Print Form Clear Form Interim/Plenary Order of Protection: 3 of 4 Pages 12. (This form replaces CCG-83-1) (Rev. 7/29/10) CCG N805 C Respondent is ordered to pay temporary support for Petitioner and/or the minor child/ren of the parties as follows: $ _________________ per ___________________, starting __________________, payable through the Clerk of the Circuit Court, or directly to Petitioner. 13. Respondent is ordered to pay $ _________________ as actual monetary compensation for loss(es) to _________________________ _________________________ on or before _______________________. Further, Respondent is ordered to pay court costs in the amount of $ ____________ and attorney fees in the amount of $ _________________ to _________________________________________ in connection with any action to obtain, modify, enforce, appeal or reopen any Order of Protection, on or before __________________________. 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. 14.5 Respondent is ordered to surrender any and all Firearm and Firearm Owner's Identification Card and to the local law enforcement agency (i.e. police department). If the Respondent is a law enforcement officer, any and all firearms must be surrendered to Respondent's employer. (All surrendered firearms shall remain confiscated for a period not to exceed two (2) years.) 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. Respondent is ordered to pay $ ________________ to the following shelter _________________________________________ on or before _________________________________. 16. 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). The Respondent may be subject to federal criminal penalties for possessing, transporting, shipping, or receiving any firearm or ammunition under the Gun Control Act (18 U.S.C. 922 (g) (8) and (9))." DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Case No. _____________________________ Copy Distribution - White: 1. CLERK OF THE CIRCUIT COURT - ORIGINAL Blue: 2. LEADS Green: 3. SHERIFF/LAW ENFORCEMENT RETURN Canary: 4. RESPONDENT Pink: 5. PETITIONER Gold: 6. STATE'S ATTORNEY