Extended Order for Protection Against Harassment in the Workplace State of Nevada NRS 33.270 Case No. ________________________________ Dept. No. ________________________________ Court ___________________________________ County __________________________________ EMPLOYER/NAME OF BUSINESS First Middle Last V. ADVERSE PARTY SEX Middle DOB EYES First RACE WT HAIR DISTINGUISHING FEATURES VEHICLE STATE TAG # Last Adverse Party’s Home Address and Phone Number: __________________________________________________ __________________________________________________ CAUTION: HT ACCESS TO WEAPONS MAKE/MODEL/ COLOR OTHER: ________________________ THE COURT HEREBY FINDS: That is has jurisdiction over the parties and subject matter, and the Adverse Party received actual notice of hearing at which such person had an opportunity to participate and be heard. THE COURT HEREBY ORDERS: That the Adverse Party be prohibited from committing further unlawful acts of harassment in the workplace. Additional terms of this order are as set forth on the following pages. The terms of this order shall expire at 11:59 p.m. on unless otherwise ordered by the Court. (month) (date) (year) 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). Form B-24 Extended Order for Protection Against Harassment in the Workplace Cover Sheet ©2007 Nevada Supreme Court June 30, 2007