STATE OF INDIANA )
) SS:
COUNTY OF DELAWARE )
) SS:
COUNTY OF DELAWARE )
IN THE DELAWARE CIRCUIT COURT NO.
CAUSE NO. 18C0
CAUSE NO. 18C0
Petitioner
vs.
Respondent
Verified Request for a Hearing
On , this Court issued
an Ex Parte Order for Protection
an Ex Parte
Modification of an Order for Protection [check one]. I, , received a copy of
the Order on . Comes now , pursuant to Indiana Code
34-26-5-10(a)(2), and requests that the Court hold a hearing on the issues in this case. The address and
daytime telephone number I wish the Court and opposing party to use in order to contact me about this
case is as follows:
I affirm, under the penalties for perjury, that the foregoing representations are true.
DATED:
Signature
Printed Name