AOC-275.10 5-96 Doc. Code: OAFP MKE/MPO Commonwealth of Kentucky Court of Justice KRS Ch.403 Case No. AFFIDAVIT AND ORDER AMENDING CERTIFIED DOMESTIC VIOLENCE FOREIGN PROTECTIVE ORDER Court___________________________ County __________________________________________________ First Middle PETITIONER Last V. __________________________________________________ First Middle Last RESPONDENT Date of Birth __________________________________________________ Name of Foreign Court which Issued Order __________________________________________________ Street Address / P.O. Box ____________________ Social Security No. __________________________________________________ City / County / State / Zip Code CAUTION: u Weapon involved u Believed to be armed/dangerous Comes the above named affiant to inform this court that the Foreign Protective Order (hereafter FPO) which has been given full faith and credit in Kentucky has been modified by the issuing foreign court as indicated in the attached certified order. Affiant therefore requests that this court modify the Domestic Violence Foreign Protective Order issued in Kentucky on ________________________ , _______ to conform to the below stated issuing foreign court modifications: u u u Foreign order expired on ______________________________, ________. Foreign order was vacated on ______________________________, ________. Foreign order was modified on _____________________________, ________, as follows: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ _________________________________________________________________________________________________. Affiant verifies that the name and address of the court which issued the FPO has been provided. Affiant acknowledges that making a false statement in this affidavit is a violation of KRS 523.030, perjury in the second degree, a Class A Misdemeanor, which is punishable by a term of imprisonment not to exceed 12 months. NOTE TO AFFIANT: Your address is confidential pursuant to KRS 403.770(1). Affiant's Signature: ________________________________________ Subscribed and sworn to before me this Current Address: _________________________________________ ________________________________, ________. _________________________________________________________ Notary Public: ______________________________ Phone #: _________________________________________________ My commission expires: _______________________ ORDER The court, having reviewed the affidavit and certified modification, finds that the conditions ordered within the certified modified FPO shall be given full faith and credit in Kentucky. IT IS THEREFORE ORDERED that the prior domestic violence foreign protective order be amended as follows: ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ _____________________________________________ Date Copies to: - Court file - Petitioner (Certified Copy) DO NOT SERVE RESPONDENT __________________________________________________ Judge - Law enforcement agency/dispatch center responsible for LINK entry ENSURE THAT ALL INFORMATION IN BOXES IS COMPLETE AND LEGIBLE 2000 © American LegalNet, Inc.