COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. ORDER OF PROTECTION INSTRUCTIONS : Calendar No. THE ORDER OF PROTECTION FORM MUST BE EXAMINED AND ATTESTED TO : JUDICIAL SUBPOENA Plaintiff(s) BY A JUDGE FOR THE ORDER TO BE VALID. -against- 1. : Temporary Order – Check this box if the order is temporary. Temporary order generally : refers to an order issued by the Judge without prior notice to the Respondent and is effective until the 20-day hearing. : 2. Permanent Order – Check this box if the respondent received notice and an opportunity Defendant(s) : . . . . . . .to . participate. . .Permanent .orders . are. .issued .after. .the 20-day hearing. Permanent orders . .......... ......... ..... .. ..... ... .. may have an ending date or be effective indefinitely. 3. Order effective until OF NEW YORK THE PEOPLE OF THE STATE– Indicate date the order will expire. Temporary orders may use the 20-day hearing date as the expiration date. TO 4. Amended Order. If this order of protection is changed/modified by the court in any way, a new face sheet should be prepared and attached, and the amended order box should be checked. Any time an order of protection is changed in any way, a new face sheet GREETINGS:be prepared and the amended box must be checked must WE COMMAND Order of all business dissolved being Court, a you face sheet you attend 5. Dissolved – If the YOU, thatProtection isand excusesby the laid aside,new and each of should be before , the Honorable and attached, indicating the date the order was dissolved. at the Court prepared located at County of in6. roomCase No. –on the a case or of , Enter day docket number. , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the 7. Court – List the name of the Court issuing the Order (e.g. Lewis & Clark County Justice Court; Fort Belknap Tribal Court) Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalfthe issuing state (Montana). a maximum penalty of $50 and all damages sustained as a 8. State - Name of this subpoena was issued for result of your failure to comply. 9. Tribal – If the Order of Protection is being issued by a Montana Tribal Court, the Tribal Witness, Honorable , blank. Court should indicate its jurisdiction. If not a Tribal Court, leaveone of the Justices of the Court in County, day of , 20 10. Blank space left for official Court Seal, if applicable. 11. Petitioner Name – Indicate the first, middle and (Attorney mustof the person requesting the last name sign above and type name below) order of protection. 12. Minor family member(s) – Indicate the: Attorney(s) for a. The first and last name of each minor family member. b. The birth date of each minor family member (mm/dd/yyyy) c. The sex (F/M) of each minor family member. d. The race (Caucasian, Native American, Black, Hispanic). Office and P.O. Address 13. Petitioner Identifiers: a. Indicate petitioner’s date of birth (mm/dd/yyyy). Telephone No.: b. Indicate petitioner’s race (Caucasian, Native American, Black, Hispanic) and sex Facsimile No.: (F/M). 1 E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. 14. Other protected Person(s) (i.e. other family members or witnesses) – Indicate the: : JUDICIAL SUBPOENA a. Protected person’s first, middle and last name. Plaintiff(s) b. Protected person’s date of birth (mm/dd/yyyy). : -againstc. Protected person’s race (Caucasian, Native American, Black, Hispanic). d. Protected person’s sex (F/M). : 15. Respondent’s Name – Indicate the first, middle and last name of the person who will : be served with this order of protection. Defendant(s) : ...................................................... 16. Respondent’s address – Indicate the respondent’s address including apartment/unit numbers. Do Not use a post office box address, use the address of the actual location where the respondent lives. THE PEOPLE OF THE STATE OF NEW YORK 17. TO Federal Firearm Disqualification Criteria: If any one element describing each section (indicated by □) applies, then the section (indicated by □) must be checked. The Brady disqualification will attach ONLY on permanent orders of protection and only if all four criteria (Hearing, Child/intimate partner, Order restrains, Order finds GREETINGS: a credible threat) are met and checked. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before The Brady disqualifier will never attachthe a Temporary Order of protection because , the Honorable at on Court hearing County the temporary order located at is exparte (only the petitioner is heard) and the of received notice , nor had the opportunity to participate in a in roomrespondent has not day of , on the 20 , at o'clock in the noon, and at any recessed hearing. The maximum evidence of boxes that can be checked are 3, therefore Brady or adjourned date, to testify and give number as a witness in this action on the part of the will not attach. a. Hearing/actual notice – Check this box if the respondent received actual notice and Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to an opportunity to