NO. _________________________
PETITIONER:
IN THE DISTRICT COURT
JUDICIAL DISTRICT
DEFENDANT:
{COUNTY, STATE}
Ex Parte Motion for Temporary Restraining Order
I, the Petitioner, hereby certify and attest that the Defendant has threatened, harassed,
intimidated, encroached, harmed, or enacted violence upon me or my family members in the
following ways:
I therefore request the following from the court:
That a Temporary Restraining Order be granted against the Defendant, keeping him/her
from contacting or approaching me and/or the immediate members of my family.
That the Defendant be required to stay
yards away from me and/or immediate
the members of my family.
That the Defendant be summoned to appear before the court and respond to the charges of
stalking and harassment.
Signature
Date