EX PARTE PROTECTION ORDER State of Alabama Unified Judicial System Form C-4 (Page 1 of 3) Rev. 7/10 (Protection from Abuse Act) §30-5-1, et seq., Ala. Code 1975 For Cases Filed on or After July 1, 2010 Case No. In the Circuit Court of ________________________ County, Alabama Amended Order PLAINTIFF FIRST PLAINTIFF MIDDLE LAST Date of Birth (DOB) of Plaintiff and/or any minor(s) on whose behalf the Petition for Protection from Abuse filed [List Name(s) and DOB(s)]: ___________________________________________________ ___________________________________________________ Other Protected Persons(s) [List Name(s) and DOB(s)]: ________________________________________ ________________________________________ V. DEFENDANT DEFENDANT IDENTIFIERS SEX First Middle Relationship to Plaintiff: Common Law Marriage RACE EYES DOB HAIR HT WT Last Spouse Ex-Spouse Child DISTINGUISHING FEATURES Child in Common Present or Former Household Member Dating Relationship DRIVER’S LICENSE # STATE Defendant’s Home Address & Telephone #:__________________ VEHICLE TAG # EXP. DATE __________________________________________________ CAUTION: WEAPONS INVOLVED Firearm Knife Hands, Feet, Fist Other:_____________________________ Weapon Present on the Property THE COURT HEREBY FINDS (Check all that apply): Pursuant to the sworn Affidavit/Petition and/or testimony of the Plaintiff seeking protection from abuse, the Court finds that it has jurisdiction over the parties and subject matter and that: A temporary order is necessary to prevent abuse. The Defendant represents a credible threat to the physical safety of the: Plaintiff; and/or child(ren); and/or any designated person to wit:_________________________________________________________________________________. THE COURT HEREBY ORDERS (Check all that apply): That the above-named Defendant be enjoined from threatening to commit or committing acts of abuse as defined in the Protection from Abuse Act. That the above-named Defendant be restrained from any contact with the Plaintiff and/or child(ren); and/or any designated person, to wit: _________________________________________________________________. Additional terms of this order follow on succeeding pages. The terms of this order shall be effective until: __________________________________, ________________________; or further Order of the Court. NOTICE TO LAW ENFORCEMENT This Order shall be enforced, even without registration, by courts and any law enforcement officer of any state, the District of Columbia, any U.S. territory, and may be enforced by Tribal lands (18 U.S.C.A. Section 2265). WARNINGS TO DEFENDANT: This Order shall be enforced, even without registration, by the courts and any law enforcement officer of any State, the District of Columbia, and any U. S. territory, and may be enforced by Tribal Lands (18 U.S.C.A. Section 2265). Crossing state, territorial or tribal boundaries to violate this Order may result in penalties, including federal imprisonment (18 U.S.C.A. Section 2262). Federal law provides penalties for possessing, transporting, shipping, or receiving any firearm or ammunition while subject to a qualified protection order or after being convicted of a misdemeanor crime of domestic violence [18 U.S.C.A. Sections 922(g)(8) and 922(g)(9)]. This Order is also enforceable on U.S. Department of Defense installations (10 U.S.C.A. Section 1561a). A willful violation of the ORDER is a Class A misdemeanor may be also punishable for contempt. Section 30-5A-3(c)(2), Ala. Code 1975. The Defendant is notified that he or she has a right to request a final hearing prior to 10 days of perfection of service of the Petition for Protection from Abuse. ONLY THE COURT CAN CHANGE THIS ORDER Original-Court Record Copy-Law Enforcement Copy-Plaintiff Copy-Defendant American LegalNet, Inc. www.FormsWorkFlow.com EX PARTE PROTECTION ORDER (Protection from Abuse Act) §30-5-1, et seq., Ala. Code 1975 State of Alabama Unified Judicial System, Form C-4 (Page 2 of 3 ) Rev. 7/10 Case No. In the Circuit Court of _______________________________County, Alabama Amended Order THE COURT FURTHER ORDERS THAT (Check all that apply): (1) The Defendant is enjoined from threatening to commit, or committing, acts of abuse, as defined in the Protection from Abuse Act, against the: Plaintiff; and/or child(ren); and/or any designated person, to wit:_____________________________ _____________________. (2) The Defendant is restrained and enjoined from harassing, stalking, annoying, telephoning, contacting, or otherwise communicating, directly