participate. the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. b. Child/Intimate partner – Check this box if the petitioner (person requesting the order of protection) is a Child, Stepchild or intimate partner of the respondent. The Witness, Honorable , one of the Justices of the petitioner is an intimate partner of the respondent if any of the following apply. Court in County, day of , 20 • A spouse or former spouse of the respondent • An individual who is a parent of a child of the respondent; or • An individual who cohabitates or has cohabited with the respondent. (Attorney must sign above and type name below) c. Order restrains respondent from future conduct – Check this box if this order restrains the respondent from harassing, stalking, or threatening the intimate partner, Attorney(s) for child of the respondent, or child of the respondent’s intimate partner; or the order restrains the respondent from engaging in other conduct that would place the intimate partner in reasonable fear of bodily injury to the partner or child. d. Order finds a credible threat – Check this Office and P.O. Address box if the order includes a finding that the respondent is a credible threat to the physical safety of the intimate partner or child; or the order, by its terms, explicitly prohibits the use, attempted use, or threatened use of physical force against the intimate No.: Telephone partner or child that would reasonably be expected to cause bodily injury.Facsimile No.: 2 E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : 18. Index No. Caution – This information is vital for the safety and protection of all parties including law : Calendar No. enforcement officers. The Caution indicator is not related to the Brady disqualifier and may be used whether or not the Brady criteria are met. : JUDICIAL act of violence. a. Weapon involved – Check this box if a weapon was involved in theSUBPOENA Plaintiff(s) b. Weapon on-againstProperty – Check this box if the respondent has a weapon on the : property, regardless of whether it was used in the act of violence. : 19. Respondent identifiers: (Please provide as much information as possible) a. Sex – Indicate (F) for female and (M) for male. : b. Race – Indicate Caucasian, Native American, Black, or Hispanic. Defendant(s) : . . . . . . . . c.. . .DOB .– Indicate .date. of birth .(mm/dd/yyyy). . . . .... ......... ... ....... ............. d. HT – Indicate approximate height in feet and inches, such as 5′ 10″. e. WT – Indicate approximate weight in pounds. f. Eyes – Indicate eye color (brown, blue, hazel) THE PEOPLE OF THE STATE OF color (brown, blonde, red, black) g. Hair – Indicate hair NEW YORK h. Social Security # - Indicate the nine digit social security number (xxx-xx-xxxx) TO i. Drivers License# - Indicate the drivers license number. j. State – Indicate the name of the state that issued the drivers license. k. Exp Date – Indicate the date that the drivers license will expire (mm/dd/yyyy) l. Vehicle Make/Model - Indicate the make and model of the respondent’s vehicle GREETINGS: (Example Ford, Explorer). m. COMMAND YOU, that all of the vehicle. WE Color – Indicate the colorbusiness and excuses being laid aside, you and each of you attend before n. the vehicle license plates and the plate number. , the HonorablePlate # - Indicate the state issuing at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or20. Distinguishing Features evidence as a any scars,this action birthmarks of the adjourned date, to testify and give – Describe witness in tattoos, on the part or other identifying features. 21. The Court Hereby Orders – Check each box (□) that applies. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to a. Check this box if the respondent is prohibited from committing acts of abuse or the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your threats to comply. failure of abuse. b. Check this box if the respondent is ordered to stay a minimum number of feet away from the petitioner’s person, home, workplace, vehicle, children’s school/daycare or Witness, Honorable , one of the Justices of the other. If this box is checked, you must fill in the number of feet and place a check (√) Court in County, day of , 20 or an (X) before the areas that apply (person, home, workplace, etc.) c. Additional terms of this order are as set forth herein. – Check this box if you have circled any item 1 through 12 on pages 2 and 3 of a standard Order of Protection (Attorney must sign above and Form or if the protection order is part of a District Court document. type name below) 22. Date Issued – Indicate the date the Order was Issued/Amended/Dissolved. Attorney(s) for 23. Signature – The District Judge/Justice of the Peace/Municipal Judge/ City Judge who issued the Order should sign. 24. The Court Finds [The Court shall continue to either fill out the Findings on Pages 2 and 3 Office and P.O. Address or may attach their own court document]. For example: attach the cover sheet to a Dissolution. If completing pages 2 and 3, circle the appropriate ordersTelephone No.: numbered 1 through 12 Facsimile No.: 1. If number one is circled and other people E-Mail Address: the petitioner are being in addition to protected, the judge must list the names of theMobile Tel. No.: to be protected. people that are 3 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. 