Free Pleading Wizard - Nevada

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Case No. ___________________ Dept. No. ___________________

IN THE JUSTICE COURT OF LAS VEGAS TOWNSHIP COUNTY OF CLARK, STATE OF NEVADA

_____________________________________ ) Applicant(s),) APPLICATION FOR ORDER FOR ) PROTECTION AGAINST vs. ) SEXUAL ASSAULT _____________________________________ ) Adverse Party(s).)
) )

NRS 200.366. Sexual assault: Definition; penalties. 1. A person who subjects another person to sexual penetration, or who forces another person to make a sexual penetration on himself or another, or on a beast, against the will of the victim or under conditions in which the perpetrator knows or should know that the victim is mentally or physically incapable of resisting or understanding the nature of his conduct, is guilty of sexual assault. . . .

PLEASE TYPE OR PRINT CLEARLY. COMPLETE THE APPLICATION TO THE BEST OF YOUR KNOWLEDGE. I am applying for protection (check all that apply):

For Myself

On behalf of another person(s)
May 2009

Application for Order for Protection Against Sexual Assault

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Applicant states the following facts under penalty of perjury:
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I reasonably believe that the Adverse Party has committed the crime of sexual assault
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as defined above. The act(s) occurred as follows:
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(NOTE: BE SPECIFIC AS TO WHO COMMITTED WHAT ACT OR ACTS, AGAINST WHOM, WHEN, WHERE, WHETHER COMMITTED OR THREATENED; INDICATE APPROXIMATE DATE(S) AND LOCATION(S).) THIS FORM IS A PUBLIC RECORD
__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

NOTE: PLEASE DO NOT WRITE ON THE BACKS OF ANY PAGES; CHECK BOX IF YOU ARE USING ADDITIONAL PAGES.

Check if you use a continuation page (to be incorporated by reference)
This matter does not have to be reported to law enforcement; however, has a report ever been filed?

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Yes

No

If yes, approximate date(s):
Application for Order for Protection Against Sexual Assault May 2009

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_____________________________________________________________________ Name of law enforcement agency: _____________________________________________________________________ Case/Event number if known: _____________________________________________________________________ (NOTE: IT IS NOT NECESSARY TO FILE A LAW ENFORCEMENT REPORT, BUT IF YOU HAVE ONE AVAILABLE, PLEASE ATTACH A COPY OR BRING IT TO THE COURT HEARING.) For purposes of this form, a "TPO Action" is defined to include the following Justice Court actions: (1) An Order for Protection Against Stalking and Harassment (NRS 200.591); (2) An Order for Protection of Children (NRS 33.400); (3) An Order for Protection Against Harassment in the Workplace (NRS 33.270). (4) An Order for Protection Against Sexual Assault A "TPO Action" is also defined to include the following Justice/Family/District Court action: (a) An Order for Protection Against Domestic Violence (NRS 33.020) Please Check the Appropriate Box Below:



In the last 2 years, Applicant or any party seeking protection has not filed a TPO action against the Adverse Party anywhere in the State of Nevada, and the Adverse Party has not filed a TPO action against Applicant or any party seeking protection anywhere in the State of Nevada. In the last 2 years, the following TPO action(s) in the State of Nevada have been filed involving Applicant and the Adverse Party: Case # Court Place of Approx. Outcome (TPO (if known) (Justice/Family) Filing Date Filed granted, denied, rescinded, etc.)



Applicant must be at least 18 years of age. If not 18 years of age, consult with the Clerk. 1. a) Applicant's Name Age _______

____________________________________________ (Last) (First) (Middle)
Application for Order for Protection Against Sexual Assault

May 2009

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b) Applicant's relationship to Adverse Party: ________________________________ c) Provide names below of those for whom you are seeking protection, including yourself, minors or household members that need this protection. Indicate the relationships of all persons listed to yourself and to the Adverse Party (e.g., spouse, intimate partner, friend, roommate, neighbor, relative, acquaintance, co-worker, stranger):
NAME AGE RELATIONSHIP TO APPLICANT Self (if applicable) RELATIONSHIP TO ADVERSE PARTY

