Name of Person Filing: Address of Person Filing: City, State, Zip code: Daytime telephone: ATLAS Number (if applicable): Attorney Bar Number (if applicable: Representing Self, Without a Lawyer For Clerk's Use Only IN THE SUPERIOR COURT OF ARIZONA, YAVAPAI COUNTY 1300DO Petitioner and ORDER FOR ISSUANCE OF A WARRANT TO TAKE PHYSICAL CUSTODY OF MINOR CHILD(REN) Respondent A verified Petition for Enforcement of a Legal Decision-Making Determination was filed with this Court on (date) by that was accompanied by a verified "Application for the Issuance of a Warrant to Take Physical Custody of Minor Child(ren)". The Court reviewed the "Petition to Enforce Legal Decision-Making Determination" and "Application for the Issuance of a Warrant to Take Physical Custody of Minor Child(ren)", [ ] held a hearing, [ ] took testimony as relevant and considered all matters. THE COURT FINDS: 1. An emergency exists and the Order must be entered immediately to avoid irreparable harm because the child(ren) named in the Application for the Issuance of a Warrant to Take Physical Custody of Minor Child(ren) is/are imminently likely to [ ] suffer serious physical harm and/or [ ] be removed from Arizona. Facts supporting this finding: 2. [] Advance notice of this Order is not required to be given to the other party, or his or her attorney or others entitled to prior notice, because [ ] to do so would result in immediate and irreparable harm to [ ] Other: Facts supporting this finding: 3. [] Authorization for law enforcement officers to enter private property to take physical custody of the child(ren) is necessary because no less intrusive remedy is effective. Facts supporting this finding: Superior Court of Arizona in Yavapai County January 2013 Page 1 of 2 CustWarrOrder American LegalNet, Inc. www.FormsWorkFlow.com 4. [] Exigent circumstances require authorization for law enforcement officers to make a forcible entry at any hour to take physical custody of the child(ren). Facts supporting this finding: 5. This Order is in the best interests of, and covers the following child(ren): Name Name Name Date of Birth Date of Birth Date of Birth 6. The above-named child(ren) are believed to be at the following location(s): THE COURT ORDERS: The Clerk of the Superior Court of Arizona in Yavapai County shall issue a "Warrant to Take Physical Custody of Child(ren)" under seal of this Court, to the Sheriff of Yavapai County or any other law enforcement officer: [] POSSESSION OF THE MINOR CHILD(REN): The Sheriff of Yavapai County or any other law enforcement officer shall immediately take possession of the minor child(ren) named above and deliver him/her to: [ ] Child Protective Services of the Arizona Department of Economic Security or such other Arizona agency as may properly care for the child(ren) OR [] [] ENTRY PRIVATE PROPERTY: The Sheriff of Yavapai County or any other law enforcement officer is authorized to enter private property to take physical custody of the child(ren) [ ] by forcible entry at any hour. OTHER: [] SERVICE UPON RESPONDENT THE PETITION FOR ENFORCEMENT OF A CHILD LEGAL DECISION-MAKING DETERMINATION AND APPLICATION FOR THE ISSUANCE OF A WARRANT TO TAKE PHYSICAL CUSTODY OF MINOR CHILD(REN), ORDER FOR ISSUANCE OF A WARRANT TO TAKE PHYSICAL CUSTODY OF MINOR CHILD(REN) AND WARRANT TO TAKE PHYSICAL CUSTODY OF MINOR CHILD(REN) SHALL BE MADE IMMEDIATELY AFTER THE CHILD(REN) IS(ARE) TAKEN INTO CUSTODY. NOTICE OF EXECUTION OF THE WARRANT SHALL BE PROVIDED IMMEDIATELY TO THE JUDICIAL OFFICER WHO ORDERED ISSUANCE OF THE WARRANT TO TAKE PHYSICAL CUSTODY OF MINOR CHILD(REN). DONE IN OPEN COURT at a.m./p.m. this day of , 20 JUDGE/COMMISSIONER/JUDGE PRO TEM OF THE SUPERIOR COURT Superior Court of Arizona in Yavapai County January 2013 Page 2 of 2 CustWarrOrder American LegalNet, Inc. www.FormsWorkFlow.com