2. If number two is circled, the judge must list the names of the family members. : Calendar 3a. Circle 3a if the petitioner’s location should remain confidential.No. 3b. If number 3b is circled, the judge must indicate the petitioner’s address. : JUDICIAL SUBPOENA 4. If number four is circled, the judge must note the distance from petitioner the Plaintiff(s) respondent must remain at all times. The judge: must also note the specific places in -againstwhich this condition is in effect; this includes addresses of schools for minor children. 5. If number five is circled, the judge must indicate the names of the people that the : respondent in prohibited from communicating with. 6. If six is circled, indicate the name of the child or children the respondent is prohibited : from taking out of the county. Defendant(s) : . . . . . . . . 7. . .Circle .7, .if .the. respondent. . . . . . or .threatened. the petitioner with a firearm. Or if the . . . . . . . . . . . . . . . . . . . . used . . . . . . . . . . . . respondent is prohibited from owning, possessing and/or purchasing a firearm. 8. Circle 8, if the respondent is prohibited from taking, hiding, selling, damaging or disposing of the petitioner’s property. THE PEOPLE OF THE STATE OF NEW YORK must indicate which items the petitioner will have 9. If number 9 is circled, the judge possession or use of. TO 10. Circle 10, if the court orders a peace officer to accompany the petitioner or the respondent when picking up property described in number 9 above. 11. Allows the court to order other conditions, not specifically set forth above, as it deems necessary. GREETINGS: 12. As in question 11 above, question 12 allows the court to order other conditions, not WE specifically set forth above, as it deems necessary. laid aside, you and each of you attend before COMMAND YOU, that all business and excuses being , the Honorable at the Court 25. of located at CountyA hearing on Petitioner’s request – Indicate the date of the hearing mm/dd/yyyy; the time or of address,and location of the the inof the hearing including a.m.day p.m.; and the , 20 room , on the at o'clock in courtroom. and at any recessed noon, or adjourned date, to testify and give evidence as a witness in this action on the part of the 26. This Order of Protection – Indicate the date of expiration of the order of protection. This date must agree with the date in questions number 3 on page 1. Your failure to comply 27. The Sheriff is hereby with this subpoena is punishable as the name and addresswill make law liable to directed to serve - Indicate a contempt of court and of the you the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a enforcement agencies that will receive a copy of this order of protection together with a copy of result of your failure to comply. the proof of service. Witness, Honorable , one of the Justices of the 28. Issued this – The judge should indicate the day, month, year and hour including a.m. or p.m. Court in order was issued. The judge must sign the20 County, day of , order of protection. that this 29. Sheriff’s Return – This is the notice of service. The law enforcement officer delivering a (Attorney this form. The law enforcement copy of the order of protection to the respondent must complete must sign above and type name below) officer should indicate the time of day including a.m. or p.m., the month, day and year of service. Date this proof of service document with the month, day and year of service and sign the proof Attorney(s) for of service document. ** Please Note that all Instructions in red are mandatory reporting fields. Office and P.O. Address 4 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case No: : Order of Protection Index No. Temporary Order : Court: ______________ No. Calendar Permanent Order ____________________ Order Effective Until _________________ : JUDICIAL Plaintiff(s) Amended Order State: Dissolved ____________________________ -against: Tribal: SUBPOENA : : PETITIONER PETITIONER IDENTIFIERS Defendant(s) : ...................................................... First Middle Last And/or on behalf of minor family member(s): (list name, date THE PEOPLE OF THE STATE OF NEW YORK of birth, sex and race): Date of Birth of Petitioner Race/Sex Other Protected Person(s): (list name, date of birth, race and sex): TO GREETINGS: RESPONDENT SEX RESPONDENT IDENTIFIERS RACE DOB HT WT WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the at the Court First Honorable Middle Last Respondent’s Address: _________________________ located at County of in room , on the day of , 20 EYES HAIR , at o'clock in the noon, and at any recessed SOCIAL SECURITY # Federal Firearm Disqualification Criteria: or adjourned date, to