Request to Revoke Restraining Order

							         IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY

In the Matter of:                 )                  CASE NO.__________________________
□ the Marriage of                 )
□ the Domestic Partnership of     )                  REQUEST FOR HEARING
                                  )                  RE: STATUTORY RESTRAINING ORDER
______________________________    )                  (ORS 107.093(4); UTCR 8.080)
Petitioner,                       )
                                  )
vs.                               )
                                  )
______________________________    )
Respondent.                       )
_________________________________ )

1.    I am the □ Petitioner □ Respondent in the above-referenced action and I request a
hearing to:

      A. Apply for further temporary order(s); specify in detail:______________________
         _________________________________________________________________
         _________________________________________________________________
         _________________________________________________________________
          □ Additional Page Attached
      B. Modify or revoke the following term(s) of the statutory restraining order:
         i. Paragraph I □ Revoke or □ Modify as follows (explain):____________________
              _______________________________________________________________
         ii. Paragraph 2 □ Revoke or □ Modify as follows (explain):____________________
              _______________________________________________________________
         iii. Paragraph 3 □ Revoke or □ Modify as follows (explain):____________________
              _______________________________________________________________
         iv. Paragraph 4 □ Revoke or □ Modify as follows (explain):____________________
              _______________________________________________________________

2.    I □ will □ will not be represented by an attorney at the hearing.

Certification of Document Preparation: You are required to truthfully complete this
certificate regarding the document you are filing with the court. Check all boxes that apply.
        □ I selected this document for myself and completed it without paid assistance.
        □ I paid or will pay money to _______________________ for assistance in preparing
          this form.

Dated:_________________________              Signed:__________________________________
                                                     □ Petitioner □ Respondent
                                             Name: ___________________________________
                                                             (Please Print)
                                             Address: _________________________________
                                                      _________________________________
                                             Phone: __________________________________




REQUST FOR HEARING RE: STATURORY RESTRAINING ORDER (ORS 107.093(4); UTCR 8.080) - PAGE 1(05/20/09)