THIS IS NOT A RESTRAINING ORDER Page of Approved for Optional Use L - 2543 ( New February 2017) ELDER O R DEPENDENT ADULT ABUSE MEDIATED SETTLEMENT AGREEMENT SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE Central Justice Center 700 Civic Center Dr. West Santa Ana, CA 92701 - 4045 PETITIONER: RESPONDENT: ELDER OR DEPENDENT ADULT ABUSE MEDIATED SETTLEMENT AGREEMENT CASE NUMBER: Petitioner present not present represented by Attorney: Respondent present not present represented by Attorney: Other appearances: THE PARTIES STIPULATE AND AGREE THAT: Parties agree to the terms stated below. The case shall be taken off calendar, and if the settlement is breached, then any document regarding the breach will be filed under the same case number. Parties agree to the terms stated below. If the respondent does not comply with this stipulation, petitioner may file a Declaration of Non-Compliance and a new Notice of Court Hearing (EA109) and Temporary Restraining Order (EA110), which will need to be personally served on the respondent. PETITIONER AND RESPONDENT FURTHER STIPULATE AS FOLLOWS: agrees to stay at least (specify): yards away from and the following persons named in the Request for Elder or Dependent Adult Abuse Restraining orders: . agrees to have no contact (directly or indirectly) with (name): and the following persons named in the Request for Elder or Dependent Adult Abuse Restraining orders: . Other (specify): See additional pages attached. Attorney for Petitioner Attorney for Respondent Guardian Ad Litem SIGNATURE OF PARTIES We have read the entire stipulation and agreement and request the court to make our stipulation and agreement fully and this Settlement Agreement is NOT a restraining order and will not be enforced by any law enforcement agencies. We understand that willful failure to comply with the provisions of this order may be a contempt of court and may be punished by fine and imprisonment. We acknowledge notice of this order. Petitioner Respondent IT IS ORDERED: Date Judge/Commissioner of the Superior Court American LegalNet, Inc. www.FormsWorkFlow.com THIS IS NOT A RESTRAINING ORDER Page of Approved for Optional Use L - 2543 ( New February 2017) ELDER O R DEPENDENT ADULT ABUSE MEDIATED SETTLEMENT AGREEMENT Case No. and Petitioner Respondent Continued from page Attorney for Petitioner Attorney for Respondent Guardian Ad Litem SIGNATURE OF PARTIES We have read the entire stipulation and agreement and request the court to make our stipulation and agreement enforced by any law enforcement agencies. We understand that willful failure to comply with the provisions of this order may be a contempt of court and may be punished by fine and imprisonment. We acknowledge notice of this order. Petitioner Respondent IT IS ORDERED: Date Judge/Commissioner of the Superior Court American LegalNet, Inc. www.FormsWorkFlow.com