward a copy of this order on or before the next
judicial day to: ________________________________ ______
County Sheriff’s Office
Police Department where respondent lives which shall personally serve the
respondent with a copy of this order and shall promptly complete and return to this court
proof of service.
Or
Petitioner has made private arrangements for service of this order.
Or
Respondent appeared; further service is not required.
The respondent is directed to appear and show cause why the court should not enter an
order for protection effective for one year or more and order the relief requested by the
petitioner or other relief the court deems proper, which may include payment of costs.
Failure to appear at the hearing or to otherwise respond will result in the court issuing
an order for protection pursuant to Chapter 10.14 RCW effective for a minimum of one
year from the date of the hearing. The next hearing date and time is shown below the
caption on page one.
A copy of this Temporary Protection Order and Notice of Hearing has been filed with
the clerk of the court.
This Temporary Order for Protection is effective until the next hearing date and time
shown below the caption on page one.
Dated
at ______ a.m./p.m.
Judge/Court Commissioner
Presented by:
Petitioner
I acknowledge receipt of a copy of this Order:
Date
Respondent
Petitioner or Petitioner’s Lawyer must complete a Law Enforcement
Information Sheet (LEIS).
Temp. Protection Order/Nt of Hearing – Harassment (TMORAH) - Page 2 of 2
UH-03.0200 (06/2014) CR 65(b), - RCW 10.14.080 (1), (2)
Date
Court of Washington
For
No.
___________________________ _____________
Petitioner,
(DOB)
vs.
___________________________ _____________
Respondent.
(DOB)
Order for Protection Harassment (ORAH)
Court
Address:____________________
______
___________________________
______
___________________________
______
Telephone Number:( )
(Clerk’s action required)
Warning to the Respondent: Violation of the provisions of this order with actual notice of its
terms is a criminal offense under chapter 10.14 RCW and will subject a violator to arrest.
Willful disobedience of the terms of this order may also be contempt of court and subject you
to penalties under chapter 7.21 RCW.
1. Full Faith and Credit: The court has jurisdiction over the parties, the minors and the subject
matter. This order is issued in accordance with the Full Faith and Credit provisions of
VAWA.18 U.S.C. § 2265.
2. Notice of this hearing was served on the respondent by
publication pursuant to court order
other
3. Minors addressed in this order:
Or for Protection (Harassment) (ORAH) – Page 1 of 3
UH-04.0500 (06/2014) - RCW 10.14.080 (4)
personal service
service by
.
Name (First, Middle Initial, Last)
Age
Race
Sex
Based upon the petition, testimony, and case record, the court finds that the respondent
committed unlawful harassment, as defined in RCW 10.14.080, and was not acting pursuant to
any statutory authority, and it is therefore ordered that:
No-Contact: respondent is restrained from making any attempts to contact petitioner
and any minors named in the table above.
Surveillance: respondent is restrained from making any attempts to keep under
surveillance petitioner and any minors named in the table above.
Stay Away: respondent is restrained from entering or being within ____________
residence
place of employment
other:
(distance) of petitioner’s
The address is confidential
Petitioner waives confidentiality of the address which is:
Other: ________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
______________________________________________________________________.
Pay Fees and Costs: judgment is granted against respondent in favor of
______________________ in the amount of $ _______ for costs incurred in bringing the
action and $ _________ for attorneys’ fees.
Notice: Petitioner, you must fill out and file a completed form WPF UH 04.0700,
Judgment Summary.
The court has granted judgment against the respondent in the amount of $__________ for
administrative court costs and service fees. A Judgment Summary, form WPF UH 04.0700,
must be completed and filed.
Surrender of Weapons and Restrictions
Does not apply.
Respondent shall immediately surrender all firearms and other dangerous weapons in his
or her possession or control, and any concealed pistol license to the person or agency
named in the Order to Surrender Weapons signed by the court on this date, under this
cause number.
