STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE _____________ JUDICIAL CIRCUIT COUNTY OF ________________ ________________________, Plaintiff, ) ) ) ) ) ) ) v. _________________________, Defendant. No. ____-____- _____ Independent Proceeding Other Civil Proceeding Criminal Proceeding Juvenile Proceeding Petitioner: Address: City: Respondent: Check if omitted pursuant to statute Address: City: Birthdate: Sex: Race: Height: Weight: Hair: Eyes: Social Security Number EMERGENCY ORDER OF PROTECTION ANY KNOWING VIOLATION OF ANY ORDER OF PROTECTION FORBIDDING PHYSICAL ABUSE, NEGLECT, EXPLOTATION, HARRASSMENT, INTIMIDATION, INTERFERENCE WITH PERSONAL LIBERTY, WILLFUL DEPRIVATION, OR ENTERING AND REMAINING PRESENT AT SPECIFIED PLACES WHEN THE PROTECTED PERSON IS PRESENT OR GRANTING EXCLUSIVE POSSESSION OF THE RESIDENCE OR HOUSEHOLD, PROHIBITING ENTERING OR REMAINING PRESENT AT THE HOUSEHOLD WHILE UNDER THE INFLUENCE OF ALOCHOL 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 CLASS A MISDEMEANOR. 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 FINE OR IMPRISONMENT. STALKING IS A FELONY. See definition of prohibited conduct on page 6. The following persons are protected by this order: _____________________________ _____________________________________________________________________. “The minor child(ren)” referred to herein are: __________________________________ _____________________________________________________________________. Emergency1 American LegalNet, Inc. www.USCourtForms.com Date, time, and Place for further hearing: Date: ____________ Time: ____________ County Courthouse _____________ Illinois. This order was issued on: This order will be in effect until: Date: ___________ Time: __________ Date: ___________ Time: ____________ The Court finds that it has jurisdiction over the subject matter and the parties; that the Petitioner has proven the material allegations of the Petition for Order of Protection by substantial, competent, and relevant evidence, and that an Order of Protection should be entered. IT IS HEREBY ORDERED THAT: 1. With respect to Petitioner and other Protected Persons, Respondent is prohibited from committing the following: Physical Abuse; 2. Harassment; Stalking; Intimidation of a dependant; Willful Deprivation; Neglect; Exploitation; Interference with personal liberty. Petitioner is granted exclusive possession of the residence and Respondent be prohibited from entering or remaining at such premises ________________________ _____________________________________________________________________ ___________________________________________________________________ 3. Respondent is ordered to stay away from Petitioner and other Protected Persons; and/or Respondent is prohibited from entering or remaining at _________________ _____________________________________________________________ while any Protected Person is present. 5. a. b. 7. a. Petitioner is granted physical care and possession of the minor child(ren;) and/or Respondent is ordered to: ξλιιι. Return the minor child(ren) ___________________________ _________________________________________________ to the physical care of _______________________________ ___________________________________________; and/or ξλιϖ. Not remove the minor child(ren) _______________________ _________________________________________________ from the physical care of Petitioner or ____________________ __________________________________________________. 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”): _________________ Emergency2 American LegalNet, Inc. www.USCourtForms.com 8. 9. 10. 11. 14. 15. 17. 18. _______________________________________________________ _______________________________________________________ b. Respondent’s visitation is restricted as follows: __________________ _______________________________________________________ _______________________________________________________. c. Respondent’s visitation is denied. d. Respondent is prohibited from meeting the minor child(ren) for visitation at Petitioner’s residence and may meet child(ren) at : _____________ _______________________________________________________ _______________________________________________________. 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 Petitioner or Petitioner’s minor child(ren) or is behaving in a violent or abusive manner. Respondent is prohibited from removing the minor child(ren) from Illinois or concealing him/her/them within Illinois. Respondent is ordered to appear at ____________________ County Courthouse, ________________________, Illinois on ________________ at ___________________.m with/without the minor child(ren). Petitioner is granted exclusive temporary possession of the following personal property and the Respondent be ordered to make available to Petitioner the following property which is in the Respondent’s possession or control: __________________________ ___________________________________________________________________ ___________________________________________________________________. a. Respondent is prohibiting from taking, transferring, encumbering, concealing, damaging, or otherwise disposing of any of the following real or personal property:___________________________________ _______________________________________________________. b. 