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: STATE OF INDIANA ) ) vs. ) ) ______________________, ) Defendant ) (DOB)___/___/___ ) (Race)____(Sex)____ ) (SSN/DL)_______________ ) (SSN)_XXX-XX-_________ ) IN THE _________________COURT___ (____________ DIVISION, ROOM ____) Case Number ____________________ NO CONTACT ORDER WHILE ON PROBATION UNDER INDIANA CODE § 35-38-2-2.3 or SERVING EXECUTED SENTENCE UNDER INDIANA CODE § 35-38-1-30 The Defendant __ does __ does not appear in person (and by counsel) and the State __ does __ does not appear by its Deputy Prosecuting Attorney and the Probation Officer __ does __does not appear (the Court having approved a plea agreement specifying a No Contact Order as a condition of probation or executed sentence), and the Court having sentenced the Defendant to probation or executed sentence, the Court now finds that a No Contact Order is necessary to preserve the peace and dignity of the community. The Court also finds that the Defendant represents a credible threat to the physical safety of the person(s) named below. The Defendant has been convicted of the crime(s) of _______________________________, a Level/Class ____ IDACS Codes felony/misdemeanor. As a condition of the Defendant's probation or executed sentence, 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 on probation. This includes, but is not limited to, acts of harassment, stalking, intimidation, threats, and physical force of any kind. 2. THE DEFENDANT IS ORDERED TO HAVE NO FIREARMS, DEADLY WEAPONS, OR AMMUNITION IN HIS/HER POSSESSION. 07 01 05 Page 2 of _____ pages TCM-NC-0102 Approved 07/02 Rev. by State Ct. Admin. 07/14 American LegalNet, Inc. www.FormsWorkFlow.com 3. THE DEFENDANT SHALL NOT VISIT THE FOLLOWING LOCATIONS DURING THE PERIOD OF THIS ORDER: (a) wherever the Defendant knows him/her/them to be located; (b) ________________________________________________________________ ________________________________________________________________. 04 4. THIS ORDER _____ DOES/_____ DOES NOT INVOLVE INTIMATE PARTNERS AS DEFINED IN 18 USC Sections 921(a)(32) and 2266. 08 5. Other conditions: __________________________________________________. This Order remains in effect during the defendant's executed sentence and/or until probation has been terminated. Violation of this order constitutes violations of Indiana Code § 35-38-2-2.3 and 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 Page 3 of _____ pages TCM-NC-0102 Approved 07/02 Rev. by State Ct. Admin. 07/14 American LegalNet, Inc. www.FormsWorkFlow.com STATEMENT OF DEFENDANT I have read the above Order and I understand it. I also understand that violation of this Order constitutes a violation of Indiana Code § 35-38-2-2.3, punishable by a revocation of my probation. I further understand that violation of this Order may cause additional charges to be filed against me. A copy of this Order has been given to me this ________ day of ______________________________, _______. ______________________________________________ Signature of Defendant Page 4 of _____ pages TCM-NC-0102 Approved 07/02 Rev. by State Ct. Admin. 07/14 American LegalNet, Inc. www.FormsWorkFlow.com