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Here is the text we could read:

C

D

1. The petitioner and respondent have never been husband and wife, resided in the same household together, had a 
  child in common, or had a dating relationship with one another. The respondent is not the unemancipated minor child 
  of the petitioner. The petitioner is not the unemancipated minor child of the respondent. The respondent is between 
  10 and 17 years of age.

B

2. a. There 

 

  are 

 

Case number

  are not 

Name of court, county, and state or province

  other pending actions in this or any other court regarding the parties. 
Name of judge

                

  b. There 

 

  are 

 

  are not 

  orders/judgments entered by this or any other court regarding the parties.

Case number

Name of court, county, and state or province

Name of judge

3. I need a personal protection order because:  Explain what has happened (attach additional sheets).     

 a.  stalking me as defined by MCL 750.411h and MCL 750.411i, which includes but is not limited to

4. I make this petition under the authority of MCL 600.2950a(1) and ask the court to grant a personal protection order 
  prohibiting the respondent from
 
 
 
 
 
 
 
 
 
 
 
 
 

 following me or appearing within my sight.
 appearing at my workplace or residence.
 approaching or confronting me in a public place or on private property.
 entering onto or remaining on property owned, leased, or occupied by me.
 sending mail or other communications to me. 
 contacting me by telephone.
 placing an object on or delivering an object to property owned, leased, or occupied by me.
 threatening to kill or physically injure me. 
 purchasing or possessing a firearm.
 other: 
 

 b. posting a message through the use of any medium of communication, including the Internet or a computer  

        or any electronic medium, pursuant to MCL 750.411s.

   
   
   
   
   
   
   
   
   
   

 

 

ASTATE OF MICHIGANJUDICIAL CIRCUITCOUNTYPETITION FOR PERSONAL PROTECTION ORDER AGAINST A MINOR (NONDOMESTIC)CASE NO. and JUDGECourt address                     Court telephone no.     Approved, SCAOForm CC 377m, Rev. 1/21MCL 600.2950a, MCL 712A.2(h), MCR 3.703Page 1 of 2Distribute form to: Court Judge/Assignment clerkRespondent PetitionerReturnPetitioner’s nameAgevRespondent’s name, address, and telephone no.AgeAddress and telephone no. where court can reach petitionerPetition for Personal Protection Order Against a Minor (Nondomestic) 
Page 2 of 2

(1/21) 

Case No. 
 

E

F

 5. I request an ex parte order because immediate and irreparable injury, loss, or damage will occur between now 
    and a hearing or because notice itself will cause irreparable injury, loss, or damage before the order can be
    entered.

 
 

 6. I have a next friend petitioning for me. I certify that the next friend is not disqualified by statute and is an adult.

G

Date

 

Petitioner’s/Next friend’s signature

Petition for Personal Protection Order Against a Minor (Nondomestic) 

(1/21) 

Case No. 

 

TO PROCESS SERVER:  You must serve the copies of the petition for personal protection order against a minor and file 
proof of service with the court clerk.  If you are unable to complete service, you must return this original and all copies to 
the court clerk. 

CERTIFICATE / AFFIDAVIT OF SERVICE / NONSERVICE

PROOF OF SERVICE

 I served 

 

 personally 

 

 by registered or certified mail (copy of return receipt attached)

  a copy of the petition for personal protection order against a minor, and the attachments listed below on: 

 I have personally attempted to serve a copy of the petition for a personal protection order against a minor, together with 
the attachments listed below, and have been unable to complete service on:

 

Respondent’s name

Place or address of service

Day, date and time of service

Name of parent/guardian/custodian

Place or address of service

Day, date and time of service

Name of parent/guardian/custodian

Place or address of service

Day, date and time of service

Attachments (if any)

 . 
 

 .

 . 

I declare under the penalties of perjury that this return of service has been examined by me and that its contents are true 
to the best of my information, knowledge, and belief.

Service fee
$

Incorrect address fee
$

Miles traveled

Miles traveled

Fee
$

Fee
$

TOTAL FEE
$

Signature

Name (type or print)

Title (if applicable)

Note: If documents are served by someone other than a sheriff, deputy sheriff, or other person listed in MCL 600.1910(b), this return must be notarized.

Subscribed and sworn to before me on 
 
 

                     
                     

Date

My commission expires on 
 
Notary public, State of Michigan, County of 

                     

 

 

 

 

 

 

 

 

 

 

Deputy clerk/Notary public signature

 . 

Name (type or print)
 

 

 . 

 Acting in the County of 

 

 This notarial act was performed using an electronic notarization system or a remote electronic notarization platform.

