Court Ph. 618 692-6250 THIRD MADISON JUDICIAL CIRCUIT State of ILLINOIS Emergency Order of Protection PETITIONER Court County Case No. First Middle Last (file stamp) Petitioner's Address/ Alternative Address: Petitioner And/or on behalf of other protected person(s) listed below Child(ren) as noted on page 6, Part C of this order Dependent (name) High Risk Adult (name) RESPONDENT First Middle Last Relationship to Petitioner: ___________________ Respondent's Address: ________________________________________ (Home) _________________________________________ (Work) (Work Hours: ) Distinguishing Features (scars, marks, tattoos, martial arts): Caution indicators: THE COURT FINDS: (A) Considered armed and /or dangerous (Y) Considered armed, dangerous and suicidal (S) Suicidal That it has jurisdiction over the Petitioner and subject matter and the Respondent will be provided with reasonable notice and an opportunity to be heard within the time required by Illinois law. THE COURT ORDERS: (Additional terms are set forth herein) That Respondent is prohibited from further acts/threats of abuse on protected persons (See R01) That Respondent is ordered to stay away from Petitioner and/or other protected persons. (See R03) The Circuit Clerk is directed to send within 24 hours Daycare / School Notice(s) (See page 7). The terms of this Order shall be effective until (Date) A hearing on entry of Plenary/Interim Order of Protection is set for: (Time am/pm) at (Date) (Time) at the Madison County Courthouse, 155 N. Main Street, Edwardsville, Illinois in Courtroom: TBA. A PLENARY (FINAL) ORDER OF PROTECTION MAY BE ENTERED AGAINST YOU BY DEFAULT IF YOU FAIL TO APPEAR AT SUCH HEARING. Form approved by the conference of Chief Circuit Judges Rev. 1/13 Page 1 of 11 ­ Emergency Order of Protection American LegalNet, Inc. www.FormsWorkFlow.com NOTICES CONCERNING THIS EMERGENCY ORDER OF PROTECTION WARNING TO RESPONDENT Violating this Order of Protection is punishable by imprisonment or fine or both, and can cause your bond to be revoked, result in a contempt of court citation against you, or the filing of a criminal charge. This protection order 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 you to federal charges and punishment. 18 U.S.C. §§ 2261-2262. Only the court can change this order. The Petitioner cannot give you legal permission to change this order. If you go near the Petitioner, even with the Petitioner's consent, you may be arrested. Unless the court modifies/dismisses this order, you can be arrested for violating this Emergency Order of Protection. You act at your own risk if you disregard this WARNING. You have been served with notice that the Petitioner has filed for a Plenary or Interim Order of Protection (effective for up to two years), and have been provided with a date on which you must appear in court if you wish to contest entry of the order. If you fail to appear, an Order of Protection may be issued in your absence. NOTICE TO PETITIONER You cannot change the terms of this order by your words or actions. If the Court has ordered no contact or exclusive possession of the residence, only the Court can allow the Respondent to contact you or return to the residence. If you and the Respondent want to resume your relationship, you must ask the Court to modify or dismiss this Order of Protection. If you wish to ask the court for an Interim or Plenary (Final) Order of Protection (effective for up to two years), you must appear in court on the date set for a hearing. NOTICE TO ALL LAW ENFORCEMENT AGENCIES AND OFFICERS 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 state and/or 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). Page 2 of 11 ­ Emergency Order of Protection Rev. 1/13 American LegalNet, Inc. www.FormsWorkFlow.com NOTICE TO RESPONDENT Any knowing violation of an 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 a protected person is present, or granting exclusive possession of the residence or household or granting a stay away order is a Class A misdemeanor and a second or subsequent violation is a Class 4 felony. The granting of exclusive possession of the residence or household shall constitute notice forbidding trespass to land. Any knowing violation of an order awarding legal custody or physical care of a child or prohibiting removal or concealment of a child may be a Class 4 felony. Stalking is a Class 4 felony for a first offense and a Class 3 felony for a subsequent offense. Any willful violation of any order is contempt of court. Any violation may result in fine or imprisonment. FINDINGS [Jurisdiction] The Court, having reviewed the verified petition and having examined the petitioner under oath or affirmation, finds that: 1. Good cause exists for granting the remedy or remedies requested without prior service of process or notice because: A. The harm that Remedies 1, 3, 5, 8, 9, 11, 14, 15, and 17 are intended to prevent would be likely to occur if the Respondent were given prior notice, or greater notice than was actually given, of the Petitioner's efforts to obtain judicial relief. B. For Remedy 2, the immediate danger of further abuse of Petitioner by Respondent, if Petitioner chooses or had chosen to remain in the residence or household while Respondent was given any prior notice or greater notice than was actually given or of Petitioner's efforts to obtain judicial relief, outweighs the hardships to Respondent of an Emergency Order granting Petitioner exclusive possession of the residence or household. C. For Remedy 10, improper disposition of the personal property would likely occur if the Respondent were given any prior notice, or greater notice than was actually given, of the Petitioner's efforts