Motion for Substituted Service in Rebecca Follmer et al v. Eugene Mazour| Trellis.Law

On January 18, 2024 a Party Discovery was filed involving a dispute between Jake D Follmer, Kaleb J Follmer, Paisley A Follmer, Rebecca A Follmer, and Eugene W Mazour, for Protection Order-Harassment in the District Court of Nuckolls County.

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Issued; 1/18/2024 Document 7392
DOCUMENT COVER SHEET

IN THE DISTRICT COURT OF NUCKOLLS COUNTY, NEBRASKA
150 South Main ,
PO Box 362
Nelson, NE 68961-0362

Case ID: Cl 24-4 Rebecca Follmer et al v. Eugene Mazour
TO: Clay County County Sheriff's Office

Please serve the attached document(s) on the following party:
Eugene W Mazour
30150 Rd C
Lawrence NE 68957

Method of Service:
Personal Service

These special instructions have been added;
Please serve: EX PARTE HARASSMENT PROTECTION ORDER, REQUEST FOR HEARING,
PROTECTION ORDER INFORMATION HARASSMENT, and PETITION AFFIDAVIT TO
OBTAIN HARASSMENT PROTECTION ORDER.

Issued: 1/18/2024 Document #: 7392
SERVICE RETURN

Received this Document on,. I hereby certify that on
,at o'clock__ M. I served copies of the
Document(s) upon the party;
by________________________________________________________________________________________

as required by Nebraska state law

Service and return $______________
Copy $______________
Mileage_______ miles $______________
TOTAL $______________

Date:_________________________ By;______________
Sheriff or Authorized Person
000016056D42

000016056D42
Nebraska State Court Form
DC 19:1 Rev. 09/2020
Neb.Rev.Stat. §§ 42-924, 28-311.09, and 28-311.11
JAN 1 8 2024

IN THE DISTRICT COURT OF NUCKOLLS COUNTY, NEBRASKA
Rebecca Ann Follmer ,
Petitioner,
Jake Donald Follmer Case No.
Paisley Ann Follmer ,
Additional Petitioner/Minor Child(ren),
PROTECTION ORDER
PRAECIPE
Kaleb James Follmer .......... ,
Additional Petitioner/Minor Child(ren),
vs.
Eugene William Mazour ,
Respondent.
TO THE CLERK OF COURT:

Please have the Sheriff of Clay County Nebraska......... County serve a
copy of the protection order and/or order to show cause, petition, and request for
hearing (if applicable) upon the respondent by personal service at any one of the
following addresses:

Home; .................. Lawrence, Ne 6895 7...............
Work:
Other locations where respondent can be found:

Directions for service:

SignaturelJDate: h

Printed N ________________________
Street Address/P.O. Box:
City/State/ZIP Code: Lp ^ ~
Telephone Number
Email address: J rfe/1 the f /L ______________

d If completed by an attorney:
Bar Number:___________________

(If you are concealing your address or phone, do not provide them. Make
separate arrangements with the clerk.)

DC 19:1 Rev. 09/2020 Page 1 of 2 Protection Order Praecipe
Fill in any of the following information if known. ' -

Description of Respondent:
Alias: ........................ ........ .......... ................ .......................... ......
Sex; Male Age;72 ......... Height............... Weight:
Eye ColorHazel Green Hair Color:White/gray Race:White...
Skin Tone: White.................
Place of Birth:..................................... .......
Scars, Marks, and Tattoos:

Other Distinguishing Features:
Wears glasses

Employer: Retired ...................... ........................
Work Days and Hour's: ............................. .......
Description of Respondent’s Vehicle:
Drivers Lie. No.: ........... ............. Issuing State;
Expiration:...............
Vehicle Lie. No.: Vehicle Year:
Issuing State; ................... Type; ...............................
Make; Model: ...................... Color(s):
VIN; .................................. ................ .

Does the Respondent:
Carry a weapon or keep a weapon nearby‘.Q yesQ no
Where and what kind? .......... .......... ....... .. .........
Have a history of mental illness? nyes □ no
Use or abuse alcohol or drugs? nyes □ no What kind?

