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Extended Order For Protection Against Domestic Violence Form. This is a Nevada form and can be use in District Court Statewide.
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Tags: Extended Order For Protection Against Domestic Violence, Nevada Statewide, District Court
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Case No. _____________
Dept. No _____________
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IN THE JUSTICE COURT OF _________________________ TOWNSHIP
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COUNTY OF ___________________________, STATE OF NEVADA
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_________________________________,
Applicant,
EXTENDED ORDER FOR
PROTECTION AGAINST
DOMESTIC VIOLENCE
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vs.
Date Issued: ___________
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_________________________________,
Adverse Party.
Date Expires: ___________
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VIOLATION OF THIS ORDER IS A CRIME
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YOU, THE ADVERSE PARTY, ARE NOTIFIED THAT YOU CAN BE ARRESTED
even if the person who obtained this Order invites or allows you to contact him or her. You have
the sole responsibility to avoid or refrain from violating the terms of this Order. Only the Court can
change this Order upon written application.
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YOU ARE FURTHER NOTIFIED THAT IF YOU ARE ARRESTED FOR VIOLATING
THIS ORDER, you will not be admitted to bail sooner than 12 hours after your arrest if: (1) the
arresting officer determines that the violation is accompanied by a direct or indirect threat of harm;
or (2) you have previously violated a temporary or extended order for protection of the type for
which you have been arrested; or (3) at the time of the violation or within 2 hours after the
violation, you have: (a) a concentration of alcohol of 0.08 or more in your blood or breath; or (b)
an amount of a prohibited substance in your blood or urine that is equal to or greater than the
amount set forth in subsection 3 of NRS 484.379.
YOU ARE FURTHER NOTIFIED that child stealing/kidnapping is a felony.
THIS ORDER is valid and enforceable throughout the State of Nevada. This Order meets
all Full Faith and Credit provisions of the Violence Against Women Act, and is enforceable in
all 50 states, the District of Columbia, U.S. Territories, and Indian Nations. All other courts
and law enforcement agencies with jurisdiction within the United States and all Indian
Nations shall give full faith and credit to this Order pursuant to 18 U.S.C. § 2265.
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Possession, shipment, transportation, or receipt of a firearm or ammunition while this
Order is in effect may constitute a felony under federal law 18 USC § 922(g)(8), and is
punishable by a fine of up to $250,000 and/or a prison sentence of up to ten (10) years.
Further, if prohibited by this Order, possession, custody, or control of a firearm while this
Order is in effect is a gross misdemeanor under NRS Chapter 33.
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The Court having considered the filings, testimony, and any evidence presented at hearing, and the
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Court having found that the above-named Adverse Party received actual notice of hearing at which such
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person had an opportunity to participate, and the Adverse Party
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represented by counsel, __________________________________, and the above-named Applicant
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was present
was not present
was present
was not present
was
was represented by counsel, ________________________________,
and the Court having jurisdiction over the parties and this matter pursuant to NRS 33.010, et seq., and it
appearing to the satisfaction of the Court from specific facts shown that an act of domestic violence has
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occurred, there exists a threat of domestic violence, and/or you represent a credible threat to the physical
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safety of the Applicant or the minor child(ren), the Court enters this Order, and as a result:
YOU ARE PROHIBITED, either directly or through an agent, from threatening, physically
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injuring, or harassing the Applicant and/or the minor child(ren). YOU ARE FURTHER
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PROHIBITED from selling, damaging, destroying, giving away, or otherwise disposing of, or
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tampering with, any property owned by the Applicant, or in which the Applicant has an interest;
YOU ARE PROHIBITED from any contact whatsoever with the Applicant, but not
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limited to, in person, by telephone, through the mail, through electronic mail (e-mail), facsimile, or
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through another person.
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1. _____
Applicant’s residence located in
__________________, County, Nevada,
CONFIDENTIAL, or at:
______________________________________________, _________________________________,
(Street)
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YOU ARE EXCLUDED AND ORDERED to stay at least 100 yards away from
(City)
or any other place that Applicant may reside. YOU shall not interfere with Applicant’s possession and
use of the residence, including utilities, phones, leases, and other related residential services;
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2. _____
The Court, having jurisdiction under and meeting the requirements of Chapter 125A
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of the Nevada Revised Statutes (UCCJA), grants to the Applicant temporary custody of the following
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minor child(ren) of the parties: ____________________________________________________________
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_____________________________________________________________________________________
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____________________________________________________________________________________;
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YOU ARE PROHIBITED from interfering with the Applicant’s custody of the minor child(ren)
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named in this paragraph. It is in the best interest of the child(ren) that no negative, insulting, or
disparaging comments be made by one party against the other party in the presence of the minor
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child(ren).
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3. _____
YOU ARE GRANTED visitation with the minor child(ren): ___________________
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____________________________________________________________________________________,
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under the following terms and conditions: ___________________________________________________
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_____________________________________________________________________________________
_____________________________________________________________________________________
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____________________________________________________________________________________.
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4. _____
YOU ARE ORDERED to pay support and maintenance of the minor child(ren) as
set forth in the attached Child Support Addendum.
