Case No. Court County General Court of Justice District Court Division NORTH CAROLINA PETITIONER/PLAINTIFF First Middle Last DOMESTIC VIOLENCE ORDER OF PROTECTION CONSENT ORDER G.S. 50B-2, -3, -3.1 PETITIONER/PLAINTIFF IDENTIFIERS Date Of Birth Of Petitioner And/or on behalf of minor family member(s): (List Name And DOB) Other Protected Persons/DOB: RESPONDENT/DEFENDANT First Middle Last VERSUS RESPONDENT/DEFENDANT IDENTIFIERS Sex Eyes Race Hair DOB HT WT Relationship to Petitioner: spouse former spouse unmarried, of opposite sex, currently or formerly living together unmarried, have a child in common of opposite sex, currently or formerly in dating relationship current or former household member child parent grandchild grandparent Respondent's/Defendant's Address Social Security Number State Expiration Date Drivers License No. Distinguishing Features CAUTION: Weapon Involved This matter was heard by the undersigned district court judge, the court has jurisdiction over the parties and subject matter, and the Respondent/Defendant has been provided with reasonable notice and opportunity to be heard. Additional findings of this order are set forth on Page 2. THE COURT HEREBY FINDS THAT: THE COURT HEREBY ORDERS THAT: The above named Respondent/Defendant shall not commit any further acts of domestic violence or make any threats of domestic violence (G.S. 50B-1). The above named Respondent/Defendant shall have no contact with the Petitioner/Plaintiff. No contact includes any defendant-initiated contact, except through an attorney, direct or indirect, by means such as telephone, personal contact, email, pager, gift-giving or telefacsimile machine. [05] Additional terms of this order are as set forth on Pages 3 and 4. The terms of this order shall be effective until , WARNINGS TO THE RESPONDENT/DEFENDANT: This order shall be enforced, even without registration, by the courts of any state, the District of Columbia, and any U.S. Territory, and may be enforced by Tribal Lands (18 U.S.C. Section 2265). Crossing state, territorial, or tribal boundaries to violate this order may result in federal imprisonment (18 U.S.C. Section 2262). Federal law makes it a crime for you to possess, transport, ship or receive any firearm or ammunition while this order is in effect even if this order does not prohibit you from possessing firearms. (18 U.S.C. Section 922(g)(8)). This order will be enforced anywhere in North Carolina. Only the Court can change this order. The plaintiff cannot give you permission to violate this order. See additional warnings on Page 4. AOC-CV-306, Page 1 of 4, Rev. 10/13 © 2013 Administrative Office of the Courts (Over) American LegalNet, Inc. www.FormsWorkFlow.com ADDITIONAL FINDINGS 1. 2. Present at the hearing were: the plaintiff, represented by the defendant, represented by As indicated by the check block under Respondent/Defendant's name on Page 1, the parties are or have been in a personal relationship. , the defendant 3. On (date of most recent conduct) attempted to cause intentionally caused bodily injury to the plaintiff a minor child(ren) in the a. custody of the plaintiff the plaintiff a member of the plaintiff's family b. placed in fear of imminent serious bodily injury a member of the plaintiff's household c. placed in fear of continued harassment that rises to such a level as to inflict substantial emotional distress a member of plaintiff's family the plaintiff a member of plaintiff's household d. committed an act defined in G.S. 1427.2 (1st deg. rape) 27.3 (2nd deg. rape) 27.4 (1st deg. sexual off.) 27.5 (2nd deg. sexual off.) 27.5A (sexual battery) 27.7 (sexual activity by substitute parent) against the plaintiff child(ren) living with or in the custody of the plaintiff by (describe defendant's conduct) 4. The defendant is in possession of, owns or has access to firearms, ammunition, and gun permits described below. (Describe all firearms, ammunition, gun permits and give identifying number(s) if known, and indicate where defendant keeps firearms.) 5. The defendant a. threatened to use a deadly weapon against the plaintiff minor child(ren) residing with or used in the custody of the plaintiff use threatened use of violence with a firearm against b. has a pattern of prior conduct involving the persons c. made threats to seriously injure or kill the plaintiff minor child(ren) residing with or in the custody of the p intiff al d. made threats to commit suicide e. inflicted serious injuries upon the in that (state facts) 6. The 7. The defendant defendant plaintiff minor child(ren) residing with or in the custody of the plaintiff plaintiff is presently in possession of the parties' residence at plaintiff is presently in possession of the parties' vehicles described below: 8. Other: (specify) AOC-CV-306, Page 2 of 4, Rev. 10/13 © 2013 Administrative Office of the Courts (Over) American LegalNet, Inc. www.FormsWorkFlow.com Name Of Defendant File No. CONCLUSIONS Based on these facts, the Court makes the following conclusions of law: 1. 2. 3. 4. 5. The defendant has committed acts of domestic violence against the plaintiff. The defendant has committed acts of domestic violence against the minor child(ren) residing with or in the custody of the plaintiff. There is danger of serious and immediate injury to the plaintiff. minor child(ren). [G.S. 50B-2(c)] The defendant's conduct requires that he/she surrender all firearms, ammunition and gun permits. (G.S. 50B-3.1) The plaintiff has failed to prove grounds for issuance of a domestic violence protective order. ORDER It is ORDERED that: 1. the defendant shall not assault, threaten, abuse, follow, harass (by telephone, visiting the home or workplace or other means), or interfere with the plaintiff. A law enforcement officer shall arrest the defendant if the officer has probable cause to believe the defendant has violated this provision. [01] 2. the defendant shall not assault, threaten, abuse, follow, harass (by telephone, visiting the home or workplace or other means), or interfere with the minor child(ren) residing with or in the custody of the plaintiff. A law enforcement officer shall arrest the defendant if the officer has probable cause to believe the defendant has violated this provision. [01] 3. the defendant shall not threaten a member of the plaintiff's family or household. [02] 3a. the defendant shall not cruelly treat or abuse an animal owned, possessed, kept, or held as a pet by either party or minor child resid