State Of Minnesota
District Court
County of:
Judicial District:
Court File Number:
Case Type:
Petitioner (first, middle, last)
vs.
Respondent (first, middle, last)
In a Harassment case, the court must keep your address and telephone number confidential, if
you ask. Under Minn. R. Pub. Access 4, subd. 1(a)(2), if your address or phone is confidential
the information will not be accessible to the public and may be disclosed only to court
personnel or law enforcement for purposes of service of process, conducting an investigation,
or enforcing an order. Your request only affects the case you are currently starting. There
may be other cases in the court records involving you, where your address is public.
I am asking for a Harassment Restraining Order.
My name is:
My phone number is:
Can court personnel leave messages at this number?
Yes
No
My address is:
Street
Apt. #
City
State
Zip
C/O
(If staying at a shelter or someone else's home, you can put their name here to make sure
the post office delivers mail to you at this address.)
Notice: The Court needs your full mailing address and phone number to be able to send
you notices and orders on your case.
HAR104
State
ENG
Rev 7/15
www.mncourts.gov/forms
Page 1 of 1
State Of Minnesota
District Court
County of:
Judicial District:
Court File Number:
Case Type:
Petitioner (first, middle, last)
vs.
Respondent (first, middle, last)
In a Harassment case, the court must keep your address and telephone number confidential, if
you ask. Under Minn. R. Pub. Access 4, subd. 1(a)(2), if your address or phone is confidential
the information will not be accessible to the public and may be disclosed only to court
personnel or law enforcement for purposes of service of process, conducting an investigation,
or enforcing an order. Your request only affects the case you are currently starting. There
may be other cases in the court records involving you, where your address is public.
I am asking for a Harassment Restraining Order.
My name is:
My phone number is:
Can court personnel leave messages at this number?
Yes
No
My address is:
Street
Apt. #
City
State
Zip
C/O
(If staying at a shelter or someone else's home, you can put their name here to make sure
the post office delivers mail to you at this address.)
Notice: The Court needs your full mailing address and phone number to be able to send
you notices and orders on your case.
HAR104
State
ENG
Rev 7/15
www.mncourts.gov/forms
Page 1 of 1
ADVERTISEMENT