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5. _____
YOU ARE ORDERED to pay the rent or make payments on a mortgage on the
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Applicant’s place of residence or pay towards the support and maintenance of the Applicant, as follows:
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____________________________________________________________________________________
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____________________________________________________________________________________
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____________________________________________________________________________________
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____________________________________________________________________________________.
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6. _____
Custody, visitation, and support of the minor child(ren) of the parties shall remain as
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ordered in the Decree of Divorce/Order entered between the parties in Case Number ________________
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in the ______________________________________ Court of the State of _______________________.
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7. ______ YOU ARE EXCLUDED AND ORDERED to stay at least 100 yards away from
the minor child(ren)’s school(s), or day care, including, but not limited to, the places listed below:
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CONFIDENTIAL
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(a) Name of School______________________________________________________________
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Address_______________________________________________________________________
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City________________________________County ___________________ Nevada.
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(b) Name of School______________________________________________________________
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Address_______________________________________________________________________
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City______________________________County ______________________Nevada.
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(c) Name of School______________________________________________________________
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Address________________________________________________________________________
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City______________________________County ______________________ Nevada.
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6. ________ YOU ARE EXCLUDED AND ORDERED to stay at least 100 yards away from
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these place(s) of employment or any other place that Applicant may be employed. YOU ARE
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PROHIBITED from any contact whatsoever with these place(s) of employment in person, by telephone,
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by mail, or any other means of communication.
CONFIDENTIAL
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(a) Name_________________________________Address_______________________________
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City________________________________County ____________________ Nevada.
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(b) Name________________________________Address_______________________________
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City______________________________County ______________________Nevada.
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(c) Name_________________________________Address_______________________________
City______________________________County ____________________ Nevada.
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9.
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YOU ARE EXCLUDED AND ORDERED to stay at least 100 yards away from
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the following places frequented regularly by Applicant and/or the minor child(ren):
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(a) Name_________________________________Address_______________________________
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City_______________________________County ____________________ Nevada.
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(b) Name_________________________________Address______________________________
City_______________________________County ____________________ Nevada.
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(c) Name_________________________________Address_______________________________
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City_______________________________County ____________________ Nevada.
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(d) Name_________________________________Address______________________________
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City_______________________________County ____________________ Nevada.
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10. (a) ______ YOU ARE PROHIBITED, either directly or through an agent, from physically
injuring or threatening to injure any animal that is owned or kept by the Applicant, the minor
child(ren), or YOU.
(b)______ YOU ARE PROHIBITED, either directly or through an agent, from taking
possession of any animal owned or kept by the Applicant or the minor child(ren).
(c) ______The arrangements for the possession and care of any animal(s) referenced above
are as follows:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________.
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11. ______ YOU ARE ORDERED to comply with the attached Firearms Addendum.
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12. ______The following provisions and exceptions are made a part of this Order:____________
____________________________________________________________________________________
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____________________________________________________________________________________
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____________________________________________________________________________________
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____________________________________________________________________________________
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____________________________________________________________________________________
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____________________________________________________________________________________
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____________________________________________________________________________________
____________________________________________________________________________________
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____________________________________________________________________________________
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____________________________________________________________________________________
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____________________________________________________________________________________
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____________________________________________________________________________________
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____________________________________________________________________________________.
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THIS ORDER WILL REMAIN IN EFFECT UNTIL 11:59 P.M. ON THE DATE SET
FORTH ON PAGE 1 UNLESS THIS COURT ORDERS OTHERWISE.
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The Adverse Party is ordered to pay all previously deferred court costs and fees of
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$ _______________ payable to ______________________________ by ________________________.
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(date)
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Pursuant to NRS 33.030(2) the Adverse Party is ordered to pay $_______________ to
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Applicant by _________________________.
(date)
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ORDER TO LAW ENFORCEMENT
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A. Any law enforcement officer who has probable cause to believe a violation of any provision of
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this Order has occurred is ordered to arrest the Adverse Party. Such party is to be charged with a criminal
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violation of this Order in addition to any other criminal charges which may be justified.
B. If such law enforcement officer cannot verify that the Adverse Party was served with a copy of
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this Application and Order, the officer shall inform the Adverse Party of the following: (1) the specific
terms of this Order; (2) that the Adverse Party now has notice of the provisions of this Order; (3) that a
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violation of this Order will result in the Adverse Party’s arrest; and (4) the location of the Court that
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issued the original Order and the hours during which the Adverse Party can obtain a copy of the Order.
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The law enforcement officer shall then provide written proof of notice to the officer’s agency and to the
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Court.
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Dated: _______________
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____________________________________
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Judge/Hearing Master
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CHILD SUPPORT ADDENDUM
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______ YOU ARE ORDERED to pay the amount of $ ____________ for the support and maintenance of
the minor child(ren): __________________________________________________________________________.
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Payments shall commence on _____________________________ and be paid on the ____________day of each
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month while this Order remains in effect. Arrears have not been addressed in this Order. If the Applicant wishes to
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have the payments made through the District Attorney’s office, the Applicant may seek relief from the local
District Attorney’s office. NOTICE: PAYMENT OF SUPPORT IS TO BE AS PROVIDED HEREIN, AND THE
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GIVING OF GIFTS, OR THE PURCHASES OF FOOD, CLOTHING, AND THE LIKE WILL NOT FULFILL
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THE OBLIGATION.
