ORIGINAL MODIFICATION CONTINUANCE ORDER AFTER HEARING DOMESTIC VIOLENCE RESTRAINING ORDERS -- REQUIRED LAW ENFORCEMENT INFORMATION The following information will be entered into the Department of Justice’s restraining order files to prevent the defendant from purchasing or attempting to purchase a firearm for as long as the order is in effect. CASE NO. PERSON PROTECTED BY DOMESTIC VIOLENCE RESTRAINING ORDER PRINT ONLY FULL NAME AND ADDRESS (THE DEFENDANT IS NOT ALLOWED TO SEE THIS FORM) , Last Name First Name Middle Name City Street Address State Zip PERSON TO BE RESTRAINED FULL NAME , Last Name First Name Middle Name Other Names used or Nicknames SEX Male Female DATE OF BIRTH HEIGHT Feet Inches WEIGHT Pounds EYE COLOR (check one only) Black Blue Brown Gray Green RACE (check one only) White Hispanic Japanese Filipino Guamanian Laotian Hawaiian Samoan Hazel Maroon Pink Multicolor Black Chinese American Indian Pacific Islander Asian Indian Vietnamese Korean Other Asian HAIR COLOR (check one only) Black Blond Brown Gray Red Sandy White ADDRESS City Street Address Zip State SOCIAL SECURITY NUMBER DRIVER’S LICENSE STATE DRIVER’S LICENSE NUMBER DRIVER’S LICENSE YEAR OF EXPIRATION THIS INFORMATION CAN HAS BEEN PERSONALLY SERVED. YOU NEED TO BRING A COPY OF THE PROOF OF SERVICE TO THE LAW ENFORCEMENT AGENCY HAVING JURISDICTION OVER YOUR RESIDENCE. TO BE COMPLETED BY LAW ENFORCEMENT AGENT: RECEIVED BY 13-18787-360 Rev. 4/93 / Name Employee Number 2000 (C) American LegalNet, Inc. / Date SB-18787 FOR LAW ENFORCEMENT USE ONLY DO NOT WRITE ON THIS SIDE DEFENDANT PRESENT AT HEARING ORI of Agency Inputting Data (9 characters alphanumeric) Restraining Order Number (2 to 13 characters alphanumeric) Court Name (20 characters alphanumeric) TYPE OF ORDER (4 characters alpha) Temporary Restraining Order/Order to Show Cause (TRO) Order After Hearing (OAH) ISSUE DATE (6 characters numeric) DATE SERVED/OR DATE OF HEARING IF THE DEFENDANT WAS PRESENT. (6 characters numeric) TIME SERVED (4 characters numeric) SERVED BY (4 to 30 characters, alpha, one comma) (Last Name, First Name) AGENT ID OR BADGE NUMBER (5 characters alphanumeric) AGENCY SERVING ORDER (4 to 30 characters, alphanumeric) EXPIRATION DATE (6 characters numeric) CAUTION CODES: (1 character alpha) A S M E X = = = = = ARMED & DANGEROUS SUICIDAL TENDENCIES MENTALLY DISTURBED ESCAPE RISK SEE MISCELLANEOUS FIELD MISCELLANEOUS FIELD (1 to 300 characters alphanumeric) ENTERED INTO CLETS BY: / Name Employee Number / Date Time 2000 (C) American LegalNet, Inc.