COURT COUNTY .OF. . . . .APPLICATION . . . . .EMERGENCY.PROTECTIVE ORDER (CLETS) EPO-001 ......... .. . . . . . . . . . . . . FOR . . . . . . . . . . . . . . . . . . . : LAW ENFORCEMENT CASE NUMBER: (Name): has provided the information in items 1-5. Index No. 1. PERSONS TO BE PROTECTED (insert names of all persons to be protected by this order): : 2. PERSON TO BE RESTRAINED (name): Sex: M F Ht.: Plaintiff(s) Wt.: Hair -against- color: Eye color: Calendar No. : JUDICIAL SUBPOENA Race: : Age: Date of birth: 3. The events that cause the protected person to fear immediate and present danger of domestic violence, child abuse, child : abduction, elder or dependent adult abuse (other than solely financial abuse), or stalking are (give facts and dates; specify weapons): : : The person to be protected lives with the personDefendant(s) and requests an order that the restrained person move out to be restrained ...................................................... 4. immediately from the address in item 9. The person to be protected has minor children in common with the person to be restrained, and a temporary custody order is requested because of the facts alleged in item 3. A custody order does does not exist. b. The person to be protected is a minor child in immediate danger of being abducted by the person to be restrained because THE PEOPLE OF THE STATE OF NEW YORK of the facts alleged in item 3. 6. A child welfare worker or probation officer has advised the undersigned that a juvenile court petition TO has already been filed. will be filed. will NOT be filed. 7. Adult Protective Services has been notified. was contacted on (date): at (time): 8. Judicial officer (name): The judicial officer granted the Emergency Protective Order that follows. 5. a. GREETINGS: By: (PRINT NAME OF LAW ENFORCEMENT OFFICER) (SIGNATURE you ENFORCEMENT you attend before WE COMMAND YOU, that all business and excuses being laid aside, OF LAWand each of OFFICER) Badge No.: , Honorable at the Telephone No.: Court located at County of EMERGENCYday of PROTECTIVE ORDER (Seeo'clock for the reverse notices.) in room , on the , 20 , at in importantnoon, and at any recessed 9. To restrained person (name): or adjourned date, to testify and give evidence as a witness in this action on the part of the Agency: the a. b. 10. You must not contact, molest, harass, attack, strike, threaten, sexually assault, batter, telephone, send any messages to, follow, stalk, destroy any personal property of, disturb the peace of, or take any action to obtain the address or location of each person named in item 1. You must stay away at least Your failure to comply with this subpoenayards from each as a contempt in item 1. and will make you liable to is punishable person named of court stay away at least yards from move out the party on whose behalf this subpoena was issued for a maximum penalty ofimmediately from $50 and all damages sustained as a (address): result of your failure to comply. (Name): minor children of the parties (names and ages): is given temporary care and control of the following Witness, Honorable , one of the Justices of the 11. Reasonable grounds for theCounty, of this order exist and an emergency protective order is necessary to prevent the occurrence issuance Court in day of , 20 or recurrence of domestic violence, child abuse, child abduction, elder or dependent adult abuse, or stalking. 12. THIS EMERGENCY PROTECTIVE ORDER WILL EXPIRE AT 5:00 P.M. ON: INSERT DATE OF FIFTH COURT DAY 13. To protected person: If you need protection for a longer period of time, you must must sign above andDAY, WHICHEVER IS OR SEVENTH (Attorney CALENDAR type name below) EARLIER; DO NOT COUNT DAY THE ORDER IS GRANTED request restraining orders at (court name and address): PROOF OF SERVICE Attorney(s) for 14. Person served (name): Time: 15. I personally delivered copies to the person served as follows: Date: Address: I am a California sheriff or marshal. 16. At the time of service I was at least 18 years of age and not a party to this cause. 17. My name, address, and telephone number are (this does not have to be server's homeP.O. Address Office and telephone number or address): I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Telephone No.: Facsimile No.: (SIGNATURE OF SERVER) E-Mail Address: EMERGENCY PROTECTIVE ORDER (CLETS–EPO) (Domestic Violence, Child Abuse, Elder or Dependent Mobile Tel. No.: (TYPE OR PRINT NAME OF SERVER) Form Adopted for Mandatory Use Judicial Council of California EPO-001 [Rev. January 1, 2007] Approved by DOJ Adult Abuse, or Stalking) ONE copy to court, ONE copy to restrained person, ONE copy to protected person, ONE copy to issuing agency Page 1 of 2 Family Code, § 6200 et seq. Penal Code, § 646.91 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkflow.com EMERGENCY PROTECTIVE ORDER EPO-001 WARNINGS AND INFORMATION VIOLATION OF THIS ORDER IS A MISDEMEANOR PUNISHABLE BY A $1,000 FINE, ONE YEAR IN JAIL, OR BOTH, OR MAY BE PUNISHABLE AS A FELONY. PERSONS SUBJECT TO A RESTRAINING ORDER ARE PROHIBITED FROM OWNING, POSSESSING, PURCHASING, RECEIVING, OR ATTEMPTING TO PURCHASE OR RECEIVE A FIREARM (PENAL CODE SECTION 12021(g)). SUCH CONDUCT IS SUBJECT TO A $1,000 FINE AND IMPRISONMENT OR BOTH. THIS ORDER SHALL BE ENFORCED BY ALL LAW ENFORCEMENT OFFICERS IN THE STATE OF CALIFORNIA WHO ARE AWARE OF OR SHOWN A COPY OF THE ORDER. UNDER PENAL CODE SECTION 13710(b), "THE TERMS AND CONDITIONS OF THE PROTECTION ORDER REMAIN ENFORCEABLE, NOTWITHSTANDING THE ACTS OF THE PARTIES, AND MAY BE CHANGED ONLY BY ORDER OF THE COURT." To the restrained person: This order will last until the date and time in item 12 on the reverse. The protected person may, however, obtain a more permanent restraining order from the court. You may seek the advice of an attorney as to any matter connected with this order. The attorney should be consulted promptly so that the attorney may assist you in responding to the order. A la persona bajo restricción judicial: Esta orden durará hasta la fecha y hora indicadas en el punto 12 al dorso. La persona protegida puede, sin embargo, obtener una orden de entredicho (restricción judicial) más permanente de la corte. Usted puede consultar a un abogado en conexión con cualquier asunto relacionado con esta orden. Debe consultar al abogado sin pérdida de tiempo para que él o ella le pueda ayudar a responder a la orden. To the protected person: This order will last only until the date and time noted in item 12 on the reverse. If you wish to seek continuing protection, you will have to apply for an order from the court at the address in item 13, or you should apply to the court in the county where you live if it is a different county and the violence is likely to occur there. You may apply for a protective order free of charge. In the case of an endangered child, you may also apply for a more permanent order at the address in item 13, or if there is a juvenile dependency action pending you may apply for a more permanent order under section 213.5 of the Welfare and Institutions Code. In the case of a child being abducted, you may apply for a Child Custody Order from the court at the address in item 13. You may seek the advice of an attorney as to any matter connected with your application for any future court orders. The attorney should be consulted promptly so that the attorney may assist you in making your application. You do not have to have an attorney to get the protective order. A la persona protegida: Esta orden durará sólo hasta la fecha y hora indicadas en el punto 12 al dorso. Si usted desea que la protección continúe, tendrá que solicitar una orden de la corte en la dirección indicada en el articulo 13, o tendrá que hacer la solicitud ante la corte del condado donde usted vive, si se trata de un condado diferente y es probable que la violencia ocurra allí. La solicitud de la orden de protección es gratis. En el caso de que un niño o una niña se encuentre en peligro, puede solicitar una orden más permanente en la dirección indicada en el articulo 13 o, si hay una acción legal pendiente de tutela juvenil, puede solicitar una orden más permanente conforme a la sección 213.5 del código titulado en inglés Welfare and Institutions Code. En el caso del secuestro de un niño o una niña, usted puede solicitar de la corte una orden para la guarda del niño o de la niña (Child Custody Order), en la dirección indicada en el articulo 13 de este formulario. Puede consultar a un abogado en conexión con cualquier asunto relacionado con las solicitudes de órdenes de la corte que usted presente en el futuro. Debe consultar un abogado sin perdida de tiempo para que él o ella le pueda ayudar a presentar su solicitud. Para obtener la orden de protección no es necesario que un abogado le represente. To law enforcement: Penal Code section 13710(c) provides that, upon request, law enforcement shall serve the party to be restrained at the scene of a domestic violence incident or at any time the restrained party is in custody. The officer who requested the emergency protective order, while on duty, shall carry copies of the order. The emergency protective order shall be served upon the restrained party by the officer, if the restrained party can reasonably be located, and a copy shall be given to the protected party. A copy also shall be filed with the court as soon as practicable after issuance. The availability of an emergency protective order shall not be affected by the fact that the endangered person has vacated the household to avoid abuse. A law enforcement officer shall use every reasonable means to enforce an emergency protective order issued pursuant to this subdivision. A law enforcement officer acting pursuant to this subdivision shall not be held civilly or criminally liable if he or she has acted in good faith with regard thereto. If a child is in danger of being abducted: This order will last only until the date and time noted in item 12 on the reverse. You may apply for a child custody order from the court. En el caso de peligro de secuestro de un niño o de una niña: Esta orden será válida sólo hasta la hora y fecha indicadas en el punto 12 al dorso. Usted puede solicitar de la corte una orden para la guarda del niño o de la niña (Child Custody Order). This emergency protective order is effective when made. This order shall expire on the date and time specified in item 12 on the reverse. The provisions of this emergency protective order take precedence in enforcement over provisions of other existing protective orders between the same protected and restrained persons to the extent the provisions of this order are more restrictive. In other words, the provisions in this emergency protective order take precedence over the provisions in any other protective order, including a criminal protective order, if (1) the person to be protected is already protected by the other protective order, (2) the person to be restrained is subject to that other order, and (3) the provisions in this emergency order are more restrictive than the provisions in that other order. The provisions in another existing protective order remain in effect and take precedence if they are more restrictive than the provisions in this emergency protective order. EPO-001 [Rev. January 1, 2007] EMERGENCY PROTECTIVE ORDER (CLETS–EPO) (Domestic Violence, Child Abuse, Elder or Dependent Adult Abuse, or Stalking) ONE copy to court, ONE copy to restrained person, ONE copy to protected person, ONE copy to issuing agency Page 2 of 2