Print Form Civil No Contact Order Clear Form CCG 0806-30M-6/11/07 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS ______________________________________________________________ ______________________________________________________________ Case No. _______________________________________ Independent Proceeding _______________________________________ himself/herself and/or on behalf of Criminal Proceeding ______________________________________________________________ Delinquency Petition Petitioner v. ______________________________________________________________ LEADS NO. _____________________________________ Respondent _____________________________________________________________________________________________________________________________________________ PETITIONER ADDRESS CITY/STATE/ZIP (Check if omitted pursuant to Statute) ___________________________________________________________________________________________________________________________________________ RESPONDENT ADDRESS CITY/STATE/ZIP _____________________________________________________________________________________________________________________________________________ Birthdate Sex Race Height Weight Hair Eyes (Required for LEADS) _____________________________________________________________________________________________________________________________________________ CIVIL NO CONTACT ORDER 4653 Emergency The following persons are protected by this Order; (1) PETITIONER’S NAME: 4654 Plenary ________________________________________________________ ________________________________________________________________________________________ ___________________________________________________________________________________________________ _______________________________________________________________________________________________________________ (2) OTHER PROTECTED PARTIES: Date, time and place for further hearing: Date: ______________________________ Time: ___________________ Courtroom/Calendar No.: ___________________________ _________________________________Location:___________________ ___________________________________________________________________________ ___ ___________________ This Order was issued on: This Order will be in effect until: Date: ___________________________________________________________________ ______________________________________________________________ ___________ Time: _______ Date: ____________________________ Time: ________________ FOR EMERGENCY ORDERS ONLY: The court finds good cause to grant the remedy, regardless of prior service of process or of notice upon the Respondent, because the harm which that remedy is intended to prevent would be likely to occur if the Respondent were given any prior notice, or greater notice than was actually given, of the Petitioner’s efforts to obtain judicial relief. BASED ON THE FINDINGS OF THIS COURT, WHICH WERE MADE ORALLY FOR TRANSCRIPTION, OR WHICH ARE SET OUT IN A SEPARATE INSTRUMENT FILED WITH THE COURT, AND WITH THE COURT HAVING JURISDICTION OF THE SUBJECT MATTER AND OVER ALL NECESSARY PARTIES, IT IS HEREBY ORDERED THAT: 1. 2. 3. 4. The Respondent is to stay away from the Petitioner. The Respondent is to stay away from any other person protected under this Civil No Contact Order. The Respondent is prohibited from physical abuse, harassment, intimidation of a dependent, interference with personal liberty, or stalking any person protected under this Civil No Contact Order. The Respondent is prohibited from entering or remaining present at the school place of employment of any person protected under this Civil No Contact Order. Atty. No. ___________________ Pro Se 99500 Attorney (or Pro Se Petitioner) Name:_______________________________ Date: _______________________________________________ Address:_____________________________________________________ State/City/Zip: ________________________________________________ Telephone: (__________) _______________________________________ ______________________________________________ Judge ANY KNOWING VIOLATION OF A CIVIL NO CONTACT ORDER IS A CLASS A MISDEMEANOR. ANY SECOND OR SUBSEQUENT VIOLATION IS A CLASS 4 FELONY. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Judge’s No.