Or for Protection (Harassment) (ORAH) – Page 2 of 3
UH-04.0500 (06/2014) - RCW 10.14.080 (4)
Respondent is prohibited from obtaining or possessing a firearm or other dangerous
weapon, or a concealed pistol license while this order is in effect.
WACIC Data Entry
It is further ordered that the clerk of court shall forward a copy of this order on or before the
County
next judicial day to __________________________________________________
Sheriff’s Office
Police Department, where petitioner lives and shall enter it into the
Washington Crime Information Center.
The clerk of court
petitioner shall forward a copy of this order on or before the next
judicial day to:
___________________________________________________ County Sheriff’s Office,
Or
______________________________________________________ Police Department,
where respondent lives which shall personally serve the respondent with a copy of this
order and shall promptly complete and return to this court proof of service.
Petitioner has made private arrangements for service of this order.
Or
Respondent appeared; further service is not required.
Or
Respondent did not appear. The restraint provisions in this order are the same as
those in the temporary order. The court is satisfied that the respondent was personally
served with the temporary order. Further service is not required.
This Antiharassment protection order expires on
.
If the duration of this order exceeds one year, the court finds that respondent is likely to resume
unlawful harassment of the petitioner when the order expires.
Dated _______________ at _____a.m./p.m.
Judge/Court Commissioner
Presented by:
I acknowledge receipt of a copy of this Order:
__________________________________
Petitioner/Petitioner’s lawyer
Print Name
Date
WSBA No.
Respondent
Date
Print Name
WSBA No.
Petitioner or Petitioner’s Lawyer must complete a Law Enforcement Information
Sheet (LEIS).
Or for Protection (Harassment) (ORAH) – Page 3 of 3
UH-04.0500 (06/2014) - RCW 10.14.080 (4)
Court of Washington
For
No.
______________________________________
Minor to be protected,
Petition for an Order for Protection
Respondent Under Age 18
______________________________________
Harassment (PTAH18) and/or
Petitioner,
Stalking (PTSTK18)
vs.
______________________________________
Minor Respondent.
 Information about appointment of a guardian ad litem for respondent:
Harassment:
•
•
If the minor respondent is not an emancipated minor, a guardian ad litem must be
appointed to represent him or her in this action under RCW 4.08.050.
The court may order the petitioner to pay guardian ad litem fees.
Stalking:
•
•
•
If the respondent is 16 or 17 years of age, appointment of a guardian ad litem is not
required. However, the court may still appoint one in certain circumstances.
If the respondent is 15 years of age or younger and is not an emancipated minor, a
guardian ad litem must be appointed to represent him or her in this action under
RCW 4.08.050.
The court will not order the petitioner to pay guardian ad litem fees.
Pt for Or for Prot - Resp Under 18- Harassment/Stalking (PTSTK18) – Page 1 of 9
UHST-05.0100 (06/2014) – RCW 10.14.040, .800, RCW 7.92.030
 This is a Petition for an Order for Protection against Harassment
and/or Stalking as checked in the caption.
I believe:
I am, or the minor I am petitioning for is, a victim of stalking because
the respondent and I, or the minor I am petitioning for, are not and never have been
related by blood or marriage, lived together or been in a dating relationship, and
the respondent has been
- stalking me or the minor either in person or (cyber stalking), and
- repeatedly contacting, or attempting to contact or monitor me or the minor for no
lawful purpose and his/her actions caused me or the minor to feel intimidated,
frightened or threatened.
The minor I am petitioning for is a victim of unlawful harassment because the
respondent’s actions toward the minor have seriously alarmed, annoyed, or harassed
the minor or are detrimental to the minor and they serve no legitimate or lawful
purpose. The respondent’s actions have caused the minor substantial emotional
distress or caused me to fear for the well-being of the minor.
The respondent and the minor:
are or have been related by blood or marriage, lived together, or been in a dating
relationship.
have not been and are not now related by blood or marriage, lived together, or
been in a dating relationship.
I have given a detailed explanation below.
1. Who is the petitioner
My name is (please print) _________________________________. I am the petitioner.
I am age 16 or 17 years of age and I am petitioning on my own behalf.
