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 LEADS NO. : _____________________ Petitioner: Address: City: Respondent:  Check if omitted pursuant to statute Address: City: Race: Hair: Birthdate: Sex: Height: Weight: Eyes: Social Security Number ORDER OF PROTECTION Interim Plenary 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 Order 1 American LegalNet, Inc. www.FormsWorkflow.com 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: _____________________________ _____________________________________________________________________. AThe minor child(ren)@ referred to herein are: ___________________________________ _____________________________________________________________________. Date, Time, and Place for further hearing (if Interim Order): Date: ____________ Time: ____________ County Courthouse _____________ Illinois. This order will be in effect until: This order was issued on: Date: ___________ Time: __________ Date: ___________ Time: ____________ Vacated by court order Specified event: ___________________ 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 is prohibited from entering or remaining at such premises _______________________ __________________________________________________________________. 3. Respondent is ordered to stay away from Petitioner and other Protected Persons; and/or xliii. Respondent is prohibited from entering or remaining at __________________ ______________________________________________________________ while any Protected Person is present; and/or xliv. Respondent is allowed access to the residence on _____________ at Order 2 American LegalNet, Inc. www.FormsWorkflow.com 6. ______________ to remove items of clothing, personal adornments, medications used exclusively by the Respondent and other items, as follows: _______________________________________________________________ ____________________________________________________________. 4. Respondent is ordered to undergo counseling at __________________ for a duration of ___________________________. 5. a. Petitioner is granted physical care and possession of the minor child(ren;) and/or b. Respondent is ordered to: xlv. Return the minor child(ren) __________________________ ________________________________________________ to the physical care of ______________________________ ___________________________________________; and/or xlvi. Not remove the minor child(ren) _______________________ _________________________________________________ from the physical care of Petitioner or ___________________ _________________________________________________. Petitioner is granted temporary legal custody of 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 Areasonable visitation): _________________________________________________________ _________________________________________________________ ______________________________________________________. 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 shall 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. 8. Respondent is prohibited from removing the minor child(ren) from Illinois or concealing him/her/them within Illinois. 9. Respondent is ordered to appear at ____________________ County Courthouse, ________________________, Illinois on ________________ at _______________.m with/without the minor child(ren). 10. Petitioner is granted exclusive temporary possession of the following personal property and the Respondent is ordered to make available to Petitioner the following property Order 3 American LegalNet, Inc. www.FormsWorkflow.com 11. 12. 13. 14. 15. 16. 17. 18. 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 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. a. Respondent is ordered to pay $ _____________ as actual monetary compensation for loss(es) to _________________ on or before ____________________________________. b. 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 __________________. 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 ordered to pay $ _____________ to the following shelter __________________________________ on or before _____________. Respondent is further enjoined as follows: _________________________________ ___________________________________________________________________ ___________________________________________________________________. The relief requested in paragraph(s) _______________ of the Petition is Reserved, because: ____________________________________ denied __________________________________________________________________ __________________________________________________________________. PLENARY ORDERS ONLY This Order shall remain in effect until: 1. Two years following date of entry of such Order, such expiration date being ________________________, or such earlier date as ordered by the Court, such expiration date being ___________________________. Order 4 American LegalNet, Inc. www.FormsWorkflow.com 2. 3. 4. 5. 6. 7. Final judgment in conjunction with Case No. ___________ is rendered. This Order is modified or vacated of such Order is incorporated into the final judgment of another civil proceeding. Termination of any voluntary or involuntary commitment, or until (not to exceed two years) ______________________________. Final disposition when a Bond Forfeiture Warrant has issued, or until (not to exceed two years) ___________________________. Expiration of any supervision, conditional discharge, probation, periodic imprisonment, parole, or supervised mandatory release, plus two years. Expiration of a term of imprisonment set by this Court, plus two years. Date: ___________________________ Judge: __________________________ Order 5 American LegalNet, Inc. www.FormsWorkflow.com DEFINITIONS PURSUANT TO THE ILLINOIS DOMESTIC VIOLENCE ACT 1. APetitioner@ 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. 2. AAbuse@ 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. 3. APhysical 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 4. AHarassment@ 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. 5. AInterference 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. 6. AWillful 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. 7. AIntimidation 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 Order 6 American LegalNet, Inc. www.FormsWorkflow.com 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. 8. AExploitation@ 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. 9. ANeglect@ 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: (g) the failure to take reasonable steps to protect a high-risk adult with disabilities from acts of abuse; (h) the repeated, careless imposition of unreasonable confinement; (i) the failure to provide food, shelter, clothing, and personal hygiene to a high-risk adult with disabilities who requires such assistance; (j) the failure to provide medical and rehabilitative care for the physical and mental health needs of a high risk adult with disabilities; or the failure to protect a high-risk adult with disabilities from health and safety hazards. Order 7 American LegalNet, Inc. www.FormsWorkflow.com