IN THE COURT COUNTY, OHIO Order of Protection Case No. Per ORC 2919.26(G)(2), this order is indexed at Judge/Magistrate LAW ENFORCEMENT AGENCY WHERE INDEXED ( ) County - State OHIO . PHONE NUMBER CRIMINAL TEMPORARY PROTECTION ORDER (TPO) (R.C. 2919.26) STATE OF OHIO/CITY OF v. New Order Modification of Previous Order DEFENDANT ALLEGED VICTIM: First Middle PERSON(S) PROTECTED BY THIS ORDER: Alleged Victim: DOB: Last Alleged Victim’s Family or Household Member(s): DOB: DOB: DOB: DOB: DEFENDANT: SEX EYES First Middle HAIR WT DATE OF BIRTH Last DRIVERS LIC NO. & EXP. DATE Address where Defendant can be found: FIREARMS ACCESS – PROCEED WITH CAUTION Ex Parte TPO Granted: TPO Granted: DEFENDANT IDENTIFIERS RACE HT STATE Distinguishing Features: Date Issued Date Issued (Violence Against Women Act, 18 U.S.C. 2265, Federal Full Faith & Credit Declaration: Registration of this form is not required for enforcement.) THE COURT HEREBY FINDS: That it has jurisdiction over the parties and subject matter, and the Defendant has been or will be provided with reasonable notice and opportunity to be heard within the time required by Ohio law. Additional findings of this order are set forth below. THE COURT HEREBY ORDERS: That the above named Defendant be restrained from committing acts of abuse or threats of abuse against the Alleged Victim and other protected persons named in this order, as set forth below. Additional terms of this order are set forth below. WARNINGS TO DEFENDANT: See the warnings page attached to the front of this Order. FORM 10.02-A CRIMINAL TEMPORARY PROTECTION ORDER (TPO) REVISED 9/1/04 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkflow.com [Side 2 of Form 10.02-A] Case # ___________________________ (Temporary) (Ex Parte) , Upon a hearing held on OR , the Court finds that the motion for a Temporary Protection Order is well taken. The Court finds that the safety and protection of protected persons named in this Order may be impaired by the continued presence of Defendant. Therefore, the following orders, which are designed to ensure the safety and protection of protected persons named in this Order, are issued to Defendant as pretrial conditions of release in addition to any bail set under Criminal Rule 46. ALL OF THE PROVISIONS CHECKED BELOW APPLY TO THE DEFENDANT 1. DEFENDANT SHALL NOT ABUSE protected persons named in this order by harming, attempting to harm, threatening, molesting, following, stalking, bothering, harassing, annoying, or forcing sexual relations upon them. [NCIC 01 and 02] 2. DEFENDANT SHALL NOT ENTER the residence, school, business, place of employment, or day care centers of the protected persons named in this Order, including the buildings, grounds and parking lots at those locations. [NCIC 04] 3. DEFENDANT SHALL NOT INTERFERE with protected persons' right to occupy any residence by canceling utilities or insurance and interrupting phone service, mail delivery, or the delivery of any other documents or items. [NCIC 03] 4. DEFENDANT SHALL SURRENDER all keys and garage door openers to the following residence: at the earliest possible opportunity after of service of this Order to the law enforcement agency that serves Defendant with this Order or as follows: 5. DEFENDANT SHALL STAY AWAY FROM PROTECTED PERSONS NAMED IN THIS ORDER and shall not be (distance) of protected persons, wherever protected persons may be present within 500 feet or found, or any place the Defendant knows or should know the protected persons are likely to be, even with protected persons' permission. If Defendant accidentally comes in contact with protected persons in any public or private place, Defendant must depart immediately. This order includes, encounters on public