COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. 1 : Index No. Case No. ____________________________ : DOMESTIC VIOLENCE Calendar No. ORDER OF PROTECTION Adjudicated Hearing Consent w/ Admissions -againstConsent w/o Admissions Default Order : JUDICIAL SUPERIOR COURTSUBPOENA OF THE DISTRICT OF COLUMBIA : (202) 879-0157 Plaintiff(s) : PETITIONER : PETITIONER IDENTIFIERS ______________________________________Defendant(s) ____________________________________ : First Name. . . .Middle . . . . . . .Last.Name . . . . . . . . . . . . . . . . . . . . . . . Date of Birth of Petitioner ..... ...... ... ..... THE PEOPLE OF THE STATE OF NEW YORK TO ____________________________________ Other protected persons/DOB Vs. RESPONDENT ______________________________________ GREETINGS: First Name Middle Last Name RESPONDENT IDENTIFIERS SEX RACE DOB HT WT WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before EYES HAIR SOCIAL SECURITY # Relationship to Petitioner: Blood; Legal Custody; , the Honorable at the Court Marriage; Having a child in common; located at County of Now or previously, having shared the same residence; , at in room on the day of , 20 o'clock in the noon, and at any recessed DRIVER’S of the STATE or adjourned date, to testify and Other (specify) Romantic/dating relationship; give evidence as a witness in this action on the partLICENSE # ___________________________________________ Respondent’s Address Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to PDID#: the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. _________________________________________________________ _________________________________________________________ THE COURTWitness, Honorable HEREBY FINDS:That it has jurisdiction over the parties andone of thematter, andthe , subject Justices of that the Respondent has been provided with reasonable notice and opportunity to be heard and: Court in County, day of , 20 That the Petitioner has established by a preponderance of the evidence that there is good cause to believe that the Respondent committed or threatened one or more intrafamily offenses within the meaning of D.C. Code (Title 16-1001). Specifically, the court finds that the Respondent committed the (Attorney must sign above and type name below) following (in paragraph(s)) ____________________________________________________________. _____________________________________________________________________________________________________________________________ That the Respondent has knowingly and voluntarily waived his right to a hearing, and Attorney(s) for The Respondent admits to: _____________________________________________________ the Respondent consents to the entry of the Civil Protection order without admissions. THE COURT HEREBY ORDERS that for a period of 12 months: Respondent shall not assault, threaten, harass, or stalk petitioner orand P.O. child(ren) or destroy Office his/her Address Petitioner’s property. Respondent shall stay at least 100 feet away from Petitioner’s person, home, workplace, Telephone No.: vehicle, children’s school/daycare, other:______________________________________. Additional terms of this order follow on succeeding pages. Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : 2 Index No. Respondent shall not contact the Petitioner in any manner, including but not limited to: : Calendar No. by telephone, in writing, in any other manner; either directly or indirectly through a third party except under the following conditions: : JUDICIAL SUBPOENA Plaintiff(s) _____________________________________________________________________________. -against- : Temporary custody of the following minor children is awarded to: Petitioner Respondent until further order of this Court or the expiration date of this Order. :(Specify names and dates of birth.): _________________________________________________________________________________ : ________________________________________________________________________________. Visitation rights with the above minor children are awarded to: Respondent Petitioner under Defendant(s) : the. following. conditions:. (specify .dates,. times,.person. who .will. pick up and drop off, etc.): . ........ ......... ....... .... ..... ..... .... .. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ THE PEOPLE OF THE STATE OF NEW YORK _____________________________________________________________________ TO ____________________________________________________________________. Respondent shall vacate the residence at:________________________________________________ on or before (date) ________________________________. GREETINGS: The Metropolitan Police Department shall accompany Respondent/Petitioneryou retrieve his/her attend before WE COMMAND YOU, that all business and excuses being laid aside, to and each of you personal Honorable from (location)_______________________________________________________ , the belongings at the Court on (date)_____________________ at (time)___________ a.m./ p.m., and stand by to ensure located at County of Petitioner’s safety and , onshall retrieve Petitioner’s keys fromat in room the day of , 20 , Respondent. in the o'clock noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Respondent shall provide Petitioner with financial assistance in the amount of $________________, per month; one time only; other payment schedule:_________________________________ ________________________________________________________________________________, Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to for rent/mortgage assistance; spousal support; property damage; medical costs; the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a other: your failure to comply. result of__________________________________________________________ Payment shall be made by (date(s)):____________________________________________________ through the D.C. Superior Court Registry, Room 4201, 500 Indiana Avenue, N.W. Washington, Witness, Honorable , one of the Justices of the D.C. 20001. Checks will be made payable to the Clerk, D.C. Superior Court. Payments shall be Court in County, day of 20 forwarded to Petitioner at (non-confidential address):, _____________________________________ ________________________________________________________________________________ Possession and use of the following jointly owned property is(Attorney must sign above and type name below) awarded to: Petitioner__________________________________________________________________________ Respondent________________________________________________________________________ Attorney(s) for Respondent shall enroll in and complete a counseling program for: alcohol; drug abuse; domestic violence; parenting skills; family violence; other: ________________________ _________________________________________________________________________________ Respondent shall enroll in designated program(s) TODAY in the Probation Office (CSOSA), Room 1230 of the D.C. Superior Court and submit to a photograph Office and P.O. Address for identification purposes. CSOSA shall make an assessment