with opportunity to participate witness in this action on the part of the testify and give evidence as a Hearing/actual notice Child or Intimate Partner (married/divorced/common DRIVERS LICENSE# STATE EXP child/cohabitates or has cohabitated) DATE Order restrains Respondent from harassing, stalking, Your failure conduct that creates or threatening, or other to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf thisto Petitioner(s) issued for a maximum penalty of $50 and all damages sustained as a reasonable fear of bodily injury subpoena was VEH. MAKE/MODEL COLOR PLATE# result of your failure threat or prohibits use, Order finds a credible to comply. attempted use, or threatened use of physical force CAUTION:Witness, Honorable Weapon Involved County, Weapon onof Court in day Property , one Distinguishing Features: of the Justices of the , 20 THE COURT HEREBY FINDS: (Attorney must sign danger type name below) That it has jurisdiction over the parties and subject matter, and that the Petitioner is inabove andof immediate harm. The Court acts without notice to the Respondent (temporary order) or Respondent has been provided with reasonable notice and opportunity to be heard (permanent order). Additional findings of this order are set forth herein or attached hereto. Attorney(s) for THE COURT HEREBY ORDERS: That the above named Respondent be restrained from committing further acts of abuse or threats of abuse. That the above named Respondent shall stay at least ____________________ feet away from Petitioner’s __ person, __ home, __ workplace, __ vehicle, __ children’s school/daycare, __ other: __________________ Additional terms of this order are as set forth herein: Office and P.O. Address Date Issued: _____________________ WARNINGS TO RESPONDENT: By:_____________________________ Judge/Justice Telephone No.: 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 on Tribal Lands (18 U.S.C. Section 2265). Crossing state, territorial,Facsimile No.: or tribal boundaries to violate this order may result in federal imprisonment (18 U.S.C. Section 2262). E-Mail Address: Federal law provides penalties for possessing, transporting, shipping or receiving any firearm or ammunition Mobile Tel. No.: (18 U.S.C. Section 922(g)(8)). Only the Court can change this order. American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. FINDINGS : Index No. : THE COURT FINDS from the Petition that the Petitioner is in danger of harm. This Court Calendar No. acts without notice or upon hearing to the Respondent because harm may result to the Petitioner if : the Order of Protection is not issued immediately. JUDICIAL SUBPOENA Plaintiff(s) 1. -against: Respondent is restrained from assaulting, threatening, abusing, harassing, following, or stalking the Petitioner. Respondent must not harass, annoy, or disturb Petitioner’s : peace or do any of those things to the following people (may include family members, witnesses to the offense, or other victims of the offense): : ___________________________________________________________________ Defendant(s) ___________________________________________________________________. : ...................................................... 2. Respondent must not threaten to commit or commit acts of violence against Petitioner or against these family members: ___________________________________________________________________ THE PEOPLE OF THE STATE OF NEW YORK ___________________________________________________________________. TO 3. The following applies to Petitioner’s present residence: a. Petitioner’s current location is a secret and should remain confidential. GREETINGS: -OR- WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court b. Respondent must stay away from Petitioner’s residence at: located at County of ________________________________________________________________ in room , on the day of , 20 , at o'clock in the noon, and at any recessed ________________________________________________________________. or adjourned date, to testify and give evidence as a witness in this action on the part of the 4. Respondent must stay 1500 feet or other appropriate distance (______ feet) away from Petitioner’s ____person, ____home, ____workplace, ____school, ____vehicle, Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to ____children’s school/daycare, ____other: _______________________________ the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a _________________________________________________________________. result of your failure to comply. 5. Respondent must not telephone, email, write, contact, or otherwise communicate, Witness, Honorable , one of the following people directly or indirectly or through a third party with Petitioner or the Justices of the Court in (may include family members, witnesses to the offense, or other victims of the County, day of , 20 offense): ________________________________________________________________ ________________________________________________________________. (Attorney must sign above and type name below) 6. Respondent must not take the following child(ren) out of this county: ________________________________________________________________. Attorney(s) for 7. Respondent used or threatened Petitioner with a firearm. Respondent is prohibited from owning, possessing and/or purchasing a firearm. 