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Here is the text we could read:

Case Number: ________________  District:_____ 
County:  ___________________________   State: Utah 
Judge:  ______________________________________  
Commissioner:  _______________________________   

equest to Modify Protective  

  R

Order  

  Petitioner (protected person): 
 

  1

 

 

 

 

This is a private record. 

Middle  

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

Last 

 

 
City – State – Zip 

Phone #:  
Name and phone number of Petitioner’s attorney (if any):  
 

 

 

2   Respondent (person you need to be protected from): 

Other people protected by this order 
(relatives or people who live with you): 

Name  

Age 

Relationship to 
Petitioner 

 

 

 
 
 
 

 
 

____________________  _____  _______________ 
____________________  _____  _______________ 
_____  _______________ 
 
____________________ 
____________________  _____  _______________ 
____________________  _____  _______________ 

/   

 

| 
/   

 

Describe Respondent 
* Required. If you do not know, write unknown. 

Sex* 

Race* 

Date of Birth* 

Ht. 

Wt. 

Middle 

Last 

______ 

______ 

__________ 

______  ______ 

ther Names Used _______________________ 
____________________________________ 
Relationship to Petitioner: ___________________ 
Address (street): ___________________________ 
____________________________________ 
City --- State --- Zip 

Eyes 

Hair 

Full Social Security # (if known) 

______ 

______ 

___________________________ 

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

Driver’s license issued by (State):_____ Expires: _______ 

Respondent’s Employer (Name and address):  
____________________________________________________________________________________ 

Other places to find Respondent (work, 
relatives, friend, hangouts, etc. – include 
city/state/zip on each address, if possible) 

 

Location type 
(work, relatives, 
friend, hangouts, 
etc.) 

Best times to find 
at this address 

Phone number 

First  

 

  O

 

 

 

 

 

 

 

 

 

Describe Respondent’s vehicle(s): 

Make 

Model 

Color 

License Plates 

 

 

 

 

 

 

Request to Modify Protective Order 

Approved Board of District Court Judges May 21, 2008 
Revised February 6, 2019 

Page 1 of 3 

   

 

 

 

 

 

 

Has the Respondent used weapons or been violent in the past? [  ] Yes  [  ] No   If yes, describe here:  

_________________________________________________________________________________________

_________________________________________________________________________________________ 

Is the Respondent on probation or parole?   [  ] Yes    [  ] No   If yes, list the name of the probation/parole 

agency, the officer, and the telephone number here:  

_______________________________________________________________________________________ 

3  What kind of protective order do you have now? (Check one, and attach a copy of your protective order to 

this form.) 
[  ] Temporary Protective Order, signed by this court on (date):  

[  ] Protective Order, signed by this court on (date): 

4  Why do you want this order changed? 

 

 

 

 

 

 

 

 

 

 

 

 

 

[  ] Check here if you need more space and attach a separate sheet of paper to this form. 

Please, Judge, I am asking you to:  

[X] Order the Respondent to go to a court hearing  
[X] Issue a new (modified) order to replace the current order. Please make the modified order the 

same as the current order except for the change(s) below.  

5 

Please change Number _____ in the current order to:   
 

 

6 

Please change Number _____ in the current order to:   
 

 

Request to Modify Protective Order 

Approved Board of District Court Judges May 21, 2008 
Revised February 6, 2019 

Page 2 of 3 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7 

Please change Number _____ in the current order to:   
 

 

 

 

 

 

 

 

 

he Petitioner must read and sign below: 

I swear that:  

 
 

I am the Petitioner and I have read this Request to Modify Protective Order. 
I understand it is a serious crime to lie to get a Protective Order. If I lie, I can be charged with 
a felony, punishable by up to 5 years in prison.  

  The statements in this Request are true and correct to the best of my knowledge. 
I believe I have the right to the protective orders I have asked for in this Request. 
 
I am not using this Request to harass the Respondent or to abuse the judicial process. 
 

I declare under criminal penalty under the law of Utah that everything stated in this document is true. 

Signed at ______________________________________________________ (city, and state or country). 

 
Date 

Signature ► 

Printed Name 

 

 

Request to Modify Protective Order 

Approved Board of District Court Judges May 21, 2008 
Revised February 6, 2019 

Page 3 of 3 

  T

Request to Modify Protective Order

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): 199
Average fields per page: 66
Reading Level: Grade 8
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.

Here are the fields we could identify.

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

Suggested Screen 0:

district
page_field__1
page_field__2
docket_number
page_field__3
state_utah
page_field__4
page_field__5
page_field__6
commissioner
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middle
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hair
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page_field__58
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violent_past_yes_describe
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form
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page_check__1
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new_order_replace_current_make
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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Request to Modify Protective Order

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