COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : : Index No. ORI Num ber _________________ Calendar No. : THE SUPERIOR COURT FOR THE COUNTY OF________________ JUDICIAL SUBPOENA Plaintiff(s) -against- : STATE OF GEORGIA : _______________________, : : Petitioner, : Civil Action File v. : Defendant(s) : _______________________, . . . . . . . . . . . . . . . . . :. . . No._____________________ .......................... ........ Respondent. : FAMILY VIOLENCE SIX THE PEOPLE OF THE STATE OF NEW YORK MONTH PROTECTIVE ORDER A hearing was held on this matter on ______________________, 20_____ for which the TO Respondent had notice as required by law and at which the Respondent appeared and/or had the opportunity to be heard and the Petitioner requested that the Protective Order entered in this case be continued. Having heard the evidence presented, reviewed the petition and the entire record GREETINGS: concerning this case and for good cause shown, IT IS HEREBY ORDERED AND ADJUDGED: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable That these proceedings be filed in the office of theCourt of this Court. at the 1. Clerk located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness throughout the the part ofit shall be the duty in this action on state and the 2. That this Order applies in every county of every court and every law enforcement official to enforce and carry out the provisions of this Order pursuant to O.C.G.A. § 19-13-4(d). Law Enforcement officers may use their arrest powers pursuant as a contempt of court and will make you Your failure to comply with this subpoena is punishable to O.C.G.A. §§ 19-13-6 and 17-4-20 liable to to behalf the terms of was issued the party on whoseenforcethis subpoena this Order.for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. 3. This Order shall be in effect for six (6) months from ____________________, 20_____ until Witness, Honorable ____________________, 20_____. , one of the Justices of the Court in 4. [pco01] County, day of , 20 That the Respondent has violated the Family Violence Act, at O.C.G.A. § 19-13-1 et seq., by committing family violence, has placed the Petitioner in reasonable fear for Petitioner’s safety, and represents a (Attorney must sign above and type namesafety of credible threat to the physical below) Petitioner and/or Petitioner’s child/ren. Respondent is hereby enjoined and restrained from doing, or attempting to do, or threatening to do, any act of injury, Attorney(s) or maltreating, molesting, following, harassing, harming, for abusing the Petitioner and/or the minor child/ren in any manner. Respondent is not to interfere with Petitioner’s travel, transportation, or communication. Respondent shall not follow, place under surveillance, or contact the Petitioner at any place of the Petitioner for Office and P.O. the purpose of harassing and intimidating the Petitioner. Address 1 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. CIVIL ACTION FILE NO. ______________ : 5. [pco02] Calendar No. That the Respondent is enjoined and restrained from doing or attempting to do, or : JUDICIAL SUBPOENA Plaintiff(s) threatening to do, any act of injury, maltreating, molesting, harassing, harming, or -againstabusing the Petitioner’s family or household. : : 6. That this Court determined that it had jurisdiction over the parties and the subject : matter under the laws of the State of Georgia and Respondent received reasonable notice and had the opportunity to be heard before this Order was issued sufficient Defendant(s) : . . . . . . . . . . . . . to .protect. the Respondent’s .due .process .rights. and this Order shall be presumed .. ..... ............... ... ...... .... valid and pursuant to18 U.S.C. § 2265(a) shall be accorded full faith and credit by any other state or local jurisdiction and shall be enforced as if an Order of the enforcing state or NEW YORK THE PEOPLE OF THE STATE OFjurisdiction. TO ONLY THE FOLLOWING THAT ARE INITIALED BY THE JUDGE SHALL APPLY _____ 7. [pco03] Petitioner is awarded sole and exclusive possession of the residence at _________ __________________________________________________________________ GREETINGS: _____ 8. Respondent is ordered to leave the family residence immediately and law WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable enforcement at ________________ (sheriff or police department) is ordered to at the Court assist Petitioner in returning to the family residence and the removal of the located at County of Respondent. Respondent shall immediately surrender to in the in room , on the day of , 20 , at o'clock law enforcement at any recessed noon, and _________________ (sheriff a police in this action on and any keys, or adjourned date, to testify and give evidence asor witness department) all the part of the garage door openers and other security devices to the family residence and law enforcement shall insure that these are given to the Petitioner. 