So that the Order of Protection is valid, after you print, YOU MUST REPLACE THIS PAGE with the Cover Sheet: Order of Protection (available for download in PDF format) American LegalNet, Inc. www.FormsWorkFlow.com STATE OF INDIANA ) COUNTY OF ___________ ) SS: STATE OF INDIANA ) vs. ) ______________________, ) Defendant ) (DOB)___/___/___ ) (Race)____(Sex)____ ) (DL)___________________ ) (SSN)_XXX-XX-_________ ) IN THE ________________COURT____ (____________ DIVISION, ROOM ____) Case Number ____________________ NO CONTACT ORDER UPON RELEASE FROM CUSTODY ON BAIL OR PERSONAL RECOGNIZANCE The Defendant __does __does not appear in person (and by counsel) and the State __does __does not appear by its Deputy Prosecuting Attorney. The State having moved the Court for an order restricting the Defendant from having contact with the alleged victim(s) and/or (a) certain witness(es) in this case, the Court now finds that such an Order is necessary to preserve the safety, peace, and dignity of the community as well as the safety of the alleged victim(s)/witness(es) named herein. The Defendant has been charged with the commission of the crime(s) of __________________________________, a Class ____ misdemeanor/felony. Pursuant to Indiana Code § 35-33-8-3.2, as a condition of the Defendant's release from custody IDACS Codes: pending trial in addition to all other conditions previously specified: 1. THE DEFENDANT IS ORDERED TO HAVE NO CONTACT WITH: ___________________________________________________________________ in person, by telephone or letter, through an intermediary, or in any other way, directly or indirectly, except through an attorney of record, while released from custody pending trial. This includes, but is not limited to, acts of harassment, stalking, intimidation, threats, and physical force of any kind. This provision shall also be effective even if the defendant has not been released from lawful detention. 2. 3. 05 01 THE DEFENDANT IS ORDERED TO HAVE NO FIREARMS, DEADLY WEAPONS, OR AMMUNITION IN HIS/HER POSSESSION. THE DEFENDANT SHALL NOT VISIT THE FOLLOWING LOCATIONS DURING THE PERIOD OF HIS/HER RELEASE: 07 04 Page 2 of _____ pages TCM-NC-0100 Approved 07/02 Rev. by State Ct. Admin. 07/10 American LegalNet, Inc. www.FormsWorkFlow.com (a) wherever the Defendant knows him/her/them to be located; (b) ________________________________________________________________ ________________________________________________________________. 4. 5. THIS ORDER ___DOES / ___DOES NOT INVOLVE INTIMATE PARTNERS AS DEFINED IN 18 USC Sections 921 (a)(32) and 2266. Other conditions: __________________________________________________. 08 This Order remains in effect until this case has been tried and the Defendant has been sentenced if found guilty. Violation of this order constitutes a violation of Indiana Code § 35-33-8-3.2, which could result in a revocation of bond or release on personal recognizance. Violation of this order also constitutes a violation of Indiana Code § 35-46-1-15.1, and may also subject the defendant 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. DATE: ____________ _____________________________ Judge STATEMENT OF DEFENDANT Page 3 of _____ pages TCM-NC-0100 Approved 07/02 Rev. by State Ct. Admin. 07/10 American LegalNet, Inc. www.FormsWorkFlow.com I have read the above Order and I understand it. A copy of this Order has been given to me this ________ day of ________________, _______. ______________________________________________ Signature of Defendant Page 4 of _____ pages TCM-NC-0100 Approved 07/02 Rev. by State Ct. Admin. 07/10 American LegalNet, Inc. www.FormsWorkFlow.com