I am a parent or guardian of a minor and I am petitioning on behalf of that minor.
I am not the parent or guardian, but I am petitioning on behalf of a minor who lives with
me; and the respondent is not a parent of that minor.
2. Information about the respondent
Pt for Or for Prot - Resp Under 18- Harassment/Stalking (PTSTK18) – Page 2 of 9
UHST-05.0100 (06/2014) – RCW 10.14.040, .800, RCW 7.92.030
The respondent’s name is listed in the caption. The respondent is
16 or 17 years of age
15 or under
Under 18; but I do not know the exact age.
You only need to complete the following if you are requesting a harassment protection
order:
Respondent has been adjudicated of the following offense against my child:
Offense:
Case Name: ______________________________ Case Number:
Court/County:
Respondent is under investigation or has been investigated for the following alleged
offense against my child:
Alleged offense:
Investigating agency:
3. Where do the parties live?
Petitioner lives in ____________________________________ county.
Did the petitioner leave their residence because of stalking conduct and that is the county of
their new residence?
Yes
No
The minor named in the caption lives in __________________________ county.
Respondent lives in ___________________________________ county.
4. Where did the Conduct take place?
The conduct took place in ____________________ county.
5. School
Do the minor to be protected and the minor respondent attend the same school?
Yes
No
If yes, please complete:
Name of school: _________________________________________________________
Address of school: _______________________________________________________
Pt for Or for Prot - Resp Under 18- Harassment/Stalking (PTSTK18) – Page 3 of 9
UHST-05.0100 (06/2014) – RCW 10.14.040, .800, RCW 7.92.030
 Statement describing the victim/s need for protection from the
respondent
 Write clearly. If you need more space below, attach additional page/s. Do not write on the
back.
6. Describe what the Respondent did or said that you think is harassment or stalking.
• You must describe what the respondent actually said.
• You must describe what the respondent actually did.
The respondent has committed acts of harassment or stalking as follows:
A. Describe the most recent act of harassment or stalking.
Date and time (on or around): __________________________________________________
Location:
__________________________________________________________________
What did the respondent do or say that you believe to be harassing or stalking
behavior?
Pt for Or for Prot - Resp Under 18- Harassment/Stalking (PTSTK18) – Page 4 of 9
UHST-05.0100 (06/2014) – RCW 10.14.040, .800, RCW 7.92.030
.
How did the respondent make these statements?
in person
mail/written notes
e-mail
text
phone
social media (such as Facebook and Twitter)
other (describe):
__________________________________________________________.
B.
Describe other incidents of harassment or stalking. For each incident, include the date,
time (on or about), location, what was said, how statements were made, and what was
done to the victim:
Pt for Or for Prot - Resp Under 18- Harassment/Stalking (PTSTK18) – Page 5 of 9
UHST-05.0100 (06/2014) – RCW 10.14.040, .800, RCW 7.92.030
.
7.
How did the incidents you describe above make you or the minor feel?
.
8.
Has the respondent used, displayed, or threatened to use a firearm or other dangerous
weapon in a felony? Please describe:
.
9.
Has the respondent previously committed an offense that makes him or her ineligible to
possess a firearm under the provisions of RCW 9.41.040? Please describe:
.
10.
Does possession of a firearm or other dangerous weapon by the respondent present a
serious and imminent threat to public health or safety, or to the health or safety of the
victim? Please describe:
Pt for Or for Prot - Resp Under 18- Harassment/Stalking (PTSTK18) – Page 6 of 9
UHST-05.0100 (06/2014) – RCW 10.14.040, .800, RCW 7.92.030
.
11. Do you have any evidence of the harassment or stalking conduct other than
testimony?
