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Here is the text we could read:

ivil Stalking Injunction 

Case Number:  _______  District:  __________ 
County:  _____________ State:  Utah 
Judge:   _______________________________ 

etitioner (person who asked for the stalking injunction): 

________________ 
First Name 

____________ 
Middle 

____________  
Last 

Address and phone # (to keep private, leave blank): 

Other people protected by this order: 
 

Name 

Age 

Relationship to 
Petitioner 
_____________ 
_____________ 

___________________________________ 
Street 

____________________ 
____________________ 

____ 
____ 

___________________________________ 
City --- State --- Zip 

____________________ 
____________________ 

____ 
____ 

_____________ 
_____________ 

___________________________________ 
Phone # 

____________________ 
____________________ 

____ 
____ 

_____________ 
_____________ 

Petitioner’s attorney (if any):________________________________________Phone #_______________ 

 

 

                    Name 

espondent  

(person who must obey this stalking injunction): 

Sex 

Race 

Height  Weight 

Describe Respondent 

Date of 
Birth 

____________ 
First Name 

_________ 
Middle 

_________  
Last 

Other Names Used _______________________ 

___________________________________ 

Address 
____________________________________ 
Street 

___________________________________ 

City --- State --- Zip 

____ 

_______  ______  _______ 

  ______ 

Eye 
Color 
____ 

Hair 
Color 
______ 

Social Security Number 
(last four digits only) 
_____ 

Distinguishing features (like scars, tattoos, limp, etc.) 
__________________________________________ 

Driver’s license issued by  

(State):____________ Expires ______________ 

          Warning! [__] Weapon involved (Box to be initialed by Court, if applicable) 

Civil Stalking Injunction 

Approved by Board of District Court Judges, June 2013 
Revised July 1, 2020 

Page 1 of 3 

  C

 

  P

   

  R

 

  _

  _

   

 

There was a hearing on (date):  
heard in the hearing that gave rise to this order. The following people were present at the hearing: 

. The Respondent was given notice and an opportunity to be 

[__] Petitioner 
[__] Respondent  [__] Respondent’s attorney (name):  
[__] Other (name)  

[__] Petitioner’s attorney (name):  

 
 
   

The Court reviewed the Request for Civil Stalking Injunction and: [__] received argument and evidence, [__] 
accepted the stipulation of the parties, [__] entered the default of the Respondent for failure to appear, [__] 
other:______________, and finds that there is reason to believe that stalking has occurred and that the 
Respondent is the stalker. (Utah Code 76-5-106.5) 
 

   

The Respondent must obey all orders initialed by the judicial officer. These orders replace any 
previous temporary stalking injunction in this case.  Violation of these orders is a criminal Class A 
Misdemeanor, punishable by up to one year in jail and a fine. A second or subsequent violation can result in 
more severe penalties.  

1  [___] 

2    [___] 

 

Personal Conduct Order  
Do not stalk the Petitioner. This means you must not follow, threaten, annoy, harass, or cause 
distress to the Petitioner. For a legal definition of stalking, see Utah Code 76-5-106.5. 

No Contact Order    
Do not contact, phone, text, mail, e-mail, or communicate either directly or indirectly in any 
way with the Petitioner and any person listed on page 1 of this order and any person listed 
below.  

Other people you must not contact:  

[__]  a.  The Petitioner’s current or future: [__] Vehicle   [__] Job   [__] School   [__] Home, premises 

and property (list current addresses below) 

3    [___] 

Stay Away Order    
Stay away from:  

  Home address:  

  Work address:  

School address:  

  Describe vehicle:  

[__]  b.  Other (specify):  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4    [___] 

Child Custody & Parent-time Orders 

The Petitioner will have temporary custody of the minor children listed below.  If you do not 
obey the custody and parent-time orders listed here, the Petitioner may ask for the court’s help 
(such as an order to show cause for contempt): 

_____________________________________________________________________ 

Civil Stalking Injunction 

 

Approved by Board of District Court Judges, June 2013 
Revised July 1, 2020 

Page 2 of 3 

5    [___] 

Other Orders:                                                                                                                                                                                                                     
_____________________________________________________________________ 

_____________________________________________________________________ 

_____________________________________________________________________ 

You will have parent-time as follows:  _________________________________________ 

_____________________________________________________________________ 

_____________________________________________________________________ 

_____________________________________________________________________ 

_____________________________________________________________________ 

You can only communicate with the Petitioner about parent-time through the following person:  

_____________________________________________________________________ 

he custody and parent-time orders are effective until modified by this court or superseded by    

another court order. 
 

  T

arnings to the Respondent:  

 

  Attention: This is an official court order. If you disobey this order, the court may find you in contempt. You 

may also be arrested and prosecuted for the crime of stalking and any other crime you may have 
committed in disobeying this order. 

  No one except the court can change this order. 
  This order is valid in all U.S. states and territories, the District of Columbia, and tribal lands. If you go to 
another U.S. state, territory or tribal land to violate this order, a federal judge can send you to prison.  
  It may be a federal crime for you to have, possess, transport, ship, or receive any firearm or ammunition, 

including hunting weapons, while this civil stalking injunction is in effect. 

his order expires in three years on:  ____________________________________       _ 

 

 

 

 

             Month                          Day                     Year 

Date: _______________                    ___________________________________________________ 

Judge (printed name) _____________________________________ 

Respondent’s Waiver of Notice 
I received a copy of this Civil Stalking Injunction, and waive my right to be personally served with the 
order. 

Respondent’s Address 

Street 
_______________________________ 

City 
__________________ 

State 
_____________ 

Zip 
___________ 

Respondent’s Signature:   ______________________________________________________________________________  
 

Civil Stalking Injunction 

Approved by Board of District Court Judges, June 2013 
Revised July 1, 2020 

Page 3 of 3 

  W

  T

Civil Stalking Injunction

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Utah 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 legacy.utcourts.gov (2023-03)
Page(s): 3
Fields(s): 253
Average fields per page: 84
Reading Level: Grade 10
LIST Grouping(s): GO-00-00-00-00.

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.

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We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

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Civil Stalking Injunction

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