or indirectly, with the Plaintiff and/or child(ren); and/or any designated family or household member, to wit: __________________________________ or threatening or engaging in conduct that would place in reasonable fear of bodily injury, the: Plaintiff; and/or child(ren) of the Plaintiff; and/or any designated person to wit: _________________ __________________________________________________. (3) The Defendant is ordered to stay away from: The Plaintiff’s residence; place of employment; school; and/or The child(ren)’s: residence; place of employment; school and/or any designated person’s, to-wit:________________ _____________________ residence; place of employment; school; and/or any specified place, which the court determines the Defendant has no legitimate reason to frequent, as designated below, frequented by: the Plaintiff; and/or child(ren); and/or any designated person. Name(s) and location(s) of the other specified place(s): ____________________________________. (4) Temporary custody of the child(ren) of the parties is hereby awarded to:_____________________________________________. (5) The Defendant is enjoined from interfering with the Plaintiff’s efforts to remove child(ren); I direct ______________________ _______________ (appropriate law enforcement officer) to accompany the Plaintiff during the effort. (6) The Defendant is enjoined from removing any child(ren) from the individual, to wit: _____________________________________, having legal custody of the child(ren), except as subsequently authorized by a custody or visitation order issued by a court of competent jurisdiction. (7) The Defendant is removed and excluded from the residence of the Plaintiff, regardless of ownership of the residence. (8) The possession and use of the automobile, _________________________________________, is awarded to ______________________ (Description, year, make) ____________________; and other essential personal effects,__________________________________________________________ (Please specify) are awarded to _______________________________________________. ___________________________________________ (the appropriate law enforcement officer) is to accompany the Plaintiff to the residence of the parties or to _______________________ ______________ as necessary to protect the Plaintiff or any child(ren) from abuse. (9) The Defendant is prohibited from: transferring; concealing; encumbering; or otherwise disposing of specified property mutually owned or leased by the parties, as follows:___________________________________________________________ _________________________________________. Original-Court Record Copy-Law Enforcement Copy-Plaintiff Copy-Defendant American LegalNet, Inc. www.FormsWorkFlow.com State of Alabama Unified Judicial System Form C-4 (Page 3 of 3) Rev. 7/10 EX PARTE PROTECTION ORDER (Protection from Abuse Act) § 30-5-1, et seq., Ala. Code 1975 Case No. In The Circuit Court of _________________________________County, Alabama AMENDED ORDER (10) The Defendant is ordered to obey the following grant of relief deemed necessary to provide for the safety and welfare of the: Plaintiff; and/or any child(ren); and/or any designated person, as follows: __________________________________________________________________________________________. _______________________________________________________________________________________________. Any law enforcement officer is hereby directed to accompany the Plaintiff to the: residence of the parties; and/or another location, _________________________________________________, as necessary to enforce any of the terms (description of location) of this Order, to wit: __________________________________________________________________________________. __________________________________________________________________________________________________________ __________________________________________________________________________________________________________. This matter is set for a final hearing on _____________________ (date) at _______________________________________ to be held at __________________________________________________________________________________________________________. The Defendant is advised that he or she has the right to counsel at this hearing at his or her expense, but not counsel appointed by the court. ____________________________________ Date Original-Court Record _________________________________________ Judge Copy-Law Enforcement Copy-Plaintiff Copy-Defendant American LegalNet, Inc. www.FormsWorkFlow.com