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OVS 08/14 Page 1 of 2 STATE OF MONTANA DEPARTMENT OF JUSTICE OFFICE OF VICTIM SERVICES In Helena: 444-5803 P.O. Box 201410 Toll Free: [PHONE REDACTED] Helena, MT 59620-1410 FAX: (406) 442-2174 HOPE CARD REQUEST FORM Instructions: Hope Cards are available to anyone with a valid, permanent order of protection. Cards are also available for any children or other individuals covered by the order. You may request more than one card per individual if, for example, you wish to provide one to a child’s school and another to the child’s after-school care program. Hope Cards are free. They are not issued based on temporary orders of protection. You will need to refer to the order of protection as you fill out the request form. You can fill out the form on the computer and print the completed form or, if you prefer, print the blank form and fill it out by hand. Mail the completed form to the Office of Victim Services at the address above. Hope Cards are mailed within approximately 10 business days. If you do not receive your card within this period, use the contact information above to check on the status of your request. Protection Order Information: Please print. All fields with a * must be completed. *Case Number: *Court: *County: *Date of Issuance: (MM/DD/YYYY) *Date of Expiration: (MM/DD/YYYY) Petitioner Information: *First Name: Middle Name: *Last Name: Suffix: *Date of Birth: (MM/DD/YYYY) *Sex: *Race: *Height: feet inches Mailing Address: *Address Line #1 Address Line #2 *City: *State: *Zip: Contact Phone ( ) E-mail: ---PAGE BREAK--- OVS 08/14 Page 2 of 2 Respondent Information: *First Name: Middle Name: *Last Name: Suffix: *Date of Birth: (MM/DD/YYYY) *Eye Color: *Hair Color: *Sex: *Race: *Height: feet inches *Weight: Distinguishing Features: (scars, marks, tattoos) Other Protected Persons Information: Person 1 *First Name: Middle Name: *Last Name: Suffix: *Date of Birth: Person 3 *First Name: Middle Name: *Last Name: Suffix: *Date of Birth: Person 2 Person 4 Number of Hope Cards Requested: