Case No. _____________________ Dept. No._____________________ 1 2 IN THE JUSTICE COURT OF _____________ TOWNSHIP 3 COUNTY OF_______________________________________, STATE OF NEVADA 4 5 _______________________________________, ) Applicant, ) TEMPORARY PROTECTION ORDER ______ STALKING/HARASSMENT NRS.200.591 10  AGGRAVATED STALKING NRS 200.591  HARASSMENT NRS 200.591 SEXUAL ASSAULT NRS 200.378 11 Date Issued: ____________________ 12 Expiration Date: _________________ 6 7 8 9 ) ) ) vs. ) ) _____________________________________ ) Adverse Party. ) 13 14 15 16 17 YOU, THE ADVERSE PARTY, ARE HEREBY NOTIFIED THAT ANY INTENTIONAL VIOLATION OF THIS ORDER IS A CRIME 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 a Temporary Order for Protection --- Sexual Assault is a gross misdemeanor which is punishable by imprisonment in the county jail for not more than one (1) year, or by a fine of not more than $2,000, or both. 18 19 20 YOU ARE FURTHER NOTIFIED, 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. 21 22 23 24 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. 25 26 27 28 YOU ARE FURTHER NOTIFIED, this order may meet the Full Faith and Credit provisions of the Violence Against Women Act and may be enforceable in all 50 states, the District of Columbia, U.S. Territories and Indian Nations 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). 1 of 6 Temporary Protection Order © 2010 Nevada Supreme Court American LegalNet, Inc. www.FormsWorkFlow.com 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 2 (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 484C.110. 3 4 5 6 7 8 An Application for a Temporary Protection Order has been filed by the above-named 9 10 Applicant and reviewed by the Court. The Court has jurisdiction over the parties and the subject 11 matter, and good cause appearing, YOU ARE HEREBY ORDERED as follows: 12 13 1. YOU ARE PROHIBITED, either directly or indirectly, or through an agent, from contacting, intimidating, threatening, or otherwise interfering in any way with the Applicant and/or 14 the following persons: 15 16 _________________________________________________________________________________ 17 _________________________________________________________________________________ 18 _________________________________________________________________________________ 19 _________________________________________________________________________________ 20 including, but not limited to, in person, by telephone, through the mail, through electronic mail 21 (e-mail), text messaging, or facsimile (fax). 22 23 24 25 2. YOU ARE ORDERED to stay away from the following places: Residence(s): ________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 26 27 _________________________________________________________________________________ _________________________________________________________________________________ 28 2 of 6 Temporary Protection Order © 2010 Nevada Supreme Court American LegalNet, Inc. www.FormsWorkFlow.com 1 Place(s) of Employment (Name & Address): ______________________________________ 2 _________________________________________________________________________________ 3 _________________________________________________________________________________ 4 _________________________________________________________________________________ 5 _________________________________________________________________________________ 6 School(s) (Name & Address): __________________________________________________ 7 8 _________________________________________________________________________________ 9 _________________________________________________________________________________ 10 _________________________________________________________________________________ 11 __________________________________________________________________________________________ 12 Other Locations (Name & Address): _____________________________________________ 13 14 _________________________________________________________________________________ 15 _________________________________________________________________________________ 16 _________________________________________________________________________________ 17 _________________________________________________________________________________ 18 19 20 21 22 23 24 25 26 27 28 3. YOU ARE FURTHER ORDERED: ___________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 3 of 6 Temporary Protection Order © 2010 Nevada Supreme Court American LegalNet, Inc. www.FormsWorkFlow.com 1 4. If an application for an Extended Order is filed within the effective period of this Temporary 2 Order, this Temporary Order will remain in effect until the hearing on an Extended Order is held. 3 4 5 5. UNLESS LATER MODIFIED BY THE COURT, THIS ORDER WILL REMAIN IN EFFECT:  6 UNTIL 11:59 P.M. ON THE DATE SET FORTH ON PAGE 1 7  8 9 10 11  12 FOR 30 DAYS AFTER THIS ORDER IS SERVED. IF THIS ORDER IS NOT SERVED WITHIN 30 DAYS OF THE ISSUANCE DATE NOTED ON PAGE 1 OF THIS ORDER, THE ORDER WILL EXPIRE BY ITS OWN TERMS, AND A NEW APPLICATION FOR AN ORDER MUST BE FILED IF PROTECTION IS NEEDED. UNTIL THE HEARING ON THE EXTENDED ORDER HAS BEEN 13 HELD. A hearing on the issuance of an Extended Order is set in Department _______ 14  A.M.  P.M. on the _______________ day of 15 at: _______________ 16 ____________________________, 20_____. YOU and YOUR witnesses may 17 approach and enter the Courthouse to attend the hearing but must stay away from 18 Applicant, any other person named in this Order, and the Applicant’s witnesses while 19 approaching, leaving, and within the Courthouse. 20 21 6. IT IS FURTHER ORDERED that the Clerk of the Court shall transmit a copy of this Order 22 together with the Application, to the _______________________________ County 23 Sheriff’s Office and/or the Constable and/or any other appropriate law enforcement agency. 24 25 7. IT IS FURTHER ORDERED that said law enforcement agency will promptly attempt to 26 serve this Order and the Application upon the Adverse Party, without charge to the Applicant, and 27 upon service, shall file a Return of Service form with the Court by the end of the next business day. 28 4 of 6 Temporary Protection Order © 2010 Nevada Supreme Court American LegalNet, Inc. www.FormsWorkFlow.com NOTICE TO LAW ENFORCEMENT 1 2 3 4 5 Any law enforcement officer, with or without a warrant, may arrest and take into custody the Adverse Party, when the law enforcement officer has probable cause to believe that (a) a Protection Order---Sexual Assault has been issued pursuant to NRS 200.378 against the Adverse Party; (b) the Adverse Party has been served with a copy of the Order; and (c) the Adverse Party is acting or has 6 acted in violation of the Order. This arrest may occur regardless of whether the violation occurred in 7 the officer’s presence. 8 Any law enforcement agency in this state may enforce a Protection Order issued 9 10 11 pursuant to the Nevada Revised Statutes, without regard to the county in which the Order is issued. 12 13 IT IS SO ORDERED this ________ day of ________________, 20__________. 14 15 _______________________________________ JUDGE 16 17 18 19 20 21 22 23 24 25 26 27 28 5 of 6 Temporary Protection Order © 2010 Nevada Supreme Court American LegalNet, Inc. www.FormsWorkFlow.com PROOF OF SERVICE UPON ADVERSE PARTY 1 2 3 I, the undersigned, personally served the Adverse Party named above with a copy of this Temporary 4 Order for Protection on the date set forth below. 5 ________________________________ Place of Service ______________________________ Signature _______________________________ Date of Service ________________________________ Print Name 6 7 8 9 _______________________________ Manner of Service 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Applicant ________________________________________________________________________ 26 Adverse Party ____________________________________________________________________ 27 Court/Case Number _______________________________________________________________ 28 6 of 6 Temporary Protection Order American LegalNet, Inc. www.FormsWorkFlow.com © 2010 Nevada Supreme Court