ALL COURTS IN ARIZONA ADDRESS CITY, ORDER OF PROTECTION [ ] Amended Order AZ ZIP CODE TELEPHONE NUMBER Case No. Court ORI No. State County Former Case No. PLAINTIFF First PLAINTIFF IDENTIFIERS Middle Last Date of Birth of Plaintiff And/or on behalf of minor family member(s) and other Protected Person(s): (List name and DOB.) V. DEFENDANT DEFENDANT IDENTIFIERS SEX First Middle RACE EYES HAIR DOB HT WT Last Defendant/Plaintiff Relationship: Arizona Prohibits Release of Social Security Numbers Defendant’s Address : DRIVER’S LICENSE # CAUTION: [ ] Weapon Alleged in Petition [ ] Estimated Date of Birth STATE EXP DATE Distinguishing Features/Alias WARNINGS TO DEFENDANT: This Order shall be enforced, even without registration, by the courts of any state, the District of Columbia, any U.S. Territory, and may be enforced by Tribal Lands (18 U.S.C. § 2265). Crossing state, territorial, or tribal boundaries to violate this Order may result in federal imprisonment (18 U.S.C. § 2262). Federal law provides penalties for possessing, transporting, shipping, or receiving any firearm or ammunition (18 U.S.C. § 922(g)(8)). Only the Court, in writing, can change this Order. This Order is effective for one year from date of service. VERIFY VALIDITY (call Holder of Record): THE COURT HEREBY FINDS: That it has jurisdiction over the parties and subject matter. [ ] Defendant received actual notice of this Hearing and had an opportunity to participate. Additional findings of this Order and warnings are set forth on the next page(s). THE COURT, FINDING REASONABLE CAUSE, HEREBY ORDERS: NO CRIMES. Defendant shall not commit any crimes against Plaintiff or Protected Person(s). [ ] NO CONTACT. Defendant shall have no contact with Plaintiff except through attorneys, legal process, court hearings, and as checked: [ ] Phone [ ] Email/Fax [ ] Mail [ ] Other: [ ] NO CONTACT. Defendant shall have no contact with Protected Person(s) except through attorneys, legal process, court hearings and as checked: [ ] Phone [ ] Email/Fax [ ] Mail [ ] Other: Effective: January 2008 Page 1 of 2 Adopted by Administrative Directive No. 2007-03 American LegalNet, Inc. www.FormsWorkFlow.com Case No. ____________________ THE COURT FURTHER ORDERS: [ ] RESIDENCE. Plaintiff is granted exclusive use and possession of the residence listed below. [ ] LAW ENFORCEMENT STANDBY. Defendant may return once with a law enforcement officer to obtain necessary personal belongings. Neither law enforcement nor this protective order can resolve conflicts over property, title, furniture, finances, real estate, or other ownership issues. PROTECTED LOCATIONS. Defendant shall not go to or near the Plaintiff’s or other Protected Person’s: [ ] Residence (leave blank if confidential): _________ ______ [ ] Workplace (leave blank if confidential): _________ [ ] School / Other: ___ [ ] FIREARMS. Because Defendant poses a credible threat of bodily injury to Plaintiff or Protected Person(s), Defendant shall not possess, receive, or purchase firearms or ammunition and shall surrender same within 24 hours of service to: OTHER ORDERS: Date Judicial Officer Printed Name WARNING This is an official Court Order. If you disobey this Order, you will be subject to arrest and prosecution for the crime of interfering with judicial proceedings and any other crime you may have committed in disobeying this Order. ADDITIONAL WARNINGS TO DEFENDANT: Violations of this Order should be reported to a law enforcement agency, not the Court. Both parties must notify this Court if an action for dissolution (divorce), separation, annulment or paternity/maternity is filed. This is NOT a parenting time (visitation) or custody order. You must file those requests separately in Superior Court. If you disagree with this Order, you have the right to request a hearing which will be held within 5 to 10 business days after your written request has been filed in the Court that issued this Order. Nothing the Plaintiff does can stop, change, or undo this Order without the Court's written approval. You must appear in Court to ask a judge to modify (change) or quash (dismiss) this Order. Even if the Plaintiff initiates contact, you could be arrested and prosecuted for violating this protective order. If you do not want the Plaintiff to contact you, you have the right to request a protective order against the Plaintiff. Effective: January 2008 Page 2 of 2 Adopted by Administrative Directive No. 2007-03 American LegalNet, Inc. www.FormsWorkFlow.com