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Temporary Civil Stalking Injunction 
Ex Parte Order 

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 #_______________ 

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 ______________ 

  P

   

    R

  _

  _

 

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

Findings: The Court has reviewed the Petitioner’s Request for Stalking Injunction, and finds that: 

a.  The Court has jurisdiction over the parties and this case,  
b.  There is reason to believe stalking has occurred, and  
c.  The Respondent is the stalker.  
d.  The Respondent has the right to a hearing, if they ask for it. 
(Utah Code 76-5-106.5) 

To: (Respondent’s name): _______________________________________________________________ 

Temporary Civil Stalking Injunction 

Page 1 of 3  

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

Obey all orders initialed by the judge.  
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    [___] 

Personal Conduct Order  
Do not stalk the Petitioner. This means that you must not do things such as follow, threaten, 
annoy, or harass the Petitioner in a way that would cause a reasonable person to suffer 
emotional distress or to be afraid for the person’s safety or the safety of another person. For a 
legal definition of stalking, see Utah Code 76-5-106.5. 

2    [___] 

 

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

Other people you must not contact: ______________________________________________ 

___________________________________________________________________________ 

3    [___] 

Stay Away Order    
Stay away from:  

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

and property (list current addresses below) 

  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): 

___________________________________________________________________________ 

___________________________________________________________________________ 

You will have parent-time as follows: _____________________________________________ 

__________________________________________________________________________ 

Temporary Civil Stalking Injunction 

Page 2 of 3  

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

 

 

 

 

 

 

 

 

  _

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

___________________________________________________________________________ 

___________________________________________________________________________ 

The custody and parent-time orders are effective until modified by this court or superseded by   
another court order. 

5    [___] 

 
Other Orders (List below): ___________________________________________________ 

___________________________________________________________________________ 

___________________________________________________________________________ 
 

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. 
 

If you do not agree with this order, you can ask for a hearing to tell your side.  Your request must be in 
writing, and must be filed at the court listed below within 10 days of the date you were served with this 
order.  If you do not ask for a hearing within 10 days, this order will last for 3 years after it is served.  You 
can still ask for a hearing after 10 days, but then you must persuade the court that the injunction is not 
needed. 

  Court address to ask for a hearing:  ______________________________________________________ 
  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. 

ate: _______________ Time: _________ [__] a.m. [__] p.m.   __________________________________ 

Judge (printed name) _________________________________ 

isability and Interpreter Services   

Assistive listening systems, sign language and oral language interpreter services are available at no 
charge in stalking proceedings. Contact the clerk’s office at least 5 days before your hearing. 

  W

  D

  D

Temporary Civil Stalking Injunction 

Page 3 of 3  

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

Temporary 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): 163
Average fields per page: 54
Reading Level: Grade 9
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:

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

Temporary Civil Stalking Injunction

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