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A.
Adverse Party’s (Obligor’s) gross monthly income $ ___________: formula amount: __________ %
equals $__________ per
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month,
other ________________________. The basis for deviation
from the State formula is as follows: ___________________________________________________
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_________________________________________________________________________________
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_________________________________________________________________________________.
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B.
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Withholding of income for the payment of the support must be carried out immediately, or
The Court finding good cause: _____________________________________________________
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withholding of income shall be postponed until such time as the Adverse Party (Obligor) becomes 30
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days delinquent under this Order. Payments shall be made directly to the Applicant by mail, at the
following address: __________________________________________________________________
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_________________________________________________________________________________,
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unless a court order states otherwise.
C.
The Adverse Party (Obligor) shall provide health insurance coverage for the minor child(ren), if
available, through an employer at a reasonable cost, and shall provide all necessary
assistance to enable Applicant to obtain the medical benefits for the minor child(ren).
The Adverse Party (Obligor) shall pay $_____________________ per month for a medical
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insurance premium, payable to _______________________________________________________.
The Adverse Party shall provide proof of medical insurance coverage including a medical
identification card and FIVE claim forms, if necessary, to the Applicant by mail, at the
following address: _________________________________________________________________,
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within ______________ days of today’s date, ___________________________________________.
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Both the Applicant and the Adverse Party shall split equally all medical expenses not covered by
medical insurance.
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FIREARMS ADDENDUM
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Any violation of the following is a gross misdemeanor under Nevada law (NRS 33.031).
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The Court has considered, among other factors: (1) whether you have a documented history of domestic
violence; (2) whether you have used or threatened to use a firearm to injure or harass the Applicant, a
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minor child, or any other person; (3) whether you have used a firearm in the commission or attempted
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commission of any crime, and: ___________________________________________________________
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____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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Pursuant to Nevada Revised Statutes Chapter 33, THIS COURT ORDERS the following:
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YOU ARE PROHIBITED from possessing or having under your custody or control any firearm
while this Order is in effect.
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Within 24 hours after service of this Order you shall:
surrender
sell
transfer
all firearms in your possession or under your custody or control to:
____________________________________________________________________________________
(transferee)
You must contact law enforcement before approaching a law enforcement officer or law
enforcement facility with firearm(s).
Not later than 72 hours or 1 business day, whichever is later, after the surrender, sale, or transfer
of such firearm(s), you shall provide a receipt to the Court from the transferee. The receipt shall include
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the name and address of the transferee and a written description of each such firearm.
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Other ____________________________________________________________________________
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____________________________________________________________________________________
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____________________________________________________________________________________
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____________________________________________________________________________________.
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Firearms Addendum No. 1
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FIREARMS ADDENDUM
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Any violation of the following is a gross misdemeanor under Nevada law (NRS 33.031).
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This Court has considered, among other factors: (1) whether you have a documented history of domestic
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violence; (2) whether you have used or threatened to use a firearm to injure or harass the Applicant, a
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minor child(ren), or any other person; (3) whether you have used a firearm in the commission or
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attempted commission of any crime, and:
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____________________________________________________________________________________
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____________________________________________________________________________________
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____________________________________________________________________________________.
Pursuant to Nevada Revised Statutes Chapter 33, THIS COURT ORDERS the following:
YOU ARE PROHIBITED from possessing or having under your custody or control any firearm
while this Order is in effect.
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Within 24 hours after service of this Order you shall:
surrender
sell
transfer
all firearms in your possession or under your custody or control to
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________________________________________________________________________________
(transferee)
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You must contact law enforcement before approaching a law enforcement officer or law
enforcement facility with firearm(s).
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Not later than 72 hours or 1 business day, whichever is later, after the surrender, sale, or transfer of
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such firearm(s), you shall provide a receipt to the Court from the transferee. The receipt shall include the
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name and address of the transferee and a written description of each such firearm.
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YOU ARE GRANTED a limited employment exception from the prohibition noted above
because you have established that:
(1) the possession or use of a firearm(s) is an integral part of your employment with:
Name of Employer_________________________________________________________
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Firearms Addendum No. 2
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Employer’s Representative__________________________________________________
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Employer’s Address_______________________________________________________
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Employer’s County, City, State______________________________________________
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Employer’s Telephone Number______________________________________________
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AND
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(2) your employer agrees to store/safeguard your firearm(s) when you are not working, and
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sufficient proof to that effect has been provided to the Court. The firearm(s) that you may possess while
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you are working is/are: (for example: make, model, caliber, serial number, etc.)
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____________________________________________________________________________________________
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____________________________________________________________________________________________
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____________________________________________________________________________________________
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____________________________________________________________________________________________
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___________________________________________________________________________________________.
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Other:____________________________________________________________________________________
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____________________________________________________________________________________________
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____________________________________________________________________________________________
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___________________________________________________________________________________________.
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Firearms Addendum No. 2
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