No
Yes. I have attached the following evidence:
Copy of letter(s)
Copy of text messages
Copy of emailed messages
Copy of social media messages
Police report
Declaration or Affidavit from the following witness(es):
________________
Other (describe):
_____________________________________________
12. Are there other court cases, civil protection orders, or criminal no-contact orders involving
the minor to be protected and the minor respondent:
Case Number
Court Name (Superior/District/Municipal) Case Title or Parties
a)_________________
b)_________________
________________________________ ______________________
________________________________ ______________________
 Requests
13. I ask the Court for an order approving the following requests for protection:
I Request an Order for Protection - following a hearing that will:
No-Contact: restrain the respondent from making any attempts to contact or having any
contact, including nonphysical contact, with the minor to be protected directly, indirectly, or
through third parties regardless of whether those third parties know of the order, except
for mailing of court documents.
Surveillance: prohibit or restrain the respondent from making any attempt to keep, or
from keeping the minor to be protected under surveillance, including electronic
surveillance.
Exclude from places: exclude the respondent from the
residence
workplace
school
daycare of the minor to be protected.
Stay Away: prohibit or restrain the respondent from entering or being within, or from
knowingly coming within, or knowingly remaining within __________________ (distance)
of the
residence
workplace
school
day care of the minor to be protected.
other:_______________________________________________________________.
Pt for Or for Prot - Resp Under 18- Harassment/Stalking (PTSTK18) – Page 7 of 9
UHST-05.0100 (06/2014) – RCW 10.14.040, .800, RCW 7.92.030
School Attendance: restrain respondent from attending ________________________
school at _______________________________________________________ (address)
attended by the minor to be protected and order respondent to transfer to a different
school.
Other:
Evaluation: order the respondent to have a
mental health
chemical dependency
evaluation
other: _______________________________________________________________.
Pay Fees and Costs: require the respondent to pay fees and costs of this action, which
may include administrative court costs and service fees and petitioner’s costs including
attorneys’ fees.
Surrender Firearms: require the respondent to surrender any firearm or other
dangerous weapon, or any concealed pistol license and prohibit the respondent from
obtaining or possessing a firearm or other dangerous weapon, or a concealed pistol
license.
Duration: Remain effective longer than one year because respondent is likely to
resume acts of unlawful harassment or stalking conduct against the minor to be protected
if the order expires in a year.
Pt for Or for Prot - Resp Under 18- Harassment/Stalking (PTSTK18) – Page 8 of 9
UHST-05.0100 (06/2014) – RCW 10.14.040, .800, RCW 7.92.030
Emergency Temporary Protection (up to 14 days) Until the Court Hearing:
An emergency exists as described below. I request that a Temporary Stalking
Protection Order granting the relief I requested above for a no-contact, surveillance,
exclude from places, stay away, or school attendance order be issued immediately,
without prior notice to the respondent, to be effective until the hearing.
I also request a temporary surrender of a firearm or other dangerous weapon without
notice to the other party because irreparable injury could result if an order is not issued
until the hearing.
What irreparable harm would result if an order is not issued immediately without prior notice
to the respondent?
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________.
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is
true and correct.
Dated:
at
Washington.
_______________________________________
Petitioner or person filing on behalf of petitioner
_______________________________________
Print or type name
My address for the purpose of receiving service of legal documents is:
_______________________________________________________________________.
This is not my residence address. My family, household or I would be at risk of abuse by
respondent if I disclosed my residence address. I agree to receive service of process at this
address.
Pt for Or for Prot - Resp Under 18- Harassment/Stalking (PTSTK18) – Page 9 of 9
UHST-05.0100 (06/2014) – RCW 10.14.040, .800, RCW 7.92.030
Court of Washington
For
NO.
Minor (Protected person),
Temporary Protection Order and
Notice of Hearing – Respondent
Under Age 18 – Harassment
(TORAH18)
(Clerk’s action required)
Next Hearing Date and Time:
Petitioner,
______________________________
vs.
At:
______________________________
Respondent.
Warning to the Respondent: Willful disobedience of the terms of this order may be
contempt of court and may subject you to detention under RCW 7.21.030(4).
RCW 10.14.120
____________________________________________ (Name) is a responsible and proper
person to be appointed and is appointed guardian ad litem of respondent in this proceeding.
