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

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

      1. (i) domestic violence;
      2. (ii) sexual assault; or
      3. (iii) stalking; and

   2. (B) the applicant fears for:

      1. (i) the applicant's safety; or
      2. (ii) the safety of a minor or an incapacitated individual on whose behalf the application is made.
2. (2) A copy of a valid protective order issued on behalf of the applicant or the minor or incapacitated individual on whose behalf the application is made.

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

   1. (A) service of process; and
   2. (B) receipt of mail.

4. (4) The:

   1. (A) mailing address; and

   2. (B) telephone number;

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

5. (5) The new address that the applicant requests not be disclosed because disclosure may increase the risk of domestic violence.
6. (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. (7) The date the applicant signed the application.

As added by P.L.273-2001, SEC.3. Amended by P.L.133-2002, SEC.12.