IN THE DISTRICT COURT OF Protection from Stalking (K.S.A. 60-31a01 et seq.) COUNTY, KANSAS Temporary Order of Protection from Stalking Judge or Division: Case Number: Court ORI Number: Plaintiff: Plaintiff Identifiers: (Date File Stamp) Year of Birth Sex: F M Defendant Identifiers: vs. Defendant: SEX HAIR Address RACE EYES DRIVERS LICENSE # Protected Person: YOB HT WT LAST 4 DIGITS OF SSN (IF KNOWN) DL STATE DL EXP. DATE (name) This order and its terms are directed at and apply to Defendant only. THIS TEMPORARY ORDER SHALL REMAIN IN EFFECT UNTIL SERVICE OF THE FINAL ORDER OR UNTIL TERMINATED BY ORDER OF THE COURT. ONLY THE COURT CAN CHANGE THIS ORDER. The Court Finds: (Only the provision(s) initialed by the judge apply.) Plaintiff filed a written verified petition on , 20 requesting a Temporary Order of Protection from Stalking. This Court has jurisdiction over Plaintiff, Defendant and subject matter. Plaintiff has established a prima facie case of stalking sufficient for the court to issue a temporary order of protection from stalking. A hearing has been set for , 20 , at : a.m. p.m. at (Court) and summons has been issued. Order The Court Orders:  The plaintiff’s address and telephone number shall remain confidential for the protection of the protected person.  The defendant shall not follow, harass, telephone, contact or otherwise communicate with the protected person. [ NCIC 01 & 05 ]  The defendant shall not abuse, molest, or interfere with the privacy rights of the protected person wherever they may be. [ NCIC 01 & 02 ]  The defendant shall not contact the protected person, either directly or indirectly. [ NCIC 04 & 05 ]  The defendant shall not direct or request another to contact the protected person, either directly or indirectly. [ NCIC 04 & 05 ]  The defendant shall not enter or come on or around the premises, the residence or workplace where the protected person resides, stays or works. [ NCIC 04 ] 07/01/2012 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF COMPLIANCE WITH THE VIOLENCE AGAINST WOMEN ACT (VAWA): This Order meets all the requirements of the Violence Against Women Act, 18 U.S.C. § 2265. This Court has jurisdiction of the parties and the subject matter; the defendant has been afforded notice and a timely opportunity to be heard as provided by the laws of Kansas. This Order is enforceable in all 50 states, the District of Columbia, all Indian tribal courts and all United States territories and shall be enforced as if it were an order of that jurisdiction pursuant to 18 U.S.C. § 2265. Additional terms of this order are set forth below, if any. Other Provisions: 1. Other orders necessary to promote the safety of the protected person: SO ORDERED: Date Judge of the District Court WARNINGS TO DEFENDANT  This order is effective when signed by the judge. Law enforcement officials shall immediately enforce this order.  Violation of this order may constitute: violation of a protective order as provided in K.S.A. 21-5924, and amendments thereto; stalking as provided in K.S.A. 21-5427, and amendments thereto; assault as provided in K.S.A. 21-5412(a), and amendments thereto; battery as provided in K.S.A. 21-5413(a), and amendments thereto; and criminal trespass as provided in K.S.A. 21-5808(a)(1)(C), and amendments thereto, and may result in prosecution and conviction under Kansas criminal statutes.  Violation of this order may also be punishable as contempt of this court.  If the defendant has a concealed carry license, that license is subject to revocation pursuant to K.S.A. 75-7c07, and amendments thereto. After a defendant’s concealed carry license has been revoked, continuing to carry a concealed weapon may constitute a violation of K.S.A. 21-6302, and amendments thereto.  Violation of this order may subject the defendant to prosecution for such federal crimes, including but not limited to: Interstate travel to commit domestic violence; Interstate stalking; and Interstate violation of a protection order. Notice of Extension of this Temporary Order (Pursuant to K.S.A. 60-31a05) If a hearing on the petition for protection is continued, the court may extend this Temporary Order of Protection from Stalking for additional periods of time as it deems necessary. 07/01/2012 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com