1 Case No.___________________ Dept. No ________________ 2 IN THE JUSTICE COURT OF _________________________TOWNSHIP 3 COUNTY OF ___________________________, STATE OF NEVADA 4 5 _________________________________, TEMPORARY ORDER FOR PROTECTION AGAINST DOMESTIC VIOLENCE Applicant, 6 vs. Date Issued: _________________ 7 _________________________________, 8 Adverse Party. Date Expires: _________________ 9 10 VIOLATION OF THIS ORDER IS A CRIME 11 YOU, THE ADVERSE PARTY, IS NOTIFIED THAT YOU CAN BE ARRESTED even if the person who obtained this Order invites or allows you to contact them. 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. 12 13 14 15 16 17 18 19 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. 20 21 22 23 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. 24 An Application and Affidavit having been filed in this Court by the above-named Applicant 25 requesting that a Temporary Order for Protection against Domestic Violence be issued by this Court 26 against YOU, the above-named Adverse Party, or the Court having received specific facts by 27 telephone/facsimile pursuant to NRS 33.020(5), and the Court having jurisdiction over the parties and 28 this matter pursuant to NRS 33.010, et seq., and it appearing to the satisfaction of the Court from specific 1 American LegalNet, Inc. www.FormsWorkflow.com 1 facts shown by a verified Application that an act of domestic violence has occurred, there exists a threat 2 of domestic violence, and/or you represent a credible threat to the physical safety of the Applicant or the 3 minor child(ren) and good cause appearing for issuing such Order without hearing, YOU ARE 4 HEREBY ORDERED as follows: YOU ARE PROHIBITED, either directly or through an agent, from threatening, physically 5 injuring, or harassing the Applicant and/or the minor child(ren). YOU ARE FURTHER 6 PROHIBITED from selling, damaging, destroying, giving away, or otherwise disposing of, or 7 tampering with, any property owned by the Applicant, or in which Applicant has an interest; YOU ARE PROHIBITED from any contact whatsoever with the Applicant, including but 8 9 10 not limited to, in person, by telephone, through the mail, through electronic mail (e-mail), facsimile, or through another person. 11 1. _____ 12 13 14 15 YOU ARE EXCLUDED AND ORDERED to stay at least 100 yards away from Applicant’s residence located in ________________County, Nevada, CONFIDENTIAL, OR at ____________________________________________________________________________, (Street Address) _______________________________, or any other place that Applicant may reside. YOU shall (City) (State) not interfere with Applicant’s possession and use of the residence, including utilities, phones, leases and 16 17 18 19 20 21 22 other related residential services; 2. _____ A law enforcement officer, within whose jurisdiction __________________________ (Applicant’s or Adverse Party’s) residence is located, shall on ONE OCCASION ONLY accompany _____________________________ (Applicant or Adverse Party) to the residence of _____________________ located at _______________________________________, (Applicant/Adverse Party) (Street Address) 23 24 _______________________, _________________and shall stand by while________________________ (City) (County) (Applicant/Adverse Party) 25 obtains clothing, toiletries, and the following additional items: 26 ____________________________________________________________________________________ 27 ____________________________________________________________________________________ 28 ____________________________________________________________________________________ 2 American LegalNet, Inc. www.FormsWorkflow.com 1 ____________________________________________________________________________________ 2 ____________________________________________________________________________________ 3 ANY PROPERTY IN DISPUTE SHALL REMAIN IN THE RESIDENCE UNLESS IT IS 4 SPECIFICALLY IDENTIFIED IN THIS ORDER. 5 6 3. _______ The Court, having jurisdiction under and meeting the requirements of Chapter 125A 7 of the Nevada Revised Statutes (UCCJA), grants to Applicant temporary custody of the following minor 8 child(ren) of the parties: 9 10 ____________________________________________________________________________________ 11 ____________________________________________________________________________________ 12 ____________________________________________________________________________________. 13 YOU ARE PROHIBITED from interfering with Applicant’s custody of the minor child(ren) named in 14 this paragraph. It is in the best interest of the child(ren) that no negative, insulting, or disparaging 15 comments be made by one party against the other party in the presence of the minor child(ren); 16 17 18 4. _______ Custody, visitation, and support of the minor child(ren) of the parties shall remain as 19 ordered in the Decree of Divorce/Order entered between the parties in Case Number ______________ in 20 the____________________________________Court of the State of __________________________; 21 22 23 24 5. _______ 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: CONFIDENTIAL. 25 (a) Name of School______________________________________________________________ 26 Address_______________________________________________________________________ 27 City________________________________County ___________________ Nevada. 