Docket No.: Page 1 of 6 LPOR 1 v.11 LOUISIANA UNIFORM ABUSE PREVENTION ORDER Docket No. Order of Protection Court: Div.: Temporary Restraining Order City/Parish State Protective Order/Preliminary or Permanent Injunction Modified Protective Order/ Preliminary or Permanent Injunction Filed : Clerk: PETITIONER First Middle/Maiden Last PETITIONER IDENTIFIERS Date of birth Race Sex: F Sex: M Protected person is: Petitioner other(s) List other(s) name & date of birth: V. DEFENDANT NAME AND ADDRESS First Middle Last No. & Street Apt. No. City State Zip Code DEFENDANT IDENTIFIERS SEX RACE DOB HT WT EYES HAIR SOCIAL SECURITY # STATE EXP DATE en-CA THE COURT HEREBY FINDS: That it has jurisdiction over the parties and subject matter, and the defendant has been or will be provided with reasonable notice and opportunity to be heard. Additional findings of this court are as set forth on the following pages. THE COURT HEREBY ORDERS: That the above named defendant be restrained from committing further acts of abuse or threats of abuse, stalking or sexual assault. Additional terms of this order are as set forth on the following pages. This order shall be effective through 11:59 PM on (month/day/year) This order shall be enforced, even without registration, by the courts of any state, the District of Columbia, any U.S. Territory, and may be enforced by Tribal Lands (18 U.S.C. Section 2265). en-CA WARNINGS TO DEFENDANT: Crossing state, territorial, or tribal boundaries to violate this order may result in federal imprisonment (18 U.S.C. Section 2262). Federal law provides penalties for possessing, transporting, shipping, or receiving any firearm or ammunition (18 U.S.C. Section 922(g)(8)). See further notice on page 5 of this Order. ONLY THE COURT CAN CHANGE THIS ORDER. ------ FOR LPOR USE ONLY ----- PNO# Date Entered: Initials: Verified by: Louisiana American LegalNet, Inc. www.FormsWorkFlow.com Docket No.: Page 2 of 6 LPOR 1 v.11 LOUISIANA UNIFORM ABUSE PREVENTION ORDER TEMPORARY RESTRAINING ORDER Pursuant to: La. R.S. 46:2131 et seq. (Domestic Abuse) La. R.S. 46:2171 et seq. (Non - intimate stalking) 46:2171 and 46:2181 valid for relationships in Box C below ONLY La. R.S. 46:2151 (Dating Violence) La. R.S. 46:2181 et seq. (Non - intimate sexual assault) La. Ch. C. Article 1564 PETITIONER Protected person is: Petitioner other(s) V. DEFENDA N T The protected person(s) is related to the defendant as: (check all that apply) A 1. current or former spouse 2. current or former intimate cohabitant 3 . child, stepchild, or foster child 4 5 . protected person and defendant have a child(ren) in common B 1. current or former dating partner 2. parent, stepparent, or foster parent 3. grandparent 4. grandchild C Select ONLY if statute 46:2171 or 46:2181 is marked above 1. s tranger/no relationship 2. a cquaintance/co - worker/neighbor or other: en-CA D FINDING: Domestic Abuse or Dating Violence THE COURT FINDS THAT THE ALLEGATIONS PRESENTED CONSTITUTE AN IMMEDIATE AND PRESENT DANGER TO THE PHYSICAL SA FETY OF THE PROTECTED PERSON(S). FINDING: Stalking THE COURT FINDS THAT THE ALLEGATIONS PRESENTED CONSTITUTE AN IMMEDIATE AND PRESENT DANGER OF STALKING. FINDING: Sexual Assault THE COURT FINDS THAT THE ALLEGATIONS PRESEN TED CONSTITUTE A SEXUAL ASSAULT. THUS THE COURT ISSUES THE FOLLOWING ORDERS, WITHOUT A HEARING: IT IS ORDERED THAT THE DEFENDANT BE SERVED WITH A COPY OF THIS ORDER. DOMESTIC ABUSE, DATING VIOLENCE, STALKING OR SEXUAL ASSAULT ONLY ORDERS CHECKED AND INITIALED BY A JUDGE SHALL APPLY 1. THE DEFENDANT IS ORDERED NOT TO abuse, harass, assault, stalk, follow, track, monitor , or threaten the protected person(s) in any manner whatsoever. This prohibition includes the use, attempted use, or threatened use of physical force that would reasonably be expected to cause bodily injury. 