Print Form Emergency Order of Protection: 1 of 3 Pages Clear Form CCG N801 A-15M-6/06/07 (This form replaces CCG 96-01) IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS People ex rel. ___________________________________________ Case No. _____________________________________ ____________________________________________ on behalf of Independent Proceeding ______________________________________ self and/or behalf of Other Civil Proceeding (Specify) ______________________________________________________ ________________________________ Criminal Proceeding Petitioner Juvenile Proceeding 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) ________________________________________________________________________________________________________________________________________ EMERGENCY ORDER OF PROTECTION CRIM CODE 952 CIVIL CODE 4553 ANY KNOWING VIOLATION OF ANY ORDER OF PROTECTION FORBIDDING PHYSICAL ABUSE, NEGLECT, EXPLOITATION, HARASSMENT, INTIMIDATION, INTERFERENCE WITH PERSONAL LIBERTY, WILLFUL DEPRIVATION, OR ENTERING OR REMAINING PRESENT AT SPECIFIED PLACES WHEN THE PROTECTED PERSON IS PRESENT OR GRANTING EXCLUSIVE POSSESSION OF THE RESIDENCE OR HOUSEHOLD, PROHIBITING ENTERING OR REMAINING AT THE HOUSEHOLD WHILE UNDER THE INFLUENCE OF ALCOHOL OR DRUGS AND SO CONSTITUTING A THREAT TO THE SAFETY AND WELL-BEING OF ANY PROTECTED PERSON, OR GRANTING A STAY AWAY ORDER, IS A CRIMINAL OFFENSE. GRANT OF EXCLUSIVE POSSESSION OF THE RESIDENCE OR HOUSEHOLD SHALL CONSTITUTE NOTICE FORBIDDING TRESPASS TO LAND. ANY KNOWING VIOLATION OF ANY ORDER AWARDING LEGAL CUSTODY OR PHYSICAL CARE OF A CHILD, OR PROHIBITING REMOVAL OR CONCEALMENT OF A CHILD MAY BE A CLASS 4 FELONY. ANY WILLFUL VIOLATION OF ANY ORDER IS CONTEMPT OF COURT. ANY VIOLATION MAY RESULT IN A FINE OR IMPRISONMENT. STALKING IS A FELONY. Any order of protection which would expire on a court holiday shall instead expire at the close of the next court business day. 750 ILCS 60/220 (f) The following persons are protected by this Order: ___________________________________________________________________ ____________________________________________________________________________________________________________ “The minor child/ren” referred to herein are: _____________________________________________________________________________ _____________________________________________________________________________________________________________ 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:________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS 1. CLERK OF THE CIRCUIT COURT Emergency Order of Protection: 2 of 3 Pages CCG N801 B-15M-2/24/05 ( (This form replaces CCG 96-02) Any order of protection which would expire on a court holiday shall instead expire at the close of the next court business day. 750 ILCS 60/220 (f) 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. With respect to all Protected Persons, Respondent is prohibited from committing the following: Physical abuse; Harassment; Interference with personal liberty; Intimidation of a dependent; Willful deprivation; Neglect; Exploitation; Stalking. 2. Petitioner is granted exclusive possession of the residence and Respondent shall not enter or remain in the household or premises located at: __________________________________________________________________________________________________. [This remedy does not affect title to property] 3. a. Respondent is ordered to stay away from Petitioner and other protected persons; and/or b. Respondent is prohibited from entering or remaining at ______________________________________________________ ____________________________________________________________ while any Protected Person is present; and/or ________________________________________________________________________________________________ c. Respondent is allowed access to the residence on (date) __________________ at (time) ______________in the presence of (name) _______________________________ to remove items of clothing, personal adornments, medications used exclusively by the Respondent and other items, as follows: ________________________________________________________________. 5. a. Petitioner is granted physical care and possession of the minor child/ren; and/or b. Respondent is ordered to: __________________________________________________________ to the physical care of ________________________________________________________; and/or not remove the minor child/ren ________________________________________________________________ from the physical care of Petitioner or __________________________________________________________________. return the minor child/ren 7. a. Respondent is awarded visitation rights on the following dates and times or under the following conditions or parameters: [No order shall merely refer to the term “reasonable visitation”] ____________________________________________________________________________________________________ _________________________________________________________________________________________. b. Respondent’s visitation is restricted as follows: _________________________________________________________________________________________________ ___________________________________________________________________________________________________. c. Respondent’s visitation is reserved/denied. (Petitioner may deny Respondent access to the minor child/ren if, when Respondent arrives for visitation, Respondent is under the influence of drugs or alcohol and constitutes a threat to the safety and well-being of Petitoner or Petitoner’s minor child/ren or is behaving in a violent or abusive manner.) 8. Respondent is prohibited from removing the minor child/ren from Illinois or concealing them within Illinois. 9. ___________________________ at ____________________________ __________________________ on __________________________ at _____________ a.m./p.m., with/without the minor child/ren. Respondent is ordered to appear in Courtroom/Calendar 10. Petitioner is granted exclusive possession of the following personal property and the Respondent is ordered to promptly make available to Petitioner said property that is in Respondent’s possession or control, to wit: _________________________________________________________________________________________________ ____________________________________________________________________________________________. [This remedy does not affect title to property] 11. Respondent is prohibited from taking, encumbering, concealing, damaging or otherwise disposing of the following personal property: ________________________________________________________________________________________________ ______________________________________________________________________, except as explicitly authorized by the Court. Further, Respondent is prohibited from improperly using the financial or other resources of an aged member of the family or household for the profit or advantage of Respondent or any other person. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Case No. ____________________________ ) Emergency Order of Protection: 3 of 3 Pages CCG N801 C-30M-12/14/04 ( ) (This form replaces CCG 96-01) Any order of protection which would expire on a court holiday shall instead expire at the close of the next court business day. 750 ILCS 60/220 (f) ` Case No. __________________________ 14. Respondent is prohibited from entering or remaining at the household or residence located at ________________________________ ______________________________________________________________________________________________________ while under the influence of alcohol or drugs and so constituting a threat to the safety and well-being of any Protected Person. 15. Respondent is denied access to school and/or any other records of the minor child/ren and is prohibited from inspecting, obtaining, or attempting to inspect or obtain such records. 17. Respondent is further ordered and/or enjoined as follows: _________________________________________________________________________________________________ ________________________________________________________________________________________________ 18. The relief requested in paragraph(s) ___________________________________ of the petition is (DENIED) (RESERVED), because: ________________________________________________________________________________________________ _____________________________________________________________________________________________ “This Order of Protection is enforceable, even without registration, in all 50 states, the District of Columbia, tribal lands, and the U.S. territories pursuant to the Violence Against Women Act (18 U.S.C. 2265). Violating this Order of Protection may subject the Respondent to federal charges and punishment (18 U.S.C. 2261-2262).” NOTICE: Upon 2 days notice to Petitioner, or such shorter notice as the Court may prescribe, a Respondent subject to an Emergency Order of Protection issued under the IDVA may appear and petition the Court to re-hear the original or amended petition. Respondent’s petition shall be verified and shall allege lack of notice and a meritorious defense. Date: _______________________________________ _____________________________________________ Judge Atty. No. ___________________ Attorney (or Pro Se Petitioner) Name: _________________________________ Address: _______________________________________________________ State/City/Zip: __________________________________________________ Phone: ________________________________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Judge’s No.