28 3 American LegalNet, Inc. www.FormsWorkflow.com 1 (b) Name of School______________________________________________________________ 2 Address_______________________________________________________________________ 3 City______________________________County ______________________Nevada. 4 5 6 (c) Name of School______________________________________________________________ 7 Address________________________________________________________________________ 8 City______________________________County ______________________ Nevada. 9 10 6. ________ YOU ARE EXCLUDED AND ORDERED to stay at least 100 yards away from 11 these place(s) of employment or any other place that Applicant may be employed. YOU ARE 12 PROHIBITED from any contact whatsoever with these place(s) of employment in person, by telephone, by mail, or any other means of communication. 13 CONFIDENTIAL. 14 15 (a) Name_________________________________Address_______________________________ 16 City________________________________County ____________________ Nevada. 17 18 (b) Name________________________________Address_______________________________ 19 City______________________________County ______________________Nevada. 20 21 22 (c) Name_________________________________Address_______________________________ 23 City______________________________County ____________________ Nevada. 24 25 26 7. ________ YOU ARE EXCLUDED AND ORDERED to stay at least 100 yards away from the following places frequented regularly by Applicant and/or the minor child(ren): 27 (a) Name_________________________________Address_______________________________ 28 City________________________________County ____________________ Nevada. 4 American LegalNet, Inc. www.FormsWorkflow.com 1 (b) Name________________________________Address_______________________________ 2 City_______________________________County ____________________ Nevada. 3 4 (c) Name_________________________________Address_______________________________ 5 6 City_______________________________County ____________________ Nevada. 7 8 8. (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 9 child(ren), or YOU. 10 11 12 (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). 13 9. ________ The following provisions and exceptions are made a part of this Order: ____________________________________________________________________________________ 14 ____________________________________________________________________________________ 15 ____________________________________________________________________________________ 16 ____________________________________________________________________________________ 17 ____________________________________________________________________________________ 18 ____________________________________________________________________________________ 19 20 ____________________________________________________________________________________ 21 ____________________________________________________________________________________ 22 ____________________________________________________________________________________ 23 ____________________________________________________________________________________ 24 THIS ORDER WILL REMAIN IN EFFECT UNTIL 11:59 P.M. ON THE DATE SET 25 FORTH ON PAGE 1 UNLESS THIS COURT ORDERS OTHERWISE. If an Application for an 26 27 28 Extended Order is filed, this Temporary Order will remain in effect until the hearing on an Extended Order is held. 5 American LegalNet, Inc. www.FormsWorkflow.com 1 If you wish to dispute this Order or have it changed, you may request a hearing by filing a written 2 request with this Court. Court staff will give you information about how to file your request. The Court 3 will set a hearing on your request as quickly as possible. 4 IT IS FURTHER ORDERED that a copy of this Order shall be transmitted forthwith together 5 6 with the verified Application and supporting Affidavit, to the _________________ Sheriff’s Office, or 7 the __________________Constable, who will promptly attempt to serve the same upon the Adverse 8 Party, and upon service, file a Return of Service form with the Court by the end of the next business day 9 after service is made. 10 ORDER TO LAW ENFORCEMENT 11 (A) Any law enforcement officer who has probable cause to believe a violation of any provision 12 of this Order has occurred is ordered to arrest the Adverse Party. Such party is to be charged with a 13 criminal violation of this Order, in addition to any other criminal charges that may be justified. 14 15 (B) If such law enforcement officer cannot verify that the Adverse Party was served with a copy of the 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 16 violation of this Order will result in the Adverse Party’s arrest; (4) the location of the Court that issued 17 the original Order and the hours during which the Adverse Party can obtain a copy of this Order; and (5) 18 the date and time set for a hearing on an Application for an Extended Order, if any. The law enforcement 19 officer shall then provide written proof of notice to the officer’s agency and to the Court. 20 21 (C) It shall be the duty of the law enforcement officer serving this Order to remove the Adverse Party from Applicant’s residence as set forth in paragraph 1 of this Order. 22 23 All fees are deferred. 24 25 Dated: ___________________ 26 27 ______________________________________________________________ Judge/Hearing Master 28 6 American LegalNet, Inc. www.FormsWorkflow.com