2 . THE DEFENDANT IS ORDERED NOT TO contact the protected person(s) personally, through a third party, or via public posting, by any means, including written, telephone, or electronic (text, email, messaging, or social media) communication without the express w ritten permission of this court . E xcept ions (if any): 3 . THE DEFENDA NT IS ORDERED NOT TO go within ( distance ) of the protected person (s) , without the express written permission of this court . Exceptions (if any ) : American LegalNet, Inc. www.FormsWorkFlow.com Docket No.: Page 3 of 6 LPOR 1 v.11 4 . THE DEFENDANT IS ORDERED NOT TO go within one hundred (100) yards of the residence, apartment complex, or multiple family dwelling of the protected person(s) . No. & Street Apt. No. City State Zip Code 5 . not to interfere in an y manner with such employment/school . Employment/School Address City State Zip Code Employment/School Address City State Zip Code 6 . THE DEFENDANT IS ORDERED NOT TO damage any belongings or property of the protected person(s) and not to shut off any utilities, telephone service, or mail delivery to the protected person(s) or in any way interfere with the living conditions of the protect ed person(s). 7 . THE COURT GRANTS THE PETITIONER or protected person(s) the use of the residence located at: No. & Street Apt. No. City State Zip Code to the exclusion of defendant by evicting defendant. The Court orders the defendant to surrender any keys to that residence to the petitioner. evict the defendant. 8 . THE COURT GRANTS THE PETITIONER or protected person(s) the use and possession of the follow ing property (including pets) and/or the return of protected person(s) property: 9 . THE COURT ORDERS a representative of to accompany petitioner to obtain property listed in Order No. 8 above. 1 0 . THE COURT PROHIBITS EITHER PARTY from transferring, encumbering, or otherwise disposing of property jointly owned or leased, except in the normal course of business or that which is necessary for the support of the petitioner and/or the minor child(ren). 1 1 . THE COURT WILL ALLOW to return to the residence at a date and time to be agreed upon by petitioner and law enforcement agency to recover his/her personal clothing and necessities, provided that s/he is accompanied by a law enforcement officer to ensure the protection and safety of the pa rties. NO FORCED ENTRY ALLOWED. 1 2 . THE COURT ORDERS a representative of to accompany to the residence located at to recover her/his personal clothing and necessities. DOMESTIC ABUSE, DATING VIOLENCE ONLY ONLY ORDERS CHECKED AND INITIALED BY A JUDGE SHALL APPLY 1 3 . THE COURT GRANTS TEMPORARY CUSTODY of the following child(ren) or alleged incompetent to the petitioner: (name, date of birth, and relationship to petitioner) American LegalNet, Inc. www.FormsWorkFlow.com Docket No.: Page 4 of 6 LPOR 1 v.11 1 4 . THE COURT ORDERS a representative of to accompany petitioner to where the minor child(ren) or alleged incompetent mentioned in paragraph above is/are currently, and to effect petitioner obtaining physical c ustody of said child(ren) or alleged incompetent. 1 5 . THE DEFENDANT IS ORDERED NOT TO interfere with the physical custody of the minor child(ren) or alleged incompetent. 16 . THE DEFENDANT IS ORDERED TO show cause on the below hearing date why s/he should not be evicted from the solely owned residence or household and the petitioner granted possession. 1 7 . THE DEFENDANT IS ORDERED TO show cause on the below hearing date why s/he should not be ordered to pay child support and/or spousal support (alimony) pursuant to Louisiana Law. The court further orders the defendant to produce at the hearing: most recent income tax returns AND pay stubs or an employer statement documenting gross income to date for the CURRENT year. If the defendant is self - employed, income and expense statements shall be produced. STALKING, SEXUAL ASSAULT ONLY ONLY ORDERS CHECKED AND INITIALED BY A JUDGE SHALL APPLY 18 . THE DEFENDANT IS ORDERED NOT TO contact family members or acquaintances of the protected person(s). DOMESTIC ABUSE, DATING VIOLENCE, STALKING OR SEXUAL ASSAULT ONLY ORDERS CHECKED AND INITIALED BY A JUDGE SHALL APPLY 1 9 . THE DEFENDANT IS ORDERED TO show cause on the below hearing date why s/he should not be ordered to pay the following: all court costs attorney fees evalu