and private roads, highways, and thoroughfares. [NCIC 04] 6. DEFENDANT SHALL NOT INITIATE OR HAVE ANY CONTACT with the protected persons named in this Order or their residences, businesses, places of employment, schools, day care centers, or babysitters. Contact includes, but is not limited to, telephone, fax, e-mail, voice mail, delivery service, writing, or communications by any other means in person or through another person. [NCIC 05] 7. DEFENDANT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY PROPERTY OR PETS owned or possessed by the protected persons named in this Order. 8. DEFENDANT SHALL NOT CAUSE OR ENCOURAGE ANY OTHER PERSON to do any act prohibited by this order. 9. DEFENDANT SHALL NOT POSSESS, USE, CARRY, OR OBTAIN ANY DEADLY WEAPON. Defendant shall turn over all deadly weapons in Defendant’s possession to the law enforcement agency that serves Defendant with this Order as follows: Any law enforcement agency is authorized to take possession of deadly weapons pursuant to this paragraph and hold them in protective custody until further Court order. [NCIC 07] 10. DEFENDANT MAY PICK UP CLOTHING and personal items from the following residence: only in the company of a uniformed law enforcement officer within 7 days of the filing of this Order or the date of Defendant’s release on bond in connection with this charge, whichever is later. Arrangements may be made by contacting: 11. DEFENDANT SHALL NOT CONSUME, USE, OR POSSESS illegal drugs or beverages containing alcohol. FORM 10.02-A CRIMINAL TEMPORARY PROTECTION ORDER (TPO) REVISED 9/1/04 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkflow.com [Side 3 of Form 10.02-A] Case # ___________________________ 12. IT IS FURTHER ORDERED: 13. DEFENDANT IS ADVISED THAT VISITATION ORDERS DO NOT PERMIT DEFENDANT TO VIOLATE ANY OF THE TERMS OF THIS ORDER. 14. IT IS FURTHER ORDERED that a copy of this Order shall be delivered to Defendant on the same day that the Order is entered. 15. THIS ORDER REMAINS IN EFFECT: (1) until modified by this court; or (2) until the criminal proceeding arising out of the complaint upon which these orders were issued is disposed by this court or by the common pleas court to which the defendant is bound over for prosecution; or (3) until a court issues a Civil Protection Order (CPO) arising out of the same activities as those that were the basis of the complaint filed in this action. IT IS SO ORDERED. JUDGE/MAGISTRATE – DATE OF EX PARTE TPO JUDGE/MAGISTRATE – DATE OF TPO NOTICE TO DEFENDANT: THE PERSONS PROTECTED BY THIS ORDER CANNOT GIVE YOU LEGAL PERMISSION TO CHANGE OR VIOLATE THIS ORDER. IF YOU VIOLATE ANY TERMS OF THIS ORDER EVEN WITH THE PROTECTED PERSON’S PERMISSION, YOU MAY BE ARRESTED. ONLY THE COURT CAN CHANGE THIS ORDER. IF THERE IS ANY REASON WHY THIS ORDER SHOULD BE CHANGED, YOU MUST ASK THE COURT TO CHANGE IT. YOU ACT AT YOUR OWN RISK IF YOU DISREGARD THIS WARNING. A HEARING on this order shall be held before Judge TO THE CLERK: COPIES OF THIS ORDER SHALL BE DELIVERED TO: or Magistrate on , at a.m./p.m., (the next court day) at the following location: Prosecutor Alleged Victim Defendant (by personal service) Attorney for Defendant Police Department Where Alleged Victim Resides: Police Department Where Alleged Victim Works: The Other County Sheriff Service acknowledged: Defendant Signature Date WAIVER OF HEARING I HAVE BEEN ADVISED OF MY RIGHT TO HAVE A HEARING ON THE MOTION FOR A CRIMINAL PROTECTION ORDER AND HEREBY KNOWINGLY AND VOLUNTARILY WAIVE THE HEARING ON THE MOTION AND AGREE TO BE BOUND BY THE TERMS OF THIS ORDER. DEFENDANT: FORM 10.02-A CRIMINAL TEMPORARY PROTECTION ORDER (TPO) DATE: REVISED 9/1/04 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkflow.com