Court Ph. Order of Protection Interim Plenary (Final) Court County Case No. JUDICIAL CIRCUIT State of ILLINOIS PETITIONER First Middle Last (file stamp) Petitioner's Address/ Alternative Address: Petition And/or on behalf of other protected person(s) Child(ren) as noted on page 6, Part C of this order (name) Dependent (name) High Risk Adult RESPONDENT SEX First Middle Last EYES RESPONDENT IDENTIFIERS RACE DOB HT. WT. Relationship to Petitioner: ___________________ Respondent's Address: _________________________________________ (Home) _________________________________________ (Work) (Work Hours:__________________) HAIR SOCIAL SECURITY (last 4#s) XXX-XX- DRIVER'S LIC. # STATE License Plate # Caution indicators: Distinguishing Features (scars, marks, tattoos, martial arts): (A) Considered armed and /or dangerous (S) Suicidal (Y) Considered armed, dangerous and suicidal THE COURT FINDS: That it has jurisdiction over the Petitioner and subject matter and the Respondent will be provided with reasonable notice and an opportunity to be heard within the time required by Illinois law. Additional findings are set forth on the following pages. THE COURT ORDERS: That Respondent is prohibited from further acts/threats of abuse on protected persons. (See R01) That Respondent is ordered to stay away from Petitioner and/or other protected persons. (See R03) The Circuit Clerk is directed to send within 24 hours: Daycare / School Notice(s) (See page 6). Firearms Notice(s) (See page 8). Additional terms of this order are set forth herein. The terms of this Order shall be effective until (Date) Form approved by the Conference of Chief Circuit Judges. Effective November 1, 2004 Use required after July 1, 2005 Page 1 of 13 - Order of Protection, 47 (Time am/pm) Rev. 12/09 NOTICES CONCERNING THIS ORDER OF PROTECTION WARNING TO RESPONDENT Violating this Order of Protection is punishable by imprisonment or fine or both, and can cause your bond to be revoked, result in a contempt of court citation against you, or the filing of a criminal charge. This protection order is enforceable, even without registration, in all 50 states, the District of Columbia, tribal lands, and the U.S. Territories pursuant to the Violence Against Women Act (18 U.S.C. § 2265). Violating this order of protection may subject you to federal charges and punishment (18 U.S.C. §§ 2261-2262). You may also be subject to federal penalties for possessing, transporting, shipping or receiving a firearm or ammunition under the Gun Control Act (18 U.S.C. § 922(g)(8) and (9)). Only the court can change this order. The Petitioner cannot give you legal permission to change this order. If you go near the Petitioner, even with the Petitioner's consent, you may be arrested. If you and the Petitioner want to resume your relationship, you must ask the Court to modify or dismiss this Order of Protection. Unless the court modifies/dismisses this order, you can be arrested for violating this Order of Protection. You act at your own risk if you disregard this WARNING. NOTICE TO PETITIONER You cannot change the terms of this order by your words or actions. If the Court has ordered no contact or exclusive possession of the residence, only the Court can allow the Respondent to contact you or return to the residence. If you and the Respondent want to resume your relationship, you must ask the Court to modify or dismiss this Order of Protection. If you wish to extend the Plenary order, you must file with the clerk of the court a Motion to Extend (including any modifications needed for your protection) at least 30 days prior to the expiration date of the present order. The motion will be set for hearing. Notice must be given to the Respondent by first class mail; a certificate stating that notice was sent must be filed with the Circuit Clerk. You must be present at the hearing on your motion. NOTICE TO ALL LAW ENFORCEMENT AGENCIES AND OFFICERS This Order of Protection is enforceable, even without registration, in all 50 states, the District of Columbia, tribal lands, and the U.S. Territories pursuant to the Violence Against Women Act (18 U.S.C. § 2265). Violating this Order of Protection may subject the Respondent to state and/or federal charges and punishment (18 U.S.C. §§2261-2262). The Respondent may also be subject to federal criminal penalties for possessing, transporting, or accepting a firearm under the Gun Control Act (18 U.S.C. § 922(g)(8)). Page 2 of 13 ­ Order of Protection NOTICE TO RESPONDENT Any knowing violation of an order of protection forbidding physical abuse, neglect, exploitation, harassment, intimidation, interference with personal liberty, willful deprivation, or entering or remaining present at specified places when a protected person is present, or granting exclusive possession of the residence or household or granting a stay away order is a Class A misdemeanor and a second or subsequent violation is a Class 4 felony. The granting of exclusive possession of the residence or household shall constitute notice forbidding trespass to land. Any knowing violation of an order awarding legal custody or physical care of a child or prohibiting removal or concealment of a child may be a Class 4 felony. Stalking is a Class 4 felony for a first offense and a Class 3 felony for a subsequent offense. Any willful violation of any order is contempt of court. Any violation may result in fine or imprisonment. FINDINGS [Jurisdiction] The Court, having reviewed the verified petition and having heard the evidence and the testimony of the petitioner under oath or affirmation, finds that: 1. Petitioner's actual address is set forth on page one (1). or Disclosure of Petitioner's address would risk further abuse. The address set forth below is the address for the purpose of service of notice on the petitioner in this case. Street or P.O. Box City State Zip Code 2. The persons protected by this Order are the Petitioner, the minor child(ren) identified in Part C, (page 6 of 13) of this order, the other protected persons listed on page 1 of 13 of this order. 3. (Check all that apply) Petitioner is present in court, in person, and/or with counsel, Respondent has been served with notice pursuant to the statute. Respondent has entered an appearance in this case. Respondent is present in court, in person, and/or with counsel, Respondent is in default Respondent has filed an answer Petitioner has diligently attempted to complete service of process, has not been able