Based upon the petition, testimony, and case record, the court is satisfied that there is
reasonable proof that the respondent committed unlawful harassment as defined in RCW
10.14.020 and .080, and that great or irreparable harm will result to the protected minors if this
order is not granted. After considering the facts of the case, the severity of the alleged offense,
any continuing physical danger or emotional distress to the minors to be protected, and the
expense, difficulty, and educational disruption that would be caused by a transfer of the
respondent to another school. It is therefore ordered that:
Temp Protection Or/Nt of Hrg.- Resp. Under 18 - Harassment (TORAH18) - Page 1 of 3
UH-05.0300 (06/2014) CR 65(b), - RCW 10.14.040, .080 (1), (2), 4.28.020
Respondent is restrained from making any attempts to contact the protected person.
Respondent is restrained from making any attempts to keep under surveillance the
protected person.
Respondent is restrained from entering or being within _______________ (distance) of
the protected person’s
residence
work place
Other:
The address is confidential.
Petitioner waives confidentiality of the protected
person’s address which is:
Respondent is restrained from attending ________________________________ school
at __________________________________________________________ (address)
attended by the protected person and shall transfer to a different school.
Other:______________________________________________________________
___________________________________________________________________
___________________________________________________________________
Surrender of Weapons
Respondent shall immediately surrender any firearms and other dangerous weapons to the
person or agency named in the Order to Surrender Weapons (Issued without Notice) signed by
the court on this date, under this cause number.
It is further ordered that the clerk of court shall forward a copy of this order on or before
the next judicial day to:
________________________ County Sheriff’s Office
_______________________ Police Department where petitioner lives which shall
enter it into the Washington Crime Information Center.
The clerk of court
petitioner shall forward a copy of this order on or before the
next judicial day to:
__________________________ County Sheriff’s Office
_________________________ Police Department where respondent lives which
shall personally serve the respondent with a copy of this order and shall promptly
complete and return to this court proof of service.
Or
Petitioner has made private arrangements for service of this order. If respondent
is age 14 or older, serve respondent. If respondent is under age 14, serve
respondent and respondent’s guardian.
Temp Protection Or/Nt of Hrg.- Resp. Under 18 - Harassment (TORAH18) - Page 2 of 3
UH-05.0300 (06/2014) CR 65(b), - RCW 10.14.040, .080 (1), (2), 4.28.020
The respondent is directed to appear and show cause why the court should not enter an
order for protection effective for one year or more and order the relief requested by the
petitioner or other relief as the court deems proper, which may include payment of costs.
Failure to appear at the hearing or to otherwise respond will result in the court issuing
an order for protection pursuant to Chapter 10.14 RCW effective for a minimum of one
year from the date of the hearing. The next hearing date and time is shown below the
caption on page one.
A copy of this Temporary Protection Order and Notice of Hearing has been filed with
the clerk of the court.
This Temporary Order for Protection is effective until the next hearing date and time
shown below the caption on page (1) one.
Dated
at ______ a.m./p.m.
Judge/Court Commissioner
Presented by:
I acknowledge receipt of a copy of this Order:
_ _________________________________
Petitioner
Date
Respondent
Petitioner or petitioner’s lawyer must complete a Law Enforcement
Information Sheet (LEIS) and include addresses for the respondent and
respondent’s guardian.
Temp Protection Or/Nt of Hrg.- Resp. Under 18 - Harassment (TORAH18) - Page 3 of 3
UH-05.0300 (06/2014) CR 65(b), - RCW 10.14.040, .080 (1), (2), 4.28.020
Date
Court of Washington
For
No.
_________________________________________
Minor (Protected person),
_________________________________________
Petitioner,
vs.
_________________________________________
Minor Respondent.
Order for Protection –
Respondent Under Age 18 –
Harassment (ORAH18)
Court
Address_____________________
_____
___________________________
______
Telephone Number: (
)
(Clerk’s action required)
School notification required
Warning to the Respondent: Willful disobedience of the terms of this order may be
contempt of court and may subject you to detention under RCW 7.21.030(4). RCW
10.14.120.
