NOTICE OF TERMINATION

STATE OF INDIANA

COUNTY OF

COURT:

PETITIONER/PLAINTIFF/STATE OF INDIANA

VS.

RESPONDENT/DEFENDANT

EMPLOYEE (IF WVRO)

CASE NO:

DATE:

Notice is hereby given that an order previously issued under the provisions of Indiana Code § 5-2-9 has been terminated.

PETITIONER/PROTECTED PERSON

Name:

Birth Year:

Race:

Sex: Male Female

RESPONDENT/DEFENDANT

Name:

Telephone No.: Home:

Date of Birth:

Work:

Sex: Male Female

Race:

Address:

Location of place of business or where person usually/often found:

REASONS FOR TERMINATION

Expiration of Order;

The case was a criminal case and the case was dismissed (Motion to Dismiss and Order must be attached);

Termination of action by request of the Petitioner/Plaintiff (If a Protective Order case, a copy of the Verified Request for Dismissal and Order must be attached);

Court Order (Order must be attached);

Protective Order hearing held, Ex Parte Order for Protection has been terminated, and new Protective Order is being issued.

WVRO hearing held, TRO has been terminated, and an Injunction is being issued.