EX PARTE 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-91 (Page 1 of 3) 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 Person(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 : Pursuant to the sworn Affidavit/Petition and/or testimony of the Plaintiff seeking protection from elder abuse, the Court finds that it has jurisdiction over the parties and matter under the law of the State and the Defendant is being provided with sufficient notice, including notice of his right to request a hearing within 10 days of service, in order to protect his or her rights to due process. Additional terms of this order follow on succeeding pages. A temporary order is necessary to prevent elder abuse. The Defendant represents a risk of imminent potential harm to the Plaintiff. The terms of this order shall be effective until (date) or further order of the Court. 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 Original - Court Record Copy - Law Enforcement Copy 226 Plaintiff Copy - Defendant Copy - Probate Court (if applicable) Judge's Initials: American LegalNet, Inc. www.FormsWorkFlow.com EX PARTE 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-91 (Page 2 of 3) 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 of ownership; 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 mutually owned 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) Date Judge Original - Court Record Copy - Law Enforcement Copy 226 Plaintiff Copy - Defendant Copy - Probate Court (if applicable) Judge222s Initials: American LegalNet, Inc. www.FormsWorkFlow.com EX PARTE 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-91 (Page 3 of 3) Court Case Number: (Number) In the Circuit Court of County, Alabama (Name of County) 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 226 Plaintiff Copy - Defendant Copy - Probate Court (if applicable) Judge222s Initials: American LegalNet, Inc. www.FormsWorkFlow.com