1.
Full Faith and Credit: This order is issued to prevent violent or threatening acts of
harassment. The court has jurisdiction over the parties, the minors and the subject matter.
This order is issued in accordance with the Full Faith and Credit provisions of VAWA.
18 U.S.C. § 2265.
2. Notice of this hearing was served on the respondent by
personal service
service by
publication pursuant to court order
other
.
3.
____________________________________________ (name)
is a responsible and
proper person to be appointed and is appointed guardian ad litem of respondent and
is
discharged when proof of service of this order on the guardian ad litem is filed in this case.
Order for Protection – Resp under 18 - Harassment (ORAH18) – Page 1 of 4
UH-05.0500 (06/2014) - RCW 10.14.040, .080, 4.28.020
Based upon the petition, testimony, and case record, the court finds that the respondent
committed unlawful harassment, as defined in RCW 10.14.020 and .080, and was not acting
pursuant to any statutory authority, and after considering the facts of the case, the severity of
the alleged offense, any continuing physical danger or emotional distress to the minors to be
protected, and the expense, difficulty, and educational disruption that would be caused by a
transfer of the respondent to another school, It is therefore ordered that:
No-Contact: respondent is restrained from making any attempts to contact the protected
person.
Surveillance: respondent is restrained from making any attempts to keep under
surveillance the protected person.
Stay Away: respondent is restrained from entering or being within ________ (distance)
of the protected person’s
residence
work place
Other:
The address is confidential
Petitioner waives confidentiality of the address which is:
School Attendance: Respondent is restrained from attending ____________________
school at _____________________________________________________ (address)
attended by the protected person and shall transfer to a different school.
Other: ________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________.
Pay Fees and Costs: judgment is granted against respondent in favor of
___________________ in the amount of $ _______ for costs incurred in bringing the
action and $ _________ for attorneys’ fees.
Notice: Petitioner, you must fill out and file a completed form WPF UH 04.0700,
Judgment Summary.
The court has granted judgment against the respondent in the amount of $__________ for
administrative court costs and service fees. A Judgment Summary, form WPF UH 04.0700,
must be completed and filed.
Surrender of Weapons and Restrictions
Does not apply.
Respondent shall immediately surrender all firearms and other dangerous weapons in his
or her possession or control, and any concealed pistol license to the person or agency
named in the Order to Surrender Weapons signed by the court on this date, under this
cause number.
Respondent is prohibited from obtaining or possessing a firearm or other dangerous
weapon, or a concealed pistol license while this order is in effect.
WACIC Data Entry
It is further ordered that the clerk of court shall forward a copy of this order on or before the
Order for Protection – Resp under 18 - Harassment (ORAH18) – Page 2 of 4
UH-05.0500 (06/2014) - RCW 10.14.040, .080, 4.28.020
next judicial day to:
_________________________________________________ County Sheriff’s Office
_________________________________________________ Police Department where
petitioner lives and shall enter it into the Washington Crime Information Center.
Service
The clerk of court
petitioner shall forward a copy of this order on or before the next
judicial day to:
__________________________________________________ County Sheriff’s Office,
__________________________________________________ Police Department,
where respondent lives which shall personally serve the respondent with a copy of this
order and shall promptly complete and return to this court proof of service.
Or
Petitioner has made private arrangements for service of this order. If respondent is
age 14 or older, serve respondent. If respondent is under age 14, serve
respondent and respondent’s guardian.
Or
Respondent appeared; further service is not required.
Or
Respondent did not appear. The restraint provisions in this order are the same as
those in the temporary order. The court is satisfied that the respondent was personally
served with the temporary order. Further service is not required.
This Antiharassment Protection Order expires on
.
If the duration of this order exceeds one year, the court finds that respondent is likely to resume
unlawful harassment of the petitioner when the order expires.
Dated _______________ at ______a.m./p.m.
