ELDER ABUSE PROTECTION ORDER (Elder Abuse Protection Order and Enforcement Act) 247247 38-9F-1 to 38-9F-12, Ala. Code 1975 Amended Order State of Alabama Unified Judicial System Form C-92 (Page 1 of 3) 8/17 Court Case Number: (Number) In the Circuit Court of County, Alabama (Name of County) PLAINTIFF (Victim) First Middle Last Date of Birth (DOB) of Plaintiff (Victim) Other Designated Persons(s) [List Name(s)]: Other Designated Persons(s) [List DOB(s)]: D E F E NDANT Defendant222s Telephone Number and Home Address: First Middle Last SEX RACE DOB H EIGHT W EIGHT CAUTION: WEAPONS INVOLVED: EYES HAIR DISTINGUISHING FEATURES Firearm Knife Hands, Feet, Fist Other: Weapon Present on the Property DRIVER222S LICENSE NUMBER STATE EXPIRATION DATE VEHICLE TAG NUMBER T H E C O U R T H ERE B Y FIN D S : That it has jurisdiction over the parties and matter under the laws of the state and that reasonable notice and opportunity to be heard was given to the person against whom the order is sought sufficient to protect the person222s right to due process. Additional findings of this Court follow on succeeding pages. (Check all that apply): After a hearing was held in which the Defendant: appeared { pro se or with counsel} or did not appear, the Court finds that the Plaintiff proved the allegations of elder abuse by a preponderance of the evidence and further finds that: Service was perfected on the Defendant on (date). If the petition was filed on behalf of the victim, service was perfected on the victim on (date). The terms of this order shall be of permanent duration; OR effective until (date). THIS ORDER IS VALID AND ENFORCEABLE IN ALL COUNTIES IN THE STATE OF ALABAMA. LAW ENFORCEMENT OFFICERS MAY USE THEIR ARREST POWERS PURSUANT TO SECTION 15-10-3, ALA. CODE 1975, TO ENFORCE THE TERMS OF THE ORDER. ONLY THE COURT CAN CHANGE THIS ORDER. 247247 38-9F-1 to 38-9F-12, Ala. Code 1975 Copy - Law Enforcement Copy - Plaintiff Copy - Defendant Copy - Probate Court (if applicable) Original - Court Record Judge222s Initials: American LegalNet, Inc. www.FormsWorkFlow.com ELDER ABUSE PROTECTION ORDER (Elder Abuse Protection Order and Enforcement Act) 247247 38-9F-1 to 38-9F-12, Ala. Code 1975 Amended Order State of Alabama Unified Judicial System Form C-92 (Page 2 of 3) 8/17 Court Case Number: (Number) In the Circuit Court of County, Alabama (Name of County) THE COURT HEREBY ORDERS THAT (Check all that apply): (1)The Defendant is enjoined from threatening to commit or committing acts of abuse, as defined in the Elder Abuse Protection Order and Enforcement Act, against the: Plaintiff; and/or any designated person, to-wit: . (Name of Person) (2)The Defendant is restrained and enjoined from: Harassing Stalking Annoying Telephoning Contacting Communicating with : the Plaintiff; OR Threatening or engaging in conduct that would place the following in reasonable fear of bodily injury: the Plaintiff; and/or any designated person, to wit:. (Name of Person) (3)The Defendant is ordered to stay away from: the Plaintiff222s residence; place of employment; and/or any specified place frequented by the Plaintiff that the Defendant has no legitimate reason to frequent, to-wit: . (Place) (4)The Defendant is removed and excluded from the residence of the Plaintiff, regardless of ownership of the residence. (5)The Defendant is ordered to provide to the Plaintiff possession and use of an: automobile and/or other essential personal effects regardless ofownership; and the appropriate law enforcement officer, to-wit: (Name) is directed to accompany the Plaintiff to the residence of the Plaintiff or other specified locations as necessary to protect the Plaintiff from abuse. (6)The Defendant is prohibited from: transferring; concealing; encumbering; or otherwise disposing of specified property mutuallyowned or leased by the parties or in which the Plaintiff had an ownership interest within the last 12 months, to-wit: (Please describe property). (7)The Defendant is prohibited from transferring the funds, benefits, property, resources, belongings, or assets of the Plaintiff to any person other thanthe Plaintiff. (8)The Defendant is restrained and enjoined from exercising control over the funds, benefits, property, resources, belongings, or assets of the Plaintiff. (9)The Defendant is ordered to provide an accounting of the disposition of the Plaintiff's income and other resources, and of the Plaintiff's debts andexpenses. (10)The Defendant is restrained from exercising any powers the Defendant has been granted as the Plaintiff's agent under power of attorney. (11)The Defendant is ordered to comply with the instructions of the Plaintiff's guardian, conservator, or agent under power of attorney. (12)The following relief is ordered and deemed necessary to provide for the safety and welfare of the: Plaintiff: and/or any designatedperson, to-wit: (Name of person) as follows: (Describe relief) THE COUR T FURTHER ORDERS THAT (Check all that apply): (13)The Defendant is ordered to return custody or control of the funds, benefits, property, resources, belongings, or assets to the Plaintiff. (14)The Defendant is ordered to pay restitution in the amount of $ to the Plaintiff. (15)The Defendant is restrained and enjoined from possessing a firearm or other weapon specified by the court, except when the weapon is necessary foremployment as a law enforcement officer or military personnel. (16)The Defendant is ordered to pay attorney222s fees in the amount of $ and court costs in the amount of $ . Original - Court Record Copy - Law Enforcement Copy - Plaintiff Copy - Defendant Copy - Probate Court (if applicable) Judge222s Initials: American LegalNet, Inc. www.FormsWorkFlow.com ELDER ABUSE PROTECTION ORDER (Elder Abuse Protection Order and Enforcement Act) 247247 38-9F-1 to 38-9F-12, Ala. Code 1975 Amended Order State of Alabama Unified Judicial System Form C-92 (Page 3 of 3) 8/17 Court Case Number: (Number) In the Circuit Court of County, Alabama (Name of County) (17)Other (please specify): . (Date) (Signature of Judge) RETURN ON SERVICE Return receipt(s) of certified mail received in this office on . [Date(s)] I certify that I personally delivered a copy(ies) of the Elder Abuse Protection Order to in [Name(s)] County, Alabama on . [Name of County(ies)]) [Date(s)] (Date) (Server222s Signature) (Type of Process Server) (Office Address of Server) (Office Telephone Number of Server) Original - Court Record Copy - Law Enforcement Copy - Plaintiff Copy - Defendant Copy - Probate Court (if applicable) Judge222s Initials: American LegalNet, Inc. www.FormsWorkFlow.com