Have a history of violence toward others? □ yes □ no
Make threats against law enforcement? □ yes □ no
Other Comments:

DC 19:1 Rev. 09/2020 Page 2 of 2 Protection Order Praecipe
Issued: 1/18/2024 Document #: 7392
DOCUMENT COVER SHEET

IN THE DISTRICT COURT OF NUCKOLLS COUNTY, NEBRASKA
150 South Main
PO Box 362
Nelson, NE 68961-0362

Case ID: Cl 24-4 Rebecca Follmer et al v. Eugene Mazour
TO: Clay County County Sheriff's Office

Please serve the attached document(s) on the following party:
Eugene W Mazour
30150 Rd C
Lawrence NE 68957

Method of Service:
Personal Service

These special instructions have been added:
Please serve: EX PARTE HARASSMENT PROTECTION ORDER, REQUEST FOR HEARING,
PROTECTION ORDER INFORMATION HARASSMENT, and PETITION AFFIDAVIT TO
OBTAIN HARASSMENT PROTECTION ORDER.
Nebraska State Court Form
REQUIRED
EX PARTE HARASSMENT
DC 19:4 Rev. 01/20
Neb. Rev. Stat § 28-^1.09 PROTECTION ORDER
Document# _

IN THE DISTRICT COURT OF NUCKOLLS COUNTY, NEBRASKATicvT
; RoyreGoi'/aies. C
Rebecca Ann Follmer ~
Petitioner,
Jake Donald Follmer, Paisley Ann Follmer,___________ Case No. Cl 24-4____________________
Additional Petitioner/Minor Child(ren),
Kaleb James Follmer______________________________
Additional Petitioner/Minor Child(ren), EX PARTE HARASSMENT
VS. PROTECTION ORDER

Eugene William Mazour___________________________
Respondent.
The protected party(ies) of this Order is/are:
1. Rebecca Ann Follmer 4. Kaleb James Follmer
2. Jake Donald Follmer________________________ 5.
3. Paisley Ann Follmer________________________ 6.__________________________________________

THE COURT, having received the Petition and Affidavit of the petitioner, finds that a harassment
protection order pursuant to Neb. Rev. Stat. § 28-311.09 should be issued. FURTHER, it reasonably appears
from the specific facts included in the affidavit that irreparable harm, loss or damage will result before this
matter can be heard on notice, therefore, the court having jurisdiction of the parties finds that a harassment
protection order should be issued without prior notice and hearing.
IT IS THEREFORE ORDERED, pursuant to Neb. Rev. Stat. § 28-311.09, unless otherwise dismissed or
modified by order of the court, a harassment protection order against the respondent is granted for a
period of one year from the date of this order and the petitioner is granted the following relief:
X 1. Respondent is enjoined from imposing any restraint upon the person or liberty of the protected
party(ies).
^£2. Respondent is enjoined from harassing, threatening, assaulting, molesting, attacking, or
otherwise disturbing the peace of the protected party(ies).
3. Respondent is enjoined from telephoning, contacting, or otherwise communicating with the
protected party(ies).

If the respondent wishes to appear and show cause why this order should not remain in effect for a period
of one year, he or she shall affix his or her current address, telephone number, and signature on the Request
for Hearing form provided and return it to the clerk of the district court within ten (10) business days after
service upon him or her. This order shall remain in effect during the time prior to ’’
Costs are waived unless otherwise ordered by the court.

