EPO-001 ONE copy to court, ONE copy to restrained person, ONE copy to protected person, ONE copy to issuing agency LAW ENFORCEMENT CASE NUMBER: EMERGENCY PROTECTIVE ORDER (See reverse for important notices.) 1. PROTECTED PERSONS (insert names of all persons protected by this Order): 2. RESTRAINED PERSON (name): Sex: 3. a. b. c. M F Ht.: Wt.: Hair color: Eye color: Race: Age: Date of birth: TO THE RESTRAINED PERSON: YOU MUST NOT harass, attack, strike, threaten, assault (sexually or otherwise), hit, follow, stalk, molest, destroy any personal property of, disturb the peace of, keep under surveillance, or block the movements of each person named in item 1. YOU MUST NOT contact, either directly or indirectly, by any means, including but not limited to by telephone, mail, e-mail or other electronic means, any person named in item 1. yards from each person named in item 1. stay away at least: YOU MUST stay away at least: (address): d. yards from move out immediately from YOU MUST NOT own, possess, purchase, receive, or attempt to purchase or receive any firearm or ammunition. If you have any firearms, you must turn them in to a law enforcement agency or sell them to, or store them with, a licensed gun dealer. e. YOU MUST NOT take any action, directly or through others, to obtain the addresses or locations of any person named in item 1. (Name): is given temporary care and control of the following 4. minor children of the parties (names and ages): 5. THIS ORDER WILL EXPIRE AT THE CLOSE OF THE COURT BUSINESS DAY ON: 6. TO THE PROTECTED PERSON: If you need protection for a longer period of time, you must request restraining orders from the court in the county where you live: (Name and address of court): If you go to court to request restraining orders, take your copy of this form with you. If a juvenile petition is pending, file in that court. 7. Reasonable grounds for the issuance of this Order exist, and an emergency protective order is necessary to prevent the occurrence or recurrence of domestic violence, child abuse, child abduction, elder or dependent adult abuse, or stalking. 8. Judicial officer (name): granted this Order on (date): at (time): INSERT DATE OF FIFTH COURT DAY OR SEVENTH CALENDAR DAY, WHICHEVER IS EARLIER; DO NOT COUNT DAY THE ORDER IS GRANTED APPLICATION 9. The events that caused the protected person to fear immediate and present danger of domestic violence, child abuse, child abduction, elder or dependent adult abuse (except solely financial abuse), or stalking are (give facts and dates; specify weapons): 10. 11. 12. By: Firearms were: observed reported searched for seized The person to be protected lives with the person to be restrained and requests an order that the restrained person move out immediately from the address in item 3c. The person to be protected has minor children in common with the person to be restrained, and a temporary custody order is does not exist. requested because of the facts alleged in item 9. A custody order does (PRINT NAME OF LAW ENFORCEMENT OFFICER) (SIGNATURE OF LAW ENFORCEMENT OFFICER) Agency: 13. Person served (name): Telephone No.: Badge No.: PROOF OF SERVICE 14. I personally delivered copies of this Order to the person served as follows: Address: Date: Time: I am a California law enforcement officer. 15. At the time of service, I was at least 18 years of age and not a party to this cause. 16. My name, address, and telephone number are (this does not have to be server's home telephone number or address): I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (TYPE OR PRINT NAME OF SERVER) Form Adopted for Mandatory Use Judicial Council of California EPO-001 [Rev. January 1, 2014] Approved by DOJ (SIGNATURE OF SERVER) Page 1 of 2 Family Code, §§ 6240 Penal Code, § 646.91 www.courts.ca.gov EMERGENCY PROTECTIVE ORDER (CLETS­EPO) (Domestic Violence, Child Abuse, Elder or Dependent Adult Abuse, or Stalking) -6275; American LegalNet, Inc. www.FormsWorkFlow.com EMERGENCY PROTECTIVE ORDER EPO-001 WARNINGS AND INFORMATION TO THE RESTRAINED PERSON: VIOLATION OF THIS ORDER IS A MISDEMEANOR PUNISHABLE BY A $1,000 FINE, ONE YEAR IN JAIL, OR BOTH, OR IT MAY BE PUNISHABLE AS A FELONY. THIS PROTECTIVE ORDER SHALL BE ENFORCED BY ALL LAW ENFORCEMENT OFFICERS IN THE STATE OF CALIFORNIA WHO ARE AWARE OF OR SHOWN A COPY OF THE ORDER. THE TERMS AND CONDITIONS OF THIS ORDER REMAIN ENFORCEABLE REGARDLESS OF THE ACTS OF THE PARTIES; IT MAY BE CHANGED ONLY BY ORDER OF THE COURT (PENAL CODE SECTION 13710(b)). YOU ARE PROHIBITED FROM OWNING, POSSESSING, PURCHASING, RECEIVING, OR ATTEMPTING TO PURCHASE OR RECEIVE A FIREARM OR AMMUNITION. (PENAL CODE SECTIONS 29825(a), 30305(a).) A VIOLATION IS SUBJECT TO A $1,000 FINE AND IMPRISONMENT OR BOTH. WITHIN 24 HOURS OF RECEIPT OF THIS ORDER, YOU MUST TURN IN YOUR FIREARMS TO A LAW ENFORCEMENT AGENCY, SELL THEM TO A LICENSED FIREARMS DEALER, OR STORE THEM WITH A LICENSED FIREARMS DEALER UNTIL THE EXPIRATION OF THIS ORDER. (PENAL CODE SECTION 29830.) PROOF OF SURRENDER, SALE, OR STORAGE MUST BE FILED WITH THE COURT WITHIN 48 HOURS OF RECEIPT OF THIS ORDER. To the restrained person: This order will last until the date and time in item 5 on the reverse. The protected person may, however, obtain a more permanent restraining order from the court. You may seek the advice of an attorney on any matter connected with this order. The attorney should be consulted promptly so that the attorney may assist you in responding to the order. A la persona bajo restricción judicial: Esta orden durará hasta la fecha y hora indicada en el punto 5 al dorso. La persona protegida puede, sin embargo, obtener una orden de entredicho (restricción judicial) más permanente de la corte. Usted puede consultar a un abogado en conexión con cualquier asunto relacionado con esta orden. Debe consultar al abogado inmediatamente para que él o ella le pueda ayudar a responder a la orden. To the protected person: This order will last only until the date and time noted in item 5 on the reverse. If you wish to seek continuing protection, you will have to apply for an order from the court at the address in item 6. You may apply for a protective order free of charge. In the case of an endangered child, you may also apply for a more permanent order at the address in item 6, or if there is a juvenile dependency action pending, you may apply for a more permanent order under section 213.5 of the