IN THE COURT OF COMMON PLEAS COUNTY, OHIO Order of Protection Case No. Per ORC 2903.214(F)(2), this order is indexed at Judge County OHIO State LAW ENFORCEMENT AGENCY WHERE INDEXED ( ) - CIVIL STALKING PROTECTION ORDER (CSPO) FULL HEARING (R.C. 2903.214) . PHONE NUMBER PETITIONER: First Middle PERSON(S) PROTECTED BY THIS ORDER: DOB: Petitioner: Petitioner’s Family or Household Member(s): DOB: DOB: DOB: DOB: Last v. RESPONDENT: SEX RESPONDENT IDENTIFIERS RACE HT EYES First Middle HAIR WT DATE OF BIRTH Last DRIVERS LIC NO. & EXP. DATE STATE Address where Respondent can be found: Distinguishing Features: FIREARMS ACCESS – PROCEED WITH CAUTION (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 Respondent was 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 Respondent be restrained from committing acts of abuse or threats of abuse against the Petitioner and other protected persons named in this order, as set forth below. Additional terms of this order are set forth below. The terms of this order shall be effective until / / . DATE CERTAIN – MAXIMUM FIVE YEARS WARNINGS TO RESPONDENT: See the warnings page attached to the front of this Order. FORM 10.03-F CIVIL STALKING PROTECTION ORDER (CSPO) FULL HEARING REVISED 9/1/04 Discard all previous versions of this form American LegalNet, Inc. www.USCourtForms.com [Side 2 of Form 10.03-F] Case # ___________________________ This proceeding came on for a hearing on Protection Order filed on were present: , , before the Court and the Stalking Ex Parte Civil , all in accordance with R.C. 2903.214. The following individuals . The Court hereby makes the following findings of fact: The court finds by a preponderance of the evidence that the Respondent has knowingly engaged in a pattern of conduct that caused Petitioner to believe that the Respondent will cause physical harm or cause or has caused mental distress. ALL OF THE PROVISIONS CHECKED BELOW APPLY TO THE RESPONDENT 1. RESPONDENT SHALL NOT ABUSE the protected persons named in this Order by harming, attempting to harm, threatening, molesting, following, stalking, bothering, harassing, annoying, or forcing sexual relations on them. [NCIC 01 and 02] 2. RESPONDENT 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 03] 3. RESPONDENT SHALL NOT INTERFERE with protected persons' right to occupy the residence including, but not limited to canceling utilities, insurance, interrupting phone service, mail delivery, or the delivery of any other documents or items. 4. RESPONDENT SHALL SURRENDER all keys and garage door openers to the following residence: at the earliest possible opportunity after service of this Order to the law enforcement agency that serves Respondent with this Order or as follows: 5. RESPONDENT SHALL STAY AWAY from protected persons named in this order, and shall not be present within (distance) of protected persons, wherever protected persons may be found, or any 500 feet or place the Respondent knows or should know the protected persons are likely to be, even with protected persons' permission. If Respondent accidentally comes in contact with protected persons in any public or private place, Respondent must depart immediately. This order includes encounters on public and private roads, highways, and thoroughfares. [NCIC 04] 6. RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY PROPERTY OR PETS owned or possessed by the protected persons named in this Order. 7. RESPONDENT SHALL NOT INITIATE OR HAVE ANY CONTACT with the protected persons named is this order at 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, writings, or communications by any other means in person or through another person. [NCIC 05] 8. RESPONDENT SHALL NOT CAUSE OR ENCOURAGE ANY OTHER PERSON to do any act prohibited by this order. 9. RESPONDENT SHALL NOT POSSESS, USE, CARRY, OR OBTAIN ANY DEADLY WEAPON. Respondent shall turn over all deadly weapons in Respondent’s possession to the law enforcement agency that serves Respondent with this Order or 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] FORM 10.03-F CIVIL STALKING PROTECTION ORDER (CSPO) FULL HEARING REVISED 9/1/04 Discard all previous versions of this form American LegalNet, Inc. www.USCourtForms.com [Side 3 of Form 10.03-F] Case # ___________________________ 10. IT IS FURTHER ORDERED: [NCIC 08] 11. RESPONDENT IS ORDERED TO COMPLETE the following counseling, rehabilitation, or batterer’s treatment program: Respondent shall contact this program within 7 days after receiving this Order and immediately arrange for an initial appointment. The counseling program is requested to provide the Court a written notice when Respondent attends the initial appointment, if the Respondent fails to attend or is discharged, and when Respondent completes the program. Respondent is required to sign all necessary waivers to allow the court to receive information from the counseling program. Respondent is ordered to appear before Judge or Magistrate on , , at m., to review Respondent’s compliance with this counseling order. Respondent is warned: If you fail to attend the counseling program you may be held in contempt of court. If you fail to appear at this hearing, the court may issue a warrant for your arrest. 12. RESPONDENT SHALL NOT CONSUME, USE, OR POSSESS illegal drugs or beverages containing alcohol. 13. IT IS FURTHER ORDERED that the Clerk of Court shall cause a copy of the Petition and this Order to be delivered to the Respondent as required by law. The Clerk of Court shall also provide certified copies of the Petition and this Order to Petitioner upon request. This Order is granted without bond. Under Federal and State Law, the Clerk shall not charge any fees for filing, issuing, registering, or serving this protection order. 14. ALL OF THE TERMS OF THIS ORDER REMAIN IN FULL FORCE AND EFFECT FOR A PERIOD OF FIVE , unless earlier modified or dismissed by YEARS FROM ISSUANCE, OR UNTIL order of this Court. IT IS SO ORDERED. APPROVED and ADOPTED by: MAGISTRATE JUDGE NOTICE TO RESPONDENT: 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. Signature of Attorney for Petitioner (if applicable) Signature of Attorney for Respondent (if applicable) Print Name & Attorney Registration Number Print Name & Attorney Registration Number Address Address City, State, Zip City, State, Zip Phone Phone FORM 10.03-F CIVIL STALKING PROTECTION ORDER (CSPO) FULL HEARING REVISED 9/1/04 Discard all previous versions of this form American LegalNet, Inc. www.USCourtForms.com [Side 4 of Form 10.03-F] Case # ___________________________ NOTICE OF FINAL APPEALABLE ORDER Copies of the foregoing Order, which is a final appealable order, were mailed by ordinary U.S. mail or handdelivered to the parties indicated on the following date: TO THE CLERK COPIES OF THIS ORDER SHALL BE DELIVERED TO: Petitioner Attorney for Petitioner Respondent Attorney for Respondent Police Department Where Petitioner Resides: Police Department Where Petitioner Works: , The Other: By: Sheriff’s Department CLERK OF COURT WAIVER OF HEARING I have been advised of my right to have a hearing on the motion for a civil stalking protection order and hereby knowingly and voluntarily waive the hearing on the motion and agree to be bound by the terms set forth above. RESPONDENT: FORM 10.03-F CIVIL STALKING PROTECTION ORDER (CSPO) FULL HEARING DATE: REVISED 9/1/04 Discard all previous versions of this form American LegalNet, Inc. www.USCourtForms.com