DATED:January 18, 2024 JUDGE

NOTICE TO RESPONDENT

PURSUANT to 18 U.S.C.2265, this order is enforced in all fifty states, the District of Columbia, tribal lands and U.S.
territories. Moreover, pursuant to 18 U.S.C.922 if a final order is entered against you after a hearing of which you had actual
knowledge and an opportunity to participate, whether or not you actually participated and if this court order restrains you from
harassing, stalking, or threatening an intimate partner or child of such intimate partner, or engaging in other conduct that would
place an intimate partner in reasonable fear of bodily injury to the partner or child, you may be subject to a federal penalty
for possessing, transporting, or accepting a firearm or ammunition.
Page 1 of 2
Ex Parte Harassment Protection
Order DC 19:4 Rev 01/20
A harassment protection order is a court order issued to a victim who has been harassed, pursuant to Neb. Rev. Stat.
§ 28-311.09 et seq.
In order to qualify for a harassment protection order:
• the petition shall state the events and dates of acts constituting the alleqed harassment. This must include the most
recent and most severe incident(s).
• the petitioner must show that the respondent has engaged in a knowing and willful course of conduct directed at the
petitioner which seriously terrifies, threatens, or intimidates the petitioner and which serves no legitimate purpose.
• A course of conduct is defined as a pattern of conduct composed of a series of acts over a period of
time, however short, evidencing a continuity of purpose, including a series of acts of following, detaining,
restraining the personal liberty of, or stalking, telephoning, contacting, or otherwise communicating with the
petitioner.
A protection order may prohibit the respondent from:
• imposing any restraint upon the petitioner or family or household member, or liberty of the petitioner,
• harassing, threatening, assaulting, molesting, attacking, or otherwise disturbing the peace of the petitioner,
• telephoning, contacting, or otherwise communicating with the petitioner.
Once the protection order petition is granted, it may not be withdrawn except upon order of the court.
The protection order shall be effective for one year unless otherwise modified by the court.
A court, on its own motion or at the request of the petitioner, may treat a petition for a harassment protection order as a
request for a sexual assault protection order or domestic abuse protection order, if it appears from the facts in the petition,
affidavit and evidence presented at a show-cause hearing that such other protection order is more appropriate.
NOTICE TO PETITIONER
Fees to cover costs associated with the filing, issuance, or service of a protection order shall not be charged, except that a
court may assess such fees and costs if the court finds that the statements contained in the application were false and that
the protection order was sought in bad faith.
NOTICE TO RESPONDENT
If there has been an Ex Parte Protection Order served upon you and you wish to request a hearing to show cause why the
order should notremain in effect, you must request a hearing on the provided "Request for Hearing” form by completing the
form and returning it to the clerk of the district court at the address listed at the bottom of the form. You must return the
form within ten (10) business days after you have been served. The court will schedule a hearing within thirty (30) days after
reviewing our request and shall notify you and the petitioner of the hearing date.
If there is a hearing scheduled and you wish to defend against the claims set forth in the application for a protection order,
you must appear at the hearing. You are warned that if you fail to appear, the case will proceed without you and a final
order may be entered against you for the relief requested in thepetition.
You are required to obey the terms of the protection order as soon as it is served upon you. If you disobey the terms of
the protection order, you will be subject to the following Nebraska Revised Statutes.
Violation of a Protection Order; Any person convicted of violating the terms of a harassment protection order after being
served shall be subject to either Neb. Rev. Stat. § 28-311.04 or § 28-311.09(4).
If a protection order has been issued against you, the following United States Federal Statutes apply to the issuance of a
valid protection order.
Full Faith and Credit Provision: Pursuant to 18 U.S.C. § 2265, this order is enforceable in all fifty (50) states, the District
of Columbia, tribal lands and U.S. territories. The penalties for violation of this order are determined by
the existing penalty of the location in which the violation occurred. Nebraska’s Harassment Full Faith and Credit
provisions are found in Neb. Rev. Stat. § 28-311.10.
Interstate Domestic ViolenceA/iolation of a Protection Order:
• If you travel across state or tribal borders with the intent to injure the petitioner and then intentionally commit a crime
of violence causing bodily injury to the petitioner, you may be convicted of committing a federal offense under
18 U.S.C. § 2261(a)(1). You may also be convicted of committing a federal offense if you cause the petitioner to cross
state or tribal borders for this purpose. 18 U.S.C. § 2262(a)(2).
• If you travel across state or tribal borders with the intent to violate the final protection order and subsequently violate
such order, you may be convicted of committing a federal offense under 18 U.S.C. § 2261 (a)(1).
• You may also be convicted of committing a federal offense if you cause the plaintiff to cross state or tribal borders
for this purpose. 18 U.S.C. § 2262(a)(2).

Page 2 of 2
Ex Parte Harassment Protection
Order DC 19:4 Rev 01/20
Nebraska State Court Form
DC 19.14 Rev. 06/2019
Neb. Rev. Stat. §§ 42-924,28-311.09,
and 28-311.11

IN THE DISTRICT COURT OF NUCKOLLS COUNTY, NEBRASKA

Rebecca Ann Follmer ,
Petitioner, ^4-4
Jake Donald Follmer, Paisley Ann FoIIm,
Additional Petitioner/Minor Child(ren),
Kaleb James Follmer , REQUEST FOR HEARING —
Additional Petitioner/Minor Child(ren), PROTECTION ORDER
vs.
Eugene William Mazour ,
Respondent.

1. I wish to request a hearing on this protection order. I understand that notice
of the time and place of the hearing shall be mailed to the address below.
2. □ I do not agree to receive notification by email.
□ I agree to receive notification by email.
email address:
NOTE: By providing this email address, I acknowledge that I am aware that
this information will be public record. I also understand that I will only receive
email communications regarding this case from the court.