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. Respondent is prohibited from entering or remaining in the residence located at ___________________________________________________________________ ___________________________________________________________________ while under the influence of drugs or alcohol and so constituting a threat to the safety and well-being of any Protected Person. Respondent is denied access to school or any other records of the minor child(ren) and prohibited from inspecting, obtaining, or attempting to inspect or obtain such records. Respondent is further enjoined as follows: _________________________________ ___________________________________________________________________ The relief requested in paragraph(s) _______________ of the Petition is denied Reserved, because: _________________________________________________ ___________________________________________________________________. Date: ___________________________ Judge: __________________________ Emergency3 American LegalNet, Inc. www.USCourtForms.com DEFINITIONS PURSUANT TO THE ILLINOIS DOMESTIC VIOLENCE ACT 1. 2. 3. 4. 45. 46. 47. 48. “Petitioner” may mean not only any named petitioner for the order of protection and any named victim of abuse on whose behalf the petition is brought, but also any other person protected by this Act. “Abuse” means physical abuse, harassment, intimidation of a dependent, interference, with personal liberty or willful deprivation, but does not include reasonable direction of a minor child by a parent or person in loco parents. “Physical Abuse” includes sexual abuse and means any of the following: (a) knowing or reckless use of physical force, confinement or restraint; (b) knowing repeated and unnecessary sleep deprivation; or (c) knowing or reckless conduct which creates an immediate risk of physical “Harassment” means knowing conduct which is not necessary to accomplish a purpose that is reasonable under the circumstances; would cause a reasonable person emotional distress; and does cause emotional distress to plaintiff. Unless the presumption is rebutted by a preponderance of the evidence. The following types of conduct shall be presumed to cause emotional distress: (a) creating a disturbance at plaintiff's place of employment or school; (b) repeatedly telephoning plaintiff's place of employment, home, or residence; (c) repeatedly following plaintiff about in a public place or places; (d) repeatedly keeping plaintiff under surveillance by remaining present outside his or her home, school, place of employment, vehicle or other place occupied by plaintiff or by peering in plaintiff's windows; (e) improperly concealing a minor child from petitioner, repeatedly threatening to improperly remove a minor child of petitioner from the jurisdiction or from the physical care of petitioner, repeatedly threatening to conceal a minor child from petitioner, or making a single such threat following an actual or attempted improper removal or concealment, unless respondent was fleeing an incident or pattern of domestic violence; (f) threatening physical force, confinement or restraint on one or more occasions. “Interference With Personal Liberty” means committing or threatening physical abuse, harassment, intimidation or willful deprivation so as to compel another to engage in conduct from which she or he has a right to abstain or to refrain from conduct in which she or he has a right to engage. “Willful deprivation” means willfully denying a person who because of age, health, or disability requires medication, medical care, shelter, accessible shelter or services, food, therapeutic device, or other physical assistance, and thereby exposing that person to the risk of physical, mental or emotional harm, except with regard to medical care or treatment when the dependent person has expressed an intent to forgo such medical care or treatment. This paragraph does not create any new affirmative duty to provide support to dependent persons. “Intimidation of dependent” means subjecting a person who is dependent because of age, health, or disability to participation in or witnessing of: physical force against another or physical confinement or restraint of another which constitutes physical abuse as defined by this Act, regardless of whether the abused person is a family or household member. “Exploitation” means the illegal, including tortious, use of a high-risk adult with disabilities or of the assets or resources of a high-risk adult with disabilities. Exploitation includes, but is not limited to, the misappropriation of assets or resources of a high-risk adult with disabilities by undue influence, by breach of fiduciary relationship, by fraud, deception, or extortion, or the use of such assets or resources in a manner contrary to law. Emergency4 American LegalNet, Inc. www.USCourtForms.com 49. “Neglect” means the failure to exercise that degree of care toward a high-risk adult with disabilities which a reasonable person would exercise under the circumstances and includes but is not limited to: (a) the failure to take reasonable steps to protect a high-risk adult with disabilities from acts of abuse; (b) the repeated, careless imposition of unreasonable confinement; (c) the failure to provide food, shelter, clothing, and personal hygiene to a high-risk adult with disabilities who requires such assistance; (d) the failure to provide medical and rehabilitative care for the physical and mental health needs of a high risk adult with disabilities; or (e) the failure to protect a high-risk adult with disabilities from health and safety hazards. Emergency5 American LegalNet, Inc. www.USCourtForms.com