FORM 10.01-O: MOTION FOR CONTEMPT OF A DOMESTIC VIOLENCE CIVIL PROTECTION ORDER IN THE COURT OF COMMON PLEAS _______________________________ COUNTY, OHIO Petitioner : Case No. : Address : Judge : City, State, Zip Code : MOTION FOR CONTEMPT OF A DOMESTIC VIOLENCE CIVIL PROTECTION ORDER : Notice: Throughout this form, check every applies v. that : Respondent : Address : DO NOT WRITE YOUR ADDRESS ON THIS FORM IF YOU ARE REQUESTING CONFIDENTIALITY. PLEASE PROVIDE AN ADDRESS WHERE YOU CAN RECEIVE NOTICES FROM THE COURT. : City, State, Zip Code Petitioner Respondent moves this Court to find in contempt of this Court’s Civil Protection Order dated for the reasons below. For any item that needs additional explanation, you may use paragraph 18 and/or attach additional pages as needed. 1. Respondent violated the Civil Protection Order by engaging in one or more of the following acts against me and/or another protected person: Harmed or attempted to harm Threatened Followed Stalked Harassed Forced sexual relations upon Committed a sexually oriented offense Other 2. Respondent failed to vacate the residence at 3. Respondent interfered with the exclusive possession of the residence located at Furthermore, Respondent interfered with my right to occupy the residence by Canceling utilities Canceling insurance Interrupted telephone service Interrupted mail delivery Interrupted delivery of any other documents or items FORM 10.01-O: MOTION FOR CONTEMPT OF A DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Effective Date: July 1, 2010 American LegalNet, Inc. www.FormsWorkFlow.com [Page 2 of Form 10.01-O] Case No.________________________ 4. Respondent failed to surrender keys and/or garage door openers to the residence for which exclusive use was ordered in the Civil Protection Order. 5. Respondent entered or interfered with the residence, school, business, place or employment, day care center, or child care provider of the protected persons. 6. Respondent violated the stay away provision of the Civil Protection Order. 7. Respondent violated the no contact provision of the Civil Protection Order. 8. Respondent failed to surrender the keys to the motor vehicle for which exclusive use was granted to the Petitioner in the Civil Protection Order. 9. Respondent removed, damaged, hid or disposed of personal property or pets in violation of the Civil Protection Order. 10. Respondent caused or encouraged another person to do acts prohibited by the Civil Protection Order. 11. Respondent violated the Civil Protection Order by possessing, using, carrying, obtaining or failing to turn over a deadly weapon. 12. Petitioner Respondent violated the temporary allocation of parental rights and responsibilities (custody). 13. Petitioner Respondent violated the visitation order. 14. Petitioner Respondent violated the support provision of the Civil Protection Order. 15. 16. Respondent used or possessed alcohol and/or illegal drugs in violation of the Civil Protection Order. Petitioner Respondent failed to attend the ordered counseling program. 17. List other violations of the Civil Protection Order here: 18. Additional explanation here: I hereby swear or affirm that the statements above are true, complete, and accurate to the best of my knowledge. I understand that falsification of this document may result in a contempt of court finding against me which could result in a jail sentence and fine, and that falsification of this document may also subject me to criminal penalties for perjury under R.C. 2921.11. SIGNATURE OF PETITIONER/RESPONDENT FORM 10.01-O: MOTION FOR CONTEMPT OF A DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Effective Date: July 1, 2010 American LegalNet, Inc. www.FormsWorkFlow.com [Page 3 of Form 10.01-O] Case No.________________________ DO NOT WRITE YOUR ADDRESS BELOW IF YOU ARE REQUESTING CONFIDENTIALITY. PLEASE PROVIDE AN ADDRESS WHERE YOU CAN RECEIVE NOTICES FROM THE COURT. Address Sworn to and subscribed before me on this day of , . NOTARY PUBLIC Signature of Attorney (if applicable) Name Address Attorney Registration Number Phone Number INSTRUCTIONS FOR SERVICE Please serve a copy of the foregoing Motion upon personal service or certified mail, return receipt requested at the following address: by FORM 10.01-O: MOTION FOR CONTEMPT OF A DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Effective Date: July 1, 2010 American LegalNet, Inc. www.FormsWorkFlow.com