□ I do not speak English. My language is

.............. Date;
Signature

Name Street Address/P.O. Box

Bar Number and Firm Name (attorneys only) City/State/ZIP Code

Phone Email Address

Phone (Work)

RETURN IO: Clerk of the District Court
(Address:) PO Box 362
Nelson, NE 68961

DC 19:14 Rev. 06/2019 Page 1 of 1 Request for Hearing - Protection Order
Nebraska State Court Form
A copy is on the reverse side of DC 19:4, 19:5, 19:6 and 19:7
DC 19:3 Rev. 01/2020
Neb. Rev. Stat. §28-311.09

PROTECTION ORDER INFORMATION - HARASSMENT

A harassment protection order is a court order issued to a victim who has been harassed,
pursuant to Neb. Rev. Stat. § 28-311.09 et seq.
In order to qualify for a harassment protection order:
• the petition shall state the events and dates of acts constituting the alleged harassment.
This must include the most recent and most severe incidcnt(s).
• the petitioner must show that the respondent has engaged in a knowing and willful course of
conduct directed at the petitioner which seriously terrifies, threatens, or intimidates the
petitioner and which serves no legitimate purpose.
• A course of conduct is defined as a pattern of conduct composed of a series of acts over
a period of time, however short, evidencing a continuity of purpose, including a series
of acts of following, detaining, restraining the personal liberty of, or stalking,
telephoning, contacting, or otherwise communicating with the petitioner.
A protection order may prohibit the respondent from:
• imposing any restraint upon the petitioner or family or household member, or liberty of the
petitioner,
• harassing, threatening, assaulting, molesting, attacking, or otherwise disturbing the peace of
the petitioner,
• telephoning, contacting, or otherwise communicating with the petitioner.
Once the protection order petition is granted, it may not be withdrawn except upon order
of the court.

The protection order shall be effective for one year unless otherwise modified by the court.

A court, on its own motion or at the request of the petitioner, may treat a petition for a
harassment protection order as a request for a sexual assault protection order or domestic abuse
protection order, if it appears from the facts in the petition, affidavit and evidence presented at a
show-cause hearing that such other protection order is more appropriate.

NOTICE TO PETITIONER
Fees to cover costs associated with the filing, issuance, or service of a protection order shall not
be charged, except that a court may assess such fees and costs if the court finds that the
statements contained in the application were false and that the protection order was sought in
bad faith.
NOTICE TO RESPONDENT
If there has been an Ex Parte Protection Order served upon you and you wish to request a
hearing to show cause why the order should not remain in effect, you must request a hearing
on the provided “Request for Hearing” form by completing the form and returning it to the

DC 19:3 Rev. 01/2020 Page 1 of 2 Protection Order Information, Harassment
clerk of the district court at the address listed at the bottom of the form. You must return the
form within ten (10) business days after you have been served. The court will schedule a hearing
within thirty (30) days after reviewing our request and shall notify you and the petitioner of the
hearing date.

If there is a hearing scheduled and you wish to defend against the claims set forth in the
application for a protection order, you must appear at the hearing. You are warned that if you fail
to appear, the case will proceed without you and a final order may be entered against you for
the relief requested in the petition.

You are required to obey the terms of the protection order as soon as it is served upon you. If
you disobey the terms of the protection order, you will be subject to the following Nebraska
Revised Statutes.

Violation of a Protection Order: Any person convicted of violating the terms of a harassment
protection order after being served shall be subject to either Neb. Rev. Stat. § 28-311.04 or
§ 28-311.09(4).
If a protection order has been issued against you, the following United States Federal Statutes
apply to the issuance of a valid protection order.

Full Faith and Credit Provision: Pursuant to 18 U.S.C. § 2265, this order is enforceable in all
fifty (50) states, the District of Columbia, tribal lands and U.S. territories. The penalties for
violation of this order are determined by the existing penalty of the location in which the violation
occurred. Nebraska’s Harassment Full Faith and Credit provisions are found in Neb. Rev. Stat.
§ 28-311.10.

Interstate Domestic ViolenceA/iolation of a Protection Order:

• If you travel across state or tribal borders with the intent to injure the petitioner and then
intentionally commit a crime of violence causing bodily injury to the petitioner, you may be
convicted of committing a federal offense under 18 U.S.C. § 2261(a)(1). You may also be
convicted of committing a federal offense if you cause the petitioner to cross state or tribal
borders for this purpose. 18 U.S.C. § 2262(a)(2).
• If you travel across state or tribal borders with the intent to violate the final protection order
and subsequently violate such order, you may be convicted of committing a federal offense
under 18 U.S.C. § 2261(a)(1).
• You may also be convicted of committing a federal offense if you cause the plaintiff to cross
state or tribal borders for this purpose. 18 U.S.C. § 2262(a)(2).

