Criminal Form 1 12/2013 ORI No: _______________ Order No: ________________ NYSID No: _______________ At a term of the _________________Court, County of ________________________ , at the Courthouse at __________________________________, State of New York ORDER OF PROTECTION Family Offenses - C.P.L. 530.12 " Youthful Offender (check if applicable) Part:____________ Index/Docket No: ___________________ ___ Indictment No., if any: Charges: [Check box]: " Ex Parte " Defendant Present In Court CJTN No._______________ PRESENT: Hon._________________________________, PEOPLE OF THE STATE OF NEW YORK _____________________________________ against ______________________________________, Defendant Date of Birth: NOTICE: YOUR FAILURE TO OBEY THIS ORDER MAY SUBJECT YOU TO MANDATORY ARREST AND CRIMINAL PROSECUTION WHICH MAY RESULT IN YOUR INCARCERATION FOR UP TO SEVEN YEARS FOR CONTEMPT OF COURT. IF THIS IS A TEMPORARY ORDER OF PROTECTION AND YOU FAIL TO APPEAR IN COURT WHEN YOU ARE REQUIRED TO DO SO, THIS ORDER MAY BE EXTENDED IN YOUR ABSENCE AND THEN CONTINUES IN EFFECT UNTIL A NEW DATE SET BY THE COURT. THIS ORDER OF PROTECTION WILL REMAIN IN EFFECT EVEN IF THE PROTECTED PARTY HAS, OR CONSENTS TO HAVE, CONTACT OR COMMUNICATION WITH THE PARTY AGAINST WHOM THE ORDER IS ISSUED. THIS ORDER OF PROTECTION CAN ONLY BE MODIFIED OR TERMINATED BY THE COURT. THE PROTECTED PARTY CANNOT BE HELD TO VIOLATE THIS ORDER NOR BE ARRESTED FOR VIOLATING THIS ORDER. " TEMPORARY ORDER OF PROTECTION - Whereas good cause has been shown for the issuance of a temporary order of protection [as a condition of " recognizance " release on bail " adjournment in contemplation of dismissal] " ORDER OF PROTECTION - Whereas defendant has been convicted of [specify crime or violation]: ________________________; And the Court having made a determination in accordance with section 530.12 of the Criminal Procedure Law, IT IS HEREBY ORDERED that the above-named defendant observe the following conditions of behavior: [Check applicable paragraphs and subparagraphs]: [01] ` Stay away from [A] ` [name(s) of protected person(s) or witness(es)]:_______________________________and/or from the [B] ` home of _____________________________, [C] ` school of __________________________________________, [D] ` business of ___________________________, [E] ` place of employment of ___________________________, [F] ` other _________________________________________________________________________________; ­ " except for contact, communication or access permitted by a subsequent order issued by a family or supreme court in a custody, visitation or child abuse or neglect proceeding. [14] ` Refrain from communication or any other contact by mail, telephone, e-mail, voice-mail or other electronic or any other means ; with [specify protected person(s)]: ­ " except for contact, communication or access permitted by a subsequent order issued by a family or supreme court in a custody, visitation or child abuse or neglect proceeding. [02] ` Refrain from assault, stalking, harassment, aggravated harassment, menacing, reckless endangerment, strangulation, criminal obstruction of breathing or circulation, disorderly conduct, criminal mischief, sexual abuse, sexual misconduct, forcible touching, intimidation, threats, identity theft, grand larceny, coercion or any criminal offense against [specify protected person(s), members of such person's family or household, or person(s) with custody of child(ren)]: ; [15] ` Refrain from intentionally injuring or killing without justification the following companion animal(s) (pet(s)) [specify type(s) ; and, if available, name(s)]: _________________________________________________________________________ [11] ` Permit [specify individual]: ____________________ to enter the residence at [specify ]:_____________________________ during [specify date/time]: ____________ with [specify law enforcement agency, if any]: __________________ to remove ; personal belongings not in issue in litigation [specify items]: [04] ` Refrain from [indicate acts]: _________________________________________________________________________that create an unreasonable risk to the health, safety, or welfare of [specify child(ren), family or household member]: __________________________________________________________________________________________ ; American LegalNet, Inc. www.FormsWorkFlow.com Criminal Form Crim-1 Page 2 [05]` Permit [specify individual(s)]: __________________________________________________________________, entitled by a court order or separation or other written agreement, to visit with [specify child(ren)]:____________________ _______________________ during the following periods of time [specify]: _____________________________________ _________________________ , under the following terms and conditions [specify]: _______________________________ ___________________________________________________________________________________________________; [12] ` Surrender any and all handguns, pistols, revolvers, rifles, shotguns and other firearms owned or possessed, including, but not and do not obtain any further guns or other limited to, the following firearms. Such surrender shall take place immediately, but in no event later than [specify date/time]: at: __________________________________________________________________________________________________. [ ] ` Promptly return or transfer the following identification documents [specify]:_________________________________________ ___________________________________________to the party protected by this Order NOT LATER THAN [specify date]:____________in the following manner [specify manner or mode of return or transfer]: _________________________________. [Check box(es) if applicable]: ` Such documents shall be made available for use as evidence in this judicial proceeding. ` [Jointly owned documents or documents in both parties' names only]: the following document(s) may be used as necessary for legitimate use by the defendant [specify]:____________________ ____________________________________________________________________________. [99] ` Specify other conditions defendant must observe for the purposes of protection: ______________________________________________________________________________________________________ IT IS FURTHER ORDERED that the above-named Defendant's license to carry, possess, repair, sell or otherwise dispose of a firearm or firearms, if any, pursuant to Penal Law §400.0