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 to stay away from Petitioner’s and Petitioner’s child/ren’s _____ 9. Respondent is ordered was issued for a maximum penalty of $50 and all damages sustained as a result of[pco04] failure to comply.workplace and/or school and any subsequent residence or workplace your residence and or school of Petitioner and/or Petitioner’s minor child/ren. Witness, Honorable Court in County, _____ 10. , one of the Justices of the day of , 20 Respondent is ordered to provide suitable alternate housing for Petitioner and/or Petitioner’s children by _______________________, 20_____. (Attorney must sign above and type name below) _____ 11. [pco01,04] That Respondent is restrained and enjoined from approaching within ______ yards of Petitioner and/or Petitioner’s minor children. Attorney(s) for _____ 12. [pco05] Respondent is ordered not to have any contact, direct, indirect or through another person with Petitioner, by telephone, pager, fax, e-mail or any other means of communication except as specified in this Order. and P.O. Address Office 2 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. CIVIL ACTION FILE NO. ______________ : _____ 13. Calendar No. That Petitioner is awarded temporary custody : the minor child/ren, namely: of JUDICIAL SUBPOENA Plaintiff(s) ___________________ DOB __________ sex ______ -against: ___________________ DOB __________ sex ______ ___________________ DOB __________ sex ______ : ___________________ DOB __________ sex ______ Respondent is ordered not to interfere with the physical custody of the minor : child/ren. Defendant(s) : . . . . . . .[pco06]. . Check . . . . .only. if. Respondent. is. awarded. temporary custody of child/ren. . . . . . . . . . . here . . . . . . . . . . . . . . . . . . . . . . . . . _____ _____ 14. OF THE STATEordered toYORK the Petitioner support for the minor child/ren in the Respondent is OF NEW pay to THE PEOPLE amount of $________ every _______________ beginning the _______ of _________________, 20_____. TO All payments are to be made by or to: ____ income deduction order ____ child support receiver ____ by mail directly to the Petitioner GREETINGS: or ____ _____________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before In determining child support the Court finds as follows: , the Honorable at the Court The gross income of the father is $________ yearly or $_______ monthly. located at County of Theon the income of the mother ,is $_______ yearly or $_______ monthly. at any recessed in room , gross day of 20 , at o'clock in the noon, and The applicable give evidence of obligor’s in this action onto be considered by the trier or adjourned date, to testify and percentages as a witness gross income the part of the of fact to determine child support are: One child 17 to 23 percent Four children 29 to 35 percent Your failure children with this subpoena is punishable as a contempt of court and will make you liable to Two to comply 23 to 28 percent Five children 31 to 37 percent the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Three children 25 to 32 percent result of your failure to comply. In this case child support is being determined for ___ child/ren and the applicable Witness, Honorable , one of the Justices of the percentage of gross income to be considered is ____ to ____ percent. The court has Court in County, day of , 20 considered the existence of special circumstances, and has found that no special circumstances OR the following special circumstances exist: _________________________________________________________________ (Attorney must sign above and type name below) _____ 15. Respondent is ordered to pay temporary support for the Petitioner in the amount of $________ every ______beginning ________________, 20_____. Attorney(s) for All payments are to be made by or to: ____ income deduction order ____ child support receiver ____ by mail directly to the Petitioner or ____ Office and P.O. Address _____________________________ 3 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. CIVIL ACTION FILE NO. ______________ _____ 16. : Calendar No. Respondent shall have visitation with the minor child/ren according to the following schedule, beginning__________________, 20_____: : JUDICIAL SUBPOENA Plaintiff(s) ____ no visitation -against: ____ no visitation until _______________________, 20_____ ____ supervised visitation, supervised by a third party as : follows:________________________________________________ : _______________________________________________________ ____ visitation every other weekend from Friday at 6 p.m. until Sunday at Defendant(s) : 6 .... ........ ............ . . . . . . . . . . . . . . . . . . . . . . . . . . . . p.m.,. beginning. __________________, 20_____ ____ other visitation _________________________________________ ____ circumstances concerning how Respondent shall pick up and return the minor child/ren shall be _____________________________________ THE PEOPLE OF THE STATE OF NEW YORK TO Strict compliance with this visitation provision shall not be a violation of the restraining provisions of this Order. _____ 17. Respondent, only when accompanied by local law enforcement, shall be able to GREETINGS: remove his/her clothing and personal items from the residence as follows: ___________________________________________________________________ ___________________________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable On ___________________, 20_____ at ______ am / pm. at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed _____ 18. date, to testify and give evidence as a witness in this action on the part of the or adjourned (Respondent)(Petitioner)(both Respondent and Petitioner) [strike through appropriate] is/are ordered not to sell, encumber, trade, damage, contract to sell, or otherwise dispose of or remove from the jurisdiction of this Court any of the property or pets of this subpoena is joint property or pets of the parties except in Your failure to comply withthe Petitioner or punishable as a contempt of court and will make you liable to the ordinary subpoena was issued the party on whose behalf thiscourse of business. for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. _____ 19. (Respondent)(Petitioner)(both Respondent and Petitioner) [strike through of the Witness, Honorable , one of the Justices appropriate] is/are day of not to disconnect or have disconnected home utilities, ordered Court in County, , 20 change or have changed and/or cancel or have canceled auto, health or life insurance for Respondent, Petitioner, and/or Petitioner’s child/ren or interfere with Respondent, Petitioner’s and/or Petitioner’s(Attorney must sign above and type name below) child/ren’s mail. _____ 20. Petitioner shall have sole, exclusive temporary possession of the vehicle: Attorney(s) for Make_____ Model ____________Year__________Color __________. Respondent shall immediately surrender all keys, proof of insurance, and registration to this vehicle to law enforcement and law enforcement shall immediately turn over said items to Petitioner. Office and P.O. Address 4 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. CIVIL ACTION FILE NO. ______________ : _____ 21. Calendar No. Petitioner shall be allowed to remove the following property from the family : JUDICIAL SUBPOENA Plaintiff(s) residence for Petitioner and/or Petitioner’s child/ren’s use ____________________ -against: ___________________________________________________________________ ________________________________________________________________. : On _________________, 20_____ at ______ am / pm and law enforcement ______________________ (sheriff or police department) is hereby ordered to : assist the Petitioner during this removal. Defendant(s) : ...................................................... _____ 22. Respondent is ordered to undergo a batterer’s intervention program and follow the recommended treatment. THE PEOPLE OF THE STATE OF NEW YORK _____ 23. TO Respondent is ordered to undergo alcohol/drug abuse evaluation and follow the recommended treatment. _____ 24. GREETINGS: That Respondent shall be required to return the following property for Petitioner and/or Petitioner’s child/ren’s use ______________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before ________________________________________________ on _______________, , the Honorable 20____ at __________and law enforcement _____________________________ at the Court located at County of (sheriff or police department) is hereby ordered to assist the Petitioner during this in room , on day of , 20 , at o'clock in the noon, and at any recessed return.the or adjourned date, to testify and give evidence as a witness in this action on the part of the _____ 25. Petitioner is awarded costs and attorney fees in the amount of _______________. 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 damages sustained as a ____ 26. Petitioner/protected party is either a spouse, former spouse, parent of a common result of your failure to comply. [pco07] Court in child, Petitioner’s child, child of Respondent, cohabitates or has cohabited with Respondent and qualifies for 18 U.S.C. 922(g). Witness, Honorable County, _____ 27. [pco08] , one of the Justices of the day of , 20 It is further Ordered __________________________________________________ __________________________________________________________________. (Attorney must sign above and type name below) SO ORDERED this _____ day of ___________________, 20____. Attorney(s) for ________________________ JUDGE, SUPERIOR COURT __________________ County ________________________ Office and P.O. Address Print or stamp Judge’s name Telephone No.: Violation of the above Order may be punishable by arrest. Facsimile No.: 5 E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. CIVIL ACTION FILE NO. ______________ : Plaintiff(s) -against- Calendar No. : JUDICIAL SUBPOENA : NOTICE TO RESPONDENT : 1. Violation of this Order may result in immediate arrest and criminal prosecution that may result in jail time and/or fines and/or may subject :you to prosecution and penalties for contempt of court. Defendant(s) : 2. This Order shall remain in effect unless specifically superceded by a subsequent Order signed ...................................................... and filed, by operation of law, or by Order of dismissal, whichever occurs first. Only this Court can void, modify or dismiss this Order. Either party may ask this Court to change or dismiss this Order. THE PEOPLE OF hearing, of which the Respondent received notice and opportunity to participate, a 3. If after a THE STATE OF NEW YORK protective order is issued which restrains Respondent from harassing, stalking or threatening TO an intimate partner, Respondent is prohibited from possessing, receiving, or transporting a firearm or ammunition which has been shipped or transported in interstate or foreign commerce for the duration of the Order. 