of each referral and place the respondent into the prescribed level of supervision. Telephone No.: Respondent may not possess, purchase, receive or sell any firearm or No.: Facsimile ammunition. E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : 3 Index No. Other: ___________________________________________________________________________ : Calendar No. ___________________________________________________________________________________ ___________________________________________________________________________________ : JUDICIAL SUBPOENA Plaintiff(s) ___________________________________________________________________________________ ___________________________________________________________________________________ -against: If Respondent has a change of address at any time, she/he immediately must provide the Domestic : Violence Clerk’s Office of the D.C. Superior Court with his/her correct, new address. : FAILURE TO COMPLY WITH THIS ORDER IS A CRIMINAL OFFENSE AND CARRIES A Defendant(s) : . . . . . . . . . PENALTY. OF .SIX .MONTHS. IN.JAIL AND/OR A FINE OF $1,000 .......... ... ... ......... .. ............. Respondent was served with a copy in open court. THE PEOPLE OF THEappear. A DEFAULT Protection Order is issued. The Court finds that there Respondent failed to STATE OF NEW YORK was proper service and notice on the Respondent of the petition, and good cause for the issuance of this order.TO Respondent shall comply with all conditions of this Protection Order. The respondent has ten (10) days from the issuance of this order to file a motion to set aside the default judgement. ____________________________________________________________________________ GREETINGS: Respondent’s signature Date WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court ____________________________________________________________________________ located at County of Judge’s/Magistrate Judge’sthe Date noon, and at any recessed in room , on signature of day , 20 , at o'clock in the or adjourned date, to testify and give evidence as a witness in this action on the part of the Child Support Addendum Attached Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to THIS on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a the partyORDER IS HEREBY EXTENDED FROM (today’s date):_________________, 20____ TO __________________________, 20_____. result of your failure to comply. ___________________________________________________________________________ Witness, Honorable , one of the Justices of the Judge’s/MagistrateCounty, signature Judge’s Date Court in day of , 20 DIRECTIONS TO LAW ENFORCEMENT OFFICER ENFORCING above and type name below) (Attorney must sign THIS ORDER This Order is valid and enforceable in the District of Columbia and all other U.S. States, Territories and Tribal Lands. This Order was issued in accord with the requirements of the Full Faith Attorney(s) for and Credit Provisions of the Violence Against Women Act; Title IV, Subtitle B, Chapter 2 of the Violent Crime Control and Law Enforcement Act of 1994, 18 U.S.C. section 2265. Reporting alleged violations. If the Respondent violates the terms of this Order and there has not been Office and P.O. Address an arrest; the Petitioner may contact the Clerk of the Circuit Court of the county/state in which the violation occurred and complete an affidavit in support of the violation, or the Petitioner may contact the prosecutor’s office for assistance in filing an action for civil or criminal contempt. The prosecutor may decide to file a criminal charge, if warranted by the evidence. Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : 4 Index No. CHILD SUPPORT ADDENDUM TO CIVIL PROTECTION ORDER : CASE NO. IF Plaintiff(s) Calendar No. : JUDICIAL SUBPOENA Child support in the amount -againstof $___________ per month shall be paid by: Respondent; : Petitioner. Payments shall occur on the __________ day of every month, beginning ______________________ and shall be made through the D.C. :Superior Court Registry, Room 4201, 500 Indiana Avenue, N.W., Washington, D.C. 20001. Checks will be made payable to the Clerk, D.C. Superior Court. The Clerk shall forward payment to the Petitioner at (non-confidential address): : _________________________________________________________________________ Defendant(s) _________________________________________________________________________________ : ...................................................... THE COURT HEREBY FINDS: (Check one) The above amount of child support is in accordance with the D.C. Child Support Guideline. The parties have agreed to the above child support amount and the Court has found this amount to THE PEOPLE OF THE STATE OF NEW YORK be fair and just. Application of the D.C. Child Support Guideline would be unjust or inappropriate in this case TO (explain): _____________________________________________________________________ ______________________________________________________________________________ THE COURT HEREBY FINDS: (Check one) GREETINGS: Support payments shall be immediately withheld from the earnings or other income of the obligor. There isWE COMMAND to impose immediate withholdingbeing laid aside, youof the obligor attend before good cause not YOU, that all business and excuses from the earnings and each of you , the Honorable at the Court (explain):_____________________________________________________________________ located at County of ______________________________________________________________________________ in room good cause the demonstrated the alternative ,method ofo'clock in the be: , on was day of , 20 at Because payment shall noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damagesfor Obligor’s Employment Information sustained as a result of your failure to comply. Withholding Purposes Witness, Honorable Name of current employer: Court in County, Address of current employer: , one of the Justices of ____________________________________________ the day of , 20 _____________________________________________ _____________________________________________ Phone number of current employer: _____________________________________________ Social security number of obligor: _____________________________________________ (Attorney must sign above and type name below) The obligor must notify the Domestic Violence Clerk’s Office of the D.C. Superior Court within 10 days of any change in the above employment information. A withholding order may Attorney(s) for be changed upon motion from either party to request a reappointment of periodic arrears payments to reflect a change in the obligor’s ability to pay. The obligor shall make all payments directly into the Court Registry until mandatory wage withholding begins. Office and P.O. Address Respondent/ Petitioner shall maintain/obtain health insurance coverage for the minor children. Telephone No.: Facsimile No.: ____________________________________________________________________________________ E-Mail Address: Judge’s/Commissioner’s signature Date Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com