Fillable IN THE DISTRICT COURT OF COUNTY, KANSAS Plaintiff

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IN THE DISTRICT COURT OF COUNTY, KANSAS Plaintiff

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Rev. 7/2018 KSJC
Page 1 of 5
IN THE DISTRICT COURT OF COUNTY, KANSAS
Plaintiff
vs. Case No.
Defendant
Petition Pursuant to K.S.A. Chapter 60
PETITION FOR PROTECTION FROM STALKING, SEXUAL ASSAULT,
OR HUMAN TRAFFICKING ORDER
(K.S.A. 60-31a01 et seq.)
1. Plaintiff seeks an order for protection from stalking, sexual assault, or human
trafficking for:
a. myself;
OR
b. a minor child (under age 18)
Plaintiff is:
the parent of the child
an adult who resides with the child
the child’s court appointed legal custodian
the child’s court-appointed legal guardian
a county or district attorney
the Kansas attorney general
The minor child’s name and year of birth are:
Minor Child’s Name:
Year of Birth:
2. Defendant can be served at: (please provide all available addresses)
HOME: street city
state zip code phone number
times when defendant is usually there
Rev. 7/2018 KSJC
Page 2 of 5
WORK: street city
state zip code phone number
times when defendant is usually there
OTHER: street city
state zip code phone number
times when defendant is usually there
4. If the defendant is a minor, a Minor Defendant Addendum is attached.
5. List any other related court cases involving Plaintiff, minor child (if applicable),
or Defendant.
(give type of case, county filed in, case number and date filed, if known)
Plaintiff:
Minor Child:
Defendant:
6. Select and complete either section A, B, or C. Attach more pages as needed.
A. Describe the incidents of stalking. Include specific facts, dates and locations:
Incident #1:
Rev. 7/2018 KSJC
Page 3 of 5
Incident #2:
Additional Incident(s), if any:
OR
B. Describe the incident of sexual assault. Include specific facts, dates and
locations:
OR
C. Describe the incident of human trafficking. Include specific facts, dates, and
locations:
Rev. 7/2018 KSJC
Page 4 of 5
7. Plaintiff/child needs a protection from stalking, sexual assault, or human
trafficking order because:
8. Plaintiff requests that the court issue an ex parte Temporary Order of Protection
and Final Order of Protection restraining defendant from:
abusing, molesting or interfering with the privacy or rights of the protected
person.
following, harassing, telephoning, contacting or otherwise communicating
with the protected person.
committing or attempting to commit a sexual assault upon the protected
person.
following, harassing, telephoning, contacting, recruiting, harboring,
transporting, or committing or attempting to commit human trafficking
upon the protected person.
entering or coming around the residence or area of the protected person.
other:
other:
9. (Check box if you are asking for the transfer of wireless telephone numbers.
Leave box blank if you are not asking for the transfer of wireless telephone
numbers.)
Plaintiff asks the court to order the transfer of rights to and billing
responsibility for the wireless telephone number of
Plaintiff and/or minor child(ren) in the care of Plaintiff.
10. The court should give copies of orders to the appropriate law enforcement
agencies; set a date, time and hearing on this matter; and issue summons to
Defendant, notifying Defendant of this action and the relief requested.
11. After a hearing, the court should issue a Final Order of Protection from Stalking,
Sexual Assault, or Human Trafficking prohibiting Defendant from committing
any acts of stalking, sexual assault, or human trafficking against the protected
person; order Defendant to pay court costs and attorney fees if appropriate; and
order any other relief necessary for the safety of the protected person including:
Rev. 7/2018 KSJC
Page 5 of 5
VERIFICATION
I verify under penalty of perjury under the laws of the state of Kansas that the foregoing is
true and correct. Executed on , 20 .
Plaintiff's Signature
Plaintiff’s Name:
(DO NOT include the residential address of Plaintiff in this petition. Plaintiff must
complete the Protection from Stalking, Sexual Assault, or Human Trafficking Confidential
Information form and include it with this petition.)
Attorney representing Plaintiff (if any)
Attorney’s Name:
Address 1:
Address 2:
City, State, Zip:
Telephone:
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IN THE DISTRICT COURT OF COUNTY, KANSAS Plaintiff

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Completed 22 July 2021

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