So that the Order of Protection is valid YOU MUST REPLACE THIS PAGE with Cover Sheet: Order of Protection American LegalNet, Inc. www.FormsWorkFlow.com STATE OF INDIANA ) COUNTY OF ___________ ) SS: In the Matter of: ) ) ______________________, ) A Child Alleged to be a ) Child in Need of Services ) IN THE ________________COURT ____ (_____________ DIVISION, ROOM ___) Case Number ____________________ NO CONTACT ORDER - CHINS Comes now the Court, under Indiana Code § 31-34-20 and/or Indiana Code § 3134-25, and issues this No Contact Order. Findings 1.___a. The Court finds that a Verified Petition for a No Contact Order has not been filed. ­ OR ___b. The Court finds that a Verified Petition for a No Contact Order has been filed by (check one): _____ the Prosecuting Attorney; _____ the Attorney for the Department of Child Services; _____ a Probation Officer; _____ a Caseworker; _____ the Department of Correction; _____ the Guardian ad litem or Court Appointed Special Advocate. 2. The Court finds that the Respondent in this matter is likely to have direct or indirect contact with ___the child and/or__a member of a foster family home in the absence of an Order. 3. The Court finds that the child has been adjudicated a Child in Need of Services. 4. The Court finds that the best interests of the child will be served if the Respondent refrains from direct or indirect contact with ___the child and/or___a member of the IDACS Codes foster family home. ORDER 1. THE RESPONDENT, _________________________, IS ORDERED TO 05 HAVE NO CONTACT WITH: _________________________________________ Page 2 of _____ pages TCM-NC-0103 Approved 07/02 Rev. by State Ct. Admin. 07/16 American LegalNet, Inc. www.FormsWorkFlow.com in person, by telephone or letter, through an intermediary, or in any other way, directly or indirectly. This includes, but is not limited to, acts of harassment, stalking, intimidation, threats, and physical force of any kind. 2. THE RESPONDENT, ______________________________________, SHALL NOT VISIT THE FOLLOWING LOCATIONS: [choose all that apply] ___ (a) wherever the Respondent knows the child to be located; ___ (b) wherever the Respondent knows a member of the foster family home to be located; ___ (c)_____________________________________________________________. 3. THE RESPONDENT IS ORDERED TO HAVE NO FIREARMS, AMMUNITION, OR DEADLY WEAPONS IN HIS/HER POSSESSION. 4. THIS ORDER ____ DOES / ____ DOES NOT INVOLVE INTIMATE PARTNERS AS DEFINED IN 18 USC Sections 921 (a)(32) and 2266. 5. Other conditions: ____________________________________________________. 08 07 04 01 This Order remains in effect until _____________________________________. Violation of an order issued under Indiana Code § 31-34-20 is a criminal offense under Indiana Code § 35-46-1-15.1 and violation of an order issued under Indiana Code § 31-34-25 is a criminal offense under Indiana Code § 35-46-1-15.3. Violation of this order may also subject the respondent to federal prosecution. This order is valid in all 50 states, the District of Columbia, tribal lands, and United States territories. Violation of this order is punishable by confinement in jail, prison, and/or a fine. If so ordered by the court, the respondent is forbidden to enter or stay at the petitioner's residence or residence of any child who is the subject of the order, even if invited to do so by the petitioner or any other person. In no event is the order for protection voided. Pursuant to 18 U.S.C. 2265, this order for protection shall be given full faith and credit in any other state or tribal land and shall be enforced as if it were an order issued in that state or tribal land. Pursuant to 18 U.S.C. 922(g), once a respondent has received notice of this order and an opportunity to be heard, it is a federal violation to purchase, receive, or possess a firearm while subject to this order if the protected person is: (a) the respondent's current or former spouse; (b) a current or former person with whom the respondent resided while in an intimate relationship; or (c) a person with whom the respondent has a child. Interstate violation of this order may subject the respondent to federal criminal penalties under 18 U.S.C. 2261 and 18 U.S.C. 2262. Page 3 of _____ pages TCM-NC-0103 Approved 07/02 Rev. by State Ct. Admin. 07/16 American LegalNet, Inc. www.FormsWorkFlow.com DATE: _______________ ___________________________________ Judge STATEMENT OF RESPONDENT I have read the above Order and I understand it. I also understand that violation of an order issued under Indiana Code § 31-34-20 is a criminal offense under Indiana Code § 35-46-1-15.1 and violation of an order issued under Indiana Code § 31-34-25 is a criminal offense under Indiana Code § 35-46-1-15.3. A copy of this Order has been given to me this ________ day of ________________, _______. ______________________________________________ Signature of Respondent Page 4 of _____ pages TCM-NC-0103 Approved 07/02 Rev. by State Ct. Admin. 07/16 American LegalNet, Inc. www.FormsWorkFlow.com