DC 19:3 Rev. 01/2020 Paee 2 of 2 Protection Order Information. Harassment
Nebraska State Court Form hl the District Court of
lot s rn
REQUIRED
DC 19:2 Rev. 01/2020
Neb. Rev. Stat. § 28-311.09
JAN 1 8 2024

luckolis Count’
IN THE DISTRICT COURT OF NUCKOLLS COUNTY, NEB ’-Gonzales, Cie’ 'k of Di st. Court

Rebecca Ann Follmer...... ........................, Case No.
Petitioner,
Jake Donald Follmer
Paisley Ann Follmer....... ................... ,
PETITION AND AFFIDAVIT
Additional Petitioner/Minor Child(ren), TO OBTAIN HARASSMENT
PROTECTION ORDER

Kaleb James Follmer ,
Additional Petitioner/Minor Child(ren),
vs.
Eugene William Mazour ,
Respondent.

1. I, Rebecca Ann Follmer, am the petitioner in this
case. I am petitioning for a harassment protection order pursuant to Neb. Rev.
Stat. §28-311.09.
I am filing this petition on behalf of:

n Myself. I have been harassed.
0 Myself and additional petitioner(s) who have been harassed and whose
name(s) is/are shown after mine in the caption of this petition. My
relationship to the additional petitioner(s)/minor child(ren) is/are: E custodial
parent, □ guardian, □ other:............................. .
O Only on behalf of the additional petitioner(s) who have been harassed and
whose name(s) is/ are shown after mine in the caption of this petition. My
relationship to the additional petitioner(s)/minor child(ren) is/are:
custodial parent, guardian, other:

AND:

S I am 19 or older or legally emancipated OR
□ I am a minor and.............. years of age.
□ I do not speak English. The language that I speak is: ................. ...... ....... ....... .

Petition and Affidavit to
DC 19:2 Rev. 01/2020 Page 1 of 6 Obtain Harassment Protection Order
2. Check Only One:
□ I have received address protection from the Secretary of State under the
Address Confidentiality Program.(Service of any court process shall be made by
mailing two copies of the process to the Office of Secretary of State, Address
Confidentiality Program, Suite 2300, State Capitol Building, Lincoln, NE, 68509)
n I am living at a safe house or shelter for my own protection. Pursuant to Neb.
Rev. Stat. § 29-4303,1 cannot identify the name, address, location or phone number
of the facility.
E] My address is:
2403 Road 4600 Edgar, NE 68935
(Street or Route/Box) (City) (State) (ZIP code)
O Mailing address (if different):

(Street or Route/Box) (City) (State) (ZIP code)

3. Neb. Ct. Rule § 2-208 requires people involved in a case who are not attorneys
to provide their email address or provide a reason why they cannot receive emails.
d I do not have the ability to receive emails. The reason I cannot receive email is:

0 My email address is: irfollmer911(^gmail.com______________________________

NOTE: By providing this email address, I acknowledge that I am aware that
this information will be public record. I also understand that I will only receive
email communications regarding this case from the court.

4.1 am filing this petition against the respondent whose age is: 72.... and who
resides at:
Lawrence, Ne 68957
(Street or Route/Box) (City) (State) (ZIP code)
Mailing address (if different):

(Street or Route/Box) (City) (State) (ZIP code)
(402)984-0976
(Phone number)

□ The respondent does not speak English. The language that the respondent speaks is:

My relationship to (he respondent is:

Petition and Affidavit to
DC 19:2 Rev. 01/2020 Page 2 of 6 Obtain Harassment Pi'otection Order
5. The respondent is a person who has willfully harassed me and has engaged in a
knowing and willful course of conduct directed at me which seriously terrifies,
threatens, or intimidates me and selves no legitimate purpose.

6. To my knowledge, The respondent and 1 □ have or 13 have not been
involved in past or cun'ent court cases together, (i.e., divorce, paternity, custody,
juvenile, criminal or protection orders) If so: when, where, type of case, name of
couil(s), and case number(s).

