Clark County Superior Court Petition for Order for Protection under RCW 26.50

Note: This Petition is as received from Karyn except that all identifying information for my wife has been replaced with her first name, Karyn, as the normal references on my web pages are to first name only. Other identifying information has been XXXXXed out.

Hand written form entries are shown in italics. The actual scanned text (slower to download and harder to search and read) is also available. The image quality is quite poor, but the copy I received was very poor quality.

The context for this petition can be found at: http://brian.carr.name/legal.htm.

PETITION FOR ORDER FOR PROTECTION (PTORPRT) - Page 1 of 4
WPF DV-1.015 (9/2001) - RCW 26.50.030
H:\FORMS\DV\Petition for Order of Protection.doc

6. Other court cases or restraining, protection, or no-contact orders involving me or the minors, and the respondent:

CASE NAME	NTHG	Residential break-in	Divorce Karyn V Carr
CASE NUMBER	Y4-8492	Vanc Police V04-20401 Clark Co 397-2424	unknown (Aug 2004)
COURT/COUNTY	District/Clark	District/Clark	Lincoln (Superior?)

REQUEST FOR TEMPORARY ORDER: AN EMERGENCY EXISTS as described in statement below: I need a temporary restraining order issued immediately without notice to the respondent until a hearing to avoid irreparable injury. I request a Temporary Order for Protection that will:

I REQUEST AN ORDER FOR PROTECTION following a hearing that will:

Mark each column to indicate the items you would like included in each order.

X	X	¹ RESTRAIN respondent from causing any physical harm, bodily injury, assault, including sexual assault, and from molesting, harassing, threatening, or stalking me the minors named in paragraph 5 above these minors only:
X	X	² RESTRAIN respondent from coming near and from having any contact whatsoever, in person or through others, by phone, ---------, directly or indirectly, except for mailing of court documents, with me the minors named in paragraph 5 above, subject to any court-ordered visitation these minors only, subject to any court-ordered visitation: e-mail OK
X	X	³ EXCLUDE respondent from our shared residence my residence my work place my school the day care or school of the minors in paragraph 5 above these minors only: other: ___________________ my address is: XXXXXXX; Vancouver, WA XXXXX I choose to observe my right to keep my residential address confidentia1.
		⁴ DIRECT respondent to vacate our shared residence and restore it to me. The address is:
X	X	⁵ PROHIBIT respondent from knowingly coming within, or knowingly remaining within 500 (feet) of our shared residence my residence my workplace my school; the day care or school of the minors named in paragraph 5 above. these minors only: other: Any Oregon Mensa social events which I attend with my friends in the Portland / Vancouver area - often with my minor son
		⁶ GRANT me possession of essential personal belongings, including the following:
		⁷ Grant me use of the following vehicle: Year_______ Make & Model _________________ Color ________ License No______
		⁸ Other: ___________________________________

PETITION FOR ORDER FOR PROTECTION (PTORPRT) - Page 2 of 4
WPF DV-1.015 (9/2001) - RCW 26.50.030
H:\FORMS\DV\Petition for Order of Protection.doc

		⁹ DIRECT the respondent to participate in appropriate treatment or counseling services.
		¹⁰ REQUIRE the respondent to pay the fees and costs of this action.
		¹¹ REMAIN EFFECTIVE longer than one year because respondent is likely to resume acts of domestic violence against me if the order expires in a year.
Complete the following boxes only if you are requesting protection involving a minor child.
I/We DO have a custody order/parenting plan. I/We DO NOT have a custody order/parenting plan.
		¹² Subject to any court-ordered visitation, GRANT me the care, custody and control of the minors named in paragraph 5 above these minors only:
		¹³ RESTRAIN respondent from interfering with my physical or legal custody of the minors named in paragraph 5 above these minors only:
		¹⁴ RESTRAIN the respondent from removing from the state: the minors named in paragraph 5 above these minors only:

REQUEST FOR SPECIAL ASSISTANCE FROM LAW ENFORCEMENT AGENCIES:

I request the court order the appropriate law enforcement agency to assist me in obtaining:
Possession of my residence. Use of designated vehicle above.
Possession of my essential personal belongings at the shared residence respondent's residence at: _____________
Custody of the minors named in paragraph 5 above these minors only (If applicable):
Other: _______________________

Domestic violence includes physical harm, bodily injury, assault, stalking, OR inflicting fear of imminent physical harm, bodlily injury or assault between family or household members.

STATEMENT: The respondent has committed acts of domestic violence as follows.
(Give a response to every question. Describe specific acts of domestic viloence or threats against you and their approximate dates; begin with the most recent event. You may want to include police responses and the outcomes.)

Describe the most recent incident or threat of violence and date:
10/9 - 10/12 Residential burglary (police report # V04-20401)/break-in
8/04 - present stalking/harrassment (unwanted contact, showing up at my social functions, interfering with my social life, unwanted phone call & email contact, harrassment, stated intent to harrass and upset,) breaking into house leaving me in fear of safety in own home.
Describe past incidents when you experienced violence, when you were afraid of injury, or when the respondent threatened to harm or kill you (and dates): No other incidents.
9/28 forced entry into residence & refused to leave
8/16 - 9/30 refused to move from residence, threatened not to leave.
2/04 - 6/04 online stalking (removed from Brainstorms online community by governing council for stalking and harrassment - banned permanently)

PETITION FOR ORDER FOR PROTECTION (PTORPRT) - Page 3 of 4
WPF DV-1.015 (9/2001) - RCW 26.50.030
H:\FORMS\DV\Petition for Order of Protection.doc

Describe violence or threats toward the children: No threats toward children. No children involved.
Has expressed an interest in taking my son to "family potlucks" and picking him up at my residence for afternoon & evening events alone which I have not allowed. I am afraid my son might "go for a ride with Brian" because he trusts him -
Describe medical treatment you received for injuries, for what, and when: No treatinent received.
Currently experiencing severe migraines as a result of stress resulting from harrassment/stalking situation. Under treatment by neurologist (name on request), taking several preventive & abortive medications as needed and in near-constant pain.
Describe any threats of suicide or suicidal behavior by respondent: Does not apply.
Describe firearms owned /possessed by respondent, and their location, if known: No firearms
Not known. Respondent was in US Army and has had a variety of firearms and weopons/combat training.
Has the respondent used firearms, weapons or objects to threaten or harm you? Does not apply.
If requesting the protection order for longer than one year, describe the reasons: Does not apply.
Check box if substance abuse is involved alcohol controlled drugs other ________________ None

I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.

Dated 10 / 15 / 04 at Vancouver , Washington.
____________Karyn___________
Signature of Petitioner

You have a, right to keep your residential address confidential. If you do, please provide an address, other than your home, where you can receive legal documents:

PETITION FOR ORDER FOR PROTECTION (PTORPRT) - Page 4 of 4
WPF DV-1.015 (9/2001) - RCW 26.50.030
H:\FORMS\DV\Petition for Order of Protection.doc

This page was last updated on April 1, 2007.