18 U.S.C. § 922(g). 4. A person commits the offense of Aggravated Stalking when such person, in violation of GREETINGS: a temporary or permanent protective Order prohibiting this behavior follows, places under surveillance, or that all business and person being laid aside, you andproperty for the before WE COMMAND YOU, contacts another excuses on public or private each of you attend purpose of harassing and intimidating the other person. This activity can subject the , the Honorable at the Court Respondent to arrest located at and prosecution for felony aggravated stalking, which carries County of in room penalties,of imprisonment for not less, than 1,year nor more than 10 years and a at any recessed on the day of 20 at o'clock in the noon, and fine of or adjournedto $10,000.00.and give evidence as a witness in this action on the part of the date, to testify up 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 damages sustained as a result of your failure to comply. Court in Witness, Honorable County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address 6 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. CIVIL ACTION FILE NO. ______________ : Pursuant to O.C.G.A. Section 19-13-3, Petitioner assisted by -against- Plaintiff(s) Calendar No. : JUDICIAL SUBPOENA : Name: _________________________ Address: _______________________ _______________________________ Telephone: _____________________ : : Defendant(s) : ...................................................... Note to Judges: This form is promulgated as a Uniform Superior Court Rule under the auspices of THE PEOPLE OF THE STATE OF NEW YORK O.C.G.A. § 19-13-53. To order a specific provision, please initial in the space provided. The court should delete or otherwise make inoperative any provision in the standardized form which is not TO supported by the evidence in the case and in order to comply with the court's application of the law and facts to an individual case. GREETINGS: 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 in room , on the day of , 20 , at o'clock in the 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 damages sustained as a result of your failure to comply. Court in Witness, Honorable County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address 7 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. CIVIL ACTION FILE NO. ______________ : : Plaintiff(s) Calendar No. JUDICIAL SUBPOENA -against: RESPONDENT’S IDENTIFYING FACT SHEET (please complete as much as possible; one of these must be provided to have the order placed in the National Crime : Information Center registry: Respondent’s date of birth, social security number, or driver’s license number) : Respondent’s social security number is _______________, date of birth is _________, sex ___, color Defendant(s) : of .hair .___________, .color .of. eyes .______________,. height. _______, weight _____. Respondent’s . ... ............ .... . .... ............... ..... . race is ______, ethnic background ____________. Respondent has distinguishing marks (tattoos, scars, etc.)_____________________. Respondent drives a _____________________, license tag number THE PEOPLE OF THE STATE OF NEW YORK _________________ and has a ____(state) driver’s license number ___________. Respondent’s home TO address ______________________________ and is employed by________________ at _______________________ and works from ____ to ____ on (days)___________. GREETINGS: 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 in room , on the day of , 20 , at o'clock in the noon, and at any recessed PETITIONER’S IDENTIFYING INFORMATION or adjourned date, to testify and give evidence as a witness in this action on the part of the Protected parties ___________________________ DOB ____ sex ____ race ______ ___________________________ DOB ____ sex ____ race ______ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to ___________________________ DOB penalty of $50 race ______ the party on whose behalf this subpoena was issued for a maximum ____ sex ____and all damages sustained as a result of your failure to comply. ___________________________ DOB ____ sex ____ race ______ Court in Witness, Honorable County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) “ Transmitted to Georgia Protective Order Registry Date _______ Clerk ________ Attorney(s) for Office and P.O. Address 8 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Rev’d 7/1/02 American LegalNet, Inc. www.USCourtForms.com