7. I hereby ask the court to enter a protection order (mark all that apply):
prohibiting the respondent from imposing any restraint upon the person(s)
seeking protection.
prohibiting the respondent from harassing, threatening, assaulting,
molesting, attacking, or otherwise disturbing the peace of the person(s)
seeking protection.
13 prohibiting the respondent from telephoning, contacting, or otherwise
communicating with the person(s)seeking protection.

8. Pursuant to Neb. Rev. Stat. § 25-2740,1 request to have a District Court
Judge, or □ County Court Judge preside over this proceeding. (I understand this
request may not be granted.)

9. The dates or approximate dates and facts of the most recent series of acts and the
most severe incident or incident(s) of harassment toward the person(s) seeking
protection are (Please write a brief but detailed description.):

Petition and Affidavit to
DC 19:2 Rev. 01/2020 Page 3 of 6 Obtain Harassment Protection Order
A.Date/Time: Sutnmer of 2014 Description:

The summer when my oldest son, Austin Mazour, gi-aduated from high school,
Eugene and Eileen tried to take him away from us. They said that we were not
doing the proper parenting by keeping him out of trouble by letting him do what
he wanted. We were bad parents by this is what he had said. They had him live
with them and that is when he got himself in trouble with the law. Austin getting
in troublei is recorded with the sheriffs office. We do not need Eugene around
our kids coursing them into there evilness. We don't want our kids around them
at all. We want them to stop attending and don't want them around at all.

B. Date/Time:........... Summer of 2023 into Winter of 2024............ Description;

Eugene has been going to some of our kids. Paisley, Kaleb, and Jake's sporting
events without an invite from either myself or the kids. This makes the kids and
myself very uncomfortable and we want it to stop. The kids can't concertrate on
there actions when playing sports. We want all this to stop!! Out kids feel like
they are being stalked

C. Date/Time: Description:

Petition and Affidavit to
DC 19:2 Rev. 01/2020 Page 4 of 6 Obtain Harassment Protection Order
10. I request the court treat this Petition and Affidavit for a Harassment
Protection Order as a request for a sexual assault protection order or a domestic abuse
protection order if it appears to the court, based on facts contained in this Petition and
Affidavit and the evidence presented at a show cause hearing, that another’ type of
protection order is more appropriate in this case, and the court makes such findings.

11. Additional Petitioner(s) (ifneeded);

Petitioner 2 (Minor Child);
Name; Paisley Ann Follmer Age; 12
Relationship to the Respondent (From list on number 4);

Residence;
The address of this Petitioner is the same as my address above.
□ This Petitioner's address is;

(Street or Route/Box) (City) (State) (ZIP code)

Petitioner 3 (Minor Child);
Name; Kaleb James Follmer Age; 10
Relationship to the Respondent (From list on number 4);

Residence;
The address of this Petitioner is the same as my address above.
□ This Petitioner's address is;

(Street or Route/Box) (City) (State) (ZIP code)

Petitioner 4 (Minor Child);
Name; Jake Donald Follmer Age; 8
Relationship to the Respondent (From list on number 4);

Residence;
1 3 The address of this Petitioner is the same as my address above .
□ This Petitioner's address is;

(Street or Route/Box) (City) (State) (ZIP code)

Petition and Affidavit to
DC 19:2 Rev. 01/2020 Page 5 of 6 Obtain Harassment Protection Order
Petitioner S (Minor Child):
Name:Age:
Relationship to the Respondent (From list on number 4):

Residence:
□ The address of this Petitioner is the same as my address
Q above. This Petitioner's address is:

(Street or Route/Box) (City) (State) (ZIP code)

Petitioner 6 (Minor Child):
Name:Age:
Relationship to the Respondent (From list on number 4):

Residence:
□ The address of this Petitioner is the same as my address
□ above. This Petitioner's address is:

(Street or Route/Box) (City) (State) (ZIP code)

I hereby swear, or affirm, under penalty of perjuiy, the forgoing affidavit is true.

(Name, Firm name, and Bar Number IF being completed by an attorney)

(do NOT sign UNTIL THE CLERK OF THE DISTRICT COURT OR
A NOTARY IS PRESENT AND WITNESSES YOU SIGNING)

Petition and Affidavit to
DC 19'.2 Rev. 01/2020 Page 6 of 6 Obtain Harassment Protection Order

Case Info

Judge

Morgan R. Farquhar Track Judge’s New Case

Case No.

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Document Filed Date

January 18, 2024

Case Filing Date

January 18, 2024

County

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Party Discovery: Rebecca Follmer et al v. Eugene Mazour

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