Explain why protection is needed for the individuals listed above: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ (NOTE: YOUR APPLICATION WILL NOT BE DENIED BASED UPON A PARTICULAR RELATIONSHIP. HOWEVER, DEPENDING UPON YOUR RELATIONSHIP, YOU MAY ALSO BE ELIGIBLE TO APPLY AT THE FAMILY DIVISION OF THE EIGHTH JUDICIAL DISTRICT COURT FOR AN ORDER OF PROTECTION AGAINST DOMESTIC VIOLENCE, PURSUANT TO NRS CHAPTER 33.) 2. Has the Adverse Party ever lived with any Party listed above? If so, for how long? ____________________________ 3. Is anyone listed above living with the Adverse Party now? Yes No If so, who? ___________________________________
Application for Order for Protection Against Sexual Assault May 2009

Yes No

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4.
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Date of separation (if applicable): _______________________________________ Are there children involved? Yes No If so, how are they involved?

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___________________________________________________________________ ___________________________________________________________________ 6.
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Has the Adverse Party ever been involved in any other relevant Court actions (e.g., eviction, divorce, custody, criminal, etc.)?

Yes No If yes, please explain: ____________________________________
___________________________________________________________________________ ___________________________________________________________________________

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___________________________________________________________________________ ___________________________________________________________________________

7.

Residence(s) where protection is needed:

CONFIDENTIAL (If confidential, check and move to the next question) or, If not confidential, list address, city, state and zip code:
_____________________________________________________________________ _____________________________________________________________________ 8. Place(s) of employment where protection is needed:

CONFIDENTIAL (If confidential, check and move to the next question) or, If not confidential, list name, address, city, state and zip code:
___________________________________________________________________________ _______________________________________________________________ 9. Location of school(s) where protection is needed:

CONFIDENTIAL (If confidential, check and move to the next question) or, If not confidential, list name, address, city, state and zip code:
Application for Order for Protection Against Sexual Assault May 2009

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_____________________________________________________________________ _____________________________________________________________________ 10. Other specific locations frequented where protection is needed (i.e., sports, extra-

curricular activities, church, employment, after-school activities, etc.):

CONFIDENTIAL (If confidential, check and move to the next question) or, If not confidential, list name, address, city, state and zip code:
_____________________________________________________________________ _____________________________________________________________________ 11. If there are persons other than those listed on page 4 that the Adverse Party should be directed not to contact, please name the individuals and explain why these precautions are needed: ___________________________________________________________ _____________________________________________________________________ 12. If there are any other safety concerns that the Court should know (e.g., firearms, etc.), please briefly explain:
____________________________________________________________________________ ____________________________________________________________________________

RELIEF REQUESTED THEREFORE, I REQUEST that a Temporary Order be issued against the Adverse Party requiring the Adverse Party to refrain from contacting, intimidating, threatening or otherwise interfering with me and/or other persons identified in this application, either directly or through an agent. I FURTHER REQUEST that the Court require the Adverse Party to stay away from the places listed above.

Application for Order for Protection Against Sexual Assault

May 2009

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I FURTHER REQUEST the following other conditions:
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__________________________________________________________________________
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_______________________________________________________________________________
__________________________________________________________________________________ __________________________________________________________________________________

I FURTHER REQUEST that this Court set a hearing date for an Extended Order as soon as possible.

Yes No
(NOTE: IF GRANTED AND SERVED, A TEMPORARY ORDER MAY BE ENFORCED FOR UP TO 30 DAYS, EXCEPT THAT IF AN EXTENDED ORDER IS REQUESTED, THE TEMPORARY ORDER REMAINS IN EFFECT UNTIL THE HEARING ON THE EXTENDED ORDER IS HELD BY THE COURT. IF GRANTED AND SERVED, AN EXTENDED ORDER MAY BE ENFORCED FOR UP TO ONE YEAR.) I ACKNOWLEDGE that an Extended Order may only be granted after notice of the petition for the Order and of the Hearing thereon is served upon the Adverse Party pursuant to the Rules of Civil Procedure, and a hearing is held on the petition. DECLARATION (NRS 53.045) I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAW OF THE STATE OF NEVADA THAT: (1) I AM THE APPLICANT HEREIN, (2) I HAVE READ THE STATEMENTS CONTAINED HEREIN OR HAVE HAD THEM READ TO ME, (3) I BELIEVE THESE STATEMENTS TO BE TRUE, AND (4) THE REQUESTED ORDER IS NEEDED.

Dated:___________________________
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__________________________________

APPLICANT'S SIGNATURE
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______________________________ PRINT NAME
Application for Order for Protection Against Sexual Assault May 2009

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