February 2007 Form 4.3: Protective Order by Consent Agreement (Section 236.3 Petition) February 2007 American LegalNet, Inc. www.FormsWorkflow.com February 2007 6 Protective Order by Consent Agreement (Section 236.3 Petition) (cont’d) On the day of , 20 , a hearing was held on the Petition for Relief from Domestic Abuse. The following persons were present and participated in the hearing: . The court FINDS by a preponderance of the evidence: (1) Respondent was personally served with a copy of the petition and the temporary protective order containing notice of this hearing. (2) The parties appeared and each consented to the entry of this order. [ ] (3) If checked, the respondent committed a domestic abuse assault against the protected party. [ ] (4) If checked, the court finds the respondent and protected party meet the definition of intimate partners as defined in 18 U.S.C. § 921(a)(32) (“‘intimate partner’ means, with respect to a person, the spouse of the person, a former spouse of the person, an individual who is a parent of a child of the person, and an individual who cohabitates or has cohabited with the person”). IF (4) IS CHECKED, the court must check box 6, prohibiting the respondent from possessing firearms. Therefore, pursuant to Iowa Code Chapter 236, the court ORDERS as follows: 1. Respondent shall not threaten, assault, stalk, molest, attack, harass or otherwise abuse the protected party. Respondent shall not use, or attempt to use, or threaten to use physical force against the protected party that would reasonably be expected to cause bodily injury. 2. Respondent shall not communicate with the protected party in person or through any means including third persons. This restriction shall not prohibit communication through legal counsel. 3. The protected party shall have exclusive possession of the residence located at . Respondent shall not go to, enter, occupy or remain in that residence or any other residence in which the protected party is staying, under any circumstance. 4. (Insert additional provisions expressly limiting contact, if any, including limitations on access to protected party’s school or workplace): 5. The is granted temporary custody of these children (list names and ages): (protected party or respondent) . is granted visitation with these children as follows (specify times, places and method (protected party or respondent) of implementation of visitation): . The respondent shall not otherwise contact these children and shall not contact the protected party about visitation except as provided in this order. [ ] 6. If checked, the respondent shall not possess firearms while this order is in effect. Respondent shall deliver all firearms to the County Sheriff or (law enforcement agency) on or before , 20 . The respondent is advised that the issuance of this protective order may also affect the right to possess or acquire a firearm or ammunition under federal law. 18 U.S.C. §§ 922(d)(8), (g)(8). 7. A RESPONDENT WHO VIOLATES THIS ORDER FACES IMMEDIATE ARREST. Violation may occur even if the protected party consents to conduct that is prohibited by this order. Only the court can relieve respondent from the restrictions contained in this order. 8. This order is effective immediately. [ ] 9. If checked, court costs are assessed against respondent. 10. The court finds, pursuant to Iowa Code section 236.10, that to protect the safety or privacy of the protected party and/or the protected party’s children, the clerk of court shall, until further order of the court (check any that apply) [ ] seal the entire file from public access, other than court orders and child support payment records. [ ] seal the following portion(s) of the file from public access: . [ ] redact protected party’s actual address and location information prior to public dissemination of court orders, child support payment records, and other records available at the clerk’s office or through the Iowa Court Information System (ICIS). Whether or not any boxes are checked above, the indices available at the clerk’s office or through the Iowa Court Information System (ICIS) shall remain open. [ [ [ JUDGE, JUDICIAL DISTRICT ] The County Sheriff shall serve and return service of this order upon the respondent. ] Respondent was personally served with a copy of this order by the court. ] The clerk of court shall provide copies of this order to the parties and law enforcement agencies, pursuant to Iowa Code sections 236.5(5) and 664A.4. NOTICE: If you have a disability and need assistance to participate in court proceedings, please call the ADA Coordinator at ( ) . If you are hearing-impaired, call Relay Iowa TTY at 1-800-735-2942. [Court Order February 18, 1997, effective March 21, 1997; January 11, 2001, effective February 15, 2001; November 9, 2001, effective February 15, 2002; July 11, 2002; August 28, 2003, effective October 1, 2003; September 1, 2005, effective November 1, 2005; January 31, 2007] February 2007 American LegalNet, Inc. www.FormsWorkflow.com