1 2 Case No. ____________________ Dept. No. ____________________ 3 4 5 IN THE JUSTICE COURT OF _____________ TOWNSHIP COUNTY OF __________________, STATE OF NEVADA 6 7 8 9 10 EXTENDED ORDER FOR PROTECTION AGAINST STALKING, AGGRAVATED STALKING, OR HARASSMENT (NRS 200.591) _______________________________________ ) Applicant,) ) vs. ) ) _______________________________________ ) Adverse Party.) Date Issued: ____________________ Expiration Date: _________________ 11 12 13 14 15 16 17 18 19 20 21 22 23 24 YOU, THE ADVERSE PARTY, ARE HEREBY NOTIFIED THAT ANY INTENTIONAL VIOLATION OF THIS ORDER IS A CRIMINAL VIOLATION and can result in your immediate arrest or issuance of an arrest warrant. Unless a more severe penalty is prescribed by law for the act that constitutes the violation of the order, a violation of an Extended Order for Protection Against Stalking, Aggravated Stalking or Harassment is a category C felony which is punishable by imprisonment in the state prison for not more than five (5) years, and a fine of not more than $10,000.00. PURSUANT TO NRS 193.166, if the act that constitutes the violation of a protection order is itself a felony, the violator shall, in addition to the term of imprisonment prescribed by statute for the crime, be punished by imprisonment in the state prison for a minimum term of not less than 1 year and a maximum term of not more than 20 years. YOU ARE FURTHER NOTIFIED that you CAN BE ARRESTED even if the person who obtained the 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 the order upon written application. WARNING: Possession of a firearm or ammunition while this order is in effect may constitute a felony under federal law punishable by a fine of up to $250,000 and/or a prison sentence of up to ten (10) years. This order meets the 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 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. Sec. 2265. Violation of the order may subject you to federal charges and punishment pursuant to 18 U.S.C. Sec. 2261(a)(1) and (2) and 2262(a)(1) and (2). 25 ©2007 Nevada Supreme Court Revised July 27, 2007 Form A-16 Extended Order for Protection Against Stalking, Aggravated Stalking or Harassment (NRS 200.591) Page 1 of 4 American LegalNet, Inc. www.FormsWorkflow.com 1 The Court having considered the filings, testimony (if applicable) and evidence 2 presented at hearing, and the Court having found that the Adverse Party received notice of 3 hearing at which such person had an opportunity to participate, and the Adverse Party 4 present, 5 6 7 8 9 ͕was ͕was not present, ͕was represented by counsel ________________________ _______________________________________________________________________ and the above-named Applicant(s) ͕was present, ͕was not present, ͕was represented by counsel ________________________, and the Court having proper jurisdiction over the parties and this subject matter, and ͕ it appearing to the satisfaction of the Court that the Adverse Party has committed 10 and/or is committing or remains a threat to commit stalking, aggravated stalking, or 11 harassment, and an Extended Order is warranted 12 or 13 ͕ based upon the stipulation of the parties, 14 The Court enters an Extended Order, and as a result: 15 YOU ARE PROHIBITED, either directly or through an agent, from contacting, 16 intimidating, using, attempting to use, or threatening the use of physical force, or otherwise 17 interfering in any way with the Applicant and/or the following persons: ________________ 18 __________________________________________________________________________ 19 including, but not limited to, in person, by telephone, through the mail, through electronic 20 mail (e-mail), facsimile (fax), or through another person; 21 22 1. ͕ YOU ARE ORDERED to stay away from the following places: ͕ Residence(s) ______________________________________ _________________________________________________ 23 24 25 ͕ Place(s) of Employment (Name & Address):_____________ _________________________________________________ ©2007 Nevada Supreme Court Revised July 27, 2007 Form A-16 Extended Order for Protection Against Stalking, Aggravated Stalking or Harassment (NRS 200.591) Page 2 of 4 1 ͕ 2 ___________________________________________________ 3 ͕ 4 5 School(s) (Name & Address): __________________________ Other Locations Frequented (Name & Address): ___________ ___________________________________________________ 2. ͕ YOU ARE FURTHER ORDERED:________________________________ 6 ____________________________________________________________________________ 7 ____________________________________________________________________________ 8 3. 9 _______________________________________________________________ 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 On the issue of costs and official fees, the Court orders as follows: _______________________________________________________________ 4. THIS ORDER WILL REMAIN IN EFFECT UNTIL 11:59 P.M. ON THE DATE SET FORTH ON PAGE 1 UNLESS THE COURT ORDERS OTHERWISE. 5. YOU ARE HEREBY 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: (a) The arresting officer determines that such a violation is accompanied by a direct or indirect threat of harm; (b) You have previously violated a temporary or extended order for protection; or (c) At the time of the violation or within 2 hours after the violation, you have: (1) A concentration of alcohol of 0.08 or more in your blood or breath; or (2) 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. 6. IT IS FURTHER ORDERED that the Clerk of the Court shall transmit a copy of this Order together with the application, to the _____________________ County Sheriff’s Office and/or the _________________ Constable and/or any other appropriate law enforcement agency. 7. IT IS FURTHER ORDERED that said law enforcement agency will promptly attempt to serve this Order upon the Adverse Party, without charge to the Applicant, and upon ©2007 Nevada Supreme Court Revised July 27, 2007 Form A-16 Extended Order for Protection Against Stalking, Aggravated Stalking or Harassment (NRS 200.591) Page 3 of 4 1 service file a return of service with the Court by the end of the next business day after service 2 is made. 3 4 NOTICE TO LAW ENFORCEMENT Any law enforcement officer, with or without a warrant, may arrest and take into 5 custody the Adverse Party, when the law enforcement officer has probable cause to 6 believe that (a) an Order has been issued pursuant to NRS 200.591 against the Adverse 7 Party; (b) the Adverse Party has been served with a copy of the Order; and (c) the 8 Adverse Party is acting or has acted in violation of the Order. This arrest may occur 9 regardless of whether the violation occurred in the officer’s presence. 10 11 Any law enforcement agency in this state may enforce a Court Order issued pursuant to NRS 200.591, without regard to the county in which the Order is issued. 12 13 IT IS SO ORDERED this ________ day of ______________, 20_____. 14 _________________________________ JUDGE 15 16 17 18 PROOF OF SERVICE UPON ADVERSE PARTY 19 I, the undersigned, personally served the Adverse Party above named with a copy of 20 this Extended Order for Protection Against Stalking, Aggravated Stalking or Harassment on 21 the date set forth below. ______________________________ Signature 22 23 ______________________________ Print Name 24 25 ______________________________ Date of Service ©2007 Nevada Supreme Court Revised July 27, 2007 Form A-16 Extended Order for Protection Against Stalking, Aggravated Stalking or Harassment (NRS 200.591) Page 4 of 4