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CONFIDENTIAL PROTECTION ORDER INFORMATION (Family Law Self Help Center)

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© 2020 Nevada Supreme Court Domestic Violence Protection Order Confidential Information Sheet
Page 1 of 2
CONFIDENTIAL PROTECTION ORDER INFORMATION
Law Enforcement: Do not serve this sheet with documents to be delivered.
Applicant: Print clearly all the information you know. This helps law enforcement locate and serve the Adverse Party.
YOUR INFORMATION
Your Name: ___________________________________________________________________________ M F O
(First) (Middle) (Last)
Birthdate: ______/______/_______ Social Security Number: ________-_______-_______ Race: _____________________
(MM) (DD) (YY)
Your Address: ________________________________________________________________________________________
(Street Address) (Bldg/Apt#) (City) (State) (Zip Code)
Mailing Address: _______________________________________________________________________________________________
(If different) (Street Address) (Bldg/Apt#) (City) (State) (Zip Code)
Home Phone: ________________________ Cell Phone: _______________________ Work Phone: ____________________
Email Address: __________________________________ I prefer to be notified of future court dates by email / mail
The Adverse Party is my: spouse ex-spouse ex-dating partner parent of my child parent
in-law: (explain) ______________________________ other: _______________________
OTHER PROTECTED PARTIES
Only fill out this section if there are other family members or household members that you asked to be protected under the
order. If there are none, skip to “Adverse Party”
Name: ________________________________________________________________________________ M F O
(First) (Middle) (Last)
Birthdate: ______/______/_______ Social Security Number: ________-_______-_______ Race: _____________________
(MM) (DD) (YY)
The Adverse Party is this person’s: parent step-parent ex-dating partner sibling other: ____________
. . . . . . . . . . . . . . . . . . . . . . . . . . .
Name: ________________________________________________________________________________ M F O
(First) (Middle) (Last)
Birthdate: ______/______/_______ Social Security Number: ________-_______-_______ Race: _____________________
(MM) (DD) (YY)
The Adverse Party is this person’s: parent step-parent ex-dating partner sibling other: ____________
. . . . . . . . . . . . . . . . . . . . . . . . . . .
Name: ________________________________________________________________________________ M F O
(First) (Middle) (Last)
Birthdate: ______/______/_______ Social Security Number: ________-_______-_______ Race: _____________________
(MM) (DD) (YY)
The Adverse Party is this person’s: parent step-parent ex-dating partner sibling other: ________________
. . . . . . . . . . . . . . . . . . . . . . . . . . .
Name: ________________________________________________________________________________ M F O
(First) (Middle) (Last)
Birthdate: ______/______/_______ Social Security Number: ________-_______-_______ Race: _____________________
(MM) (DD) (YY)
The Adverse Party is this person’s: parent step-parent ex-dating partner sibling other: ________________
© 2020 Nevada Supreme Court Domestic Violence Protection Order Confidential Information Sheet
Page 2 of 2
ADVERSE PARTY INFORMATION
Name: ________________________________________________________________________________ M F O
(First) (Middle) (Last)
Other Name Used: _____________________________________________________________________________________
(First) (Middle) (Last)
Birthdate: ______/______/_______ Social Security Number: ________-_______-_______ Race: _____________________
(MM) (DD) (YY)
Height: _______ Weight: _______ Hair Color: ________ Eye Color: ________
Home Address: _______________________________________________________________________________________
(Street Address) (Bldg/Apt#) (City) (State) (Zip Code)
Is this address difficult to find? No Yes: explain:
Mailing Address: _______________________________________________________________________________________________
(If different) (Street Address) (Bldg/Apt#) (City) (State) (Zip Code)
Other Likely Address: __________________________________________________________________________________
(Street Address) (Bldg/Apt#) (City) (State) (Zip Code)
Home Phone: ________________________ Cell Phone: _______________________ Work Phone: ____________________
Employer: _________________________ Position: ___________________Work Days: _________ Work Hours: _________
Work Address: ________________________________________________________________________________________
(Street Address) (Bldg/Apt#) (City) (State) (Zip Code)
Scars/Marks/Tattoos (Description and Location):
Vehicle Make: ______________ Model: ____________ Year: ___________ License Plate Number/State: _______________
Do you live with Adverse Party now? Yes No
Have you ever lived with Adverse Party? Yes No
Do you have children with Adverse Party? Yes No
Does the Adverse Party speak English? Yes No: What language does he/she speak? ____________
Do you work for the same employer? Yes No
Is the Adverse Party likely to act violently when served? Yes No
Is the Adverse Party likely to avoid service? Yes No
Does the Adverse Party have a CCW Permit? Yes No
Does the Adverse Party have access to weapons? Yes No
If yes, describe type and location of weapon(s):
Does the Adverse Party have a history of violent behavior or crimes? Yes No
If yes, explain:
Do not write in this space. For court purposes only.
Issuing Court ORI: NV ________________ Court Case Number: _________________
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CONFIDENTIAL PROTECTION ORDER INFORMATION (Family Law Self Help Center)

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Completed 15 January 2021

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