Judge/Court Commissioner
Presented by:
Order:
I acknowledge receipt of a copy of this
__________________________________
Petitioner/Petitioner’s Lawyer
Date
Respondent
Order for Protection – Resp under 18 - Harassment (ORAH18) – Page 3 of 4
UH-05.0500 (06/2014) - RCW 10.14.040, .080, 4.28.020
Date
Print Name
WSBA No.
Print Name
Respondent’s Guardian ad Litem Date
Print Name
WSBA No.
Petitioner or petitioner’s lawyer must complete a Law Enforcement
Information Sheet (LEIS) and include addresses for the respondent and
respondent’s guardian.
Order for Protection – Resp under 18 - Harassment (ORAH18) – Page 4 of 4
UH-05.0500 (06/2014) - RCW 10.14.040, .080, 4.28.020
LAW ENFORCEMENT
INFORMATION
Do NOT serve or show this sheet to the restrained person!
Do NOT FILE in the court file. Give this form to law enforcement.
Type or print clearly! This completed form is required by law enforcement. This information is necessary to serve, enforce
and enter your order into the state wide law enforcement computer. Fill in the following information as completely as possible.
Court:
Case Number:
Domestic Violence
Unlawful Harassment
Dissolution/Separation/Invalidity/Nonparental Custody/Paternity
Vulnerable Adult
Sexual Assault
Restrained Person’s Information (This is the person that you want the court to restrain.)
Name:
First
Middle
Date of Birth
Male
Female
Race
Last Known Address
Street:
City:
Employer
Vehicle License Number
Nickname
Last
Height
Weight
Eye Color
Relationship to Protected Person
Hair Color
Skin Tone
Phone(s) w/Area Code
State:
Zip:
Employer's Address
Vehicle Make and Model
Vehicle Color
Vehicle Year
Build
Need Interpreter? Yes or No
Language:
WORK
Hours:
Phone: (
)
Drivers License or ID number
State
Does the restrained person have a disability, brain injury, or impairment requiring special assistance when law enforcement
serves the order?
No
Yes. If yes, describe (continue on back, if needed):
Hazard Information Restrained Person’s History Includes:
Involuntary/Voluntary Commitment
Assault
Assault with Weapons
Weapons:
Handguns
Location of Weapons:
Rifles
Vehicle
Suicide Attempt or Threats
Alcohol/Drug Abuse
Other:
Knives
Explosives
On Person
Residence
Other:
Describe in detail:
Current Status (Circle Yes, No or N/A.)
Is the restrained person a current or former cohabitant as an intimate partner? Y N
Are you and the restrained person living together now? Y N Does the restrained person know he/she may be moved out of the home? Y N N/A
Does the restrained person know you’re trying to get this order? Y N
Is the restrained person likely to react violently when served? Y N
Protected Person’s Information (This is the person you want the court to protect.)
Name:
First
Middle
Last
Date of Birth
Race
Height
Weight
Eye Color
Male
Female
If your information is not confidential, you must enter your address and phone number(s).
Hair Color
Skin Tone
Build
Current Address
Phone(s) w/Area Code Need interpreter? Yes or
No Language:
Street:
City:
State:
Zip:
If your information is confidential, you must provide the name, address and phone number of someone willing to be your “contact.”
Contact Name
Contact Address
Contact Phone
If you filed for someone else,
list your name, phone number
and address:
Minor’s Information
Name: First
Middle
Last
Describe the minor’s relationship using terms such
as: child, grandchild, stepchild, nephew, none. 
Sex
Race
Birth date
Resides With
Victim’s Household Members or Adult Children Protected
Name:
birth date:
WPF All Cases 01.0400 LEIS (6/2010)
Name:
Name:
Minor’s Relationship to
Protected
Restrained
Person
Person
birth date:
birth date:
See Reverse For Additional Information 
CONFIDENTIAL INFORMATION FORM (INFO)
County:
Cause Number:
Do not file in a
COURT CLERK: THIS IS A RESTRICTED ACCESS DOCUMENT
public access file.
