Form CC 376M PERSONAL PROTECTION ORDER AGAINST A MINOR (DOMESTIC RELATIONSHIP) Use this form if you filled out Form CC 375M, Petition for Personal Protection Order Against a Minor. American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR COMPLETING "PERSONAL PROTECTION ORDER AGAINST A MINOR" Please print neatly. Press firmly since you are printing on 6 copies. Items A through E must be completed before you give this form to the court clerk. Please read the instructions for each item. Then fill in the correct information for that item on the form. A B C If you checked box H on Form CC 375M, check the box "Ex Parte." Fill in the "Case No." from Form CC 375M. Fill in the "petitioner" and "respondent" the same way you did on Form CC 375M. If you want your address and telephone number to be kept from the respondent, do not write your address here. Put in the address of a relative or friend or a post office box where the court can contact you. Write in the respondent's name and as much of the other information as you know. This information will help the police to identify the respondent if he or she disobeys the restraining order. Be sure to identify the respondent accurately. The race, sex, and date of birth are required for law enforcement to enter an order on the Law Enforcement Information Network (LEIN). Write in the name(s) and address(es) of the respondent's parent(s), guardian(s), or custodian(s). D E The court will complete the rest of this form. NOTE: There are only 6 copies of this form. You will need to make extra copies of this form for each parent, guardian, or custodian of the respondent. You must read the booklet "Instructions for Personal Protection Orders" for directions on the legal process. · · If you asked for an ex parte order (order without a hearing), read pages 3 and 4 of the booklet. If you did not ask for an ex parte order or the judge refuses to sign an ex parte order, read pages 5 and 6 of the booklet. American LegalNet, Inc. www.FormsWorkFlow.com Approved, SCAO Original - Court 1st copy - Law enforcement agency (file)(green) 2nd copy - Respondent (blue) 3rd copy - Petitioner (pink) 4th copy - Return (yellow) 5th copy - Return (goldenrod) STATE OF MICHIGAN PERSONAL PROTECTION ORDER AGAINST JUDICIAL CIRCUIT A MINOR (DOMESTIC RELATIONSHIP) COUNTY A EX PARTE PAGE 1 OF 2 Court address ORI MI- B CASE NO. Court telephone no. C Petitioner's name Address and telephone no. where the court can reach petitioner v Respondent's name, address, and telephone no. D Full name of respondent (type or print)* Height Weight Race* Sex* Date of birth or Age* Hair color Eye color Driver's license number (if known) Other identifying information *These items must be filled in for the police/sheriff to enter on LEIN; the other items are not required but are helpful. E Full name of respondent's parent, guardian, custodian (type or print) Address and telephone no. if different from above Full name of respondent's parent, guardian, custodian (type or print) Address and telephone no. if different from above **Needed for NCIC entry Date: 1. This order is entered THE COURT FINDS: Judge: without a hearing. **after hearing. Bar no. 2. A petition requested respondent be prohibited from entry onto the premises, and either the petitioner has property interest in the premises, or respondent does not have a property interest in the premises. 3. The respondent is less than 18 years of age, is unemancipated, and is not the minor child of the petitioner. 4. The petitioner is less than 18 years of age, is unemancipated, and is not the minor child of the respondent. 5. The petitioner requested an ex parte order, which should be entered without notice because irreparable injury, loss, or damage will result from delay required to give notice or notice itself will precipitate adverse action before an order can be issued. ** 6. The respondent poses a credible threat to the physical safety of the petitioner and/or a child of the petitioner. 7. The respondent **is the spouse or former spouse of the petitioner, had a child in common with the petitioner, or is residing or had resided in the same household as the petitioner. has or had a dating relationship with the petitioner. IT IS ORDERED: 8. Name is prohibited from: a. entering onto property where petitioner lives. b. entering onto property at ** c. assaulting, attacking, beating, molesting, or wounding Name . . d. removing minor children from petitioner who has legal custody, except as allowed by custody or parenting-time order provided removal of the children does not violate other conditions of this order. An existing custody order is dated . An existing parenting-time order is dated (SEE SECOND PAGE) CC 376M (7/16) American LegalNet, Inc. www.FormsWorkFlow.com . PERSONAL PROTECTION ORDER AGAINST A MINOR (Domestic Relationship), Page 1 18 USC 922(g)(8)(c) MCL 600.2950, MCL 712A.2(h), MCR 3.705, MCR 3.706 Approved, SCAO Original - Court 1st copy - Law enforcement agency (file)(green) 2nd copy - Respondent (blue) 3rd copy - Petitioner (pink) 4th copy - Return (yellow) 5th copy - Return (goldenrod) STATE OF MICHIGAN PERSONAL PROTECTION ORDER AGAINST JUDICIAL CIRCUIT A MINOR (DOMESTIC RELATIONSHIP) COUNTY A EX PARTE PAGE 2 OF 2 Court address ORI MIC Petitioner's name B CASE NO. Court telephone no. Respondent's name v IT IS FURTHER ORDERED: 8. (continued from page 1) ** e. stalking as defined under MCL 750.411h and MCL 750.411i, which includes but is not limited to: following or appearing within sight of the petitioner. appearing at workplace/residence of the petitioner. approaching or confronting the petitioner in a public place or on private property. entering onto or remaining on property owned, leased, or occupied by the petitioner. sending mail/other communications to the petitioner. contacting the petitioner by telephone. placing an object on or delivering an object to property owned, leased, or occupied by the petitioner. f. interfering with petitioner's efforts to remove his/her children or personal property from premises solely owned or leased by respondent. ** g. threatening to kill or physically injure Name . ** h. interfering with petitioner at his/her place of employment or education or engaging in conduct that impairs his/her employment or educational relationship or environment. i. having access to information in records concerning a minor child of petitioner and respondent that will reveal petitioner's address, telephone number, or