Statutes: Indiana

Sec. 2. The office of the attorney general shall approve an application filed in the manner and on a form prescribed by the office of the attorney general if the application contains the following:

(1) A sworn statement by the applicant that the applicant has good reason to believe that:

(A) the applicant, the minor or incapacitated individual on whose behalf the application is made, or a household member of the applicant is a victim of:

(i) domestic violence;

(ii) harassment;

(iii) human trafficking;

(iv) intimidation;

(v) invasion of privacy;

(vi) sexual assault; or

(vii) stalking; and

(B) the applicant fears for:

(i) the applicant’s safety; or

(ii) the safety of a minor or an incapacitated individual on whose behalf the application is made.

(2) A copy of a valid protective order, if any, that has been issued on behalf of the applicant, the minor or incapacitated individual on whose behalf the application is made, or household member of the applicant.

(3) A designation of the office of the attorney general as an agent of the applicant for the purpose of:

(A) service of process; and

(B) receipt of mail.

(4) The:

(A) mailing address; and

(B) telephone number;

where the applicant may be contacted by the office of the attorney general.

(5) The new address that the applicant requests not be disclosed.

(6) The signature of the applicant and of any representative of an agency designated under IC 5-26.5-3-4 that assisted in the preparation of the application.

(7) The date the applicant signed the application.

(8) A description of the applicant’s plan, developed with the assistance of a representative of an agency designated under IC 5-26.5-3-4, to maintain the confidentiality of the applicant’s new address.

(9) The office of the attorney general may require the applicant to provide additional information:

(A) to determine the truth or falsity of the sworn statement as described in subdivision (1); or

(B) about the applicant’s plan described in subdivision (8).