I acknowledge that I have received of a copy of the petition for personal protection order against a minor, together with

ACKNOWLEDGMENT OF SERVICE

 on

 Date and time

Signature of respondent

ttachments

  A

Signature of respondent’s parent/guardian/custodian

Signature of respondent’s parent/guardian/custodian

    

MCR 2.105(A)

CC 377m, Petition for Personal Protection Order Against a Minor (Nondomestic)

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Michigan state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.courts.michigan.gov/PPO (2023-03)
Page(s): 3
Fields(s): 74
Average fields per page: 24
Reading Level: Grade 11
LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

stat_e_f_n_l_county was STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY (0.59 conf)
petitioners_name was Petitioners name (0.46 conf)
age__1 was Age (0.36 conf)
age__2 was Age_2 (0.40 conf)
address_court_petitioner was Address and telephone no where court can reach petitioner (0.48 conf)
are was are (0.38 conf)
are_not was are not (0.41 conf)
docket_number was Case number (1.00 conf)
name_court_county_state__1 was Name of court county and state or province (0.45 conf)
name_judge__1 was Name of judge (0.48 conf)
are_2 was are_2 (0.37 conf)
are_not_2 was are not_2 (0.39 conf)
case_number was Case number_2 (0.40 conf)
name_court_county_state__2 was Name of court county and state or province_2 (0.46 conf)
name_judge__2 was Name of judge_2 (0.44 conf)
defined_mc_l_includes_limited was a stalking me as defined by MCL 750411h and MCL 750411i which includes but is not limited to (0.43 conf)
message_use_including was b posting a message through the use of any medium of communication including the Internet or a computer (0.33 conf)
following_within_sight was following me or appearing within my sight (0.41 conf)
appearing_workplace_residence was appearing at my workplace or residence (0.38 conf)
approaching_public_private was approaching or confronting me in a public place or on private property (0.40 conf)
owned_leased_occupied was entering onto or remaining on property owned leased or occupied by me (0.49 conf)
sending_mail_communications was sending mail or other communications to me (0.39 conf)
contacting_telephone was contacting me by telephone (0.48 conf)
placing_owned_leased was placing an object on or delivering an object to property owned leased or occupied by me (0.41 conf)
threatening_kill_injure was threatening to kill or physically injure me (0.47 conf)
purchasing_possessing_firearm was purchasing or possessing a firearm (0.37 conf)
other was other (0.43 conf)
undefined__1 was undefined (0.38 conf)
text__1 was Text1 (0.35 conf)
judge was Judge (0.39 conf)
text__2 was Text3 (0.35 conf)
text__3 was Text4 (0.35 conf)
text__4 was Text5 (0.35 conf)
irreparable_injury_damage_occur was 5 I request an ex parte order because immediate and irreparable injury loss or damage will occur between now (0.45 conf)
petitioning_disqualified_statute was 6 I have a next friend petitioning for me I certify that the next friend is not disqualified by statute and is an adult (0.34 conf)
signature_date__1 was Date (1.00 conf)
text__5 was Text6 (0.35 conf)
served was I served (0.36 conf)
personally was personally (0.35 conf)
registered_return_receipt was by registered or certified mail copy of return receipt attached (0.47 conf)
attempted_serve_together was I have personally attempted to serve a copy of the petition for a personal protection order against a minor together with (0.38 conf)
respondents_name was Respondents name (0.33 conf)
place_address_service__1 was Place or address of service (0.34 conf)
day_date_time_service__1 was Day date and time of service (0.36 conf)
name_parentguardiancustodian__1 was Name of parentguardiancustodian (0.39 conf)
place_address_service__2 was Place or address of service_2 (0.36 conf)
day_date_time_service__2 was Day date and time of service_2 (0.35 conf)
name_parentguardiancustodian__2 was Name of parentguardiancustodian_2 (0.41 conf)
place_address_service__3 was Place or address of service_3 (0.36 conf)
day_date_time_service__3 was Day date and time of service_3 (0.35 conf)
attachments__1 was Attachments if any (0.41 conf)
service_fee was Service fee (0.45 conf)
name_type_print__1 was Name type or print (0.45 conf)
tota_l_fee was TOTAL FEE (0.46 conf)
title_applicable was Title if applicable (0.37 conf)
signature_date__2 was Date_2 (1.00 conf)
undefined__2 was undefined_2 (0.39 conf)
name_type_print__2 was Name type or print_2 (0.40 conf)
undefined__3 was undefined_3 (0.39 conf)
acting_county was Acting in the County of (0.37 conf)
undefined__4 was undefined_4 (0.39 conf)
notarial_act_performed_using_electronic_notarization_system_remote_platform was This notarial act was performed using an electronic notarization system or a remote electronic notarization platform (0.44 conf)
attachments__2 was Attachments (0.43 conf)
date_time was Date and time (0.34 conf)
text__6 was Text7 (0.35 conf)
text__7 was Text8 (0.35 conf)
text__8 was Text9 (0.35 conf)
text__9 was Text10 (0.35 conf)
text__10 was Text11 (0.35 conf)
text__11 was Text12 (0.35 conf)
text__12 was Text13 (0.35 conf)
text__13 was Text14 (0.35 conf)
text__14 was Text15 (0.35 conf)
text__15 was Text16 (0.35 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

CC 377m, Petition for Personal Protection Order Against a Minor (Nondomestic)

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02