IN THE TRIBAL COURT OF THE

LOWER SIOUX INDIAN COMMUNITY IN MINNESOTA

LOWER SIOUX INDIAN RESERVATIONSTATE OF MINNESOTA

______

______,

Petitioner,CASE NO.: CIV/RO-___-____

v.PETITION FOR EX PARTE AND

TEMPORARY PROTECTION ORDER

______,

Respondent,

______

NOW COMESthe Petitioner and in support of hisor her petition for an ex-parte and permanent order for protection states and alleges as follows:

  1. That I am a memberor non-member of the Tribe and a residentor non-resident of the reservation residing at:

(optional, do not need to put address)

That Respondent is a member ornon-member of the Tribe presently residing at:

he orshe may also be located at

  1. That Respondent is my: spouse boyfriendgirlfriend,former spouse former boyfriend former girlfriend, parent of my child/children, household member,employer, co-employer or other.

Explain other:

  1. That I and Respondent have _____child(ren), whose names and ages areas follows:

That the minor child(ren) are presently residing with

and their address is:

(address is optional)

That Respondent is employed at

and earns approximately ______per month.

  1. That Petitioner requests Respondent be restrained from harassing, annoying or contacting me either in person or through his family members or third parties on an ex parte basis until the hearing and on a permanent basis after the hearing.
  1. That Petitioner requests Respondent be temporarily excluded pending hearing from the following premises:

Home:

Work:

That said premises are owned or leased by.

  1. That Petitioner requests immediate temporary custody pending hearing of the above-referenced minor child(ren), subject to the following visitation: ______or subject to no visitation.
  1. That Petitioner requests Respondent temporarily be relieved ofthe following weapons:______, ______, ______, (any guns, knives or other weapons the Respondent may have). ***OPTIONAL***
  1. That Petitioner feels there is in immediate and present danger of harm to her orhim because of the following recent events: (Describe in detail what Respondent has done to cause you to fear that heor she may commit violence against you).

WHEREFORE, Petitioner prays that this Court enter a temporary ex parte restraining order and order for protection immediately and schedule this matter for hearing at which time Petitioner requests that the Court enter a permanent restraining order preventing Respondent from harassing, annoying or contacting Petitioner and all other relief requested herein.

VERIFICATION

I have read this petition and to the best of my knowledge believe that the facts stated above are true. I make this statement voluntarily.

Dated this _____ day of ______, 2016.

______

Petitioner

Subscribed to and sworn to before me this _____ day of ______, 2016.

______

Clerk of Court