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5 IN THE CIRCUIT COURT OF THE STATE OF OREGON

6 FOR THE COUNTY OF __________________

)
7 In the Matter of: )
)
8 _________________________, ) Case No. _______________
)
9 Petitioner, ) PETITIONER’S DECLARATION IN
) SUPPORT OF MOTION FOR PROTECTIVE
10 and ) ORDER
_________________________, )
11 )
)
12 Respondent. )
13
STATE OF _____________ )
14 ) ss.

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County of ______________ )

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My name is __________________ and I am the Petitioner in this matter. I am asking the

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court to issue a permanent Stalking Protective Order in the above-referenced matter because

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Respondent has subjected me to repeated and unwanted contact, as detailed in □ my Petition for

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Stalking Protective Order, dated ______________, 20___ / □ the law enforcement Citation dated

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______________, 20___. These contacts have been profoundly alarming to me, and I am very

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much afraid for my personal safety.

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A merits hearing in this matter has been set for ______________, 20___.

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Respondent’s counsel has served me with a Notice (copy attached) directing me to appear

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in counsel’s office for deposition on ______________, 20___.

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1 – PETITIONER’S DECLARATION IN SUPPORT OF MOTION FOR

PROTECTIVE ORDER
 1 I do not have the money to retain an attorney in this matter, and I respectfully believe that

2 taking my deposition would serve no purpose, except to harass, embarrass and inconvenience

3 me. As noted above, I am afraid of Respondent, and fear that information taken in my deposition

4 could be misused by him to place me and those I care about in even greater danger. I would like

5 the stalking to end. Thank you.

6 I HEREBY DECLARE THAT THE ABOVE STATEMENT IS TRUE TO THE BEST OF

7 MY KNOWLEDGE AND BELIEF, AND THAT I UNDERSTAND IT IS MADE FOR USE AS

8 EVIDENCE IN COURT AND IS SUBJECT TO PENALTY FOR PERJURY.

9 Certification of Document Preparation

10 You are required to truthfully complete this certificate regarding the document you are

11 filing with the court. Check all boxes and complete all blanks that apply:

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□ I selected this document for myself and I completed it without paid assistance.

□ I paid or will pay money to ____________________ for assistance in preparing this

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document.
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□ I was provided this document by an attorney at no cost to me, and I completed it
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without paid assistance.
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DATED this _____ day of _______________, 20___.
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________________________________
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Signature of Petitioner
19 ________________________________
Print Name
20 ________________________________
Address or Contact Address
21 ________________________________
City, State, Zip Code
22 ________________________________
Telephone or Contact Telephone
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2 – PETITIONER’S DECLARATION IN SUPPORT OF MOTION FOR

PROTECTIVE ORDER