8. Respondent must not take, hide, sell, damage or dispose of Petitioner’s property. 9. Respondent must give Petitioner possession or use of the following items (items may Telephone No.: include the residence, automobile, and other essential personal property regardless Facsimile No.: of ownership): ______________________________________________________ E-Mail Address: __________________________________________________________________. Office and P.O. Address Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : 10. Index No. Petitioner needs a peace officer to accompany him/her to pick up the property listed in Number 9, or Respondent must be accompaniedCalendar No. officer when picking by a peace : up his/her property or to accompany respondent to pick up his/her belongings. 11. Plaintiff(s) The Court orders the following to provide for Petitioner’s safety and welfare and -against: Petitioner’s family’s safety and welfare: _________________________________________________________________ : _________________________________________________________________. : JUDICIAL SUBPOENA : Other relief: _______________________________________________ __________________________________________________________________ Defendant(s) : . . . . . . . . . .__________________________________________________________________. ............................................ 12. A hearing on Petitioner’s request that this order be made an Order of Protection for a specific time THE STATE permanently will THE PEOPLE OF or effective OF NEW YORK be held before this Court on ________________________________, 200__, at the hour of ______.m, or as soon TOthereafter as the matter may be heard, in the courtroom at ________________________________________________________________. This Order of Protection shall continue in full force and effect until GREETINGS: _________________________________________. WE COMMAND YOU, that all business and excuses violation of this and each law Petitioner: You should immediately report any being laid aside, you order toof you attend before , the enforcement. You also have the rightat the Honorable Court to return to court to report any violation of this order. located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed Respondent: testify fail to evidence as witness in this action on the part of the or adjourned date, toIf you and giveappear forathe hearing the judge will make a decision about the order of protection in your absence. This decision could affect your ability to own or possess firearms. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to WARNING the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. may be a criminal offense under applicable Federal or Tribal Violation of this Order law and is a criminal offense under Mont. Code Ann. § 45-5-220 or § 45-5-626 and may , jail sentence. carryWitness, Honorable to $10,000 in fines and up to a 5 year one of the Justices of the penalties of up Court in County, day of , 20 This Order is issued by the Court and the Respondent is forbidden to do any act listed in the Order, even if invited by the Petitioner or another person. This Order may be amended only by further order of this Court or another court that assumes (Attorney must sign above and type name below) jurisdiction over this matter. The Sheriff is hereby directed to serve, without cost to Petitioner, a copy of this Order of Protection together with a copy of Petitioner’s petition upon Respondent and to file a return Attorney(s) for of service with the clerk of this court. This service will be as soon as possible and before the date of the hearing. Upon receipt of proof of this Order, the clerk is hereby directed to mail or otherwise promptly deliver a copy of this Order, together with a copy of the proof of service, to the following law enforcement agencies: _________________________________________________________________________ Office and P.O. Address _________________________________________________________________________ ____________________________________________________ ISSUED this ___________day of _________________,______, at the hour of Telephone No.: ________.m. Facsimile No.: _____________________________ Judge/Justice E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Plaintiff(s) -against- Calendar No. : JUDICIAL SUBPOENA : SHERIFF’S RETURN : : I served this Order of Protection on the Respondent by delivering a copy to him/her at _____.m., on ____________________, 200___. Defendant(s) : ...................................................... Dated this _____day of _________________, 200___. _____________________________ THE PEOPLE OF THE STATE OF NEW YORK TO GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com