DR - - 1 of 7 Final Order of Protection Amended Order Case No. Circuit Court, Div. County: Petitioner/Plaintiff , Arkansas This Order is Effective Until: (mm/dd/yyyy) Race Sex Minor Children Protected under this Order First Middle Last Versus Respondent Identifiers Respondent/Defendant First Middle Last Address: Employer : CAUTION: Distinguishing Characteristics: Respondent possesses a firearm Respondent has history of extreme violence d.o.b. d.o.b. d.o.b. d.o.b. Sex Race DOB mm/dd/yyyy Ht. Wt. Eyes Hair SS# Phone # DL # or other ID # Pursuant to Federal law, this Order shall be enforced by law enforcement officers in all states, territories, districts and tribal lands regardless of whether this Order of Protection is registered locally. American LegalNet, Inc. www.FormsWorkFlow.com DR - - 2 of 7 Relationship Identifiers: Current or former spouses Parents of child(ren) in common Live together Curre nt or past dating relationship Other Relative (Explain) THE COURT HEREBY FINDS AND ORDERS: That there is jurisdiction over the parties and subject matter, and the Respondent has been provided with proper notice and the opportunity to be heard. That the victim(s) is (a re) in immediate and present danger of domestic abuse and therefore an Order of Protection is hereby granted pursuant to the terms herein. A hearing on this matter was held on the day of , 2 The Petit ioner appeared pro se. The Petitioner was represented by counsel. The Respondent appeared pro se. The Respondent was represented by counsel. Th e Respondent failed to appear despite proper notice. The Respondent is restrained from committing any criminal act against the victim(s) including, but not limited to : acts of violence or Domestic Abuse, A.C.A. 2479 - 15 - 103(3); Harassment A.C.A. 2475 - 71 - 208; Harassing Communications A.C.A. 2475 - 71 - 209; Stalking A.C .A. 2475 - 71 - 229; or Terroristic Threatening A.C.A. 2475 - 13 - 301. The Respondent is prohibited from initiating any contact with the victim(s) including, but not limited to, physical presence, telephonic, electronic, oral, written, visual, or video. Respondent also shall not use a third party to contact the victim(s) except by legal counsel or as authorized by law or court order. Petitioner's Addr e ss : (or) Respondent. The Respondent is also prohibited from the following places: American LegalNet, Inc. www.FormsWorkFlow.com DR - - 3 of 7 : Schools: Other (Identify): is awarded temporary custody of the minor child(ren) for the duration of order or until future orders shall be issued from a Court with jurisdiction over the parties: Names) Visitation with regard to the minor child(ren) is established as follows: is ordered to pay child support to through the Child Support Clearinghouse American LegalNet, Inc. www.FormsWorkFlow.com DR - - 4 of 7 in the amount of $ per , plus any administrative fees as they come due with said payments to begin on . This amount is according to the Child income of per . This amount does / does not (check one) deviate from the Child Support Chart. .) is ordered to pay spousal support in the amount of $ pe r , beginning on The spousal support shall be paid until . Method of payment shall be: Note: A s there is an expiration date on all Orders of Protection, future matters regarding Child Support, Alimony and Visitation should be handled through another Domestic Relations case (i.e. divorce, paternity, or t hrough the Office of Child Support Enforcement). A law enforcement officer with jurisdiction is ordered to assist the Petitioner in gaining possession of the dwelling, and/or to otherwise assist in execut ion of the Order of Protection. A law enforcement officer with jurisdiction is ordered to serve the Order of Protection on the Respondent. A law enforcement officer with jurisdiction is ordered to assist the Petitioner in obtaining his or her personal effects from the dwelling upon proper and timely request of the Petitioner. A law enforcement officer with jurisdiction is ordered to assist the Respondent in obtaining his or her personal effects from the dwelling upon proper and timely request of the Respondent. Other Orders: American LegalNet, Inc. www.FormsWorkFlow.com DR - - 5 of 7 Respondent is hereby assessed an additional cost of twenty - five dollars ($25.00) to be paid through the Circuit within the Department of Finance and Administration for deposit as special revenues into the Domestic Violence Shelte r Fund. of the following wireless telephone numbers: . Respondent is prohibited from termina ting these accounts. An order transferring the billing responsibility for and rights to the wireless telephone number(s) will be filed separately herein. If the parties (or other persons named herein) are subject to the jurisdiction of another court (i.e. through a divorce or paternity action), upon proper notice and the opportunity to be heard, said court may amend the terms of this Order as appropriate. On this day of , 20 , IT IS SO ORDERED. CIRCUIT JUDGE/DISTRICT JUDGE American LegalNet, Inc. www.FormsWorkFlow.com DR - - 6 of 7 WARNINGS TO RESPONDENT - Pursuant to A.C.A. 2479 - 15 - 207, a violation of an Order of Protection is a Class A misdemeanor carrying a maximum penalty of one year imprisonment in the county jail or a fine of up to $2,500, or both. A violation of an Order of Protection under this sectio n within five (5) years of a previous conviction for violation of an Order of Protection is a Class D felony punishable by up to six years in prison or up to a $10,000 fine or both. - It is a federal offense for an individual who is subject to a Final Orde r of Protection or convicted of a misdemeanor of domestic violence to ship, transport, or possess a firearm or ammunition pursuant to U.S.C. 247922(g)8) and (9). - Crossing state, territorial, or tribal boundaries to violate this Order may result in federal imprisonment pursuant to 18 U.S.C. 2472262. NOTICE TO LAW ENFORCEMENT - In the event that any law enforcement officer has probable cause to believe that the Respondent named in the above Order has violated this Order and has verification of this Order the o fficer, may, without a warrant - 15 - 207(f). - A law enforcement officer SHALL NOT arrest a Petitioner for the violation of an Order of Protection issued against a Respondent. See A.C.A. 2479 - 15 - 207(e). - This Order of Protection is enforceable in every county of this state by any court or law enforcement officer. See A.C.A. 2479 - 15 - 207(g). - This Order is entitled to full faith and credit in any jurisdiction of the U nited States. See 18 U.S.C. 2472265. American LegalNet, Inc. www.FormsWorkFlow.com DR - - 7 of 7 PROOF OF SERVICE Case # Court Date SERVED : Date Time Place Attempts Made: List only date and time 1) 2) 3) Served On (Print Name) Manner of Service Served By (Print Name) Title Badge # DECLARATION OF SERVER I declare, under penalty of perjury under the laws of the State of Arkansas , that the foregoing information contained in the proof of service is true and correct. Executed on Date Signature of Server Address of Server American LegalNet, Inc. www.FormsWorkFlow.com