STATE OF MAINE DISTRICT COURT Location Docket No. Plaintiff: individually and on behalf of: ORDER FOR PROTECTION FROM ABUSE on behalf of: (19-A M.R.S.A. §§ 4007) v. Defendant: on behalf of: After due notice and opportunity for full hearing Protection from Abuse, the following parties being present: full hearing on the merits of the Complaint for Plaintiff Defendant, THE COURT FINDS THAT: (only checked boxes apply) (1)The parties are family or household members; (2)The plaintiff was abused by the defendant; (3)The defendant presents a credible threat to the physical safety of the plaintiff/minor child(ren); (4)The parties have agreed to the following Order, which is made without findings of abuse. THEREFORE, it is hereby ORDERED that: (A-1) The defendant is prohibited from threatening, assaulting, molesting, attacking, harassing or otherwise abusing the plaintiff and any minor child(ren) residing in the household. (A-2) The defendant is prohibited from the use, attempted use or threatened use of physical force that would reasonably be expected to cause bodily injury against the plaintiff or a minor child residing in the household. (B) The defendant is prohibited from having any contact, direct or indirect with plaintiff Except contact permitted in paragraphs I and/or O below. Except . (C) The defendant is prohibited from going upon the premises of the plaintiff’s residence. (D) The defendant is restrained from, repeatedly and without reasonable cause, following the plaintiff. (E) The defendant is restrained from, repeatedly and without reasonable cause, being at or in the vicinity of the plaintiff's home, school, business or place of employment. (F) The defendant is prohibited from possession of a firearm or other dangerous weapon. (G)The plaintiff is granted possession of and the defendant is excluded forthwith and prohibited from entering the residence at (H)The parties' personal property and household goods are divided as follows: and the following order for protection of property is entered: (I) The plaintiff is awarded temporary parental rights and responsibilities (custody) of minor child(ren), whose names and dates of birth are as follows: The defendant's rights of contact are limited as follows: VIOLATION OF AN ORDER CONTAINED IN PARAGRAPHS (A) THROUGH (I) IS ALWAYS A CLASS D, AND SOMETIMES A CLASS C CRIME. POSSESSION OF A FIREARM OR AMMUNITION WHILE THIS ORDER IS IN EFFECT IS PROHIBITED UNDER FEDERAL AND/OR STATE LAW IF ANY ONE OR MORE OF THE FOLLOWING BOXES HAVE BEEN CHECKED: A-1, A-2, OR F. PA-009, Rev. 07/03 Page 1 See second page for additional orders. American LegalNet, Inc. www.USCourtForms.com It is further ORDERED AS FOLLOWS: (only checked boxes apply) (J) The defendant shall pay child support pursuant to the attached child support order. (K)The defendant receive counselling from a social worker, family service agency, mental health center, or psychiatric or other guidance service, as follows: (L) The defendant pay the sum of $ per (week) (month) toward the support of the plaintiff, first payment due . (M)The defendant is prohibited from interfering with or destroying plaintiff’s property. (N)The parties' personal property and household goods are further divided as follows: and the following order for protection of property is entered: (O) : The defendant's rights of contact are limited as follows: (P) It is further ORDERED: (Q) See the attached additional sheet(s) which are incorporated herein by reference. MONEY JUDGMENT ORDERS (R) The defendant pay to the plaintiff, the sum of $ forthwith, as monetary compensation for losses suffered as a direct result of the abuse, execution to issue. (S) The (defendant) (plaintiff) pay to the sum of $ as counsel fees; the sum of $ as court costs. Payment is to be made within ____________________ days, execution to issue. (T) No child support order is issued at this time (but will be issued as soon as the parties file a child support affidavit, to be filed no later than ________________)(because there is a pre-existing child support order). WARNING: VIOLATION OF PARAGRAPHS “J” THROUGH “T” MAY BE CONTEMPT OF COURT. THESE PARAGRAPHS ARE ALSO ENFORCEABLE AS A CIVIL JUDGMENT WARNING TO THE DEFENDANT: AS LONG AS THIS ORDER IS IN EFFECT, YOU MUST OBEY IT. NO ONE, INCLUDING THE PLAINTIFF, CAN GIVE YOU PERMISSION TO VIOLATE THE PROVISIONS OF THIS ORDER. This order is effective forthwith and shall remain in full force and effect until , unless earlier modified or vacated by order of court or, with respect to Child Support or Parental Rights and Responsibilities, by a Case Management Officer. It is ORDERED that a copy of this Order be served in hand on the defendant by the following law enforcement agency: _____. Copies of this order shall be furnished by the clerk to the law enforcement agency with jurisdiction in the location of the plaintiff's residence. This Order is incorporated into the docket by reference pursuant to M.R.Civ.P 79(a). Date: ____________________ Judge, District Court A true copy, attest: ____________________________________ (Deputy) Clerk ***************************************************************************** On ______________________________, I made service of the Order for Protection from Abuse by delivering a copy in hand to the defendant at Defendant’s date of birth ___________________________________ Authorized Officer PA-009, Rev. 07/03 Page 2 American LegalNet, Inc. www.USCourtForms.com