FILING OF FOREIGN PROTECTIVE ORDER VA. CODE § 16.1-279.1 Commonwealth of Virginia Case Number: Court Name of Party Filing Foreign Protective Order: Virginia Address of Party Filing Order: Name of Person(s) Protected by the Order: Name of Defendant/Respondent: Issuing Jurisdiction: STATE COUNTY OR CITY Name of Court which issued Order: Date of Entry: Case No.: Expiration Date (if any): SIGNATURE OF PARTY FILING ORDER Defendant/Respondent's Description (for VCIN entry): Full Name: Address: Sex Height Race Weight Date of Birth Hair SSN Eyes Telephone No. CLERK'S CERTIFICATION An attested or exemplified copy of the above-identified foreign protective order has been filed with this Court. DATE CLERK DEPUTY CLERK FORM DC-684 PDF 7/97 American LegalNet, Inc. www.USCourtForms.com