CERTIFICATION FOR DISSOLUTION OF RESTRAINING ORDER
Plaintiff _________________________________ hereby certifies and says:
1. I am the plaintiff in the above captioned matter. 2. On __________ I appeared in Superior Court ( ) OR in the Police station ( )
and signed a complaint and application for a Temporary Restraining Order. 3. On _________, I obtained a Final Restraining Order. 4. Since that time, I have reconciled with or reconsidered my relationship with the
defendant. Therefore, I am asking the court to dissolve all the restraints against
the defendant. 5. My Restraining Order does ( ) OR does not ( ) include provisions for custody,
time sharing and/or child support. I want ( ) OR I do not want ( ) these
provisions continued without a restraining order. 6. I have had my options explained to me and I have reviewed the information on
the form “What Dissolving a Restraining Order Means.” I am asking for this dismissal voluntarily, of my own free will and without coercion or interference from any person.
7. I am further aware that should I wish to contact an attorney, domestic violence program or counseling group that I may do so prior to completing this Certification.
8. I am aware that if any criminal charges were filed by me or the police, I will need to go to the municipal court (or superior court, criminal division) to request their dismissal.
9. I am aware that if there are further acts of domestic violence and I want a new Restraining Order, I must reapply for a Restraining Order either at the courthouse or the police station.
I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment.