Divorce/Separation/Invalidity/Nonparental Custody/Paternity/Modifications
Other
Domestic Violence
Antiharassment
Information Change (Check if you are updating information)
A restraining order or protection order is in effect protecting the petitioner the respondent
the children.
The health, safety, or liberty of a party or child would be jeopardized by disclosure of address
information because:
The following information about the parties is required in all cases:
(Use the Addendum To Confidential Information Form to list additional parties or children)
Petitioner Information
Respondent Information
Type or Print only
Name (Last, First, Middle)
Race
Sex
Name (Last, First, Middle)
Birthdate
Race
Sex
Birthdate
Driver’s Lic. or Identicard (# and State)
Driver’s Lic. or Identicard (# and State), (or, if
unavailable, residential address)
Mailing Address (P.O. Box/Street, City, State, Zip)
Mailing Address (P.O. Box/Street, City, State, Zip)
Relationship to Child(ren)
Relationship to Child(ren)
The following information is required if there are children involved in the proceeding.
(Soc. Sec. No. is not required for petitions in protection order cases (Domestic Violence/Antiharassment).
1) Child's Name (Last, First, Middle)
Child's Race/Sex/Birthdate
Child's Soc. Sec. No. (If required)
Child's Present Address or Whereabouts
2) Child's Name (Last, First, Middle)
UH-01.0600 Confidential Information Form (INFO) (12/2001) - Page 1 of 2
Child's Race/Sex/Birthdate
Child's Soc. Sec. No. (If required)
Child's Present Address or Whereabouts
List the names and present addresses of the persons with whom the child(ren) lived during the
last five years:
List the names and present addresses of any person besides you and the respondent who has
physical custody of, or claims rights of custody or visitation with, the child(ren):
Except for petitions in protection order cases (Domestic Violence/Antiharassment),
the following information is required:
Petitioner's Information
Respondent's Information
Soc. Sec. No.:
Soc. Sec. No.:
Residential Address (Street, City, State, Zip)
Residential Address (Street, City, State, Zip)
Telephone No.: (
Telephone No.: (
)
Employer:
Employer:
Empl. Address:
Empl. Address:
Empl. Phone No.: (
)
Empl. Phone No.: (
)
)
Additional information:
Addendum To Confidential Information Form is attached.
I certify under penalty of perjury under the laws of the state of Washington that the above information is
true and accurate concerning myself and is accurate to the best of my knowledge as to the other party, or
is unavailable. The information is unavailable because
.
Signed on __________________ (Date) at ____________________________________ (City
and State).
Petitioner/Respondent
UH-01.0600 Confidential Information Form (INFO) (12/2001) - Page 2 of 2
COURT OF WASHINGTON
FOR
NO.
RETURN OF SERVICE HARASSMENT
(RTS)
Petitioner
vs.
Respondent
1. My name is
. I am
a peace officer
18 years of age or
older and not the petitioner.
2.
I was unable to make personal service on the respondent.
I have notified the
petitioner that respondent was not served.
Personal service was attempted on the following date(s):
No service was attempted because
________________________________________________
3.
_________________________________________________________________
__________.
I served
with the following documents:
(name of person served)
Temporary Order for Protection/Notice of
Hearing
Petition for an Order for Protection
Motion to Modify/Terminate Order for
Protection
Other:
Reissuance of Temporary Order for Protection
and Notice of Hearing
Order for Protection - Harassment
4. I served these documents on ______________________ at __________________ at this
address:
(date)
(time)
__________________________________________________________________________
_____
RETURN OF SERVICE (HARASSMENT) (RTS) – Page 1 of 2
UH-04.0110 (6/2002) - RCW 10.14.011(4)
__________________________________________________________________________
_____.
5.
Other:
_________________________________________________________________________
__________________________________________________________________________
_____.
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is
true and correct.
DATED
Fees:
at
Service
Mileage
, Washington.
Signature of Server
Total
Law Enforcement Agency
RETURN OF SERVICE (HARASSMENT) (RTS) – Page 2 of 2
UH-04.0110 (6/2002) - RCW 10.14.011(4)