AOC-275.11 Rev. 6-97 Doc. Code: OAFP MKE/MPO Commonwealth of Kentucky Court of Justice KRS Ch.403 Case No. AFFIDAVIT AND TEMPORARY ORDER AMENDING UNCERTIFIED DOMESTIC VIOLENCE FOREIGN PROTECTIVE ORDER Court___________________________ County __________________________________________________ First Middle PETITIONER Last V. __________________________________________________ First Middle RESPONDENT Last Date of Birth __________________________________________________ Name of Foreign Court which Issued Order __________________________________________________ ____________________ Street Address / P.O. Box Social Security No. __________________________________________________ City / County / State / Zip Code CAUTION: u Weapon involved u Believed to be armed/dangerous Comes the above named affiant to inform this court that the Foreign Protective Order (hereafter FPO) which has been given full faith and credit in Kentucky has been modified by the issuing foreign court as indicated in the attached uncertified order. Affiant therefore requests that this court modify the Domestic Violence Foreign Protective Order issued in Kentucky on __________________ , ________ to conform to the below stated issuing foreign court modifications: u Foreign order expired on ______________________________, _________. u u Foreign order was vacated on ______________________________, ________. Foreign order was modified on _____________________________, ________, as follows: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ _________________________________________________________________________________________________. Affiant verifies that the name and address of the court which issued the FPO has been provided. Affiant acknowledges that making a false statement in this affidavit is a violation of KRS 523.030, perjury in the second degree, a Class A Misdemeanor, which is punishable by a term of imprisonment not to exceed 12 months. NOTE TO AFFIANT: Your address is confidential pursuant to KRS 403.770(1). Affiant's Signature: ________________________________________ Subscribed and sworn to before me this Current Address: _________________________________________ ________________________________, ________. _________________________________________________________ Notary Public: ______________________________ Phone #: _________________________________________________ My commission expires: _____________________ ORDER The court, having reviewed the affidavit and uncertified modification, finds that the conditions ordered within the uncertified modified FPO shall be given full faith and credit in Kentucky until ____________________________, _________ (which does not exceed 28 days from the date of issue), at which time this temporary FPO will be deleted from Link, a statewide law enforcement computer network, unless within this period a certified copy of the modified FPO has been filed in the Kentucky circuit clerk's office in this county. Subject to this expiration date, IT IS THEREFORE ORDERED that the prior domestic violence foreign protective order be amended as follows: ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ _____________________________________________ Date __________________________________________________ Judge Copies to: - Court file - Petitioner (Certified Copy) Law enforcement agency/dispatch center responsible for LINK entry DO NOT SERVE RESPONDENT. ENSURE THAT ALL INFORMATION IN BOXES IS COMPLETE AND LEGIBLE 2000 © American LegalNet, Inc.