Form CC 376 PERSONAL PROTECTION ORDER (DOMESTIC RELATIONSHIP) Use this form if you filled out form CC 375, Petition for Personal Protection Order. American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR COMPLETING "PERSONAL PROTECTION ORDER" Please print neatly. Press firmly because you are printing on six copies. Items A through D 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 G on form CC 375, check the box "Ex Parte." Fill in the "Case no." from form CC 375. Fill in the "petitioner" information the same way you did on form CC 375. 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 information 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). D The court will complete the rest of this form. 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. Important: If the respondent violates this personal protection order and is arrested, the court will set a date, time, and place for a hearing on the charges against the respondent to be held within 72 hours after arrest. The court or prosecutor is responsible for giving you notice of this hearing. If you are not notified within 24 hours of the arrest, contact the judge who signed this order. If a hearing is not held within 72 hours, the respondent may be released from jail after posting bond pending the hearing. If the respondent violates this personal protection order and there is no arrest, use form CC 382, Motion and Order to Show Cause for Violating Personal Protection Order. This form is available from the circuit court clerk. American LegalNet, Inc. www.FormsWorkFlow.com Approved, SCAO STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY Court address ORI MIPetitioner's name A Original - Court 1st copy - Law enforcement agency (file) (green) 2nd copy - Respondent (blue) PERSONAL PROTECTION ORDER EX PARTE (DOMESTIC RELATIONSHIP) PAGE 1 OF 2 B 3rd copy - Petitioner (pink) 4th copy - Return (yellow) 5th copy - Return (goldenrod) CASE NO. Court telephone no. C D v Respondent's name, address, telephone no., and DLN Address and telephone no. where court can reach petitioner D Height Weight Race* Sex* Date of birth or age* Hair color Eye color Other identifying information **Needed for NCIC entry *These items must be filled in for the police/sheriff to enter on LEIN; the other items are not required but are helpful. Date: 1. This order is entered Judge: without a hearing. **after hearing. Bar no. THE COURT FINDS: 2. A petition requested respondent be prohibited from entry onto the premises, and either the parties are married, petitioner has a property interest in the premises, or respondent does not have a property interest in the premises. 3. Petitioner requested an ex parte order, which should be entered without notice because irreparable injury, loss, or damage will result from the delay required to give notice or notice itself will precipitate adverse action before the order can be issued. ** 4. Respondent poses a credible threat to the physical safety of the petitioner and/or a child of the petitioner. 5. 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: 6. 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 ** e. stalking as defined under MCL 750.411h and MCL 750.411i that includes but is not limited to: following petitioner or appearing within his/her sight. appearing at petitioner's workplace or residence. sending mail or other communications to petitioner. contacting petitioner by telephone. approaching or confronting petitioner in a public place or on private property. entering onto or remaining on property owned, leased, or occupied by petitioner. placing an object on or delivering an object to property owned, leased, or occupied by petitioner. (SEE SECOND PAGE) MCL 600.2950, MCR 3.705, MCR 3.706, 18 USC 922(g)(8)(c) American LegalNet, Inc. www.FormsWorkFlow.com . CC 376 (7/16) PERSONAL PROTECTION ORDER (Domestic Relationship) , Page 1 Approved, SCAO STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY Court address ORI MIPetitioner's name A Original - Court 1st copy - Law enforcement agency (file) (green) 2nd copy - Respondent (blue) PERSONAL PROTECTION ORDER EX PARTE (DOMESTIC RELATIONSHIP) PAGE 2 OF 2 B 3rd copy - Petitioner (pink) 4th copy - Return (yellow) 5th copy - Return (goldenrod) CASE NO. Court telephone no. Respondent's name C v IT IS ORDERED: 6. (continued) f. interfering with petitioner's efforts to remove his/her children/personal property from premises solely owned/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 employment address or that will reveal the child's address or telephone number. j. intentionally causing petitioner mental distress or exerting control over petitioner by: injuring, killin